By S. Berek. William Penn College.
Any medicine that is being given covertly must be checked to ensure it is safe when administered in this fashion and that the chemical nature of the medicine is not changed purchase zestril 10mg otc hypertension 33 weeks pregnant. A full written assessment of the resident is performed prior to the administration of medicines covertly effective zestril 5 mg hypertension 1 symptoms. The assessment identifies the medicines being administered, the indications for these medicines, alternative measures that have been taken and the rationale for the use of covert administration. All decisions to administer medicines covertly must be made following a multidisciplinary agreement that this practice is in the resident’s best interests. This agreement must be documented and reviewed in line with the relevant legislation or more often if circumstances change. If a medicine is to 22 Medicines Management Guidance Health Information and Quality Authority be administered covertly, this should be stated on the prescription sheet. Where medicines are covertly administered it is important to observe for and document side effects. Residents may be given the opportunity to self-administer their medicines in line with their needs and wishes, following an assessment. Where self-administration of medicines is carried out, an individual risk assessment should be carried out to consider: the resident’s choice the amount of support a resident needs to self administer medicines the resident’s ability to understand the process the resident’s knowledge of their medicines and treatment plan the resident’s literacy and ability to read labels the resident’s dexterity and ability to open bottles and containers if the resident can take the correct dose of their own medicines at the right time in the right way where the resident’s medicines will be stored the responsibilities of residential care staff. The level of support and resulting responsibility of the staff should be written in the care plan for each resident. This should also include how to monitor whether the resident is still able to self-administer medicines and should detail the ongoing supervision to ensure adherence with the treatment plan. Monitoring and reviewing how the resident manages to take their 23 Medicines Management Guidance Health Information and Quality Authority medicines forms part of the person’s care. In residential centres where children self administer medicines, a risk assessment should be carried out and recorded in the care plan. It should determine: that the resident is able to look after and self administer their own medicines whether any monitoring is needed to assess the ability to self-administer or willingness to take the medicines as prescribed that medicine has been taken as prescribed (either by seeing this directly or by asking the resident) who has recorded that the medicine has been taken. Residential services should ensure that their process for self‑administration of Schedule 2 and 3 controlled drugs includes additional specific information about: obtaining or ordering Schedule 2 and 3 controlled drugs storing Schedule 2 and 3 controlled drugs recording supply of Schedule 2 and 3 controlled drugs to residents disposal of unused or expired Schedule 2 and 3 controlled drugs. Residents should be offered the medicines at the times they are experiencing the symptoms either by telling a member of staff or by staff identifying the resident’s need as outlined in the care plan. Staff who may need to administer such medicine require additional training so that they can administer it safely and confidently in an emergency. If a second dose of medicine is prescribed, then the prescription must state the period of time after administration of the first dose in which the second dose can be administered. Medicines used for the management of seizures should be reviewed and evaluated on a regular basis. The centre’s medicines management policy should include guidance to staff on how to manage refusal of medicines. This guidance should include the actions to be taken if medicines are refused, who to contact and the documentation to be completed. If a resident agrees to take a medicine later than the prescribed time, this must be documented clearly in the medicines administration record. If a medicine is given at a later time than prescribed, the prescriber should be contacted to ensure that there are no contra-indications. If there is a pattern where a resident often refuses medicine, a plan must be put in place with involvement of the staff, multidisciplinary team, the resident and their representatives, if appropriate. This plan must be reviewed on a regular basis, in line with the relevant legislation or more often if circumstances change. There are legal requirements for the storage, administration, records and disposal of Schedule 2 and 3 controlled drugs. All medicines, including Schedule 2 and 3 controlled drugs (except those for self administration) are administered by a registered nurse or medical practitioner in older persons’ residential services. In social care settings such as residential services for people with disabilities, other personnel may be trained to administer medicines.
