psychiatric emergencies

Question 1

behavioral emergency*

Answer 1

• 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

Question 2

psychiatric emergency*

Answer 2

• 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

Question 3

four broad categories of abnormal behavior

Answer 3

• 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

Question 4

biologic or organic causes of abnormal behavior

Answer 4

• 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

Question 5

environmental causes of abnormal behavior

Answer 5

• 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

Question 6

causes of abnormal behavior: injury and illness

Answer 6

• 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

Question 7

causes of abnormal behavior: substance-related

Answer 7

• alcohol
• cigarettes
• illicit drugs
• other substances
• can be prescribed medications in excess or mixed together

Question 8

emergency medical care

Answer 8

• 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***

Question 9

communication techniques

Answer 9

• 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

Question 10

what do you do when someone is talking

Answer 10

you are either:
-listening
-planning the next thing you will say
,or
-you don't care

Question 11

physical restraint

Answer 11

• 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

Question 12

chemical restraint

Answer 12

• 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

Question 13

RASS score

Answer 13

• 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

Question 14

agitated delirium pathophysiology

Answer 14

• 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

Question 15

agitated delirium assessment

Answer 15

• try to reorient patients

- perform a thorough assessment

Question 16

agitated delirium management

Answer 16

• identify the stressor or metabolic problem

- ex. drug, substance

Question 17

suicide

Answer 17

• any willful act designed to end ones life

- becomes more emergent when there is a plan -> more details the worse

Question 18

suicidal ideation assessment

Answer 18

• 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

Question 19

suicidal ideation management

Answer 19

• dont leave the patient alone
• collect implements of self-destruction
• acknowledge the patients feelings
• encourage transport

Question 20

violence

Answer 20

• 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

Question 21

risk factors of violence, abuse, and neglect

Answer 21

• scenarios including:
• alcohol or drug consumption
• crowd incidents
• violence has already occurred
• people who are:
• intoxicated
• experiencing withdrawl
• psychotic
• delirious

Question 22

warning signs of violence, abuse, and neglect

Answer 22

• posture- sitting tensely
• speech- load, critical, threatening
• motor activity- unable to sit still, easily startled
• clenched fists, avoidance of eye contact
• your own feelings

Question 23

mood disorders

Answer 23

• unipolar mood disorder- mood remains at one pole of the continuum (always happy, neutral, sad)
• bipolar mood disorder- mood alternates between mania and depression

Question 24

manic behavior

Answer 24

• 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

Question 25

GAS PIPES

Answer 25

- MIDTERMMMMM - Guilt - Appetite - Sleep disturbance - Paying attention - (decreased) Interest - Psychomotor abnormalities - (decreased) energy - suicidal thoughts

Question 26

schizophrenia

Answer 26

- typical onset occurs during early adulthood - experience may include: - delusions - hallucinations - a flat affect- no emotion in speech, neutral - erratic speech

Question 27

generalized anxiety disorder (GAD)

Answer 27

- 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

Question 28

phobias

Answer 28

- unreasonable fear, apprehension, or dread of a specific situation or thing - simple phobias focus all anxieties on one class of objects or situations

Question 29

panic disorders

Answer 29

- 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

Question 30

eating disordes

Answer 30

- 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

Question 31

anorexia nervosa

Answer 31

- weight loss jeopardizes health and lives - typical patient: - decreased body weight based on age and height - intense fear of obesity - experience amenorrhea

Question 32

antipsychotics

Answer 32

- 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

Question 33

problems associated with medication noncompliance

Answer 33

- 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