Veterans: Traumas resurface at end-of-life - UPI.com

U.S. researchers have tailored a program to help veterans whose traumas resurface at end-of-life.

Researchers led by Dr. Joshua Hauser of Northwestern University Feinberg School of Medicine in Chicago and Dr. Amos Bailey of the University of Alabama at Birmingham have developed a program they say is tailored to meet veterans' end-of-life needs.

"Many veterans, at the end of their lives, struggle with issues related to a traumatic event they had during their time in service," Bailey says in a statement. "They may have had a physical or emotional disability related to their time in service."

In addition to dealing with battle experiences, the new program -- Education on Palliative and End-of-Life Care for Veterans Project -- addresses sexual trauma and substance abuse during service, as well as how the particular war in which a veteran served affects both emotional and physical care, and other issues.

"Because these war memories come up more frequently near the end of life, palliative care providers need to be alert for these issues," Hauser says. "We want to show healthcare professionals how someone's individual war memories come up and how those can be talked about."

The program, which began in October, is scheduled to be introduced in 170 Veterans Administration Medical Centers around the country during the next 12 months.

via upi.com

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Psychiatric Nurse "Misses" Festering Wound Infection? Is She Held To The Same Standard?

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

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Summary: Registered Nurses in their training cover each of the accepted areas that a new graduate might be expected to work in. Once in the field, it is expected that additional and specific training to a Department or Specialty will be obtained. In this case, the Psychiatric nurses did not pick up on a festering infection in a patient that had tried to commit suicide. Was the fact that they were Psychiatric nurses a valid excuse?

The patient was admitted to the facility after he had tried to commit suicide. He had taken a loaded gun, covered his abdomen with a pillow and shot himself. Emergency Medical Services were summoned and the patient was transported to a nearby Emergency Department.

"Suicide Facts:

• Over 32,000 people in the United States kill themselves every year accounting for 1.4% of all deaths, suicide is the 9th leading cause of death in the U.S..
• A person commits suicide about every 15 minutes in the U.S. but it is estimated that an attempt is made about once a minute.
• 60% of all people who commit suicide kill themselves with firearms.
• There are 4 male suicides for every female one however, at least twice as many females as males attempt suicide.
• 3/4 of all suicides are committed by white males."2

The patient was examined and stabilized. After Assessment by the Emergency Department physician, a consult with a surgeon was ordered.

His condition was considered serious and transfer to the Intensive Care Unit was performed.

The ICU surgeon arrived and examined the patient's wound. It was clearly a wound into the abdomen with portions of the pillow "stuffing" imbedded inside the body.

No surgical intervention was performed at that time for the patient's self-inflicted gunshot wound. From the date of admission till discharge from the Psychiatric Unit, the patient would receive only a single dose of Intravenous Antibiotics.

During the patient's stay, signs/symptoms of an active infection were noted from the gunshot wound. It is unclear if this was brought to the attention of the physician. It was not documented by the Nursing staff.

What is clear, is that on discharge, the patient was seen by his family physician and was immediately put on antibiotics to treat an active abdominal infection.

Later at home, the patient and his wife had "removed" pieces of the pillow still intact in the patient's wound from the time of the gunshot wound.

A surgeon would again be consulted and a series of three operations to debreed and remove foreign bodies from the patient's abdomen followed.

The surgeon stated plainly, that all of the material present could have been removed when the patient was seen in the hospital initially.

The delay in treatment of the patient's injury clearly had led to both an active infection and the need for further debreeding. The surgeon stated also that further operations still may be required for the wound to heal properly.

The question would arise of "why wasn't the patient treated when initially seen."

The patient sued the hospital, the nursing staff and the physicians who had initially treated him in the hospital. An Emergency Department Physician witness for the plaintiff offered testimony as to standards of care to be observed in this case. The defense moved to have his testimony disallowed.

Questions to be answered:

1. Was the standard of care for a patient admitted for a gunshot wound breached by either the hospital staff, nurses or physicians during the patient's admission.

2. Was either the physician, psychiatrist or nursing staff negligent in their diagnosis/observation of a potentially life threatening infection during the patient's hospital stay in the Psychiatric Unit?

3. Did the documented delay in treatment cause harm to come to the patient and necessitate further medical treatment/attention.