The company of other addicts who know us well is a source of comfort and strength 5mg zestril otc arrhythmia gatorade. We have found that a strong foundation in recovery prepares us to face all phases of our life with a measure of dignity and grace cheap zestril 2.5 mg without prescription blood pressure classification. We prepare ourselves to handle the reality of our illness with all the spiritual strength and hope our recovery can provide. We avoid the tendency to judge ourselves harshly and don’t allow ourselves to be isolated by feelings of fear and inadequacy. When we are close to someone with an illness, whether they are a friend, a partner, or a sponsor, we may ﬁnd ourselves facing intense feelings. The ﬁrst reaction to news of an illness or trauma may be to get caught up in our self-centeredness and other character defects. We remember that we have the ability to put spiritual principles into action today. The process of working the steps has given us the ability to love and accept who we are, and become able to truly love others. Taking care of ourselves and being committed to our own recovery allows us to be an ongoing source of strength for those close to us. We strive to set aside the self-obsession of our disease and offer care and concern to our loved ones during difﬁcult times. But I shared about it with friends and at meetings, and by being open to the message of recovery I realized that I was doing the best I could and that my effort was good enough. This is not an invitation to interfere with the medical treatment or personal wishes of our loved ones. We greet these requests for support humbly and gratefully, knowing that it takes courage to reach out for help. Making the effort to pick someone up for a meeting or visiting them while they are convalescing are acts of kindness that our fellow members will appreciate. They may ask us to prepare meals, or assist them in other daily activities that they are unable to accomplish on their own. They may also ask for our help in more serious matters like seeking advice from legal or ﬁnancial The process of working the steps has given us the ability to love and accept who we are, and become able to truly love others. We remember that there are many times when something as simple as a phone call can make a big difference to an addict who feels isolated by illness. When we face the loss of a loved one in recovery, we strive to remember this simple fact. Even with time in the program, our ﬁrst tendency may be to run from painful situations. We do what we can to assist them in facing the end of their lives with dignity and grace. When we encourage them to reach out and share with us honestly, we may ﬁnd that there are details about their medical care that they would prefer remain conﬁdential. We counter our own self- centeredness by focusing on life, and on the miracle of recovery that brought us all together. However, it is important to remember that some addicts’ families may not understand our close relationships to their loved ones. They may feel that their privacy is being invaded if groups of unfamiliar people descend on their home or their loved one’s hospital room. Our experience has shown that the atmosphere of recovery we cherish in our meetings can translate to these situations as well. We can be examples of the spiritual principles of anonymity, integrity, and prudence no matter where we are. In doing this, we display gratitude for our loved one, our life, and our recovery. We can express love in a number of ways when our loved ones are facing an illness. We can call our friend on the phone, pick them up for a meeting, visit them, prepare meals, or assist them in other daily activities that they are unable to accomplish on their own. When we apply the spiritual principles we learn in the steps, we are able to face reality and be there to support those we love. In the beginning we may experience many familiar feelings like denial, anger, rationalization, self-deception, and grief.
These self- destructive acts are often precipitated by potential separation from others generic zestril 5 mg free shipping prehypertension pubmed, perceived or actual re- jection or abandonment generic zestril 5 mg amex blood pressure 9555, or the expectation from others that they assume more responsibility. The usual dysphoric mood of these indi- viduals is often punctuated by anger, panic, or despair and is only infrequently relieved by periods of well-being. These episodes may be triggered by the individual’s extreme reactivity to interpersonal stressors. Many experience inappropriate, intense anger or have difficulty controlling their anger. For example, they may lose their temper, feel constant anger, have verbal outbursts, or engage in physical fights. This anger may be triggered by their perception that an important person is neglectful, withholding, uncaring, or abandoning. Expressions of anger may be fol- lowed by feelings of being evil or by feelings of shame and guilt. It is not necessary for an individual to have all of the above features for borderline person- ality disorder to be diagnosed. As indicated in Table 1, the diagnosis is given if at least five of the nine diagnostic criteria are present. These episodes usually last for minutes or hours and are generally of insufficient duration or severity to warrant an additional diagnosis. Another common associated feature is a ten- dency for these individuals to undermine themselves when a goal is about to be reached (e. Individuals with this dis- order may feel more secure with transitional objects (e. Despite their significant relationship problems, they may deny that they are responsible for such problems and may instead blame others for their difficulties. Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the childhood histories of those with borderline personality disorder than in those without the disorder. Such Treatment of Patients With Borderline Personality Disorder 41 Copyright 2010, American Psychiatric Association. Complications Borderline personality disorder is characterized by notable distress and functional impairment. Completed suicide occurs in 8%–10% of individuals with this disorder, a rate that is approximately 50 times higher than in the general population. Risk of suicide appears to be highest when patients are in their 20s as well as in the presence of co-occurring mood disorders or substance-related disorders (87). Physical handicaps may result from self-inflicted injury or failed suicide attempts. These individuals often have notable diffi- culty with occupational, academic, or role functioning. Their functioning may deteriorate in unstructured work or school situations, and recurrent job loss and interrupted education are com- mon. The social cost for patients with borderline personality disorder and their families is sub- stantial. Longitudinal studies of patients with borderline personality disorder indicate that even though these patients may gradually attain functional roles 10–15 years after admission to psy- chiatric facilities, still only about one-half will have stable, full-time employment or stable mar- riages (40, 134). Recent data indicate that patients with borderline personality disorder show greater lifetime utilization of most major categories of medication and of most types of psycho- therapy than do patients with schizotypal, avoidant, or obsessive-compulsive personality dis- order or patients with major depressive disorder (135). The additional use of assessment instruments can be useful, especially when the diagnosis is unclear. Certain assessment issues relevant to all personality disorders should be considered when di- agnosing borderline personality disorder. For the diagnosis to be made, the personality traits must cause subjective distress or significant impairment in functioning. The traits must also deviate markedly from the culturally expected and accepted range, or norm, and this deviation must be manifested in more than one of the following areas: cognition, affectivity, control over impulses, and ways of relating to others. The clinician should also ascertain that the personality traits are of early onset, pervasive, and enduring; they should not be transient or present in only one situation or in response to only one specific trigger. It is important that borderline personality disorder be assessed as carefully in men as in women. The ego-syntonicity of the personality traits may complicate the assessment process; the use of multiple sources of information (e.
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