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Psychiatric/Psychosocial
Emergencies
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Specific Psychosocial Emergencies
• Anxiety and Panic Reactions
• Bipolar Disorder
• Depression
• Eating Disorders
• Grief
• Homicidal or Violent Behavior
• Ineffective Coping and Situational Crisis
• Psychotic, or Brief Psychotic, Behavior
• Suicide or Suicidal Behavior
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ANXIETY AND PANIC REACTIONS
• Anxiety is the body’s natural reaction to stress with a feeling of fear or worry about
what will come. Anxiety, which triggers the fight-or-flight response, can be due to
situational event or could be a chronic response to ineffective coping skills. Levels
range from mild to severe. While panic is a sudden intense fear that sets off severe
physical reactions, where there is no hazard or obvious cause.
Assessment
• Subjective data collection
• History of presenting illness/injury/chief complain
• Previous episodes
• Precipitating events
• Measures were already taken by the patient that has helped
• Family history of organic disease and anxiety disorder
• Occurrence during the developmental cycle
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Assessment cont..
• Physical ailment causing pain or impairment in function
• Impaired communication abilities secondary from stroke, hearing
impairment, blindness, or lack of language fluency
• Insufficiency of previously used coping pattern
• Acute changes in health
• Lack of knowledge regarding available resources
• Inadequate parenting patterns with maltreatment
• Recent life change
• Difficulty with sleep
• Events causing anger
• Passivity in face of threats
• The feeling of impending doom, including the sensation of heart
attack or chocking
• Reports of sexual difficulties, including impotence, lack of desire,
dyspareunia
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Past medical history
• Current or preexisting disease/illness
• Phobias
• Hyperventilation syndrome
• Substance use/abuse
• Medication
• Allergies
• Immunization status
Objective data collection
1. Physical examination
a) general appearance
b) inspection
c) auscultation
d) palpation/percussion
2. Diagnostic procedures (CBC with deferential, serum chemistries,
serum and urine toxicology screen, and ECG)
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Analysis: differential nursing
diagnoses/collaborative problems
• Anxiety/fear
• Impaired gas exchange
• Impaired verbal communication
• Ineffective individual or family coping
• Risk for injury
• Deficient knowledge
• Disturbed thought processes
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Planning and implementation/intervention
a) Maintain airway, breathing, and circulation
b) Provide supplemental oxygen as indicated
c) Establish IV access for administration of crystalloid
fluids/medications as needed
d) Prepare for/assist with medical interventions
e) Administer pharmacologic therapy as ordered
f) Educate patient/significant others
Evaluation and ongoing monitoring
i. Decrease in anxiety
ii. Hemodynamic status
iii. Breath sounds and pulse Oximetry
iv. Cardiac rate and rhythm
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BIPOLAR DISORDER
• Also known as manic-depressive illness is a disease
characterized by alternating euphoric moods and depressed
periods. Affect can be uncertain and labile with mood
interchange occurring in minutes, hours, or days or there could
be long periods of stability between episodes. When the patient
is in a manic state, they can be euphoric, highly social, and/or
sexually inappropriate.
• Causes of bipolar disorder are unknown but several factors have
been associated with the disorder such as biological differences
where people with bipolar disorder appear to have physical
changes in their brain with the significance of the changes
uncertain. Genetics is another associated factor with bipolar
disorder with persons who have a first-degree relative more
likely to develop the disease.
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Bipolar disorder cont..
• About 2.8% of the population in the U.S has bipolar
disorder with symptoms always showing by the age of
25 years. An estimated 4.4% of U.S adult is experiences
bipolar disease at some point in their life.
• Bipolar disorder assessment includes mental status
evaluation as well as an assessment of appearance,
affect/mood, thought content, perception, suicide/self-
destruction, violence/ aggression, judgment/insight,
cognition, and physical health. Bipolar is mostly
diagnosed based on the patient’s history and clinical
assessment, laboratory studies are necessary to rule out
other causes of signs and symptoms of the patient and
having baseline tests before starting treatment.
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Assessment
Subjective data collection
1. history of presenting illness/injury/chief complain
a) previous manic and/or depressive episodes
b) sleep pattern disturbances (with the patient
frequently feeling he/she requires very little sleep)
c) Rapid onset of symptoms usually during 2 weeks
d) labile emotions; euphoria and depression
e) Noncompliance with prescribed medication
regimen (e.g., lithium, divalproex sodium
[Depakotel], carbamazepine [Tegretol],
clonazepam [klonopin]) may be precipitant.
