chapter 23 Flashcards by GABI MANCINI

behavior

what you can see of a persons response to the environment: his or her actions

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behavioral crisis

patient who exhibit agitated, violent, or uncooperative behavior or who are a danger to themselves or others; a pattern, not isolated incident

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chronic depression

a persistent feeling of sadness and despair

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what is one of the most common mental disorders

anxiety

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anxiety disorders include

generalized anxiety disorder, panic disorder, social and other phobias, ptsd, ocd

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more serious mental issues are often handled by a:

psychologist

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Severe psychological conditions require a - mainly to prescribe medications

psychiatrist

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underlying causes of behavioral health disorders

social and situational stress such as divorce or death of loved one, schizophrenia, alcohol or drug use

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caused by non-compliance of medication regimens

electrolyte imbalances, diabetic emergencies

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two basic categories of diagnosis a physician will use is

organic (physical) and functional (psychological)

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organic disorders

organic brain syndrome is a temporary or permanent dysfunction of the brain caused by a disturbance in the physiological functioning of the brain tissue; altered mental status due to hypoglycemia, hypoxia, impaired cerebral flow, hyper(hypo) thermia

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causes of organic disorders

sudden illness
tbi
seizures
drug/alcohol abuse
overdose/withdrawal
diseases of the brain (Alzheimer’s, meningitis)

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functional disorders

physiologic disorder that impair bodily functions when the body seems to be structurally normal (cannot be traced to change in the structure or physiology of the brain and body)

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example of functional disorders

schizophrenia
anxiety
phobias
OCD
depression

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Primary Assessment

mechanism of injury/nature of illness
form a general impression
airway and breathing
circulation
transport decision

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history taking; investigate the chief complaint and obtain a SAMPLE history

-is the patients central nervous system functioning properly?
-Are hallucinogens or other drugs or alcohol a factor?
-Are significant life changes, symptoms, or illnesses involved?
-Is there a history of behavioral health illness?

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secondary assessment; physical examination

unconscious; begin with a physical exam
conscious; patient may not respond to your questions but attempt to obtain vitals without worsening patients emotional condition

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you can tell a lot about a patients emtional state from

facial expressions
pulse rate
respirations

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if restraints are necessary, reassess and document every - minutes

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reassessment; interventions

-diffuse/control situation
-best treatment may be a good listener
-intervene only as much as it takes to accomplish tasks
-if pharmacologic restraint in necessary, request ALS asap

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reassessment; communication and documentation

-give hospital advanced warning of behavioral health emergency and document thoroughly and carefully.
-if restraints are used, say WHICH TYPES and WHY they were used.

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is a state of delusion in which the person is out of touch with reality

psychosis

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causes of psychosis

-mind altering substance
-intense stress
-delusional disorders
-schizophrenia

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what is reflective listening?

repeating, in question form, what the patient has said

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is a complex disorder that is not easily defined or treated

Schizophrenia; onset in adulthood from genetics, brain damage and psychologic and social influences

symptoms of schizophrenia include;

-delusions -hallucinations - a lack of interest or pleasure -erratic speech

guidelines for dealing with a psychotic patient:

-determine if the situation is dangerous -clearly identify yourself -be calm, direct, and straightforward -maintain an emotional distance -dont argue/challenge patient -dont randomly touch patient -explain what you'd like to do -involve ppl who the patient trusts

condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions

Delirium

characterized by restless and irregular physical activity

Agitation

Symptoms of delirium:

-hyperactive irregular behavior -vivid hallucinations -hypertension -tachycardia -diaphoresis -dilated pupils

if the patient has overdosed,

take all medications bottles or illegal substances to the medical facility.

what can excited delirium lead to

SUDDEN DEATH

When can you use restraints?

It must be a true emergency to restrain a patient

If you must restrain a patient,

use only reasonable force

Types of restraint:

-soft -velcro -cloth -harness -seatbelts -hard

Avoid hard restraints if possible like:

-Leather -zip ties -cuffs

you may use restraints only:

-to protect yourself/others from bodily harm -to prevent the patient from injuring themselves

process of restraining a patient:

-make sure police are on the scene -carry the decision out quickly -there should be 5 ppl to help, one for each extremity and one for the head -there should be a team leader and plan of action -use minimum force necessary

level of force will vary, depending on these factors:

-the degree of force that is necessary to keep the patient from injuring self and others -sex, size, strength, and mental status -type of abnormal behavior the patient is exhibiting

restraint; monitor the patient for:

-vomiting -airway obstruction - respiratory status -circulatory status (blood pressure) -changes in level of consciousness

potentially violent patient; history

Has the patient previously exhibited hostile, overly aggressive, or violent behavior?

potentially violent patient; Posture

-How is the patient sitting or standing? -Is the patient tense, rigid, or sitting on the edges of his or her seat?

potentially violent patient: the scene

is the patient holding or near potentially lethal objects?

potentially violent patient; vocal activity

-which kind of speech is the patient using? -loud, obscene, erratic, and bizarre speech patterns usually indication emotional distress

most telling factor of all (in regards to potentially violent patient)

physical activity; pacing, restlessness, clenched fists

depression is the single most significant factor that contribute to

suicide

if a patient states suicidal thoughts or a plan to EMS, they must be;

transported (even if its against their will)

A suicidal patient may be

homocidal

PTSD occurs after exposure to, or injury from, a traumatic event like:

