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Mental Health Nursing · Chapter 6

Red Flag Desk and the SBAR Call

Six people on a behavioural health unit are deteriorating in six different ways, and each one needs a different immediate action. Name what you are looking at, separate the two syndromes that get confused, decide what can be handed to assistive personnel — then build the escalation call one line at a time and hear how it sounds.

Red flag desk

0 of 6 identified

Serotonin syndrome or neuroleptic malignant syndrome?

Both cause fever, altered mental status and autonomic instability. Almost everything else separates them. Tap each finding.

The two-word discriminator: hyperreflexia and clonus point to serotonin; rigidity with hyporeflexia points to NMS. Add the clock — serotonin syndrome arrives within about twenty-four hours of a new agent or a dose increase, neuroleptic malignant syndrome evolves over days.

Delegate, or keep?

You may delegate a task. You may never delegate the nursing process. Sort each one.

What you are looking at

Name the red flag to beginEach case gets the reasoning, the discriminating feature, and the immediate nursing action — and where a wrong answer would have been actively dangerous, that is spelled out too.

Build the SBAR call

The call, as assembled

Rules worth keeping

Know the onset of every agent you give. Benzodiazepines work in minutes. Hydroxyzine in fifteen to sixty. Propranolol within the hour. Prazosin over days to weeks. Buspirone takes two to four weeks and is therefore worthless as a PRN — say so out loud, or the person will abandon it in week one. SSRIs and SNRIs take four to six weeks, and eight to twelve for obsessive-compulsive disorder.
Start low and go slow in anxious patients. A full starting dose commonly produces early jitteriness and a genuine worsening of anxiety in the first one to two weeks. A person who is not warned will stop the drug and conclude that medication makes them worse. All antidepressants carry a boxed warning for increased suicidal ideation and behaviour under twenty-five — monitor closely in the first weeks and after every dose change.
Taper, never stop. Abrupt benzodiazepine discontinuation after regular use produces tremor, diaphoresis, autonomic instability, delirium and seizures, and can be fatal. SSRI and SNRI discontinuation syndrome — flu-like symptoms, dizziness, electric-shock sensations, insomnia, irritability — is worst with short-half-life agents such as paroxetine and venlafaxine.
And mind the language. A person asking about their benzodiazepine dose is asking a question. Describe the behaviour, assess the need, and write what you observed — “asked three times today about the timing of her lorazepam and reported that the night dose was late” — rather than a label that ends the thinking of everyone who reads the chart after you.