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Assessment cont.…
2. Past medical history
a) current or preexisting diseases/illness
i. Repeated cycles of mania and depression,
ii. Infections
iii. Endocrine disorders
iv. Neoplastic disorders
b) Substance and/or alcohol use/abuse
c) Medications
d) Allergies
e) Immunization status
Objective data collection
• It entails the physical examination and diagnostic procedures. Physical examination
starts with general appearance examination where the level of consciousness, behavior,
affect: hallucinations, a flight of ideas; sadness, hygiene (poor, unkempt appearance or
grandiose and bright clothing), and moderate to severe distress/discomfort
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Assessment cont.…
• In inspection we inspect for;
a) Rapid and pressured speech, or low and depressed speech patterns
b) Grandiose context to speech or monotone voice
c) Intact intellect
d) Hyperactivity/hypoactivity
• Diagnostic procedures include; CBC with differentials, ESR, Serum chemistries (including
glucose, BUN, creatinine), Serum and urine toxicology screen and drug levels, serum alcohol
levels, thyroid function tests, urinalysis (pregnancy test in female patients of childbearing
age), and ECG.
Analysis: differential nursing diagnoses/collaborative problems
• Disturbed thought processes
• risk of injury
• disturbed sensory perception; visual or auditory
• noncompliance
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Planning
• Maintain airway, breathing, and circulation
• Provide supplementary oxygen as indicated
• Establish IV access for administration of crystalloid fluids/medications as needed
• Prepare for/assist with medical interventions
i. Institute cardiac and pulse oximetry monitoring
ii. Acknowledge thought disorder and orient to reality if the patient is delusional.
iii. Provide safety by restrains per institutional policy, as necessary, and by continuous
observation.
iv. Treatment of injuries sustained as a result of psychotic behavior.
v. Removing all elements or objects which may cause harm to the patient or others.
vi. Treat any medical problems that may have developed due to malnutrition (e.g.
dehydration and electrolyte imbalance.)
vii. Work with the health care team to make appropriate disposition to a supportive
environment.
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Planning cont.…
• Administer pharmacologic therapy as ordered
a) Lithium
b) Anticonvulsant
c) Antipsychotic agents
d) Antianxiety agents
• Educate patient/significant others
a) Refer patient to crisis intervention nurse or
psychiatrist for evaluation.
b) Instruct the patient on the importance of taking
prescribed medication.
Evaluation and ongoing monitoring
• Hemodynamics
• Cardiac rate rhythm
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DEPRESSION
• It consists of specific alterations in mood, often accompanied by
negative self-concept, physical changes, along with changes in
activity and interest levels. Depression is suspected when at least
five of the following characteristics last for more than 2 weeks: loss
of interest in usual activities, depressed mood, increase or decrease
of appetite with weight change, insomnia or hypersomnia, fatigue,
psychomotor agitation or retardation, decreased ability to think
recurrent thoughts of death or feelings of worthlessness. Symptoms
of clinical depression are distinct from those that may occur in
situational events such as in bereavement, medical conditions, or
substance abuse.
• Causes of depression ranges from biological to circumstantial with
the common causes being; family history, early childhood trauma, life
circumstances, brain structure, drug use, and certain medical
conditions such as chronic illness, insomnia, chronic pain, and
attention-deficit hyperactivity disorder(ADHD).
• Depression is the leading cause of disability in the U.S.A for persons
aged 15-44.3 years and it affects more than 16.1 million American
adults (about 6.7% of the population)
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Assessment
• Subjective data/ collection
1. History of presenting illness/injury/chief complain
a) Precipitating events
b) Depressed affect and loss of interest in diversional activities and social relationship
c) Fatigue and insomnia or hypersomnia
d) Somatic complains (low back pain, fatigue, and headaches)
e) Weight changes (i.e. loss or gain)
f) Psychomotor agitation or retardation
g) Difficulty in concentration
h) Recurrent suicidal thoughts
i) Feeling of worthlessness
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Assessment cont.…
j) Increased substance abuse (alcohol, prescription drugs, or
OTC drugs use)
k) Situational crisis
1. postpartum depression
2. loss of significant other or support system,
3. acute health changes,
4. chronic illness resulting from perpetual strains of long-term
treatment regimens
5. separation from spiritual or cultural background
6. changes in role performance, occupational status, and power
base
j) Occurrence during the development cycle
i. Children may show hyperactivity, enuresis, or regressive
behavior
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ii. Adolescents may present as the result of delinquency or injuries related to trauma;
they may be cynical, detached, angry, hostile, disillusioned, and lonely; there may
also be sexual promiscuity, acting-out behavior, alcohol and drug abuse
iii. Adults, including elderly, may have symptoms similar to adolescents; they may have
poor hygiene; and they may relay loss or interest in social life, decreased sexual
activity and inability to concentrate.
