psychiatric emergencies Flashcards
1
Q
behavioral emergency*
A
- some disorder of mood, thought, or behavior that interferes with activities of daily living (ADLs)
- physiological response of emergent
- emergent nature to you and your lifestyle -> not necessarily emergency care
- ex. OCD
- BH- behavioral health
2
Q
psychiatric emergency*
A
- behavior that threatens a persons health or safety and the health and safety of another person
- danger to self and others
- ex. someone threatening to stab someone else and themselves
3
Q
four broad categories of abnormal behavior
A
- biologic or organic in nature- ex. schizophrenia
- resulting from the environment- ex. stressors, torture
- resulting from acute injury or illness- ex. acute brain injury
- substance-related- could be illegal or legal (in excess), combining drugs
4
Q
biologic or organic causes of abnormal behavior
A
- organic brain syndrome
- conditions alter the functioning of the brain
- dementia
- Alzheimer’s
- not external
- brain tumor
- use medication to get back to normalcy -> need to take that medication continuously
5
Q
environmental causes of abnormal behavior
A
- psychosocial and sociocultural influences
- when consistently exposed to stressful events patients develop abnormal reactions -> constant stress
- sociological factors affect biology, behavior, and responses to the stress of emergencies
- constant stress impulse can alter brain chemistry
- external impulse- radiation, espestis
6
Q
causes of abnormal behavior: injury and illness
A
- illness results in stress on coping mechanisms
- acute trauma creates stress
- post-traumatic stress disorder (PTSD)
- abuse, life events
- leading cause of traumatic death caused by weapons is domestic violence
7
Q
causes of abnormal behavior: substance-related
A
- alcohol
- cigarettes
- illicit drugs
- other substances
- can be prescribed medications in excess or mixed together
8
Q
emergency medical care
A
- if the erratic behavior could be caused by a medical disorder:
- treat that before presuming the behavior is due to an emotional or psychiatric cause
- assume that any erratic or unusual behavior is medical cause until proven otherwise **
- medical causes of unusual behavior are more death inducing in an acute phase than psychiatric emergencies -> faster and more frequent***
9
Q
communication techniques
A
- verbal de-escalation- don’t need hands, tools, just listen and maintain composure, acknowledge, make them feel heard
- active listening
- begin with an open-ended question
- let there patient talk
- listen, and show that you are listening
- dont be afraid of silence
- acknowledge and label feelings
- dont argue
- facilitate communication
- direct the patients attention
- do not engage in confrontation -> this solves nothing
10
Q
what do you do when someone is talking
A
you are either: -listening -planning the next thing you will say ,or -you don't care
11
Q
physical restraint
A
- improvised or commercially made devices
- lead to high amount of untourt deaths -> not checking vital signs after restraint *
- be familiar with restraints used by your agency
- make sure you have sufficient personnel
- restraining someone causes damage to skin, genitals, and vasculature
- continuously monitor the patient
- never place your pt face down -> positional asphyxia
- check peripheral circulation every few minutes
- be careful if a combative pt suddenly becomes calm
- document everything in the patients chart
- you may defend yourself against an attack
- minimum of four trained, able bodied people (for each limb)
- discuss the plan of action before you begin
- include law enforcement when appropriate
- use the minimum force necessary
- dont immediately move toward the patient
12
Q
chemical restraint
A
- use of medication to subdue a patient
- alter consciousness to make the situation calmer
- benzodiazepine- sedative- very common -> used for seizures
- these medication may also cause vasodilation, bronchodilation, apnea, respiratory distress -> be aware of ALL effects
- RASS score
- closely monitor the patients:
- pulse rate
- blood pressure
- respiratory rate
- be prepared to support ventilation
13
Q
RASS score
A
- Richmond agitation sedation scale***
- from +4 to -5
- scales how excited someone is to how calm
- -1–2 light sedation
- not trying to comatose
- 5 combative
- -5- unconscious
14
Q
agitated delirium pathophysiology
A
- Delirium: a state of global cognitive impairment
- Dementia: more chronic process
- Patients may become agitated and violent
- physiological signs- high heart rate, rapid breathing, excessive sweating, high blood pressure
