CCS - Psychiatry (2006), Psychologia po angielsku
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Current Clinical Strategies
Psychiatry
2006 Edition
Rhoda K Hahn, MD
Lawrence J. Albers, MD
Assistant Clinical Professor
Department of Psychiatry and Human Behavior
University of California, Irvine, College of Medicine
Christopher Reist, MD
Vice Chairman
Department of Psychiatry and Human Behavior
University of California, Irvine, College of Medicine
Copyright 2006 Current Clinical Strategies Publishing.
Assessment and
Evaluation
Clinical Evaluation of the
Psychiatric Patient
I. Psychiatric History
A. Identifying information.
Age, sex, marital status,
race, referral source.
B. Chief complaint (CC).
Reason for consultation;
the reason is usually a direct quote from the
patient.
C. History of present illness (HPI)
1.
Current symptoms: date of onset, duration and
course of symptoms.
2.
Previous psychiatric symptoms and treatment.
3.
Recent psychosocial stressors: stressful life
events that may have contributed to the
patient's current presentation.
4.
Reason the patient is presenting now.
5.
This section provides evidence that supports
or rules out relevant diagnoses. Therefore,
documenting the absence of pertinent
symptoms is also important.
6.
Historical evidence in this section should be
relevant to the current presentation.
D. Past psychiatric history
1.
Previous and current psychiatric diagnoses.
2.
History of psychiatric treatment, including
outpatient and inpatient treatment.
3.
History of psychotropic medication use.
4.
History of suicide attempts and potential
lethality.
E. Past medical history
1.
Current and/or previous medical problems.
2.
Type of treatment, including prescription, over-
the-counter medications, home remedies.
F. Family history.
Relatives with history of
psychiatric disorders, suicide or suicide attempts,
alcohol or substance abuse.
G. Social history
1.
Source of income.
2.
Level of education, relationship history
(including marriages, sexual orientation,
number of children); individuals who currently
live with patient.
3.
Support network.
4.
Current alcohol or illicit-drug usage.
5.
Occupational history.
H. Developmental history.
Family structure during
childhood, relationships with parental figures and
siblings; developmental milestones, peer
relationships, school performance.
II. Mental Status Exam
. The mental status exam is an
assessment of the patient at the present time.
Historical information should not be included in this
section.
A. General appearance and behavior
1.
Grooming, level of hygiene, characteristics of
clothing.
2.
Unusual physical characteristics or
movements.
3. Attitude.
Ability to interact with the interviewer.
4. Psychomotor activity.
Agitation or
retardation.
5.
Degree of eye contact.
B. Affect
1. Definition.
External range of expression,
described in terms of quality, range and
appropriateness.
2. Types of affect
a. Flat.
Absence of all or most affect.
b. Blunted
or restricted.
Moderately reduced
range of affect.
c. Labile.
Multiple abrupt changes in affect.
d. Full or wide range of affect.
Generally
appropriate.
C. Mood.
Internal emotional tone of the patient (ie,
dysphoric, euphoric, angry, euthymic, anxious).
D. Thought processes
1. Use of language.
Quality and quantity of
speech. The tone, associations and fluency of
speech should be noted.
2. Common thought disorders
a. Pressured speech.
Rapid speech, which is
typical of patients with manic disorder.
b. Poverty of speech.
Minimal responses,
such as answering just “yes or no.”
c. Blocking.
Sudden cessation of speech,
often in the middle of a statement.
d. Flight of ideas.
Accelerated thoughts that
jump from idea to idea, typical of mania.
e. Loosening of associations.
Illogical
shifting between unrelated topics.
f. Tangentiality.
Thought that wanders from
the original point.
g. Circumstantiality.
Unnecessary
digression, which eventually reaches the
point.
h. Echolalia.
Echoing of words and phrases.
i. Neologisms.
Invention of new words by the
patient.
j. Clanging.