j) Toxic ingestion
2. Past medical history
a) Current or preexisting disease/illness (depression including a family history of
depression and illnesses necessitating prolonged and painful treatment regimens or
that doesn’t have a cure)
b) An injury that has caused debilitation/ chronic pain
c) Medications
d) Allergies
e) Immunization status
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Objective data collection
I. Physical examination which entails
1. General appearance
a. Level of consciousness, behavior, affect: quiet and withdrawn demeanor, restricted
affect [limited emotional expression], dysphoric mood
b. Slowed gait
c. Unkempt poor hygiene
d. Moderate to severe distress/discomfort
II. Diagnostic procedures include;
i. thyroid function test
ii. serum and urine toxicology screen
iii. serum alcohol level
iv. urinalysis; pregnancy test in female patients of childbearing age
v. brain CT scan or MRI
vi. ECG.
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Analysis: differential nursing
diagnosis/collaborative problems
a) Impaired verbal communication
b) Ineffective coping
c) Risk of injury
d) Deficient knowledge
e) Disturbed through processes
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Planning and implementation/interventions
a. Maintain airway, breathing, circulation
b. Provide supplemental oxygen as indicated
c. Establish IV access for administration of crystalloid fluids/medications as needed
d. Prepare for/assist with medical interventions
1) Institute cardiac and pulse oximetry monitoring as indicated
2) Convey attitude of acceptance
3) Encourage patient to identify feelings
4) Assist patient in recognizing causes and effects of depression
5) Place patient in safe and observable area
6) Determine whether poison ingestion has occurred and treat: gastric
lavage, activated charcoal
e. Administer pharmacologic therapy as ordered
f. Educate patient/significant other
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Evaluation and ongoing monitoring
a. Improvement in depression
b. Hemodynamic monitoring
c. Breath sounds and pulse oximetry
d. Cardiac rate and rhythm
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EATING DISORDERS
• Eating disorders are mental illnesses characterized by abnormal
eating habits, which affect a person’s physical and/or mental
health negatively. The actual cause of eating disorders is
unknown but several factors have been associated with eating
disorders which include; genetics, biological, behavioral,
psychological, and social factors.
• Eating disorders are among the deadliest mental illnesses only
second to opioid overdose and it has a prevalence of at least 9%
globally with about 9% of the U.S population developing an
eating disorder in their lifetime. 88% of all eating disorder
admissions are females with the admitting diagnoses including-
unspecified (39%), anorexia nervosa (34%), bulimia nervosa
(21%), pica (6%) and psychogenic vomiting (2%)
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Assessment
1. Subjective data collection
a. History of presenting illness/chief complain (appetite and weight changes, exercise
patterns, pain, vomiting, and diarrhea)
b. Past medical history
i. Current/preexisting diseases/illness (psychological disorders, and anorexia/bulimia)
ii. Substance and/or alcohol use/abuse
iii. Laxative and/or diet pill use
iv. If a female of childbearing age ask about the last normal menstrual period date
v. Current medications (prescription or OTC/herbal)
vi. Allergies
vii. Immunization status
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2. Objective data collection
A. Physical examination
i. General appearance: level of consciousness, possible depression, possible
hypotension, tachycardia, orthostasis, and moderate to severe distress/discomfort
ii. Inspection: thinness, dry and brittle hair, yellow skin, erosion of tooth enamel, and
cardiac dysrhythmias on the monitor
iii. Palpation/percussion: diminished deep tendon reflexes, cool and dry skin with poor
skin turgor
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Diagnostic procedures
• CBC with differential
• Serum chemistries including glucose, BUN, and creatinine
• ABGs (metabolic alkalosis with prolonged vomiting and metabolic acidosis with laxative
abuse)
• ESR
• Serum and urine toxicology screen
• Pregnancy test in female patients of childbearing age
• Thyroid function tests
• ECG
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Analysis: differential nursing diagnosis/collaborative problems
a. Imbalanced nutrition: less than body requirements
b. Situational/ chronic low self-esteem
Planning and implementation/interventions
a. Maintain airway, breathing, circulation
b. Provide supplemental oxygen as indicated
c. Establish IV access for administration of crystalloid fluids/medications as needed
d. Prepare for/assist with medical interventions
e. Administer pharmacologic (electrolyte replacement) therapy as indicated
f. Educate patient/significant others the importance of a nutritionally balanced diet
• Evaluation and ongoing monitoring
a. Hemodynamic status
b. Cardiac rate and rhythm
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GRIEF
• Grief is the normal process of reacting to a loss
(physical, social, or occupational) with death being the
most significant loss type. Other losses include changes
in health, body function, body parts, mental acuity, self-
image, relationships, economic security, independence,
material possessions, and home. In emergency care,
setting it might affect patients who have survived when
others have perished or by family members who must
cope with the sudden loss of a loved one. Acceptance,
comprehension of the loss, and the process of detaching
oneself often begin in the emergency care setting.
