Agitation Medication  Side Effects Follow Up and Documentation 100 100 100 100 200 200 200 200 300 300 300 300 400 400 400 400 500 500 500 500

Name three possible causes for medical delirium.

• brain diseases (dementia, stroke) • metabolic disorders (electrolyte disorders) • infections • drugs • pain • immobility • malignancy

Which form should you use for documenting a medical evaluation of an agitated patient?

The Agitation, Delirium, and Psychosis Form

True or False: Someone who is physically violent and refuses medication would be considered a moderately agitated patient.

False, they would be a severely agitated patient.

Once you give medication to an agitated patient, what do you need to monitor?

Vital signs OR Side effects

Name three calming interventions for agitated patients.

• Ask: ‘How can I help?’ • Reassure the patient that you are there to keep the patient safe • Use a soft voice and slow movements • Decrease stimuli • Allow venting

Why do we suggest that risperidone be prescribed first over haloperidol?

Because risperidone has fewer long-term side-effects than haloperidol.

What supplement should you give to a pregnant woman on risperidone, haloperidol or carbamazepine?

4 mg folic acid (5 mg is correct, too)

With what type of medication should alcohol withdrawal be treated?

Diazepam

Should a moderately agitated patient be offered oral medication or given an intramuscular injection?

Offered oral medication.

What side-effect of antipsychotic medications is the AIMS intended to monitor?

Tardive dyskinesia

When do physicians administer the Abnormal Involuntary Movement Scale (AIMS)?

When they first prescribe medication, then every six months.

What side effect of medication could be deadly and require that the patient stop taking the medication and return to the hospital? (Name one.)

A rash that develops after the patient begins a new medication. An acute dystonic reaction that could close the patient’s throat, or cause blindness. Any kind of muscle tightness or physical discomfort that could be Neuroleptic Malignant Syndrome

What are possible serious side effects of antipsychotic medications, aside from death? Name two possible side effects.

• Weight gain leading to heart disease • Diabetes • Tardive dyskinesia/permanent abnormal muscle movements • Cardiac arrhythmia

If a patient develops acute dystonia, what medication should be given to resolve the dystonia immediately?

Diphenhydramine

What cadre of health worker is responsible for monitoring potential side-effects from antipsychotics for agitated patients?

Nurses

True or False: Physicians will administer the WHODAS and Clinical Global Impressions Scale to determine a patient’s improvement.

False

What cadre of clinicians will physicians work most closely with to determine if a psychotic patient is improving over time?

Psychologists/SWs

What form does the physician fill out each time they see a patient for a follow up appointment?

Mental Health Follow-Up Form

The physician is deciding to medicate a severely agitated patient who is violent and refuses oral medication. Which two forms will assist the physician with deciding how to medicate the patient?

The Agitated Patient Protocol Medication Card