The Emergency Department Physician in his testimony stated clearly that foreign material present in a gunshot wound presented an imminent danger of infection and sepsis. He questioned why it had not been removed initially.

In his discussion of the medical and nursing care in the Psychiatric Unit, he made the following observations.

The sole order written to address a potential infection was a single dose of IV antibiotics.

During the stay the wife and patient noted purulent drainage and foreign material still intact in the wound. They claimed to have brought this to the attention of the Nursing staff. Examination of the charting and documentation in the Nurses Notes revealed no such observation.

A medical chart including nurses notes have long been recognized as legal records. The fact that the patient's abdominal wound was not mentioned in the documentation, strongly reinforced the argument that negligent nursing care had been rendered. This omission of observation demonstrated a significant breach of applicable Nursing Standards.

It should be noted that the lack of thorough documentation of the patient's wound by the nurse significantly strengthened the plaintiff's case. Often testimony by "witnesses" can be dismissed or invalidated by an opposing attorney. Clear and concise documentation in a medical chart by a nursing professional, when available, carries much more weight.

The patient's infection was likewise not addressed in the physicians or psychiatrists progress notes.

"When an injured patient seeks legal advice about filing a medical malpractice lawsuit, the attorney's first task is to review the medical records. The attorney is looking for specific acts of negligence and at the overall quality of the record. The strongest medical malpractice lawsuits are based on well-documented, specific acts of negligence. In most cases, however, the negligence is inferred from documented and undocumented events."3

The observation of the patient and duty to report any actual or potential change in condition is a basic nursing standard. The prudent nurse, that is a nurse in any department or specialty with experience similar to the psychiatric nurses in this case, at the first sign of a potential infection of an open wound, would be expected to notify the physician. The next logical step would be to obtain an order to culture the purulent material to identify the organism and it's susceptibilities.

An argument was made and dismissed that because the nurses caring for the patient were not Medical Surgical, Emergency or nurses experienced in Wound Care that their potential liability should be lessened.

It is clearly defined the in nurse practice acts of each state that a licensed "nurse" will be competent to perform certain basic duties. This is regardless of where or under what specialty that nurse is practicing in. Failure to perform these duties will be grounds for disciplinary action against a nurse's privilege to hold a license.

The duty to the patient of observation, accurate charting and documentation, and duty to report to a phsyician (or psychiatrist in this case) significant changes in condition was breached.

The consequences of the delay in treatment were apparent and documented well by the patient's family physician and surgeon performing the three sucessive surgeries.

The main question raised by the defense was the "appropriateness" of a Emergency Physician documenting on the performance of duties of another physician, the surgeon and the nursing staff.

It was ruled that as an Emergency Physician, familiar with standards of care in the Emergency Department, he could give satisfactory testimony on the alleged negligence of both the Medical and Nursing staff.

He stated unequivocally that the patient should not have left the Emergency Room or Intensive Care Unit until arrangements had been made for surgical intervention to treat the patient's gunshot wound and remove the clearly evident foreign bodies.

The simple fact that the patient's condition went untreated both initially and well into his admission merited a finding of negligence on the part of each party involved in the patient's stay.

Related Nursing Link Sections:

Abuse: Domestic, Physical, Verbal Links, Direct Patient Care on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htm

Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/directpatientcare/clinical.documentation...

Courtroom Directory:
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/courtrooms....

Direct Patient Care Links on: The Nurse Friendly:
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Physical and Mechanical Restraints, Direct Patient Care Links on: The Nurse Friendly:
http://www.nursefriendly.com/nursing/directpatientcare/physical.mechanical.re...

Psychiatric Nurses:
http://www.nursefriendly.com/nursing/directory/spec/psych.html

Psychiatric Links, Direct Patient Care on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/psychiatric.htm

Suicide, Psychiatric & Mental Health, Direct Patient Care on: The Nurse Friendly:
http://www.nursefriendly.com/nursing/directpatientcare/psychiatric/suicide.htm

Violence & Violent Patients:
http://www.nursefriendly.com/nursing/directpatientcare/violence.violent.patie...

