Psychiatric Emergencies: Crisis Intervention

Question 1

Uses of Benzodiazepines

Answer 1

Anxiety
ETOH Withdrawal
Panic Disorder
Anti-convulsant

Question 2

Side effects of Benzos

Answer 2

Severe sedation
Paradoxical reactions (psychosis, agitation)
Amnesia
Depression
Tolerance and dependence
Resp. depression
Withdrawal if fast D/C (Benzo withdrawal syndrome)

Question 3

Benzo trade names

Answer 3

Ativan, Xanax, Valium, Librium, Klonopin

Question 4

Use of Buspar

Answer 4

Generalized Anxiety Disorder
Off-label uses:
Management of aggression in MR
Augment anti-depressants
PMS

Question 5

Buspar side effects

Answer 5

Slight risk of cognitive/motor impairment
Dizziness
Restlessness (akathisia, tremor)
Not for use with kidney or liver impairment
Withdraw benzos before starting
Takes 2-3 wks for full effect

Question 6

Uses of Antihistamines
(Hydroxyzine)

Answer 6

GAD
Social anxiety disorder

Question 7

Side effects of Antihistamines

Answer 7

Sedating
Dizziness, dry mouth
Blurred vision
GI disturbances

Question 8

Uses of Phenothiazines
(Chlorpromazine)

Answer 8

Psychosis

Question 9

Side effects of Phenothiazines

Answer 9

Sedation
Weight gain
EPS
Dry mouth
Constipation
Agitation

Question 10

Antidepressants for Anxiety Disorders

Answer 10

-SSRIs (Prozac, Luvox)
-SNRIs (Effexor)
-TCAs (Elavil, Pamelor)

Question 11

SSRIs

Answer 11

Effective for all anxiety disorders
OCD requires higher doses

Question 12

-SNRIs

Answer 12

Effective for GAD

Question 13

SSRIs trade names

Answer 13

Prozac, Luvox

Question 14

SNRIs trade names

Answer 14

Effexor

Question 15

TCAs trade names

Answer 15

Elavil, Pamelor

Question 16

Treatment for anxiety disorders

Answer 16

CBT, Exposure therapy, Interpersonal therapy

Question 17

Complementary & alternative treatments

Answer 17

Acupuncture, yoga, exercise, herbs (Chamomile, Valerian, Melatonin, L-tryptophan, 5-HTP), acupuncture, music therapy, meditation

Question 18

The nurse is engaged in crisis intervention with a female patient who states, “I have no reason to keep on living.” What is the nurse’s initial intervention?

Answer 18

Ask the patient, “Do you have any plans to hurt yourself or anyone else?”

Question 19

Successful crisis outcomes depend on…

Answer 19

Realistic prescription of event
Adequate supports
Adequate coping mechanisms

Question 20

Erick Lindemann’s Crisis Theory: behaviors

Answer 20

Preoccupation with the lost one
Identification with the lost one
Expressions of guilt and hostility
Disorganization in daily routine
Somatic complaints

Question 21

Types of Crisis

Answer 21

Maturational (developmental) crisis
Situational crisis
Adventitious crisis

Question 22

Caplan’s phase 1 of crisis

Answer 22

exposure to stress leading to increased anxiety which stimulates usual coping and defense mechanisms

Question 23

Caplan’s phase 2 of crisis

Answer 23

usual coping and defense mechanisms fail and threat persists, anxiety rises more, discomfort arises, individual function is disorganized. Trial and error attempts at problem solving and restoring balance

Question 24

Caplan’s phase 3 of crisis

Answer 24

trial and error attempts fail, anxiety escalates to severe and panic levels, use automatic relief behaviors like withdrawal and fight or flight, resolution may occur and be achieved by compromising needs or redefining situation to acceptable solution

Question 25

Caplan’s phase 4 of crisis

Answer 25

if problem is not solved and new coping skills are ineffective, anxiety can overwhelm and lead to serious personality disorganization, depression, confusion, violence against others, suicidal ideations

Question 26

Assessment

Answer 26

Initial task is to assess potential for suicide (safety)
Next want to look at the perception of event, situational supports, and personal coping skills
Self Assessment - recognize own triggers and responses to them, as well as debriefing

Question 27

Foundation for crisis intervention

Answer 27

Crisis usually lasts 4-6 weeks before it is resolved
Once resolved person will have either higher, same, or lower level functioning (want to be at least at same level - is goal of crisis intervention)
Crisis intervention is here and now oriented focusing on immediate crisis, nurse takes more active and directive role

Question 28

Nursing Diagnosis:

Answer 28

Can diagnose someone experiencing anxiety, inefficient communication, problem solving difficulty, decreased ability to recognize or access resources with crisis

Question 29

Family crisis

Answer 29

if occurring within family functioning and communication, changes in family relationships

Question 30

Impaired coping

Answer 30

inability to meet basic needs or role expectations, useful when ineffective behaviors are present

Question 31

Impaired family/community coping

Answer 31

a crisis is experienced and events are severe and widespread

Question 32

Anxiety

Answer 32

Can be mild, moderate, severe, or panic - severe and panic are first priority

Question 33

Outcome

Answer 33

crisis resolution through effective coping and reduced anxiety

Question 34

Planning

Answer 34

Nurse can plan and intervene through varieties of crisis

Question 35

Psychosocial interventions

Answer 35

focus is on present problem and has two goals of safety and anxiety reduction

Question 36

Primary prevention

Answer 36

promotes mental health and reduces mental illness

Question 37

Secondary Prevention

Answer 37

establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization

Question 38

Tertiary Prevention

Answer 38

programs and services for long term support to those who have experienced crisis

Question 39

Critical Incident Stress Debriefing

Answer 39

Phase 1 - Introductory phase - meeting purpose explained, debrief is provided, confidentiality is ensured
Phase 2 - Fact phase - facts of situation are discussed, introduce selves, tell involvement, and say their point of view
Phase 3 - Thought phase - discuss first thoughts
Phase 4 - Reaction phase - talk about worst part of incident, what they want to forget
Phase 5 - Symptom phase - describe cognitive, physical, emotional, or behavioral experiences at scene and describe symptoms felt after event
Phase 6 - Teaching phase - normalcy of expressed symptoms is acknowledged and affirmed, group is in stress management techniques
Phase 7 - Reentry phase - review material discussed, introduce new topics, as questions, discuss closure

Question 40

Evaluation

Answer 40

goal is to return people to pre crisis level of functioning, evaluation is done to see if goal was achieved

Question 41

Treatment Modalities

Answer 41

Emergency care/crisis care:
1. Crisis call lines
2. Warm lines - prevent escalation of distress
3. Crisis intervention teams
4. Crisis stabilization facilities
5. Psychiatric advance directive plan

Question 42

Disaster Response

Answer 42

Mitigation - attempt to limit a disaster impact on human health and community function
Preparedness - plan designed before event takes place to structure response, assess risk, and evaluate damage
Response - immediate aftermath of a disaster, operations do not function properly, person safely and well being depends on preparedness
Examples are sending out messages, providing shelter, evacuation, search and rescue
Recovery - restoration efforts occur concurrently with regular activities
Evaluation is always important to end with as it can help better prepare for future