Speech based on sound, such
as rhyming and punning rather than logical
connections.
k. Perseveration.
Repetition of phrases or
words in the flow of speech.
l. Ideas of reference.
Interpreting unrelated
events as having direct reference to the
patient, such as believing that the television
is talking specifically to them.
E. Thought content
1. Definition.
Hallucinations, delusions and other
perceptual disturbances.
2. Common thought content disorders
a. Hallucinations.
False sensory perceptions,
which may be auditory, visual, tactile,
gustatory or olfactory.
b. Delusions.
Fixed, false beliefs, firmly held
in spite of contradictory evidence.
i. Persecutory delusions.
False belief
that others are trying to cause harm, or
are spying with intent to cause harm.
ii. Erotomanic delusions.
False belief
that a person, usually of higher status,
is in love with the patient.
iii. Grandiose delusions.
False belief of
an inflated sense of self-worth, power,
knowledge, or wealth.
iv. Somatic delusions.
False belief that
the patient has a physical disorder or
defect.
c. Illusions.
Misinterpretations of reality.
d. Derealization.
Feelings of unrealness
involving the outer environment.
e. Depersonalization.
Feelings of
unrealness, such as if one is “outside” of
the body and observing his own activities.
f. Suicidal and homicidal ideation.
Suicidal
and homicidal ideation requires further
elaboration with comments about intent and
planning (including means to carry out
plan).
F. Cognitive evaluation
1. Level of consciousness.
2. Orientation:
Person, place and date.
3. Attention and concentration:
Repeat five
digits forwards and backwards or spell a five-
letter word (“world”) forwards and backwards.
4. Short-term memory:
Ability to recall three
objects after five minutes.
5. Fund of knowledge:
Ability to name past five
presidents, five large cities, or historical dates.
6. Calculations.
Subtraction of serial 7s, simple
math problems.
7. Abstraction.
Proverb interpretation and
similarities.
G. Insight.
Ability of the patient to display an
understanding of his current problems, and the
ability to understand the implication of these
problems.
H. Judgment.
Ability to make sound decisions
regarding everyday activities. Judgement is best
evaluated by assessing a patient's history of
decision making, rather than by asking
hypothetical questions.
III. DSM-IV Multiaxial Assessment Diagnosis
Axis I:
Clinical disorders
Other conditions that may be a focus of clinical
attention.
Axis II:
Personality disorders
Mental retardation
Axis III:
General medical conditions
Axis IV:
Psychosocial and environmental problems
Axis V:
Global assessment of functioning
IV. Treatment plan.
This section should discuss
pharmacologic treatment and other psychiatric
therapy, including hospitalization.
V. General medical screening of the psychiatric
patient.
A thorough physical and neurological
examination, including basic screening laboratory
studies to rule out physical conditions, should be
completed.
A. Laboratory evaluation of the psychiatric
patient
1.
CBC with differential.
2.
Blood chemistry (SMAC).
3.
Thyroid function panel.
4.
Screening test for syphilis (RPR or MHA-TP).
5.
Urinalysis with drug screen.
6.
Urine pregnancy check for females of
childbearing potential.
7.
Blood alcohol level.
8.
Serum levels of medications.
9.
Hepatitis C testing in at-risk patients.
10.
HIV test in high-risk patients.
B.
A more extensive work-up and laboratory studies
may be indicated based on clinical findings.
Admitting Orders
Admit to:
(name of unit)
Diagnosis:
DSM-IV diagnosis justifying the admit.
Legal Status:
Voluntary or involuntary status- if
involuntary, state specific status.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
Standard orders are q shift x 3, then q day if
stable; if there are medical concerns, vitals should be
ordered more frequently.
Activity:
Restrict to the unit or allow patient to leave
unit.
Precautions:
Assault or suicide precautions, elopement
precautions.
Diet:
Regular diet, ADA diet, soft mechanical.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
serum levels of medications.