Related Nursing Malpractice Cases:

August 22, 1999: Psychiatric Nurse, Sued By hospital After Developing Relationship With Client?
Wright v. Mercy Hosp. Of Janesville - 557 N.W. 2d 846 - WI (1996)
Summary: Doctors and Nurses by nature of their positions deal with patients when they are vulnerable, off-balance and emotionally needy. When the population includes the psychiatric patient, the potential exists for a client to develop "feelings" for the caregiver. In this case, a sexually abused mother of three was admitted for multiple mental disturbances. During the course of the treatment, a relationship developed and led to sexual encounters following discharge. When it came to light, the patient successfully sued. The hospital would attempt to recover damages against the nurse following her testimony in defense of the facility. This is commonly called a Subrogation action.
http://www.nursefriendly.com/nursing/clinical.cases/082299.htm

August 15, 1999: Violent Psychiatric Patient Attacks Nurse,
No Legal Recourse Against Facility or Psychiatrist?
Charleston v. Larson, 696 N.E. 2d 793 – IL 1998
Summary: It would seem absurd, that if a physician admits and facility assigns a nurse to care for a known violent patient, that it has no legal obligation to protect that nurse against violence. In this case, a psychiatric patient sought admission to facility. On admission, he threatened to attack a nurse. When the patient would follow through on his threat, the nurse was denied legal recourse against the psychiatrist who could have taken precautions against the attack.
http://www.nursefriendly.com/nursing/clinical.cases/081599.htm

August 1, 1999: Nursing Duty To Patient, "Does Not Guarantee" Safety Or Quality Of Care.
Summary: When a nurse accepts report and responsibility for the care of a patient a duty to the patient is also accepted. This duty is to provide a reasonable standard of care as defined by the Nurse Practice Act of the individual state and the facility Policy & Procedures. In this case, a post-op abdominal aneurysm repair patient was injured after falling from his bed to the floor. When a lawsuit was filed the court initially mistook expert testimony to imply the role of the nurse includes a guarantee of safety.
Downey v. Mobile Infirmary Med. Ctr. - 662 So. 2d 1152 (1995).

July 4, 1999: Diabetic Coronary Artery Bypass Patient, Septic & Noncompliant.  Nursing Duty and Responsibility Questioned.
Patient noncompliance can present serious challenges to nurses  and physicians providing care.  If aware of the proper measures to be taken, what happens when the patient does not agree or comply with the course of treatment?  In this case, a patient after having a coronary artery bypass grafting developed a sternal infection. When advised by a nurse to return for treatment, the patient refused.
Kind v. State Ex Rel. Dept. of Health, 728 S.o. 2d 1027 -LA (1999).
http://www.nursefriendly.com/nursing/clinical.cases/070499.htm

June 27, 1999: Elderly Patient Repeatedly Injured In Nursing Home "Accidents." Negligence, Coincidence or Abuse?
As the elderly population continues to increase, more and more families are faced with the decision to place loved ones in nursing homes.  When a family member is placed in a facility, a certain standard of care is expected.  In this case, a resident was injured repeatedly while under their care.  When the patient died a few days after being "dropped" the family sued.
Brickey v. Concerned Care of Midwest Ince. 988 S.W. 2d 592 MO (1999)
http://www.nursefriendly.com/nursing/clinical.cases/062799.htm

June 6, 1999: Emergency Department Nurse Verbally Abused, Physician History Well Documented
Official tolerance for verbal abuse and sexual harassment is approaching zero.  It is clear that both are still prevalent in healthcare settings today.  Enforcing and reporting instances of abuse are critical to an end being put to the situation.  In this case, a physician had a "history" of verbal abuse in the facility involved.  It was the documentation of previous events that made formal action and administration of a suspension feasible.
http://www.nursefriendly.com/nursing/clinical.cases/060699.htm
Gordon v. Lewiston Hospital, 714 A.2d 539 – PA (1998)

May 30, 1999: Patient Left Unrestrained, Patient Injured. Nurses Judgement Call
The decision to use or not use restraints must be made with caution and good judgement. Their intended purpose must be to protect either the patient or others who may be injured by the patient including the staff caring for the client. The ultimate determination of necessity is left with the physician. Often, the moment to moment necessity is determined by the nurse. In this case a nurse did not feel restraining the patient was necessary. When an injury occurred, the patient sued.
Gerard v. Sacred Heart Medical Center - 937 P. 2d 1104 (1997)

