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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is It Legal For The Nurse To Teach The Caregiver To Administer The Haldol IM?

Hi - I m a hospice nurse in California. We are caring for an elderly woman with CHF and complications from diabetes who is becoming increasingly agitated and combative. She is on Lorazepam 2 mg q4h and Seroquel 100 mg bid (these are increases from a week ago). She was uncontrollably combative but bedridden for the caregiver last night. We have a new order for Haldol 4 mg IM q6h and a nurse has given her one dose today. She is calm at the moment. My question is about whether it is a good idea or even legal for the nurse to teach the caregiver to administer the Haldol IM? I realize the caregiver is responsible for the other meds but something about this makes me uncomfortable. I m looking up regs right now in California but happened upon this website. What do you think? Thank you.
Tue, 19 Nov 2013
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Internal Medicine Specialist,  's  Response
Hello,
Thanks for posting your query.
The patient is likely having acute delirium most likely causes are hypoxia due to CHF, sepsis, dyselectrolytemia or ICU delirium.
She should be reviewed by a physician to decide on the cause and treat accordingly.
If other causes are ruled out and it happen idiopathic delirium then the Haldol is drug of choice but the drug can not be started by an RN or caregiver.
A doctor must assess the ECG and electrolytes before starting it and deciding the doses.
Avoid Lorazepam as it will cause undue drowsiness and will not control agitation as such.
Seroquel cannot be given with Haldol so must be stopped.
I hope this answers your query.
In case you have any follow up queries or doubts, you can forward them for me, and I shall be glad to help you.
Please accept my answer in case you do not have further queries.
Wishing you good health.
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Is It Legal For The Nurse To Teach The Caregiver To Administer The Haldol IM?

Hello, Thanks for posting your query. The patient is likely having acute delirium most likely causes are hypoxia due to CHF, sepsis, dyselectrolytemia or ICU delirium. She should be reviewed by a physician to decide on the cause and treat accordingly. If other causes are ruled out and it happen idiopathic delirium then the Haldol is drug of choice but the drug can not be started by an RN or caregiver. A doctor must assess the ECG and electrolytes before starting it and deciding the doses. Avoid Lorazepam as it will cause undue drowsiness and will not control agitation as such. Seroquel cannot be given with Haldol so must be stopped. I hope this answers your query. In case you have any follow up queries or doubts, you can forward them for me, and I shall be glad to help you. Please accept my answer in case you do not have further queries. Wishing you good health.