Medications:
As indicated by the patient’s diagnosis or
target symptoms. Include as-needed medications,
such as Tylenol, milk of magnesia, antacids.
Schizophrenia Admitting Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Schizophrenia, Continuous Paranoid Type,
Acute Exacerbation.
Legal Status:
Involuntary by conservator.
Condition:
Actively Psychotic.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Assault precautions.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function.
Medications:
Risperidone (Risperdal) 2 mg po bid x 2 days, then 4
mg po qhs.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Bipolar I Disorder Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Bipolar I Disorder, Manic with psychotic
features.
Legal Status:
Involuntary (legal hold, 5150 in
California).
Condition:
Actively Psychotic.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Elopement precautions.
Diet:
Regular.
Labs
: Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
valproate level.
Medications:
Aripiprazole (Abilify) 10 mg po qd.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Depakote 500 mg po tid.
Zaleplon (Sonata) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Major Depression Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Major Depression, severe, without psychotic
features.
Legal Status:
Voluntary.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Suicide precautions.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function.
Medications:
Sertraline (Zoloft) 50 mg po qAM.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Trazodone (Desyrel) 50 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Alcohol Dependence Admitting
Orders
Admit to:
Alcohol Treatment Unit.
Diagnosis:
Alcohol Dependence.
Legal Status:
Voluntary.
Condition:
Guarded.
Allergies:
No known allergies.
Vitals:
q shift x 3 days, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Seizure and withdrawal precautions.
Diet:
Regular with one can of Ensure with each meal.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function.
Medications:
Folate 1 mg po qd.
Thiamine 100 mg IM qd x 3 days, then 100 mg po qd.
Multivitamin 1 po qd.
Lorazepam (Ativan) 2 mg po tid x 2 days, then 2 mg
bid x 2 days, then 1 mg po bid x 2 days, then
discontinue.
Lorazepam (Ativan) 2 mg po q 4 hours prn alcohol
withdrawal symptoms (pulse >100, systolic BP
>160, diastolic BP >100 [not to exceed 14 mg/24
hour]).
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Opiate Dependence Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Heroin dependance.
Legal Status:
Voluntary.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
q shift x 3 days, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Opiate withdrawal.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
hepatitis panel, HIV.
Medications:
Clonidine (Catapres) 0.1 mg po qid, hold for systolic
BP <90 or diastolic BP <60). Give 0.1 mg po q 4
hours prn signs and symptoms of opiate
withdrawal.
Dicyclomine (Bentyl) 20 mg po q 6 hours prn
cramping.
Ibuprofen (Advil) 600 mg po q 6 hours prn
pain/headache.
Methocarbamol (Robaxin) 500 mg po q 6 hours prn
muscle pain.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Schizoaffective Disorder Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Schizoaffective disorder, bipolar type,
depressed.
Legal Status:
Voluntary.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Suicide precautions.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
lithium level.
Medications:
Quetiapine (Seroquel) 100 mg po bid x 2 days, then
200 mg po bid.
Lithium 600 mg po bid.
Citalopram (Celexa) 20 mg po q am.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours).
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Restraint Orders
1. Type of Restraint:
Seclusion, 4-point leather
restraint, or soft restraints.
2. Indication:
Confused, threat to self.
Agitated, threat to self.
Combative, threat to self/others.
Attempting to pull out tube, line, or dressing.
Attempting to get our of bed, fall risk.
3. Time
Begin at _____o’clock.
Not to exceed (specify number of hours).
4.
Monitor patient as directed by hospital policy.
5.
Staff may decrease or release restraints at their
discretion.
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Current Clinical Strategies
Psychiatry
2006 Edition
Rhoda K Hahn, MD
Lawrence J. Albers, MD
Assistant Clinical Professor
Department of Psychiatry and Human Behavior
University of California, Irvine, College of Medicine
Christopher Reist, MD
Vice Chairman
Department of Psychiatry and Human Behavior
University of California, Irvine, College of Medicine
Copyright 2006 Current Clinical Strategies Publishing.