Sources:

1. 40 RRNL 5 (October 1999)

2. American Foundation for Suicide Prevention. 1996. Suicide Facts. Retrieved October 24, 1999 from the World Wide Web: http://www.afsp.org/suicide/facts.html
3. Richards, Edward P. Medical Records as a Plaintiff's Weapon. Retrieved June 13, 1999 from the World Wide Web: http://plague.law.umkc.edu/Xfiles/x188.htm

The Uniform Resource Locator (URL) or Internet Street Address of this page is
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Send comments and mail to Andrew Lopez, RN

Created on November 1, 1999

Last updated by Andrew Lopez, RN on Monday, January 25, 2010

via nursefriendly.com

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

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Schizophrenia, Schizophrenics, Paranoid, Paranoia, Treatments, Symptoms, Psychiatric Mental Health Resources, 4Nursing.com, Nursing & Healthcare Resources

About Schizophrenia.com:"Started in 1995, Schizophrenia.com is a leading web community dedicated to providing high quality information, support and education to the family members, caregivers and individuals who's lives have been impacted by schizophrenia. The site is managed by a group of about 10 independent volunteers around the world - all of whom are either family members (with sons & daughters, brothers and sisters, or parents who have suffered from schizophrenia) or people who have schizophrenia. While none of us are mental health professionals, we are very familiar with the disease both through direct personal experience and extensive reading on the topic. We rely upon what we believe are good sources of scientifically accurate materials relating to schizophrenia and frequently consult with an ever growing group of schizophrenia researchers who act as unofficial advisors to the site - these schizophrenia researchers who help on an unofficial basis by answering our questions and occasionally providing feedback on different areas of the site."
The Tides Center Workteam1, (Schizophrenia.com)
PO Box 29907
San Francisco, CA 94129
szwebmaster@yahoo.com
http://www.schizophrenia.com/

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Schizophrenia in Children, American Academy of Child and Adolescent Psychiatry (AACAP):"Schizophrenia is a medical illness that causes strange thinking, strange feelings, and unusual behavior. It is an uncommon psychiatric illness in children and is hard to recognize in its early phases. The behavior of children and adolescents with schizophrenia may differ from that of adults with this illness. Child and adolescent psychiatrists look for several of the following early warning signs in youngsters with schizophrenia: seeing things and hearing voices which are not real (hallucinations), odd and eccentric behavior, and/or speech, unusual or bizarre thoughts and ideas, confusing television and dreams from reality."
American Academy of Child and Adolescent Psychiatry
3615 Wisconsin Ave., N.W., Washington, D.C. 20016-3007
voice: 202-966-7300 fax: 202-966-2891
http://www.aacap.org/publications/factsfam/schizo.htm

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Schizophrenia, Associated Problems in Prepsychotic or Postpsychotic Phase, Internet Mental Health:"Reckless or Impulsive Behavior Obsessive Thinking or Compulsive Rituals Prolonged Anxiety, Tension or Worry Fidgeting, Pacing, or Hyperactivity Sad or Depressed Mood Irritability or Hostility Feeling Worthless or Guilty Fatigue (Physically Tired All Day) Poor Concentration or Attention Sleeping Problem Appetite or Eating Problem Poor Sexual Interest or Ability Overly Dependent Behavior Poor Physical Health."
editor@mentalhealth.com
http://www.mentalhealth.com/dis/p20-ps01.html

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Schizophrenia & Psychosis, Mental Help Net:"Schizophrenia is a mental disorder that severely impacts how 2.5 million Americans think, feel, and act. It is a disorder that makes it difficult for a person to tell the difference between real and imagined experiences, to think logically, to express normal emotional responses or to behave appropriately in social situations. Schizophrenia can be draining on both the person with schizophrenia and their families. People with schizophrenia often have difficulty functioning in society, at work and in school. Family members may have to help out financially and make sure that medication is taken as prescribed."
Mental Help Net A service of CenterSite, LLC
570 Metro Place Dublin, OH 43017
http://mentalhelp.net/poc/center_index.php?id=7

