Psychosocial Emergencies

Question 1

how many US adults have mental health diagnosis

Answer 1

1 out of 5

Question 2

define anxiety

Answer 2

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

Question 3

synonyms for anxiety

Answer 3

discontent
concern
apprehension
fearfulness
tension

Question 4

define situational crisis

Answer 4

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

Question 5

managing situational crisis

Answer 5

typically with outpatient followup

Question 6

pyschosocial crises that bring people to ED

Answer 6

job loss
divorce
sudden illness
sudden death

Question 7

grieving variables

Answer 7

culture
personality
hx of loss
coping skills

Question 8

sx situational crisis

Answer 8

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

Question 9

types of anxiety disorders

Answer 9

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

Question 10

define panic attack

Answer 10

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

Question 11

sx of panic attack

Answer 11

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

Question 12

intervene for panic attack

Answer 12

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

Question 13

pharm for panic attack

Answer 13

clonazepam
lorazepam
diazepam

Question 14

pharm for anxiety disorder

Answer 14

benzo
anxiolytic
antidepressant

Question 15

define OCD

Answer 15

rituals or actions performed to reduce anxiety

Question 16

define compulsion

Answer 16

repetitive behaviors

Question 17

define obsessions

Answer 17

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

Question 18

sx OCD

Answer 18

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

Question 19

intervene OCD

Answer 19

anxiolytics, antidepressants

supportive therapy

Question 20

define PTSD

Answer 20

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

Question 21

acute vs chronic PTSD

Answer 21

acute < 3 mo

chronic > 3 mo

Question 22

sx PTSD

Answer 22

re-experiencing (flashbacks, dreams)

avoidance (loss of interest, isolation)

hyperarousal (startle reflex, tense, irritable)

Question 23

intervene PTSD

Answer 23

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

Question 24

define depression

Answer 24

common but serious illness, particularly if untreated or unmanaged

Question 25

define major depression

Answer 25

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

Question 26

how often does depression occur?

Answer 26

may occur only once, but often pt has several episodes

Question 27

types of depressive episodes

Answer 27

psychotic depression postpartum depression seasonal affective disorder

Question 28

psychotic depression

Answer 28

associated w/ psychotic hallucinations or delusions

Question 29

postpartum depression

Answer 29

10-15% of postpartum women

Question 30

season affective disorder

Answer 30

characterized by seasonal onset of depression during winter months effectively treated w/ light therapy and Vit. D

Question 31

sx depression

Answer 31

``` 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 ```

Question 32

define bipolar disorder

Answer 32

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

Question 33

meds that precipitate manic event in bipolar disorder

Answer 33

``` antidepressants steroids bronchodilators alcohol cocaine decongestants ```

Question 34

sx bipolar disorder

Answer 34

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 ```

Question 35

intervene bipolar disorder

Answer 35

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

Question 36

pharm interventions for bipolar disorder

Answer 36

lithium carbamazepine divalproex

Question 37

precipitants of lithium toxicity

Answer 37

``` hyponatremia dehydration tetracycline phenytoin cyclosporine diuretics ACE inhibitors NSAIDs ```

Question 38

sx lithium toxicity

Answer 38

``` N/V/D weakness, fatigue lethargy tremulousness dystonia hyperreflexia, ataxia cardiac dysrhythmias ```

Question 39

intervene lithium poisoning

Answer 39

stabilize, reverse life-threatening conditions IV fluids with isotonic NS monitor cardiac fxn HD if severe

Question 40

define psychosis

Answer 40

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

Question 41

psychosis overview

Answer 41

state of bizarre and profoundly altered thinking with associated deterioration of thought processes often w/ sensory hallucinations/delusions r/o alternatives (medical, drug-induced)

Question 42

causes of psychosis

Answer 42

``` organic vs psychiatric delirium dementia depression schizophrenia ```

Question 43

sx psychosis

Answer 43

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

Question 44

define delirium

Answer 44

acute disturbance in attention and cognition

Question 45

sx delirium

Answer 45

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

Question 46

define dementia

Answer 46

degenerative disturbance in cognition

Question 47

sx dementia

Answer 47

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

Question 48

define schizophrenia

Answer 48

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

Question 49

schizophrenia overview

Answer 49

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

Question 50

sx schizophrenia

Answer 50

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

Question 51

intervene schizophrenia

Answer 51

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

Question 52

dystonic reactions

Answer 52

aka severe extrapyramidal sx occur w/in hours-week of new antipsychotic meds disordered muscle tonicity oculogyric risis torticollis

Question 53

oculogyric crisis

Answer 53

deviation of eyes in all directions

Question 54

torticollis

Answer 54

spasm of neck muscles with twisting to side

Question 55

intervene dystonic rxn

Answer 55

diphenhydramine benztropine trihexyphenidyl

Question 56

define neuroleptic malignant syndrome

Answer 56

life-threatening condition caused by antipsychotic agents

Question 57

sx neuroleptic malignant syndrome

Answer 57

``` hyperthermia AMS severe muscle rigidity autonomic instability diaphoresis leukocytosis elevated CK renal failure ```

