11 CEN: Mental Health emergencies Flashcards
11 items on exam
What are characteristics of Bipolar disorder?
/Chronic, recurring cycles of depression and elation (mania).
S/S: major depressive episode followed by inappropriate elation, increased energy (highest risk of harming themselves and others) and insomnia, pressured speech, grandiose notions, poor judgement, racing thoughts, impulsivity, risk-taking behavior, and promiscuity;
TX: provide safety, minimize external stimuli, medications like Lithium to control severe mood swings and carbemazepine (Tegretol)
What are S/S of Lithium toxicity?
toxicity: SAD LITH - Seizures, Ataxia - impaired balance, Dystonia - muscle contractions, Lethargy/Leukocytosis, Insipidus (DI), Tremors, Hypothyroidism)
What is psychosis? Priority with these patients?
Psychosis - mental disorder evidenced by bizarre thinking, often accompanied by sensory hallucinations (illusions) and delusions (misconceptions of belief).
Priority is safety, setting boundaries is ineffective.
What are things that must be ruled out for pts presenting with psychosis?
Treatment?
Provide medical clearance - rule out brain tumors (head CT), use of psychoactive drugs (LSD), sepsis, etc.
Treat with Haldol (risk of neuroleptic malignant hyperthermia) or Ziprasidone (Geodon). **Both prolong QT interval, so get ECG when safe.
What is Schizophrenia and S/S?
Schizophrenia - bizarre behavior including inability to care for self or manage activities of daily living, typical onset in early 20’s;
S/S: delusions, hallucinations, disorganized speech.
What is Tx for schizophrenia?
TX: orient to reality for safety; use short, concrete sentences avoid figures of speech); administer antipsychotic medications and watch for extrapyramidal symptoms (EPS), dystonic reactions from neuroleptic medications like Haldol and Thorazine.
TX: of EPS - diphenhydramine (Benadryl), benztropine (Cogentin), trihexyphenidyl (Artane). Treatment effective when muscles relax.
What is Neuroleptic Malignant Syndrome ?
S/S? Tx?
life-threatening condition that can be caused by antipsychotic medications (Haldol, Thorazine),
S/S: manifested by hyperthermia, muscle rigidity, and autonomic instability (fluctuations in BP);
TX: ABCs, reduce temperature with cooling blankets and ice packs.
What is depression? S/S?
symptoms that interfere with the person’s ability to work, sleep, and actively participate in life;
S/S: loneliness, lack of energy, sleep disturbances, weight changes, decreased libido, decreased interest in usual activities;
**ask directly about thoughts of suicide and plan.
Who is at increased risk of suicide?
increased risk if Caucasian, family history of attempts; behavioral health history; substance abuse; history of abuse; prior attempts; chronic physical illness; gender identity crisis.
What are S/S of SI? Interventions?
D/c instructions if meds prescribed?
S/S: feeling worthless, hopeless, and helpless; indifference; social isolation.
TX: undress patient and remove anything that may pose danger, encourage communication, involve family and friends; look for positives in life and demonstrate worth.
D/C INSTRUCTIONS: Antidepressants take weeks for full effect, contact someone if thoughts of hurting yourself
Toxicology/ Ingestions/GI Decontamination.
For pts who attempt suicide with ingestion, what are the GI interventions?
- Activated charcoal with sorbitol (cathartic) every 4-6 hours for 12-24 hours for extended-release or enteric-coated medications; **commonly used for acetaminophen overdose.
- Gastric lavage only for toxic, symptomatic patient with recent ingestion (< 1 hour; risk of esophageal perforation.
- Whole bowel irrigation with Go-lytely or MiraLAX for body packers (cocaine packs).
S/S and Tx of Iron overdose?
S/S: N/V and abdominal pain early, hematemesis.
TX: No charcoal - Iron does NOT bind to charcoal. Desferal Deferoxamine) - chelating agent that binds free iron, it is excreted renally - rust, pink or “vin rose” urine color expected.
What organ does an acetaminophen overdose affect?
Dx and Tx?
Toxic to liver
DX: quantitative level at 4 hours from ingestion, monitor LFT’s.
TX: Consider lavage and activated charcoal, N-acetylcysteine (Acetadote) within 8 hours for best response.
S/S and Tx of Salicylates overdose?
S/S: tachypnea to compensate for metabolic acidosis, N/V, abdominal pain, tinnitus, hypoglycemia.
TX: sodium bicarbonate for urine alkalization, dextrose for hypoglycemia, hemodialysis.
Tricyclic Antidepressants (TCAs) Elavil, Tofranil. What are the 3 C’s for S/S of overdose?
Tx?
S/S: altered LOC (Coma), ventricular tachycardia (Cardiac dysrhythmias), seizures (Convulsions)
TX: cardiac monitoring, intubation, sodium bicarbonate for urine alkalization, lidocaine, a magnesium sulfate if polymorphic ventricular tachycardia develops.