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Schizophrenia, Mental Wellness.com, Janssen Pharmaceutica Products:"Schizophrenia is a severe mental illness described by the American Psychiatric Association as "one of the most debilitating and baffling mental illnesses known." The mental disorder is characterized by a dysfunction of the thinking process, such as hallucinations and delusions, and withdrawal from the outside world. Years of research have shown that schizophrenia is a biologically based brain disease. The most recent advances in brain imaging have confirmed imbalances of two brain chemicals – dopamine and serotonin – in those who suffer from schizophrenia. Dopamine is responsible for emotions and motivation; serotonin acts as a messenger and stimulates muscle movement, switching nerves on and off. The brains of people with schizophrenia have elevated dopamine and serotonin activity."
Janssen Pharmaceutica Products, L.P 1-800-JANSSEN (526-7736) http://www.mentalwellness.com/schizophrenia/about/schizophrenia.jsp

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NARSAD: National Alliance for Research On Schizophrenia and Depression:"NARSAD is a private, not-for-profit public charity 501(C)(3) organized for the purpose of raising and distributing funds for scientific research into the causes, cures, treatments and prevention of severe psychiatric brain disorders, such as schizophrenia and depression."
NARSAD
60 Cutter Mill Road, Suite 404 Great Neck, New York 11021 USA
Main Line: 516 829-0091
Research Grants Program: 516 829-5576 FAX: 516 487-6930
(800) 829-8289 or e-mail info@narsad.org
http://www.narsad.org/

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Rethink (formerly The National Schizophrenia Fellowship):"Rethink is the largest severe mental illness charity in the UK. As of 2nd July 2002 'Rethink' is the new operating name for 'The National Schizophrenia Fellowship'. We are dedicated to improving the lives of everyone affected by severe mental illness, whether they have a condition themselves, care for others who do, or are professionals or volunteers working in the mental health field. With more than 30 years of experience, and over 1800 staff, Rethink provide a wide range of community services including employment projects, supported housing, day services, helplines, residential care, and respite centres. All our services try to help people take more control of their own lives by building their confidence and strengthening their skills. With nearly 400 services, we support around 5000 people every day."
Rethink, Head Office
30 Tabernacle Street London EC2A 4DD
Tel: 020 7330 9100/01 Fax: 020 7330 9102
National Advice Line Tel: 020 8974 6814 (open 10am to 3pm, Monday to Friday)
email info@rethink.org
http://www.rethink.org/

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Schizophrenia, Schizophrenia Society of Canada:"• Is a treatable biochemical brain disorder • Strikes 1 in 100 people • Manifests itself usually between the ages of 15 to 25 years • Causes 40% of people with schizophrenia to attempt suicide of which 10% complete the act. • Costs Canadian taxpayers an estimated $4 billion annually in direct and indirect costs It is NOT: The fault of the person or their family. Founded in 1979, the Schizophrenia Society of Canada (SSC) is a national registered charity. SSC works with 10 provincial societies and their over 100 chapters/branches, to alleviate the suffering caused by schizophrenia and related mental disorders. To this end, SSC and its provincial affiliates carry out public awareness & education, family support, advocacy and research funding initiatives and programs."
Schizophrenia Society of Canada
50 Acadia Avenue - Suite 205 Markham, ON L3R 0B3
Tel: (905) 415 - 2007 Fax: (905) 415-2337
Call Toll Free in Canada: 1-888-SSC-HOPE [1-888-772-4673] e-mail: info@schizophrenia.ca
http://www.schizophrenia.ca/

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Schizophrenics Anonymous (SA):"Schizophrenics Anonymous (SA) is a self-help group for persons who have schizophrenia or a schizophrenia-related illness. .A was founded in the Detroit area in July of 1985 and since that time, thousands of people have participated in meetings. There are currently more than 150 groups meeting throughout 31 states, as well as Australia, Brazil, Canada, Mexico, France, India and Venezuela. Statement of Purpose: Schizophrenics Anonymous is organized and managed by persons experiencing schizophrenia or a related disorder. It is administered in partnership with the National Schizophrenia Foundation. 403 Seymour Avenue
Suite 202 Lansing, Michigan 48933
Phone: (517) 485-7168 (800) 482-9534 (Consumer Line) Fax: (517) 485-7180
General Questions: inquiries@nsfoundation.org
http://www.sanonymous.org/