Assessment and
Evaluation
Clinical Evaluation of the
Psychiatric Patient
I. Psychiatric History
A. Identifying information.
Age, sex, marital status,
race, referral source.
B. Chief complaint (CC).
Reason for consultation;
the reason is usually a direct quote from the
patient.
C. History of present illness (HPI)
1.
Current symptoms: date of onset, duration and
course of symptoms.
2.
Previous psychiatric symptoms and treatment.
3.
Recent psychosocial stressors: stressful life
events that may have contributed to the
patient's current presentation.
4.
Reason the patient is presenting now.
5.
This section provides evidence that supports
or rules out relevant diagnoses. Therefore,
documenting the absence of pertinent
symptoms is also important.
6.
Historical evidence in this section should be
relevant to the current presentation.
D. Past psychiatric history
1.
Previous and current psychiatric diagnoses.
2.
History of psychiatric treatment, including
outpatient and inpatient treatment.
3.
History of psychotropic medication use.
4.
History of suicide attempts and potential
lethality.
E. Past medical history
1.
Current and/or previous medical problems.
2.
Type of treatment, including prescription, over-
the-counter medications, home remedies.
F. Family history.
Relatives with history of
psychiatric disorders, suicide or suicide attempts,
alcohol or substance abuse.
G. Social history
1.
Source of income.
2.
Level of education, relationship history
(including marriages, sexual orientation,
number of children); individuals who currently
live with patient.
3.
Support network.
4.
Current alcohol or illicit-drug usage.
5.
Occupational history.
H. Developmental history.
Family structure during
childhood, relationships with parental figures and
siblings; developmental milestones, peer
relationships, school performance.
II. Mental Status Exam
. The mental status exam is an
assessment of the patient at the present time.
Historical information should not be included in this
section.
A. General appearance and behavior
1.
Grooming, level of hygiene, characteristics of
clothing.
2.
Unusual physical characteristics or
movements.
3. Attitude.
Ability to interact with the interviewer.
4. Psychomotor activity.
Agitation or
retardation.
5.
Degree of eye contact.
B. Affect
1. Definition.
External range of expression,
described in terms of quality, range and
appropriateness.
2. Types of affect
a. Flat.
Absence of all or most affect.
b. Blunted
or restricted.
Moderately reduced
range of affect.
c. Labile.
Multiple abrupt changes in affect.
d. Full or wide range of affect.
Generally
appropriate.
C. Mood.
Internal emotional tone of the patient (ie,
dysphoric, euphoric, angry, euthymic, anxious).
D. Thought processes
1. Use of language.
Quality and quantity of
speech. The tone, associations and fluency of
speech should be noted.
2. Common thought disorders
a. Pressured speech.
Rapid speech, which is
typical of patients with manic disorder.
b. Poverty of speech.
Minimal responses,
such as answering just “yes or no.”
c. Blocking.
Sudden cessation of speech,
often in the middle of a statement.
d. Flight of ideas.
Accelerated thoughts that
jump from idea to idea, typical of mania.
e. Loosening of associations.
Illogical
shifting between unrelated topics.
f. Tangentiality.
Thought that wanders from
the original point.
g. Circumstantiality.
Unnecessary
digression, which eventually reaches the
point.
h. Echolalia.
Echoing of words and phrases.
i. Neologisms.
Invention of new words by the
patient.
j. Clanging.
Speech based on sound, such
as rhyming and punning rather than logical
connections.
k. Perseveration.
Repetition of phrases or
words in the flow of speech.
l. Ideas of reference.
Interpreting unrelated
events as having direct reference to the
patient, such as believing that the television
is talking specifically to them.
E. Thought content
1. Definition.
Hallucinations, delusions and other
perceptual disturbances.
2. Common thought content disorders
a. Hallucinations.
