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CEN > Psychosocial Emergencies > Flashcards

Psychosocial Emergencies Flashcards

1. Explain concepts related to the assessment of an emergency department patient experiencing a psychosocial emergency. 2. Describe various patient presentations related to psychosocial emergencies. 3. List interventions necessary for a patient presenting with a psychosocial emergency.

1
Q

how many US adults have mental health diagnosis

A

1 out of 5

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2
Q

define anxiety

A

feeling of worry, nervousness, unease, typically about an imminent even or something with an uncertain outcome

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3
Q

synonyms for anxiety

A 
discontent
concern
apprehension
fearfulness
tension
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4
Q

define situational crisis

A

series of life events rooted in anxiety that may cause pt to present to ED

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5
Q

managing situational crisis

A

typically with outpatient followup

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6
Q

pyschosocial crises that bring people to ED

A

job loss
divorce
sudden illness
sudden death

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7
Q

grieving variables

A

culture
personality
hx of loss
coping skills

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8
Q

sx situational crisis

A 
shock, disbelief, denial
emotional lability
slow speech
inability to concentrate
hyperfocused
helplessness
anorexia
appetite/weight change
sleep alterations
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9
Q

types of anxiety disorders

A 
panic attack
specific phobia
social phobia
OCD
PTSD
acute stress disorder
generalized anxiety disorder
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10
Q

define panic attack

A

discrete period of intense fear of discomfort in which 4 or more sx develop abruptly and reach peak w/in 10 min

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11
Q

sx of panic attack

A 
palpitations, sweating
trembling, shaking
sob
feeling of choking
cp
N, GI upset
dizziness, LH
derealization/ depersonalization
fear of losing control
fear of dying
paresthesias
chills, hot flashes
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12
Q

intervene for panic attack

A 
therapeutic communication
de-escalation
trusting relationship
reassure
low stimulation
assess risk of SI/HI
psych
substance use
dc for support services
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13
Q

pharm for panic attack

A

clonazepam
lorazepam
diazepam

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14
Q

pharm for anxiety disorder

A

benzo
anxiolytic
antidepressant

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15
Q

define OCD

A

rituals or actions performed to reduce anxiety

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16
Q

define compulsion

A

repetitive behaviors

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17
Q

define obsessions

A

recurrent and persistent thoughts, impulses, images that are regarded as unwanted and inappropriate

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18
Q

sx OCD

A

repeated handwashing, checking
recurring/persistent thoughts
thoughts that are not simply excessive worries
attempts to ignore thoughts

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19
Q

intervene OCD

A

anxiolytics, antidepressants

supportive therapy

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20
Q

define PTSD

A

provoked by traumatic incident that person relives or constantly fears will recur

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21
Q

acute vs chronic PTSD

A

acute < 3 mo

chronic > 3 mo

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22
Q

sx PTSD

A

re-experiencing (flashbacks, dreams)

avoidance (loss of interest, isolation)

hyperarousal (startle reflex, tense, irritable)

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23
Q

intervene PTSD

A 
trusting relationship
supportive dc plan
referral to counseling
support groups
low stimulation
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24
Q

define depression

A

common but serious illness, particularly if untreated or unmanaged

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25
Q

define major depression

A

severe sx that interfere with pt’s ability to work, sleep, study, actively participate in life

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26
Q

how often does depression occur?

A

may occur only once, but often pt has several episodes

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27
Q

types of depressive episodes

A

psychotic depression
postpartum depression
seasonal affective disorder

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28
Q

psychotic depression

A

associated w/ psychotic hallucinations or delusions

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29
Q

postpartum depression

A

10-15% of postpartum women

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30
Q

season affective disorder

A

characterized by seasonal onset of depression during winter months

effectively treated w/ light therapy and Vit. D

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31
Q

sx depression

A 
worthlessness, helplessness
loneliness, sadness
physical fatigue
lack of energy
sleep disturbance
irritability
weight change
decreased interest
feelings of guilt
SI, death preoccupation
psychomotor retardation/agitation
decreased libido
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32
Q

define bipolar disorder

A

chronic, recurring condition characterized by cycles of depression and elation or mania

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33
Q

meds that precipitate manic event in bipolar disorder

A 
antidepressants
steroids
bronchodilators
alcohol
cocaine
decongestants
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34
Q

sx bipolar disorder

A

major depression sx

mania:
inappropriate elation, irritability
severe insomnia
increased talking
rapid, pressured speech
grandiose notions
poor judgment
disconnected, racing thoughts
increased sexual desire
inappropriate social behavior
increased energy
impulsivity
risk-taking behavior
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35
Q

intervene bipolar disorder

A 
safety, security
minimize external stimuli
do not isolate
assess SI
allow decision making
support systems
safe dc
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36
Q

pharm interventions for bipolar disorder

A

lithium
carbamazepine
divalproex

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37
Q

precipitants of lithium toxicity

A 
hyponatremia
dehydration
tetracycline
phenytoin
cyclosporine
diuretics
ACE inhibitors
NSAIDs
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38
Q

sx lithium toxicity

A 
N/V/D
weakness, fatigue
lethargy
tremulousness
dystonia
hyperreflexia, ataxia
cardiac dysrhythmias
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39
Q

intervene lithium poisoning

A

stabilize, reverse life-threatening conditions

IV fluids with isotonic NS

monitor cardiac fxn

HD if severe

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40
Q

define psychosis

A

severe mental disorder in which thoughts and emotions are impaired or distorted to the point that contact with reality is lose