- agitated delirium requires a physical exam bc of this
15
Q
agitated delirium assessment
A
- try to reorient patients
- perform a thorough assessment
16
Q
agitated delirium management
A
- identify the stressor or metabolic problem
- ex. drug, substance
17
Q
suicide
A
- any willful act designed to end ones life
- becomes more emergent when there is a plan -> more details the worse
18
Q
suicidal ideation assessment
A
- every depressed patient must be evaluated for suicide risk
- broach the subject in a stepwise fashion
- do not ask someone if there are planning on harming themselves -> 80% Of people will say no…bc they are thinking of killing themselves
- higher-risk patients include patients who have:
- made previous attempts
- detailed, concrete plans
- history of suicide among close relatives
19
Q
suicidal ideation management
A
- dont leave the patient alone
- collect implements of self-destruction
- acknowledge the patients feelings
- encourage transport
20
Q
violence
A
- most angry patients can be calmed by a trained person who conveys confidence
- personnel should prepare to deal with hostile or violent behavior
- preventive action is best to ensure no harm
21
Q
risk factors of violence, abuse, and neglect
A
- scenarios including:
- alcohol or drug consumption
- crowd incidents
- violence has already occurred
- people who are:
- intoxicated
- experiencing withdrawl
- psychotic
- delirious
22
Q
warning signs of violence, abuse, and neglect
A
- posture- sitting tensely
- speech- load, critical, threatening
- motor activity- unable to sit still, easily startled
- clenched fists, avoidance of eye contact
- your own feelings
23
Q
mood disorders
A
- unipolar mood disorder- mood remains at one pole of the continuum (always happy, neutral, sad)
- bipolar mood disorder- mood alternates between mania and depression
24
Q
manic behavior
A
- patients typically have abnormally exaggerated happiness with hyperactivity and insomnia **
- insomnia is used to diagnose mania**
- pressured and rapid speech
- tangential thinking
- grandiose and unrealistic ideas
- be calm, firm, and patient
- minimize external stimulation
25
Q
GAS PIPES
A
- MIDTERMMMMM
- Guilt
- Appetite
- Sleep disturbance
- Paying attention
- (decreased) Interest
- Psychomotor abnormalities
- (decreased) energy
- suicidal thoughts
26
Q
schizophrenia
A
- typical onset occurs during early adulthood
- experience may include:
- delusions
- hallucinations
- a flat affect- no emotion in speech, neutral
- erratic speech
27
Q
generalized anxiety disorder (GAD)
A
- patient worries for no particular reason or worrying prevents decision making abilities
- treated with pharmacologic agents and counseling
- when dealing with a patient with GAD:
- identify yourself in a calm, confident manner
- listen attentively
- talk with the person about their feelings
28
Q
phobias
A
- unreasonable fear, apprehension, or dread of a specific situation or thing
- simple phobias focus all anxieties on one class of objects or situations
29
Q
panic disorders
A
- sudden feelings of fear and dread
- if allowed to continue, panic attacks can cause severe lifestyle restrictions
- agoraphobia- fear of going into public areas
- signs and symptoms usually peak in 10 minutes
- separate from panicky bystanders
- provide a calm environment
- be tolerant of the disbaility
- reassure the patient
- help the patient regain control
30
Q
eating disordes
A
- persons may experience severe electrolyte imbalances
- two thirds report anxiety, depression, and substance abuse disorders
- bulimia nervosa:
- consumption of large amounts of food
- compensated by purging techniques
- binging and purging
31
Q
anorexia nervosa
A
- weight loss jeopardizes health and lives
- typical patient:
- decreased body weight based on age and height
- intense fear of obesity
- experience amenorrhea
32
Q
antipsychotics
A
- newer medications have less risk of adverse effects and are more effective
- know as atypical antipsychotic (AAP) drugs
- relieve delusions and hallucinations
- improve symptoms of anxiety and depression
- may cause metabolic side effects
- cardiovascular effects depends on medication
- erectile dysfunction in men
- bipolar and schizophrenia -> leading
33
Q
problems associated with medication noncompliance
A
- increases the likelihood that a person with mental illness will commit a violent act
- someone stops taking medications bc they think they are better (bc the medication is working) but fails after stop taking medication
- when obtaining medication history, include:
- previously prescribed medications
- missed doses
- leading factor of what could cause an emergent response