Question 58

intervene neuroleptic malignant syndrome

Answer 58

``` O2, intubate stabilize BP reduce temperature reduce muscular rigidity ICU ```

Question 59

mandated reporting requirements

Answer 59

child abuse elder abuse if in gov't home in domestic abuse, pt must make complaint

Question 60

types of abuse

Answer 60

``` neglect physical sexual emotional abandonment financial ```

Question 61

types of neglect

Answer 61

failure to provide basic needs: ``` medical physical emotional educational mental ```

Question 62

types of physical abuse

Answer 62

``` intentional trauma excessive discipline punishment torture unreasonable force ```

Question 63

define sexual abuse

Answer 63

inappropriate sexual contact (physical, verbal, other)

Question 64

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

Answer 64

``` 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 ```

Question 65

fractures in high index of suspicion for maltreatment

Answer 65

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

Question 66

head injuries in high index of suspicion for maltreatment

Answer 66

``` traumatic alopecia uneven growth head injuries subdural hematomas skull fracture unexplained LOC sx increased ICP ```

Question 67

EENT injuries in high index of suspicion for maltreatment

Answer 67

``` 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 ```

Question 68

genitalia and perineum in high index of suspicion for maltreatment

Answer 68

``` trauma discharge bleeding pain UTI sx STIs ```

Question 69

poisoning in high index of suspicion for maltreatment

Answer 69

ingestion of alcohol or drugs

Question 70

burns in high index of suspicion for maltreatment

Answer 70

``` 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 ```

Question 71

bruising in high index of suspicion for maltreatment

Answer 71

various stages of healing shape of identifiable object human bite marks

Question 72

behavioral in high index of suspicion for maltreatment

Answer 72

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

Question 73

interviewing in c/f abuse

Answer 73

``` set tone, augment information interview caregivers separately listen, watch evaluate appearance nonjugemental nonaccusatory ```

Question 74

memorializing events and history in c/f abuse

Answer 74

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

Question 75

risk factors for dependent adult abuse

Answer 75

``` 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 ```

Question 76

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

Answer 76

cupping | coining

Question 77

physiologic manifestations that may be mistaken for abuse

Answer 77

coag disorders failure to thrive mongolian spots

Question 78

define Munchausen by proxy

Answer 78

adult caregiver fabricates child's illness or actually creates symptoms

Question 79

commonly reported sx in Munchausen by proxy

Answer 79

``` apneic spells cardiac/resp arrest SZs allergic rxns dehydration suffocation ```

Question 80

commonly manufactured sx in Munchausen by proxy

Answer 80

``` rashes sepsis hemorrhage vomiting diarrhea ```

Question 81

common characteristics of Munchausen by proxy

Answer 81

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

Question 82

define anorexia

Answer 82

weight loss > 25% below baseline failure to gain weight after diagnosis

Question 83

define builimia

Answer 83

bingeing and purging behavior

Question 84

characteristics of bulimia

Answer 84

``` vomiting laxatives diuretics diet pills fasting excessive exercise ```

Question 85

risk factors for eating disorders

Answer 85

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

Question 86

sx anorexia nervosa

Answer 86

``` amenorrhea hypercarotenemia muscle weakening constipation cool skin peripheral edema thinning hair nail fragility dehydration hypocalcemia ```

Question 87

sx laxative abuse

Answer 87

hypokalemia hypocalcemia dehydration hypoglycemia

Question 88

sx diuretic abuse

Answer 88

hyponatremia hypokalemia increased uric acid hypercalcemia

Question 89

sx excessive diet pill use

Answer 89

``` hypertension renal failure dysrhythmias intracerebral bleeding MI HF ```

Question 90

sx induced vomiting

Answer 90

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

Question 91

assessing eating disorders

Answer 91

changes in appetite, weight, exercise | N/V

Question 92

history in eating disorders

Answer 92

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

Question 93

intervene for eating disorders

Answer 93

``` medical clearance IV, monitor psych, diet consult electrolytes protective environment antidepressants admission ```

Question 94

aggression continuum

Answer 94

``` thought plan means access action ```

Question 95

risk factors for aggression

Answer 95

SI/HI ideas, plans, attempts, intent

Question 96

cognitive assessment in aggression

Answer 96

``` loss of executive fxn tunnel vision polarized thinking closed-mindedness self-report tools ```

Question 97

gender in SI risk assessment

Answer 97

``` females attempt males succeed (4x) ```

Question 98

age in SI risk assessment

Answer 98

highest rate 45-64 yo second highest 85+ younger groups have lower rates

Question 99

race in SI risk assessment

Answer 99

white males 70% | second highest American Indians and Native Alaskans

Question 100

risk factors for SI

Answer 100

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

Question 101

sx SI

Answer 101

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

Question 102

intervene for SI

Answer 102

``` undress remove belongings manage illness meds as appropriate involve social support as appropriate psych suicide hotline number ```

Question 103

psychological risk factors for HI

Answer 103

anxiety/fear for personal safety overwhelming feelings hx abuse

Question 104

organic risk factors for HI

Answer 104

alcohol, drugs side effects of meds pain delirium

Question 105

psychiatric risk factors for HI

Answer 105

``` delusions of persecution "command" hallucinations acute depression suicide attempt mania ```

Question 106

intervene for HI

Answer 106

``` 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 ```