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41
Q

psychosis overview

A

state of bizarre and profoundly altered thinking with associated deterioration of thought processes

often w/ sensory hallucinations/delusions

r/o alternatives (medical, drug-induced)

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42
Q

causes of psychosis

A 
organic vs psychiatric
delirium
dementia
depression
schizophrenia
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43
Q

sx psychosis

A

delusion: personal belief
hallucination: sensory
disorganized speech
grossly disordered behavior

44
Q

define delirium

A

acute disturbance in attention and cognition

45
Q

sx delirium

A 
rapid onset
fluctuating course
hallucinations
disorientation
memory impairment
change in temperament
blunted affect
confabulation
difficulty thinking clearly
lack of insight into problems
46
Q

define dementia

A

degenerative disturbance in cognition

47
Q

sx dementia

A 
gradual onset
repetitive speech
recent memory loss
disorientation
lack of awareness of problem
impaired cognition
personality changes
sundowning
48
Q

define schizophrenia

A

disease state characterized by bizarre behavior including self or other reports of inability to care for self or manage other activities of daily living

49
Q

schizophrenia overview

A

r/o organic causes
manageable but not cureable
usual onset in 20s
typically no family hx

50
Q

sx schizophrenia

A 
delusions
hallucinations
disorganized thinking, speech
disorganized motor behavior
negative sx
-flat affect/speech
-impaired cognition
51
Q

intervene schizophrenia

A 
orient but don't deny reality
short, concrete sentences
avoid figures of speech
antipsychotic meds
maybe restraints
observe
52
Q

dystonic reactions

A

aka severe extrapyramidal sx

occur w/in hours-week of new antipsychotic meds

disordered muscle tonicity
oculogyric risis
torticollis

53
Q

oculogyric crisis

A

deviation of eyes in all directions

54
Q

torticollis

A

spasm of neck muscles with twisting to side

55
Q

intervene dystonic rxn

A

diphenhydramine
benztropine
trihexyphenidyl

56
Q

define neuroleptic malignant syndrome

A

life-threatening condition caused by antipsychotic agents

57
Q

sx neuroleptic malignant syndrome

A 
hyperthermia
AMS
severe muscle rigidity
autonomic instability
diaphoresis
leukocytosis
elevated CK
renal failure
58
Q

intervene neuroleptic malignant syndrome

A 
O2, intubate
stabilize BP
reduce temperature
reduce muscular rigidity
ICU
59
Q

mandated reporting requirements

A

child abuse
elder abuse if in gov’t home

in domestic abuse, pt must make complaint

60
Q

types of abuse

A 
neglect
physical
sexual
emotional
abandonment
financial
61
Q

types of neglect

A

failure to provide basic needs:

medical
physical
emotional
educational
mental
62
Q

types of physical abuse

A 
intentional trauma
excessive discipline
punishment
torture
unreasonable force
63
Q

define sexual abuse

A

inappropriate sexual contact (physical, verbal, other)

64
Q

behavioral signs in an abuser that indicates high index of suspicion for maltreatment

A 
delay care, bypassing EDs
child fearful of caregiver
events confusing
vague answers 
focuses on child behavior 
denies knowledge
recent caregiver change
emphasizes unrelated details
focuses on own concerns
tension btwn caregivers
uncooperative, demanding
hx multiple ED visits
describes pt as clumsy
refuses to leave communicative pt alone
65
Q

fractures in high index of suspicion for maltreatment

A 
humerus
ribs
scapulae
distal clavicle
fingers/femur in immobile child
various stages of healing
any fracture < 3 yo
66
Q

head injuries in high index of suspicion for maltreatment

A 
traumatic alopecia
uneven growth
head injuries
subdural hematomas
skull fracture
unexplained LOC
sx increased ICP
67
Q

EENT injuries in high index of suspicion for maltreatment

A 
displaced nasal cartilage
bleeding from septum
retinal hemorrhages
detached retina
hyphema
periorbital ecchymosis
ruptured tympanic membrane
battle sign
fractured mandible
lacerated frenulum
loose, missing teeth
petechiae around head/neck
68
Q

genitalia and perineum in high index of suspicion for maltreatment

A 
trauma
discharge
bleeding
pain
UTI sx
STIs
69
Q

poisoning in high index of suspicion for maltreatment

A

ingestion of alcohol or drugs

70
Q

burns in high index of suspicion for maltreatment

A 
lips and tongue
rectum and perineum
cigarette
chemical
electrical
lines of demarcation
uniform burn depth
burns in shape of object
splash burns of non-uniform depth
71
Q

bruising in high index of suspicion for maltreatment

A

various stages of healing
shape of identifiable object
human bite marks

72
Q

behavioral in high index of suspicion for maltreatment

A 
PTSD
ADHD
secondary enuresis or fecal soiling in toilet-trained child
nightmares
inappropriate sexual behavior
73
Q

interviewing in c/f abuse

A 
set tone, augment information
interview caregivers separately
listen, watch
evaluate appearance
nonjugemental
nonaccusatory
74
Q

memorializing events and history in c/f abuse

A 
quotes
photos 
objective descriptions
draw injuries on body map
medical terms
record dates/times accurately
don't assume, make conclusions
mandated reporting
75
Q

risk factors for dependent adult abuse

A 
shared living
psychopathology of abuser
caregiver stress
extensive care needs
generational abuse
caregiver inexperience
lack of caregiver support
unpredictable needs of pt
poor physical living conditions
financial distress
76
Q

cultural, ethnic practices that produce physical marks that may be mistaken for abuse