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WFSAD: World Fellowship for Schizophrenia & Allied Disorders:"The World Fellowship for Schizophrenia and Allied Disorders (WFSAD) is the only global organization dedicated to lightening the burden of schizophrenia and allied disorders for sufferers and their families. WFSAD strives to increase knowledge, understanding and compassion and reduce the fear, stigma, discrimination and abuse that accompany these difficult conditions. WFSAD and its member organizations focus on the humane treatment of people with mental illnesses and on their primary care, which falls frequently upon the family, most often the parents, and can last a lifetime. There is need for housing, rehabilitation, recreation and a decent life for those battling these difficult conditions. It is estimated that some 40% of sufferers have no contact with formal mental health systems. Support, training and education is necessary for families and their sick loved-ones, who have an enormous and continuing burden to shoulder."
124 Merton Street, Suite 507, Toronto, Ontario, M4S 2Z2, Canada
Tel: +1.416.961.2855 Fax: +1.416.961.1948 E-mail: info@world-schizophrenia.org
http://www.world-schizophrenia.org/

See also: Addictions, Substance Abuse, Mental Health Abuse

Clinical Nursing Case Studies, Malpractice Cases: http://www.nursingcasestudy.com

October 15, 2000: Physician Restraint Orders Unclear On Transfer, Do You Apply In The Interim?
Summary: The use of Mechanical or Physical Restraints on confused patients is highly controversial. Due to substantial Death & Injury attributed to their use they are considered a last resort measure in providing for the safety of a patient. In this case, orders specifying what restraints and when they were to be used were unclear. In a patient that was clearly at high risk for injury, should they have been applied till the physician could have been contacted?
Tousignant v. St. Louis County, 602 N.W.2d 882 - MN (1999)
http://www.nursefriendly.com/nursing/clinical.cases/2000/101500.htm

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September 19, 1999: Abusive Psychiatric Patient Restrained, Placed In Seclusion For Angering Nursing & Medical Staff?
Summary: In dealing with violent, abusive or angry psychiatric patients, the safety of the patient and staff are the priority concerns. When restraints or seclusion are deemed necessary, justification for the measures must be documented concisely. In this case, an unruly patient angered the nurse caring for him. When leather restraints were applied and maintained for a prolonged period of time, the patient would object and later sue for damages.
Alt v. John Umstead hospital 479 S.E. 2d 800
http://www.nursefriendly.com/nursing/clinical.cases/091999.htm

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August 15, 1999: Violent Psychiatric Patient Attacks Nurse,
No Legal Recourse Against Facility or Psychiatrist?
Charleston v. Larson, 696 N.E. 2d 793 – IL 1998
Summary: It would seem absurd, that if a physician admits and facility assigns a nurse to care for a known violent patient, that it has no legal obligation to protect that nurse against violence. In this case, a psychiatric patient sought admission to facility. On admission, he threatened to attack a nurse. When the patient would follow through on his threat, the nurse was denied legal recourse against the psychiatrist who could have taken precautions against the attack.
http://www.nursefriendly.com/nursing/clinical.cases/081599.htm

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Direct Patient Care Resources:

Violence & Violent Patients, Direct (Bedside Nursing) Patient Care
http://www.nursefriendly.com/violent/

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Drugs, Prescription Medications:

Abilify, Aripiprazole, Antpsychotic, Prescriptions Drugs, Medications, Medicines
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Ativan (Lorazepam), Anti Anxiety, Antianxiolytic, Sedative, Hypnotic
http://www.prescriptionforviagra.com/lorazepam/

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clonezapam (Klonopin), Benzodiazepines, Anticonvulsants, Antiseizure
http://www.prescriptionforviagra.com/clonezapam

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Ropinirole Hydrochloride, Requip, Parkinsons Disease, Dementia, Prescription Drugs, Medications
http://www.prescriptionforviagra.com/ropinirole/

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Nursing Humor:

Psychiatric, Mental Health Humor

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http://www.4nursing.com/direct-patient-care-psychiatric-mental-health-schizop...

Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010

via 4nursing.com

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Any questions, please drop me a line.

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Sincerely,

Andrew Lopez, RN
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38 Tattersall Drive, Mantua New Jersey 08051
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