Mental Health Flashcards
Who enacts a Section 19?
Doctor or accredited person
Who enacts a Section 22?
Police
Who enacts a Section 20?
Ambulance Officer
Who enacts a Section 24?
Magistrate
Who enacts a Section 80?
Arrangement between facilities
When can we enact a Section 20?
If the person appears to be mentally ill or mentally disturbed and that it would be beneficial to the person’s welfare to be dealt with in accordance with this Act.
What are the 2 questions to ask yourself before enacting a Section 20?
Does the person appears to be either Mentally ill or Mentally disturbed?
Would it be beneficial to the person’s welfare to be dealt with in accordance with the ACT?
What statement should precede the description in the S20?
At the time of assessment
+3 Sedation Assessment Tool (SAT) behaviour score description
combative, violent, out of control
+2 Sedation Assessment Tool (SAT) behaviour score description
very anxious and agitated
+1 Sedation Assessment Tool (SAT) behaviour score description
very anxious/restless
0 Sedation Assessment Tool (SAT) behaviour score description
Awake/calm and cooperative
-1 Sedation Assessment Tool (SAT) behaviour score description
asleep
-2 Sedation Assessment Tool (SAT) behaviour score description
physical stimulation
-3 Sedation Assessment Tool (SAT) behaviour score description
no response to stimulation
+3 Sedation Assessment Tool (SAT) verbal score description
continual loud outbursts
+2 Sedation Assessment Tool (SAT) verbal score description
loud outbursts
+1 Sedation Assessment Tool (SAT) verbal score description
normal/talkative
0 Sedation Assessment Tool (SAT) verbal score description
speaks normally
-1 Sedation Assessment Tool (SAT) verbal score description
slurring or prominent slowing
-2 Sedation Assessment Tool (SAT) verbal score description
few recognisable words
-3 Sedation Assessment Tool (SAT) verbal score description
nil
What are some acute and medical causes of behavioural disturbance?
- Acute delirium
- Dementia
- Encephalitis, meningitis, or other infection
- Encephalopathy (particularly from liver or renal failure)
- Head trauma
- Hypoxia
- Intoxication or withdrawal
- Metabolic derangement (e.g. hyponatremia, hypocalcemia, hypoglycemia)
- Pain/Injury
- Seizure (post-ictal)
What mental health conditions can cause behavioural disturbance?
- Psychotic disorders
- Mania
- Agitated depression
- Anxiety disorders
- Borderline and antisocial personality disorders
What other conditions or situations can cause behavioural disturbance?
- Developmental issues
- Psychosocial adjustment
- Situational crisis
- Impulse control disorders
- Pain in patients with intellectual disability or cognitive impairment
What are indicators of an organic cause of behavioural disturbance?
- First presentation/episode of acute behavioural disturbance in a person aged > 45 year
- Abnormal vital signs
- Focal neurological findings
- Decreased awareness of surroundings
- Difficulty paying attention
- Absence of a clear trigger or cause of the acute behavioural disturbance.
What does the verbal de-escalation tool DEFUSE stand for?
Decide: Assess if verbal de-escalation is appropriate. Suitable candidates are responsive, engaged in conversation and not an active threat.
Ensure Safety: Have adequate backup, clear the area of potential weapons and maintain a safe distance (about two arms’ length).
Form Relationship: Introduce yourself, ask how they prefer to be addressed and seek permission to assist.
Utilise Interests: Acknowledge the patient’s feelings and agree as much as possible. Reassure that no harm will come to them.
Set Limits: Clearly outline the consequences of negative behaviour and provide choices.
Enforce/Evaluate: If aggression escalates, withdraw and call for assistance. After de-escalation, debrief everyone involved.
What steps should be undertaking during the post procedural care for sedated Pts?
Continuously monitor vital signs (SpO2, EtCO2, NIBP, and ECG)and SAT score.
Document SAT and VSS every 5 minutes post each parenteral sedation for 20 minutes then 30 minutes for two hours or until transfer of care is complete.
Reassessment and management of organic causes of acute behavioural disturbance.
Monitoring should always be supplemented with vigilant clinical observation, as equipment alone may not detect all forms of clinical deterioration
How should bariatric Pts be positioned post sedation?
Laterally, however if unable to then;
supine with ramping or head elevation
What are the indications for the use of physical or mechanical restraints?
- The patient has a medical or psychiatric condition requiring care, and
- The patient is at the time incapable of responding to reasonable requests from clinicians to cooperate, and measures promoting self-control are impractical or have failed, and
- The patient’s behaviour is putting themselves or others at serious risk of harm, and
- Less restrictive alternatives are not appropriate
When implementing restraint as an act of self-defence to defend oneself or another person during an assault which is likely to continue or to prevent a threatened and imminent assault. What should the clinician believe?
that it is necessary to defend him or herself or another person, or to protect property; and
is a reasonable response to the circumstances
What are the physiological impacts of prone restraint?
a decrease in ventilation and / or cardiac output (CO) whilst in a prone restraint
Metabolic acidosis is noted with increased physical activity, in restraint associated cardiac arrest and simulated encounters
a decrease in ventilation and CO can significantly worsen acidosis and haemodynamics
Deaths associated with prone physical restraint are due to cardiac arrest secondary to metabolic acidosis compounded by inadequate ventilation and reduced CO
A prone restrained patient who says ‘I can’t breathe’ is a potential warning sign for what?
imminent cardiovascular collapse
How should a Pt with decreased LOC be positioned when in mechanical restraints?
- Laterally
- Attach the extension strap to one of the wrist cuffs and attach to the stretcher frame. If necessary reposition the other wrist cuff on the waist belt.
Note: Ensure that the person’s airway, breathing and circulation are not compromised. Once restrained all normal monitoring procedures must be maintained.
Stretcher harness must be used during transport in addition to the MRD.
How should a pregnant Pt be positioned when in mechanical restraints?
- No waist belt
- Left lateral
- Attach the wrist extension strap to one of the wrist cuffs and attach it to the upper part of the stretcher frame. Attach the other wrist extension strap to the other wrist cuff and attach to the mid-section of the stretcher frame.
Note: Ensure that the person’s airway, breathing and circulation are not compromised. Once restrained all normal monitoring procedures must be maintained.