A

cupping

coining

77
Q

physiologic manifestations that may be mistaken for abuse

A

coag disorders
failure to thrive
mongolian spots

78
Q

define Munchausen by proxy

A

adult caregiver fabricates child’s illness or actually creates symptoms

79
Q

commonly reported sx in Munchausen by proxy

A 
apneic spells
cardiac/resp arrest
SZs
allergic rxns
dehydration
suffocation
80
Q

commonly manufactured sx in Munchausen by proxy

A 
rashes
sepsis
hemorrhage
vomiting
diarrhea
81
Q

common characteristics of Munchausen by proxy

A

illness unexplained, prolonged, recurrent, rare unresponsive

Sx only in perpetrator’s presence

perp overly knowledgeable, interested in interacting with healthcare team

not concerned about painful procedures

believes ill child will improve relationship with partner

hx emotionally deprived childhood

uses illness to escape responsibilities

gains gratification in presence of providers

82
Q

define anorexia

A

weight loss > 25% below baseline

failure to gain weight after diagnosis

83
Q

define builimia

A

bingeing and purging behavior

84
Q

characteristics of bulimia

A 
vomiting
laxatives
diuretics
diet pills
fasting
excessive exercise
85
Q

risk factors for eating disorders

A 
female (95%)
model children
academic success
asexual behavior
excessively dependent
developmentally immature
preference for isolation
OCD
personal crises
86
Q

sx anorexia nervosa

A 
amenorrhea
hypercarotenemia
muscle weakening
constipation
cool skin
peripheral edema
thinning hair
nail fragility
dehydration
hypocalcemia
87
Q

sx laxative abuse

A

hypokalemia
hypocalcemia
dehydration
hypoglycemia

88
Q

sx diuretic abuse

A

hyponatremia
hypokalemia
increased uric acid
hypercalcemia

89
Q

sx excessive diet pill use

A 
hypertension
renal failure
dysrhythmias
intracerebral bleeding
MI
HF
90
Q

sx induced vomiting

A 
Mallory-Weiss tears
pancreatitis
tooth enamel erosion
callus on index finger
hypokalemia
hypomagnesemia
metabolic acidosis
fractured ribs
91
Q

assessing eating disorders

A

changes in appetite, weight, exercise

N/V

92
Q

history in eating disorders

A

psychological disorders
anorexia or bulimia
substance use
laxative or diet pill use

93
Q

intervene for eating disorders

A 
medical clearance
IV, monitor
psych, diet consult
electrolytes
protective environment
antidepressants
admission
94
Q

aggression continuum

A 
thought
plan
means
access
action
95
Q

risk factors for aggression

A

SI/HI ideas, plans, attempts, intent

96
Q

cognitive assessment in aggression

A 
loss of executive fxn
tunnel vision
polarized thinking
closed-mindedness
self-report tools
97
Q

gender in SI risk assessment

A 
females attempt
males succeed (4x)
98
Q

age in SI risk assessment

A

highest rate 45-64 yo
second highest 85+

younger groups have lower rates

99
Q

race in SI risk assessment

A

white males 70%

second highest American Indians and Native Alaskans

100
Q

risk factors for SI

A 
family hx
hx behavioral health 
hx substance abuse
hx other abuse
spring season
access to weapon
prior attempts
chronic physical illness
101
Q

sx SI

A 
worthless, hopeless, helpless
confusion, impaired insight
restlessness, agitation
irritability
indifference, fatigue
insomnia
decreased physical activity
withdrawal
social isolation
102
Q

intervene for SI

A 
undress
remove belongings
manage illness
meds as appropriate
involve social support as appropriate
psych
suicide hotline number
103
Q

psychological risk factors for HI

A

anxiety/fear for personal safety
overwhelming feelings
hx abuse

104
Q

organic risk factors for HI

A

alcohol, drugs
side effects of meds
pain
delirium

105
Q

psychiatric risk factors for HI

A 
delusions of persecution
"command" hallucinations
acute depression
suicide attempt
mania
106
Q

intervene for HI

A 
calm pt
collaborative relationship
appear calm, unthreatening
personal safety
threats taken seriously
confiscate objects
clear furniture
remove bystanders
don't hurry patient
engage in conversation
simple, direct sentences
allow verbalization of complaints
speak calmly
reassure
help regain self control
be clear, honest
avoid confrontation
stand sideways
hands visible
clear exit
get assistance

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