False sensory perceptions,
which may be auditory, visual, tactile,
gustatory or olfactory.
b. Delusions.
Fixed, false beliefs, firmly held
in spite of contradictory evidence.
i. Persecutory delusions.
False belief
that others are trying to cause harm, or
are spying with intent to cause harm.
ii. Erotomanic delusions.
False belief
that a person, usually of higher status,
is in love with the patient.
iii. Grandiose delusions.
False belief of
an inflated sense of self-worth, power,
knowledge, or wealth.
iv. Somatic delusions.
False belief that
the patient has a physical disorder or
defect.
c. Illusions.
Misinterpretations of reality.
d. Derealization.
Feelings of unrealness
involving the outer environment.
e. Depersonalization.
Feelings of
unrealness, such as if one is “outside” of
the body and observing his own activities.
f. Suicidal and homicidal ideation.
Suicidal
and homicidal ideation requires further
elaboration with comments about intent and
planning (including means to carry out
plan).
F. Cognitive evaluation
1. Level of consciousness.
2. Orientation:
Person, place and date.
3. Attention and concentration:
Repeat five
digits forwards and backwards or spell a five-
letter word (“world”) forwards and backwards.
4. Short-term memory:
Ability to recall three
objects after five minutes.
5. Fund of knowledge:
Ability to name past five
presidents, five large cities, or historical dates.
6. Calculations.
Subtraction of serial 7s, simple
math problems.
7. Abstraction.
Proverb interpretation and
similarities.
G. Insight.
Ability of the patient to display an
understanding of his current problems, and the
ability to understand the implication of these
problems.
H. Judgment.
Ability to make sound decisions
regarding everyday activities. Judgement is best
evaluated by assessing a patient's history of
decision making, rather than by asking
hypothetical questions.
III. DSM-IV Multiaxial Assessment Diagnosis
Axis I:
Clinical disorders
Other conditions that may be a focus of clinical
attention.
Axis II:
Personality disorders
Mental retardation
Axis III:
General medical conditions
Axis IV:
Psychosocial and environmental problems
Axis V:
Global assessment of functioning
IV. Treatment plan.
This section should discuss
pharmacologic treatment and other psychiatric
therapy, including hospitalization.
V. General medical screening of the psychiatric
patient.
A thorough physical and neurological
examination, including basic screening laboratory
studies to rule out physical conditions, should be
completed.
A. Laboratory evaluation of the psychiatric
patient
1.
CBC with differential.
2.
Blood chemistry (SMAC).
3.
Thyroid function panel.
4.
Screening test for syphilis (RPR or MHA-TP).
5.
Urinalysis with drug screen.
6.
Urine pregnancy check for females of
childbearing potential.
7.
Blood alcohol level.
8.
Serum levels of medications.
9.
Hepatitis C testing in at-risk patients.
10.
HIV test in high-risk patients.
B.
A more extensive work-up and laboratory studies
may be indicated based on clinical findings.
Admitting Orders
Admit to:
(name of unit)
Diagnosis:
DSM-IV diagnosis justifying the admit.
Legal Status:
Voluntary or involuntary status- if
involuntary, state specific status.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
Standard orders are q shift x 3, then q day if
stable; if there are medical concerns, vitals should be
ordered more frequently.
Activity:
Restrict to the unit or allow patient to leave
unit.
Precautions:
Assault or suicide precautions, elopement
precautions.
Diet:
Regular diet, ADA diet, soft mechanical.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
serum levels of medications.
Medications:
As indicated by the patient’s diagnosis or
target symptoms. Include as-needed medications,
such as Tylenol, milk of magnesia, antacids.
Schizophrenia Admitting Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Schizophrenia, Continuous Paranoid Type,
Acute Exacerbation.
Legal Status:
Involuntary by conservator.
Condition:
Actively Psychotic.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Assault precautions.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function.
