Psych/Mental Health Nursing – Restraints, Benzodiazepines, and Speech Patterns

Restraint Use in Acute Care

Always employ least-invasive interventions first; document each step clearly.
- Ethical principle: Respect for patient autonomy and minimization of harm.
Primary goal of any intervention = calm the patient (not punishment or convenience).
Ongoing assessment requirements while restraints are in place:
- Inspect all restrained extremities for paleness, coolness, or other signs of decreased circulation.
- Document findings, time, and any actions taken (e.g., loosening, repositioning, notifying provider).
ATI testing assumption: Questions default to an acute-care setting unless otherwise specified.
- In acute care, bed alarms are NOT classified as restraints.
- In long-term care, classification depends on individual facility policy and the type of alarm used.

Common side effect: drowsiness.
- Patient teaching: Avoid driving, operating heavy machinery, or performing tasks requiring alertness until they know how the medication affects them.
Reversal/antidote for benzodiazepines = \text{Flumazenil (Mazicon)}.
- Must be readily available when administering IV or high-dose benzodiazepines.
- Monitor for resedation; flumazenil’s half-life may be shorter than the benzo being reversed.

Acute care: Bed alarms are considered a fall-prevention tool, not a restraint.
Long-term care: Alarm classification varies by facility policy and alarm type; consult local protocol.

Circumstantiality: Excessive, unnecessary detail before eventually reaching the point.
Neologism: Creation and use of made-up words understood only by the speaker.
Echolalia: Repetition of another person’s words.
Verbigeration: Repetition of entire sentences or phrases in a loop.
Loose Association: Series of sentences connected by a single shared word or concept, but overall topic drifts.
- Example: “The sky is blue. Blue is my old dog. Dogs like walks.”
Flight of Ideas: Rapid shift between unrelated sentences/topics.
- Example: “I have homework. My car is red. The light needs changed.”
Word Salad: Random, unconnected words thrown together.
- Example: “dog, rain, ceiling.”
Clang Association: Speech driven by rhyming or sound, not meaning.
- Example: “I’m blue and need a clue to tie my shoe.”

Differentiate therapeutic vs. non-therapeutic methods (e.g., open-ended questions, reflection, validation vs. giving advice, false reassurance).
Apply speech-pattern knowledge to choose appropriate interventions (e.g., focusing, clarifying, summarizing).

Pre-interaction: Nurse reviews data and self-prepares before meeting client.
Orientation (Introduction): Establish rapport, contract, purpose, and boundaries.
Working: Implement interventions, promote insight, evaluate progress.
Termination: Summarize achievements, separate professionally, plan for follow-up if needed.

All listed speech-pattern terms will appear on the test; know definitions and examples.
Understand when and why restraints are applied, documentation standards, and ongoing assessments.
Link medication safety (benzos + flumazenil) to patient teaching and acute emergencies.
If any concept is unclear, contact instructor Jodie for clarification.