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sassyann85

sassyann85

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sassyann85's Latest Activity

  1. sassyann85

    scheduled meds with prns

    Hi everyone: So I often have patients on scheduled antipsychotics like risperdal or abilify and then they have PRN antipsychotics ordered. How do you know if these can be given together or how long you have to wait between meds? IE- a patient on scheduled PO risperdal comes and taken their med and then reports they are really agitated and wants their PRN IM Geodon? Or a patient on scheduled risperdal PO takes their med and then requests their PRN PO Haldol because they are starting to feel really agitated?
  2. sassyann85

    CT/MRI contrast

    Is it standard procedure for all patients (unless they are fluid restricted or there is some other contraindication) to receive IV fluids following a test that requires IV contrast, to help flush the contrast out of their system? or is that done just for certain patients at increased risk for nephrotoxicity?
  3. sassyann85

    dischargin psych pts question

    oop,s you are right. I guess what I am asking is, in this case is there any type of follow-up that should occur? Obviously if a patient elopes while inpatient, there is a process that occurs. But, once they are technically discharged, even if staff see them take off, there really isnt anything we could do, correct? (assuming they were a voluntary admission)
  4. sassyann85

    dischargin psych pts question

    The answer to this is probably pretty obvious. However, I guess I feel a 'maternal' role/responsibility with these patients, which is why I bring up the following. So if a patient is on a voluntary committment and is getting discharged, if they do not have a ride home or to the shelter or whatever follow-up program they are going to, we offer them bus tickets or a cab slip. The Dr writes a discharge order and then staff will walk them off the unit and down to to security to get whatever belongings that are stored there from when they were admitted. After that, we will take them to the hospital exit and direct them to the bus stop, or call the cab for them. Now let's say as you are calling the cab, the patient takes off in the other direction, leaves their belongings, and isn't around to get the cab when it comes to the hospital. I guess this is their right, once they are discharged they can go and do what they want. But I just feel like, oh no-they missed their ride, how will they get where they are going? But I guess even if given bus tickets, we don't walk them to the bus stop and stay there to make sure they actually get on the bus. We don't ride with them to make sure they get off at the correct stop. We can't come home with them and make sure they take their meds. It's just so disheartening when you think a patient will do well, and then they take off to who knows where.
  5. sassyann85

    restraint/seclusion order question

    one last question I promise! :) when a patient is going into limb restraints, and staff is holding them down while the restraints are retrieved/applied, would the order have to specify 'manual restraint' in addition to 'physical restraint'? (I am assuming the pt did not need carried down to the room where the restraints are) or would 'physical restraint' alone cover this? thanks again!!
  6. sassyann85

    restraint/seclusion order question

    that totally makes sense to me. Thanks so much for taking the time to explain all this. So, if the setup is that the restraint bed is in the seclusion room, if the patient is restrained, even if the door is left open, the order would be for physical restraint AND seclusion (since the person is prevented from leaving the seclusion room since they are restrained)? Also, manual restraint if they needed to physically be brought to the seclusion room.
  7. sassyann85

    restraint/seclusion order question

    this is our set-up too. so if the seclusion door remained open with the patient in restraints, it would just be considered "restraint" and not "restraint and seclusion," right?
  8. sassyann85

    restraint/seclusion order question

    thanks! when elkpark mentioned "if your policy doesn't call for seclusion along with the physical restraints (which is hard for me to imagine, but ...)"....I am just wondering: if a patient is in, say, 4 pt restraints, what would be the purpose of seclusion at the same time as this? I can see a patient going into seclusion then if that doesn't help them calm down, next needing to be restrained, but if they are restrained, wouldn't seclusion at that point not be necessary?
  9. sassyann85

    restraint/seclusion order question

    thanks so much this was very very helpful! One last question, if you don't mind. I just want to make sure I am doing everything right. If a RN initiates the restraint/seclusion, let's say at 6:30 pm, and then by the time they call the Dr. to get a verbal order for this it is 6:45pm, then does the 4 hour order renewal have to occur at 10:30 pm or 10:45 pm? ie-is it 4 hours from when the pt actually went into restraint or 4 hours from the order for restraint? thanks again!!
  10. sassyann85