Medications:
Risperidone (Risperdal) 2 mg po bid x 2 days, then 4
mg po qhs.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Bipolar I Disorder Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Bipolar I Disorder, Manic with psychotic
features.
Legal Status:
Involuntary (legal hold, 5150 in
California).
Condition:
Actively Psychotic.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Elopement precautions.
Diet:
Regular.
Labs
: Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
valproate level.
Medications:
Aripiprazole (Abilify) 10 mg po qd.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Depakote 500 mg po tid.
Zaleplon (Sonata) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Major Depression Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Major Depression, severe, without psychotic
features.
Legal Status:
Voluntary.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Suicide precautions.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function.
Medications:
Sertraline (Zoloft) 50 mg po qAM.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Trazodone (Desyrel) 50 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Alcohol Dependence Admitting
Orders
Admit to:
Alcohol Treatment Unit.
Diagnosis:
Alcohol Dependence.
Legal Status:
Voluntary.
Condition:
Guarded.
Allergies:
No known allergies.
Vitals:
q shift x 3 days, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Seizure and withdrawal precautions.
Diet:
Regular with one can of Ensure with each meal.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function.
Medications:
Folate 1 mg po qd.
Thiamine 100 mg IM qd x 3 days, then 100 mg po qd.
Multivitamin 1 po qd.
Lorazepam (Ativan) 2 mg po tid x 2 days, then 2 mg
bid x 2 days, then 1 mg po bid x 2 days, then
discontinue.
Lorazepam (Ativan) 2 mg po q 4 hours prn alcohol
withdrawal symptoms (pulse >100, systolic BP
>160, diastolic BP >100 [not to exceed 14 mg/24
hour]).
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Opiate Dependence Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Heroin dependance.
Legal Status:
Voluntary.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
q shift x 3 days, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Opiate withdrawal.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
hepatitis panel, HIV.
Medications:
Clonidine (Catapres) 0.1 mg po qid, hold for systolic
BP <90 or diastolic BP <60). Give 0.1 mg po q 4
hours prn signs and symptoms of opiate
withdrawal.
Dicyclomine (Bentyl) 20 mg po q 6 hours prn
cramping.
Ibuprofen (Advil) 600 mg po q 6 hours prn
pain/headache.
Methocarbamol (Robaxin) 500 mg po q 6 hours prn
muscle pain.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours.
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Schizoaffective Disorder Admitting
Orders
Admit to:
Acute Psychiatric Unit.
Diagnosis:
Schizoaffective disorder, bipolar type,
depressed.
Legal Status:
Voluntary.
Condition:
Stable.
Allergies:
No known allergies.
Vitals:
q shift x 3, then q day if stable.
Activity:
Restrict to unit.
Precautions:
Suicide precautions.
Diet:
Regular.
Labs:
Chem 20, CBC with diff, UA with toxicology
screen, urine pregnancy test, RPR, thyroid function,
lithium level.
Medications:
Quetiapine (Seroquel) 100 mg po bid x 2 days, then
200 mg po bid.
Lithium 600 mg po bid.
Citalopram (Celexa) 20 mg po q am.
Lorazepam (Ativan) 2 mg po q 4 hours prn agitation
(not to exceed 8 mg/24 hours).
Zolpidem (Ambien) 10 mg po qhs prn insomnia.
Tylenol 650 mg po q 4 hours prn pain or fever.
Milk of magnesia 30 cc po q 12 hours prn
constipation.
Mylanta 30 cc po q 4 hours prn dyspepsia.
Restraint Orders
1. Type of Restraint:
Seclusion, 4-point leather
restraint, or soft restraints.
2. Indication:
Confused, threat to self.
Agitated, threat to self.
Combative, threat to self/others.
Attempting to pull out tube, line, or dressing.
Attempting to get our of bed, fall risk.
3. Time
Begin at _____o’clock.
Not to exceed (specify number of hours).
4.
Monitor patient as directed by hospital policy.
5.
Staff may decrease or release restraints at their
discretion.
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