Behavioral Health Emergencies Flashcards
Patients with OCD or panic disorder (do/ do not) require emergent psychiatric consultation
do not
Patient with acute psychosis and homicidal ideation (do/ do not) require emergent consultation
do
The death of a patient within 24 hours of using a restraint is considered a ____ event.
sentinel
you need an order from a ILP within __ hour of initiating restraints.
Independent licensed practitioner with do a face to face eval within __ hour
one
1
The most common causes of acute mental status changes are ____, not ____
organic
psychiatric
Organic causes include
6
metabolic issues, unrecognized head injuries, medications, drug intoxication, withdrawal, illnesses that cause delirium.
Patients who present with SI, HI, or acute psychosis require psychiatric consultation. Any patient with panic disorder, and OCD require psychiatric treatment but not on an _____ basis.
emergent
restrain as needed” or “restrain for the duration of visit” is not an acceptable order, there must be a ____.
timeframe
For an adult, restraint orders are to be renewed every __ hour, __ hours for ages 9-17, and __ hour for ages under 9
4
2
1
The two classes of medications that are used as chemical restraints are ____ and ____.
Benzodiazepines and antipsychotic.
The most common type of psychiatric disorder to present in the emergency dept are ____ disorders, they may range from mild to incapacitating. They may be resulting from a normal response to a threatening situation.
anxiety
Anxiety: Things worth documenting are such as
7
changes in behavior, somatic symptoms such as HA and dizziness, previous psych issues, affect, speech pattern, comprehension, memory.
Placing a patient in isolation does not generally treat ____
anxiety
Before a dx of ____ is made, causes of medications, medical illness, substance abuse, and metabolic disorder must be ruled out.
anxiety
____ disorder may include somatic symptoms such as hyperventilation, palpitations, dizziness, vertigo, faintness, shakiness. Psychological symptoms include fears of unreality, going insane, losing control, death.
Panic
Panic disorder is usually accompanied with (4)
OCD, PTSD, social phobias, generalized anxiety disorder.
Conditions that can mimic panic disorder include
6
asthma, dysrhythmia, metabolic problems, thyroid storm, hypoxia, hypoglycemia
____ can be caused by a genetically inherited neurochemical dysfunction such as autonomic imbalance, increased adenosine-receptor function, increased cortisol level, diminished benzodiazepine-receptor function, and disturbances in serotonin, norepinephrine, gamma-aminobutyric acid, dopamine, cholecystokinin, and interleukin-1 beta.
Panic
Panic disorder may be related to a genitc disturbance in the neurotransmitter ____
norepinephrine
____ used for treatment include Ativan (fast acting), and BuSpar
Benzodiazepines
____ ____ can be used for associated tachycardia, not to reduce intrinsic anxiety.
Beta blockers
Medications for depression include
3
Cyclic antidepressants
SSRI
MOI
these medications block the reuptake of norepinephrine and serotonin from the postsynaptic membrane
Cyclic antidepressants
These medications block the reuptake of serotonin from the postsynaptic membrane
SSRI- Selective serotonin reuptake inhibitors
These medications prevent the activity of the enzyme monoamine oxidase at the central nervous system storage sites, leading to increased levels of epinephrine, serotonin, and dopamine at neuronal receptor sites
MOI- Monoamine Oxidase Inhibitors
Medications for Bipolar disorder include
5
Lithium, Carbamazepine (tegretol), valproic acid ((depakote) or other anticonvulsants), olanzapine (Zyprexa) or other antipsychotics, Clonzapam (klonopin) or other antianxiety agents
another name for Carbamazepine is
tegretol
another name for depakote is
valproic acid
another name for olanzapine is
Zyprexa
another name for Clonzapam is
Klonopin
Complications associated with the use of antipsychotics include
(6)
Fever, muscle rigidity, confusion- may be signs of neuroleptic malignant syndrome, life-threatening adverse effect
Heatstroke from the inhibition of sweating
Dystonia
Tardive dyskinesia
what is Tardive dyskinesia?
full orientation to time and place, involuntary movements of the tongue, trunk, face and extremities with normal mental status.
Medical causes may be ruled out by ordering tests such as
Obtain specimens such as BMP, CBC, toxicology, thyroid, CXR, radiology for organic brain disorder. ABG to rule out acid base abnormalities
Anxiety is associated with the neurotransmitters norepinephrine, serotonin, and gamma-aminobutyric acid.
Some Eating disorder Physical characteristics include
4
cachexia, flat affect, thinning hair, psychomotor alterations
Metabolic considerations regarding eating disorder include
protein deficiency, hypothermia, hypoglycemia, electrolyte disturbances such as; hypo- calcemia, natremia (dehydration), kalemia (starvation or laxative abuse), hypochloremic alkalosis (from vomiting)
____ syrup, an over the counter available product can be used to induce vomiting after poisoning, can cause cardiomegaly when used chronically for bulimia nervosa
Ipecac
pH; (renal manifestations) abnormalities caused by eating disorders include
metabolic alkalosis from vomiting, metabolic acidosis from laxative use.
with eating disorders, you may encounter Increased uric acid level from ____ use or volume depletion.
diuretic
What are Carpopedal spasms?
painful spasms of the hands and feet due to electrolyte imbalance
Common complaints of Bulimia nervosa are
7
muscle weakness, abdominal pain (possible Mallory-weiss tear), heartburn, sore throat, muscle cramps, carpopedal spasms, menstrual irregularity.
Treatment for bulimia nervosa will include
thiamine, multivitamins, and magnesium
Cachexia is another name for
wasting syndrome
With depression, The primary neurotransmitters involved are ____ and ____, but ____ has also been a related cause.
norepinephrine and serotonin, but dopamine has also been a related cause.
