Psych

Question 1

age that most psych illnesses are diagnosed by

Answer 1

45 years

Question 2

most common psych illness

Answer 2

anxiety

Question 3

PE, ACS, Aortic Dissection, Thyroid disfunction, Arrythmias, Hypoglycemia, Elicit Drugs, EtOH withdrawal, caffeine/energy drinks, marijuana, phobia, PTSD, OCD

Answer 3

differentials for anxiety

Question 4

intense fear + tension + restlessness + palpitations + SOB + hyperventilation + paresthesisa + carpal/pedal spasm + dizziness + agitation

Answer 4

anxiety

Question 5

Management of acute anxiety reaction

Answer 5

benzodiazepine → NOT in the ED

Question 6

MC diagnose in the ED for combative patients

Answer 6

drug and alcohol withdrawal

Question 7

What should you obtain in all patients

Answer 7

rapid serum glucose
pulse ox
complete set of vitals

Question 8

Accronym for causes of agitation

Answer 8

FIND ME

[Functional, Infectious, Neurologic, Drugs, Metabolic, Endocrine]

Question 9

first step in evaluating combative patient

Answer 9

risk assessment and attention to safety

Question 10

what should you never do to an agitated patient?

Answer 10

lie to them

Question 11

which patients require immediate restraint

Answer 11

actively violent
severely agitated
those who exhibit signs of impending violence

Question 12

Physical restraints

Answer 12

4 point restraints on extremities + one arm up/down + HOB elevated + padding to prevent neurovascular injury

Question 13

How often do you check for neurovascular injury on patient with physical restraint

Answer 13

q 15 - 30 min

Question 14

What do you always have to do for patient with physical restraints

Answer 14

document reason
which limbs are restrained
frequency of NV checks
review the need every 12 hours

Question 15

types of chemical restraints

Answer 15

IM, IV, or SubQ Benzo or Antipsychotic

Question 16

what do you need to be on the lookout for with Benzo?

Answer 16

decreased respiratory drive

Question 17

MC chemical restraint ?

What is it good especially for?

Answer 17

Lorazepam (Ativan)

excellent for EtOH withdrawal

Question 18

Preferred chemical restraint agents in pediatrics?

Answer 18

haloperidol and lorazepam

Question 19

disturbance in cognition that impairs memory, judgement, personality, higher critical function and abstract thought process

Answer 19

dementia

Question 20

How does dementia start and how is level of consciousness?

Answer 20

gradual onset

level of consciousness maintained

Question 21

How does delerium differ from dementia?

Answer 21

Delirium → acute impairment of cognitive function and decreased LOC, Visual hallucinations are common

Question 22

MC cause of delirium

Answer 22

infection → UTI, meningitis, pneumonia, electrolyte abnormalities

Question 23

persistent dysphoric mood or loss of interest and please in usual activities (anehedonia)
feeling guilty or worthless
hopeless, thoughts of death/suicide
weight loss, decreased appetite, insomnia/hypersomnia, decreased concentration, flat affect, decreased hygeine

Answer 23

depression

Question 24

Red flag for depression

Answer 24

giving away possessions

Question 25

What must you do with depressed patients?

Answer 25

ask all about suicidal ideation

Question 26

Job with handling Depression in the ED

Answer 26

rule out organic causes first → CBC, TSH, HIV, RPR, CMP, EtOH, UDS, Ammonia, CT of head

Question 27

what do you never do with depressed patient in ED?

Answer 27

Never give new or previous diagnosis of depression in the ED → ALWAYS consult psych

Question 28

risk factors for suicide

Answer 28

caucasian/native american, family history, male, >65 years, unmarried, lives alone, recent stressor, substance abuse, TMI, MH disorder, prior attempt/plan, access to carry out plan

Question 29

If your patient in the ED had a suicide attempt, what should you do ?