    restraint/seclusion order question

    thanks for the reply! so if both restraint and seclusion are going on simultaneously, in terms of the 4 hour renewel for the orders, you would have two different timelines going on (on for renewing the seclusion order and one for the restraint?) thanks!
  11. sassyann85

    restraint/seclusion order question

    Hi everyone, So on our physician order form for restraint and seclusion (which we often get the order as a verbal from the Dr.) there are check boxes for "type of restraint/seclusion" and the little boxes to select for: seclusion, manual restraint, physical extremity restraints, etc. My question is, what if you initially start the patient out in locked seclusion (less restrictive measure than restraints in most cases) and then they escalate and end up needing physical restraint (extremities) as well? When you first put them in seclusion, you may very well not know that they are going to end up requiring extremity restraints as well. So, on the order, if you get a verbal for seclusion and then they end up needing extremity restraints, do you need a whole new order and have to call the Dr again? Once our psychiatrists leave, we use the hospitalist to call for restraint orders. How do you handle this in terms of your orders? I have often seen locked seclusion patients requiring physical restraints when the seclusion does not manage them. thanks so much for any input!
  12. sassyann85

    combining PRNS

    Hi everyone. I tried to research this, but I can't seem to find anything specific. I came from a floor that treated mainly depressed patients, and now I am working on a floor where there is more psychosis, aggression, etc. I am trying to figure out which PRNs can be safely combined, as a general rule. For example, I have seen Ativan + Haldol frequently. I have seen Prolixin + Ativan. But what about Geodon + Ativan at the same time in someone really agitated? Is this ok, as a general rule of combining meds? What about Risperdal + Ativan (either both as PRNS given together, or if a patient gets scheduled risperdal and then when he is getting this scheduled med, asks for a PRN ativan? Can I give it, or should I have him wait awhile?) Thanks for any help!
  13. sassyann85

    HIPAA/pharmac

    Kind of an odd question. But is a nurse in a hospital allowed to call a pharmacy to verify that a pt's PCP called in a script for them, or do you need to have the pt sign a release of information consent? Recently, an elderly patient I was caring for was getting discharged and the MD at the hospital was going to call in her scripts, but she thought her PCP had already called in some of the same scripts recently, but she hadn't had a chance to pick them up. She asked me to call her pharmacy to inquire.
  14. sassyann85

    patients on methadone plus PRN pain meds

    thanks everyone for your responses! very helpful! What about a patient on suboxone? I have seen PRN Tramadol. If they are well established on suboxone maintenance, would prn tramadol precipitate withdrawal if given a short time before suboxone? Should you wait an hour AFTER taking suboxone to take tramadol, will this help get a better pain effect than taking it shortly after suboxone?
  15. sassyann85

    how to find the right answers?

    I am wondering where everyone gets their resources at. I try to look things up in my old nursing textbooks/online and ask coworkers, but it seems every coworker gives me a different answer. For example, I tried to post a question on the general forum about methadone and PRN pain meds, but got varying answers. I just want to make sure I am doing things correctly/safely. I never really worked with patients on methadone and suboxone before. Now I am seeing alot of patients on these meds. Often times, the methadone maintenance patients will have PRN oxycodone for pain. Sometimes, they ask for both their methadone and oxy together. Some nurses say absolutely DO NOT give them together, while others say it is ok to give. Sometimes they will have PRN Ativan for anxiety and it's the same thing...some nurses say wait and others say that methadon has such a long half life that it won't make a difference if you wait or give them together. I just want to do what is safe for the patient, but I can't figure out what is best practice. Same thing with suboxone maintenance patients--I have seen them ordered PRN ultram for pain and I dont know if these can be given together/how fart apart they should be spaced for safe administration? IF a sub maintenance patient gets their suboxone q 8am and 5pm daily, and come up and asks for PRN ultram at 6am, is it ok to give it then? Or will the suboxone they take at 8am come and knock the tramadol off the receptors and cause withdrawal sx? IF given along with the suboxone, would it could decreased respirations and those worries? Any insight is much appreciated. I want to be informed, but not sure where to get the information from!
  16. sassyann85

    patients on methadone plus PRN pain meds

    i was thinking that bc methadone has such a long half0life, the methadone will be in their system a long time no matter if you wait an hour or not to give a pain med/controlled med. correct?