Stages of grief start with denial or isolation followed by
anger, then bargaining, depression and later acceptance
of the loss although not always in that order.
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Assessment
1. Subjective data collection
A. History of presenting illness/injury/chief complain
i. Identifies whether the loss is real or threatened
ii. Describes attempts to resolve situations that have been successful or
unsuccessful
iii. Somatic complains (abdominal pains, vague symptoms similar to now-
deceased family member/friend)
iv. Syncope
B. Past medical history
i. Current or preexisting diseases/illness (cardiovascular disease, pulmonary
disease)
ii. Medications
iii. Allergies
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Assessment cont.…
2. Objective data collection
A. Physical examination
• General appearance (level of consciousness, behavior, affect, agitation,
withdrawn, tachypnea, tachycardia, and mild to moderate
distress/discomfort)
B. Diagnostic procedures
i. Thyroid function test
ii. Serum and urine toxicology screen
iii. Serum alcohol level
iv. ECG
v. Urinalysis of a female of childbearing age for a pregnancy test
Analysis: differential nursing diagnoses/collaborative problems
1. Anticipatory/dysfunctional grieving
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Planning and implementation/interventions
1. Maintain airway, breathing, and circulation
2. Provide supplemental oxygen as indicated
3. Establish IV access for administration of crystalloid
fluids/medications as needed
4. Assist with medical interventions
a) Institute cardiac and pulse oximetry monitoring
b) Appear confident and establish trustworthy relationship
c) Escort into private room
d) Facilitate discussion of concerns, worries and feelings
e) Provide periodic updates
f) Seek assistance from health care members team
g) Call other persons in social network for support
h) Actively listen to responses
i) Evaluate survivors coping ability and express
confidence in their coping ability
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HOMICIDAL OR VIOLENT BEHAVIOR
• Violence is an assault on a person/object with intent
to harm or destroy while homicide is violence to kill
another human being. Violence is the acting out of
emotions of fear or anger to achieve the desired
goal/s. during violence or homicide, a high level of
panic might be experienced leading to loss of
reasoning ability leading to the use of violence as a
self-defensive mechanism to protect self or loved
ones when a person feels attacked emotionally or
physically. Patients could be the victim or the
attacker.
• Causes of violence can be secondary to psychosis,
antisocial behavior, or organic diseases.
• Violent behavior is becoming increasingly common
in the emergency department and is imperative that
personnel take measures to protect themselves and
their patients from any form of harm
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Assessment
1. Subjective data collection
A. History of presenting illness/injury/chief complain
i. Precipitating events
ii. Substance and/or alcohol use/abuse
iii. Previous homicidal or violent behavior
iv. Suicidal thoughts
v. Child maltreatment
vi. Preoccupation with sexual thoughts and fantasies
vii. Childhood history of enuresis, fire setting, cruelty to an animal, fighting, and school problems
B. Past medical history
i. Current or preexisting diseases/illness (psychosis, organic disease e.g. temporal lobe epilepsy
and head injury)
ii. Medications
iii. Allergies
iv. Immunization status
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Assessment cont.…
2. Objective data collection
A. Physical examination
i. General examination (level of consciousness, behavior, affect, agitation, tachycardia,
hypertension, moderate to severe distress)
ii. Inspection (possible obvious injuries, skin color, cardiac dysrhythmias on monitor)
iii. Palpation (skin diaphoretic)
B. Diagnostic procedures
i. CBC with differential
ii. Serum chemistries
iii. Serum and urine toxicology screen
iv. serum alcohol level
v. ECG
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Analysis: differential nursing diagnoses/collaborative problems
i. Ineffective coping
ii. Disturbed thought processes
iii. The risk for self-directed or other-directed violence
iv. Risk for injury
v. Anxiety/fear
Planning and implementation/interventions
i. Maintain airway, breathing, and circulation
ii. Provide supplemental oxygen
iii. Establish IV access for administration of crystalloid fluids/medications as needed
iv. Prepare for/assist with medical interventions
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INEFFECTIVE COPING AND SITUATIONAL
CRISIS
• Ineffective coping occurs when an individual is unable to solve problems and deal with
internal or external stressors where the events may be unexpected or anticipated
situations with unanticipated consequences. A situational crisis begins after a period of
shock with a heightened emotional response followed by an inability to function. The
situational crises may give rise to behaviors that include alcohol intake, drug abuse, and
suicidal, homicidal, or criminal behavior.
