NR 607 Week 8 Final Exam (Weeks 1-7 Master Study Tables)

NR607 Final Exam — Weeks 1–7 Master Study Tables Involuntary Used when legal criteria are met and patient refuses needed admission hospitalization, typically involving danger to self/others or grave Mental illness alone ≠ commitment. disability. Psychiatric hold Temporary emergency detention for evaluation/stabilization when DIG: Danger to self, Imminent/significant danger to statutory criteria are satisfied. others, Grave disability Capacity Clinical determination of ability to make a specific healthcare UARC: Understand, Appreciate, Reason, decision. Can fluctuate and is decision-specific. Communicate Competence Legal determination generally made by a court. Capacity = clinical; competence = legal. Bad decision A patient may make a decision the clinician dislikes and still have Bad decision ≠ incapacity. capacity. Requires adequate information, understanding, capacity, voluntariness, Informed consent and authorization. Discuss risks, benefits, alternatives and CUVD: Capacity, Understanding, Voluntariness, consequences of refusal. Decision Refusal of A capable adult generally has the right to refuse treatment. Exceptions Respect autonomy unless a valid exception applies. treatment may include emergencies, incapacity or court-authorized treatment. Civil commitment Legal process for involuntary detention/treatment when statutory Diagnosis alone is insufficient. criteria are met and less restrictive alternatives are inadequate. Patient rights Dignity, privacy, confidentiality, information, participation, least Psychiatric diagnosis does not remove civil rights. restrictive care and freedom from unnecessary restraint/seclusion. Involuntary isolation from which the patient cannot leave. Used for Seclusion immediate dangerous behavior when less restrictive interventions Never punishment or staff convenience. fail/are inadequate. Restraints Last-resort intervention for immediate serious danger. Use shortest LAST: Least restrictive first, Actual danger, duration possible and monitor carefully. Shortest duration, Thorough monitoring Before restraint Calm communication, decrease stimulation, respect space, listen, offer CALM: Calm environment, Allow space, Listen, choices, set limits, voluntary medication when appropriate. Make choices Restraint Monitor ABCs, circulation, vital signs, LOC, skin, hydration, Remove as soon as safe. monitoring elimination, ROM, psychological status and ongoing necessity. Generally protected but may have exceptions for serious safety Safety can override confidentiality when legal Confidentiality concerns, abuse reporting, court requirements and other legal criteria are met. mandates. Duty to Serious threats toward identifiable victims may require protective Threat + identifiable victim = assess immediately. warn/protect action depending on applicable law. Ethical principles Autonomy = patient chooses; Beneficence = do good; Nonmaleficence ABNJ: Autonomy, Beneficence, Nonmaleficence, = avoid harm; Justice = fairness; Fidelity = keep commitments; Justice NR607 Final Exam — Weeks 1–7 Master Study Tables toxicity function/electrolytes. Severe toxicity may require hemodialysis. = lithium toxicity. Clozapine indication Treatment-resistant schizophrenia; also important in reducing recurrent suicidal 2 adequate antipsychotic failures behavior in appropriate schizophrenia/schizoaffective patients. → think clozapine. Clozapine monitoring ANC, myocarditis/cardiac symptoms, bowel function, seizures, metabolic ANC → HEART → BOWEL effects. → METABOLIC Clozapine + fever/sore throat Evaluate urgently for neutropenia; obtain CBC/ANC. Fever = check ANC. Clozapine + chest Consider myocarditis. Heart warning. pain/tachycardia Clozapine + severe Consider severe GI hypomotility/ileus. Constipation can be dangerous. constipation Serotonin syndrome Fever, agitation, sweating, tremor, diarrhea, hyperreflexia and clonus. Usually FAST: Fever, Agitation, Sweating, rapid onset after serotonergic change/interaction. Twitching Stop serotonergic agents, supportive care, benzodiazepines; cyproheptadine may