Client is triaged by nursing staff and right wrist is not swollen or visibly deformed and he is now rating pain at 3-4/10. Client is brought into the PEC / CSU and taken immediately to Res

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Client is triaged by nursing staff and right wrist is not swollen or visibly deformed and he is now rating pain at 3-4/10. Client is brought into the PEC / CSU and taken immediately to Restraint Room 1 and emergency orders were received from the on-call provider to seclude and restrain the client, if necessary, as KCSO and MET are placing him on a 5150-Psych hold for Danger to Others (DTO) and Danger to Self (DTS). Hold to remain in effect for up to 72 hours as per the law allows and be within compliance of the LPS Act. Further, orders were also received to administer emergency medications if deemed necessary as follows: Ativan 2 mg IM x 1 now with Haldol 5 mg IM x 1 now with Benadryl 50 mg IM x 1 now. Psych consult arrives in the ED and finds a catastrophe awaits his assessment. The provider directs the nursing staff in ED to administer: Thorazine 50 mg, IM and if necessary to repeat with another 50 mg Thorazine IM if not improved after one hour of time. The 5150 is upheld and the client will be going inpatient. Arrangements are made for a direct admit upstairs into the psych unit when a bed becomes available. Client will be transferred to Medical / Surgical (Med/Surg) Wing on 3rd floor, under 1 to 1 observation until provisions can be made for transfer to IPU.
Medications are administered, not once, but the second dose was needed for the client to go to sleep. Once the client was noted to be resting peacefully, Orthopedics was consulted, and the client woke up while a cast was being applied to his right wrist due to necessity of the misalignment to be realigned. Decision was then made when client became violent again and was attempting to break the new cast to take him into surgery to repair the right wrist and apply the cast again.
Why didn’t the initial emergency medications work after they were administered? What else could be onboard in the client’s system that does not play well with Ativan? Thoroughly discuss this issue and recommendations for improvement in the future for this client.
Describe in detail the treatment recommendations for this orthopedic condition.
Describe in detail the possible outcomes for the elderly couple. What safety concerns should be discussed and possibly evaluated by nursing staff of the ED?

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