Assessment
1. Subjective data collection
A. History of presenting illness/injury/chief complaint
i. Precipitating event or change in the previous level of functioning
ii. Recent loss or change of body appearance
iii. Persistent/sudden/recent stressor (new employment, new geographical location,
frequent illness/accidents or demands of school/job/family)
iv. Maturational crisis of patient or family member
v. Ingestion of substance to alter the mood
vi. Reliance on ineffective or inappropriate coping strategies
vii. Natural disaster
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Assessment cont.…
B. Past medical history
i. Current or preexisting diseases/illness (pulmonary disease, diabetes, or cardiovascular
disease)
ii. Substance or alcohol abuse
iii. Medications
iv. Allergies
v. Immunization status
Objective data collection
A. Physical examination
i. General appearance (level of consciousness, behavior, affect, agitation, tremors,
tenseness, altered affect, altered thought process, hygiene, and moderate to severe
distress)
ii. Inspection ( tremors, diminished impulse control, and evidence of physical violence or
self-destructive behavior)
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B. Diagnostic procedures ( CBC with differentials, serum chemistries, serum and urine
toxicology screen)
Analysis: differential nursing diagnoses/collaborative problems
i. Ineffective individual or family coping
ii. Situational low self-esteem
iii. Disturbed thought process
iv. Dysfunctional grieving
v. Anxiety/fear
vi. Ineffective health maintenance
Planning and implementation/interventions
i. Maintain airway, breathing, and circulation
ii. Provide supplemental oxygen as indicated
iii. Establish IV access for administration of crystalloid fluids/medications as indicated
iv. Prepare for/assist with medical interventions
a. Institute cardiac and pulse oximetry monitoring
b. Assist patient to identify precipitating event
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c. Assist patient to identify measures to resolve problem with usual
method of coping
d. Help patient to define and clarify realistic options
e. Structure priorities for problem-solving interventions
f. Provide time and opportunity for communication and support the
patient in seeking assistance in the emergency department
g. If thought processes are disturbed, protect patient from harm
v. Administer pharmacologic therapy as ordered
vi. Educate patient/significant others
Evaluation and ongoing monitoring
i. Decreased agitation, tenseness
ii. Hemodynamic state
iii. Breath sounds and pulse oximetry
iv. Cardiac rate and rhythm
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H. PSYCHOTIC, OR BRIEF PSYCHOTIC,
BEHAVIOR
Psychotic behavior results from a pathologic process that is acute
or chronic with distorted perceptions, disorganized thinking,
impaired judgment, impaired decision-making, and regression.
Manifestation occurs in the areas of effect, behavior, perception,
and thinking. Behaviors exhibited may include acting-out,
impulsiveness, and psychomotor retardation, or agitation. Other
psychotic behavior changes include changes in perception such
as illusions, hallucinations, and depersonalization. Impaired
thinking manifests with delusions, loose association, and
incoherence. Psychoses can be functional or organic with the
functional types include schizophrenia, mania, psychotic
depression, and brief reactive psychosis. Organic psychoses
include dementia, delirium, and toxic drug-induced psychosis.
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Assessment
• Subjective data collection
1. History of present illness/injury/chief complain
i. Schizophrenia: familial history and onset before age 45 years (bizarre
behavior, delusions, auditory hallucinations, and paranoia)
ii. Mania ( previous episodes, decreased need for sleep, increased physical
ability, paranoia may be present, impulsive and flamboyant behavior,
euphoria and unrealistic plans or thoughts)
iii. Psychotic depression (loss of energy and pleasure, possible command
hallucinations, agitation, lack of communication with others, psychomotor
retardation, decreased ability or desire to care for self)
iv. Delirium (organic disorders must be ruled out)
v. Dementia
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Assessment cont.….
