A patient with psychosis became aggressive, struck another ...

[lak]

A patient with psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation.
 
  a. Patient struck another patient who attempted to leave day room to go to bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two patients away from each other for 24 hours.
  b. Seclusion ordered by physician at 1415 after command hallucinations told the patient to hit another patient. Careful monitoring of patient maintained during period of seclusion.
  c. Seclusion ordered by MD for aggressive behavior. Begun at 1415. Maintained for 2 hours without incident. Outcome: Patient calmer and apologized for outburst.
  d. Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, I'll punch anyone who gets near me, and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.

Question 2

A family member of a patient with delusions of persecution asks the nurse, Are there any circumstances under which the treatment team is justified in violating a patient's right to confidentiality?
 
  The nurse should reply that confidentiality may be breached:
 
  a. under no circumstances.
  b. at the discretion of the psychiatrist.
  c. when questions are asked by law enforcement.
  d. if the patient threatens the life of another person.

[Harbringer]

Answer to Question 1

ANS: D
Documentation must be specific and detail the key aspects of care. It should demonstrate implementation of the least restrictive alternative. Justification for why a patient was secluded should be recorded, along with interventions attempted in an effort to avoid seclusion. Documentation should include a description of behavior and verbalizations, interventions tried and their outcomes, and the name of the health care provider ordering the use of seclusion.

Answer to Question 2

ANS: D
The duty to warn a person whose life has been threatened by a psychiatric patient overrides the patient's right to confidentiality. The right to confidentiality is not suspended at the discretion of the therapist or for legal investigations.

[lak]

TY

[Harbringer]

Happy to Help