Answer 29

place in safe rom 1:1 with sitter → paper gowns and no ties/strings

Question 30

unnatural shifts in mood, energy acitivty levels

Answer 30

Bipolar Disorder

Question 31

Three types of Bipolar Disorder

Answer 31

Manic Depressive Bipolar Affective Cyclothymic

Question 32

Described manic phase of bipolar disorder

Answer 32

``` grandiosity easily distracted pressured speech insomnia racing thoughts/flight of ideas increased focus on activity excessive pleasurable activities poor judgement ```

Question 33

depressed phase of Bipolar Disorder

Answer 33

Suicidal Ideation | feeling worthless

Question 34

Which phase of bipolar episode with have delusions/hallucinations?

Answer 34

either phase

Question 35

potential causes of bipolar episode that you must rule out

Answer 35

``` infection HIV syphilis head injury thyroid dysfunction schizophrenia ```

Question 36

bizarre hallucinations + paranoia + social withdrawal + delusions + distrubed thinking processes + flat affect + abnormal behavior

Answer 36

Schizophrenia

Question 37

when does the onset of schizophrenia usually occur?

Answer 37

late teens and mid 30s

Question 38

major symptoms of schizophrenia

Answer 38

psychosis

Question 39

when are most schizophrenic patients seen in the ED?

Answer 39

first psychotic break or acute flares (due to noncompliance of meds)

Question 40

How does psychosis differ from schizophrenia?

Answer 40

psychosis symptoms include delusions + hallucinations + impaired relationship with reality + short lasting

Question 41

what is schizophrenia?

Answer 41

disorder of thinking and perception → information processing and reality testing are impaired → unable to distinguish fantasy and reality [delusions and hallucinations]

Question 42

four categories of schizophrenia symptoms

Answer 42

positive negative cognitive mood

Question 43

four types of positive symptoms in schizophrenia

Answer 43

hallucinations delusions disorganized speech behavior

Question 44

Types of hallucinations seen in schizophrenia

Answer 44

auditory (if visual or tactile think organic etiology)

Question 45

types of delusions seen in schizophrenia

Answer 45

bizarre or illogical false beliefs, often paranoids, grandoise, persecutory, or religious false interpretation of normal perceptions, taunting voices, 2 or more discussing or arguing with eachother

Question 46

How will the speech be in a patient with schizophrenia?

Answer 46

disorganized → tangential, incoherent, rambling speech, neologisms

Question 47

Negative symptoms seen in shcizophrenia

Answer 47

decrease in emotion poverty of speech loss of interest and drive

Question 48

cognitive symptoms seen in schizophrenia

Answer 48

``` neurocognitive deficits (memory, attention, executive funcitons) difficulty understanding subtle interpersonal cues/relationships ```

Question 49

Mood symptoms in schizophrenia

Answer 49

labile, anxious, depressed, suspicious, angry, cheerful

Question 50

ED management for schizophrenic patient

Answer 50

haldol, risperdal, olanzapine treat agitation psych consult

Question 51

assault by forcible, inappropriate sexual behavior

Answer 51

sexual assault

Question 52

What should you include in history of patient who was sexually assaulted?

Answer 52

``` brief description of incident time it occurred location of assault weapon/drugs changed clothes, showered, douched since incident? ```

Question 53

when would you do GU exam in sexual asault patient?

Answer 53

concern for life thretening injury (hemorrhaging)

Question 54

When can you have evaluation from specially sexual assault trained RN?

Answer 54

assault must be within 3 days

Question 55

labs you may want to order for sexual assault patient

Answer 55

UA/UPT, GC/Chlamydia, Wet Prep, HIV, Hep B, Syphilis

Question 56

Sign of child abuse in infants

Answer 56

failure to thrive without underlying cause

Question 57

Where are unusual fracture sites or injuries that may indicate child abuse ?

Answer 57

``` clavicle ribs arms seizures retinal hemorrhages ```

Question 58

What is most often the indication of a presenting child that child abuse is going on?

Answer 58

inappropriate delay in seeking care