-sexual/physical assault -child abuse -serious accidents -natural disasters -war -loss of a loved one -stressful life changes

symptoms of PTSD include feelings of:

-helplessness -anxiety -anger -fear

ppl with PTSD

-fight or flight mechanism is continuous and not easily suppressed -can last seconds to hours, and occur at any time, even years after the exposure.

combat veterans are prone to:

-early heart disease -alcohol and drug abuse -loss of brain gray matter -higher incidence of TBIs

is assumed with a patient who is NOT mentally competent to grant consent

implied consent

In psychiatric cases, a court law would probably consider your actions in providing life-saving care to be appropriate;

carefully document the patients' statements and behavior to support your actions

A behavioral crisis is MOST accurately defined as:

any reaction to events that interferes with activities of daily living or has becomes unacceptable to the patient, family, or community.

Depression and schizophrenia are examples of:

functional disorders

When assessing a patient with a behavioral crisis, your primary concern must be:

whether the patient will cause harm to you or your partner.

General guidelines to follow when caring for a patient with a behavioral crisis include all of the following, EXCEPT:

rapidly transporting the patient

Reflective listening, an assessment technique used when caring for patients with an emotional crisis, involves:

repeating, in question form, what the patient tells you

Which of the following patients is at HIGHEST risk for suicide?

A 33-year-old man who regularly consumes alcohol and purchased a gun

When caring for a patient with an emotional crisis who is calm and not in need of immediate emergency care, your BEST course of action is to

attempt to obtain consent from the patient to transport

when physically restraining a violent patient, the EMT should:

continually talk to the patient as he or she is being restrained

Upon arrival at the residence of a young male with an apparent emotional crisis, a police officer tells you that the man is acting bizarrely. You find him sitting on his couch; he is conscious but confused. He takes medications but cannot remember why. His skin is pale a diaphoretic, and he has noticeable tremors to his hands. You should FIRST rule out:

hypoglycemia

Which of the following signs is LEAST indicative of a patients potential for violence?

The patient is 6'5'' tall and weighs 230 lb.

PTSD can happen after:

exposure to or injury from a traumatic occurrence

a physiologic disorder that impairs bodily function when the body seems to be structurally normal is called a:

functional disorder

Your are assessing a conscious 55-year old male with a sudden change in behavior. Which of the following clinical findings would be MOST suggestive of a dysfunction of this patient's central nervous system?

Rapid eye movement

A 22-year-old male with a history of clinical depression called 9-1-1 and stated that he has attempted to kill himself. Your unit and law enforcement officers arrive at the scene simultaneously. You find the patient lying supine on the living room floor. He is unresponsive and cyanotic. An empty bottle of hydromorphone (Dilaudid) is found on an adjacent table. You should:

open the patients airway and assess his respirations

In which position should you restrain a physically uncooperative patient?

Supine

Which of the following is an example of a functional behavioral disorder?

Schizophrenia

--- is what you can see of a person's response to the environment

Behavior

When caring for a patient experiencing excited delirium, the EMT should remember that:

sudden death can occur if the patient's violence is not controlled

A 38-year-old male with a history of schizophrenia is reported by neighbors to be screaming and throwing things in his house. You are familiar with the patient and have cared for him in the past for unrelated problems. Law enforcement officers escort you into the residence when you arrive. The patient tells you that he sees vampires and is attempting to ward them off by screaming and throwing things at them. He has several large lacerations to his forearms that are actively bleeding. The MOST appropriate way to manage this situation is to:

restrain the patient with appropriate force in order to treat his injuries

You respond to a call for an unknown emergency. When you arrive at the scene, the patient's husband meets you at the door and states that his wife has been depressed and has locked herself in an upstairs bedroom. He further tells you that he keeps his handgun in the bedroom. You should:

Remain in a safe place and request law enforcement.

After ensuring his or her own safety, the EMT's next priority when caring for a patient with a behavioral emergency is to:

assess the patient's response to his or her environment

organic brain syndrome is defined as

a dysfunction of the brain caused by abnormal physical or physiological function

law enforcement personnel request your assistance for a 30-year-old man who was pulled over for erratic driving. The patient became acutely violent while he was being questioned, which required one of the officers to subdue him with a Taser. When you arrive and assess the patient, you find that he is very agitated and is experiencing apparent hallucinations. His skin is flushed and diaphoretic. You should:

limit physical contact with the patient as much as possible and avoid interrupting him is he is attempting to communicate with you

A technique used to gain insight into a patient's thinking, which involves repeating in question form what the patient has said, is called

reflective listening

Signs of excited delirium include

diaphoresis, tachycardia, and hallucinations

immediately after physically restraining a violent patient, the EMT should:

reassess the patient's airway and breathing

You receive a call for a domestic dispute. When you arrive at the scene, you find a young male standing on the front porch of his house. You notice that an adjacent window is broken. The patient has a large body, is clenching his fists, and is yelling obscenities at you. Which of the following findings is LEAST predictive of this patient's potential for violence?

his large body size

The first step in assessing a patient with a behavioral emergency is to

ensure your safety

in contrast to a behavioral crisis, a behavioral health emergency occurs when a person:

becomes agitated or violent and is a threat to him-or herself or others

the term "behavioral crisis" is MOST accurately defined as

a situation in which a patient of any age exhibits agitated, violent, or uncooperative behavior.

chapter 23 Flashcards

behavioral health (86 cards)