A patient in a long-term care facility has been increasingly disruptive and difficult to manage, crying loudly about wanting to leave and running in the halls at times. He is not aggressive but is loud and rude to staff. Since dinner is about to be served, one of the nurses on the unit suggests giving him a dose of Temazepam (Restoril) PRN that is ordered for sleep to calm him down so they can manage the milieu easier. Which of the following would be the appropriate nursing action?

Ask the physician to discuss a new PRN order with the patient.


•The nurse should ask the physician to discuss a new PRN order with the patient. The patient may benefit from a PRN medication, but it is unethical to give a PRN drug for sleep to an agitated patient in the afternoon for the staff's convenience. This is considered a "chemical restraint".

•The physician can meet with the patient to discuss his symptoms and feelings and get consent for another drug that may help with agitation, or get consent from the DPOA if the patient is incapable of giving consent. However, even the DPOA cannot give permission to use chemical restraints for discipline or staff convenience.

•The Omnibus Budget Reconciliation Act of 1987 (OBRA '87) contains the Nursing Home Bill of Rights, which states that residents have "the right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms" and that "physical or chemical restraints may only be imposed... to ensure the physical safety of the resident or other residents." 

Incorrect answers:

•Writing a nurse's note in the chart about the patient's agitation is a good idea, but does not address the current situation which is the patient's immediate state of agitation.

•Both options that including administering the temazepam are incorrect. This medication is intended for sleep and can only be given at HS for that purpose and no other.

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