2. Past medical history
i. Current or preexisting diseases/illness (known psychiatric disorder)
ii. Substance and/or alcohol use/abuse
iii. Medications
iv. Allergies
v. Immunization status
Objective data collection
A. Physical examination
i. General appearance (level of consciousness, behavior, affect, presence of
hallucinations, possible tachycardia, hypertension, tachypnea, and severe
distress/discomfort)
ii. Inspection
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Assessment cont.….
Diagnostic procedures
i. CBC with differential
ii. Serum chemistries including glucose, BUN, and creatinine
iii. Serum and urine toxicology screen
iv. Urinalysis: leukocytes present if infection, pregnancy test in female patients of
childbearing age
v. Thyroid function tests
vi. Venereal Disease Research Laboratories (VDRL) or rapid plasma regain (RPR) test
vii. ABGs
viii. Stool for occult blood
ix. Lumbar puncture: cerebral spinal fluid analysis
x. ECG
xi. Head CT scan
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Analysis: differential nursing diagnoses/collaborative problems
i. Disturbed sensory perception: visual or auditory
ii. Impaired verbal communication
iii. Risk for injury
iv. Ineffective coping
Planning and implementation/interventions
i. Maintain airway
ii. Provide supplemental oxygen as indicated
iii. Establish IV access for administration of crystalloid fluids/medications as needed
iv. Prepare for/assist with medical interventions;
a. Maintain airway, breathing and circulation.
b. Orient patient to reality (time, place, person)
c. Provide safety per institution policy
d. Orient patient with respect to hallucinations or delusion
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e. Provide atmosphere for open and objective communication
f. Treat injuries sustained due to psychotic behaviors
g. Calm the patient
h. Work with healthcare team to make appropriate disposition to protective environment.
v. Administer pharmacologic therapy as prescribed
vi. Educate patient/significant other
Evaluation and ongoing monitoring
i. Decrease in hallucinations
ii. Hemodynamic status
iii. Breath sounds and pulse oximetry
iv. Cardiac rate and rhythm
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SUICIDE OR SUICIDAL BEHAVIOR
Suicidal behavior includes acts of self-harm, suicidal ideation or
intention, attempted suicide, and thoughts or behaviors that
indicate a risk of suicide. Suicide is the tenth leading cause of
death in the U.S and suicide attempts are responsible for a
significant number of mental health-related emergency department
admission. The highest number of suicides are committed among
the following age groups; 45-64 years, 85 years and over, and 15-
24 years. Females have the largest suicide percentage with 92%
and men 8% whereas the ratio of men to women persons who die
due to suicide is 4:1. Patients who come to the emergency
department may require immediate intervention for life-threatening
situations, depending on methods used to self-harm with the
patients exhibiting suicidal behavior frequently experiencing
depression and/or anxiety.
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Assessment
1. Suicide screening tools are used as part of the assessment process for
emergency department patients who present with behavioral health complaints
or disorders.
2. Subjective data collection
A. History of presenting illness/injury/chief complain
i. Precipitating factors
ii. Family history of suicide attempt or succeeding in suicide
iii. Newly diagnosed disease with body changes
iv. Substance and/or alcohol use/abuse
v. Signs of depression
vi. Prior psychiatric history
vii. Previous suicide attempts
viii. Presence of impulsive, violent temperament
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Assessment cont.…
B. Past medical history
i. Current or preexisting disease/illness
ii. Substance use/abuse
iii. Medication
iv. Allergies
v. Immunization status
3. Objective data collection
i. Physical examination (general appearance, inspection, and
palpation/percussion)
ii. Diagnostic procedures (serum and urine toxicology screen, serum alcohol
level, ECG, cerebrospinal fluid 5-hydroxy indole acetic acid, urinalysis;
pregnancy test in a female patient of childbearing age)
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Analysis: differential nursing diagnoses/collaborative problems
i. Ineffective coping
ii. The risk for violence: self-directed
iii. Disturbed thought process
Planning and implementation/interventions
i. Maintain airway, breathing, and circulation
ii. Provide supplemental oxygen as an indication
iii. Establish IV access for administration of crystalloid fluids/blood products/medications
as needed
iv. Prepare for/assist with medical interventions
v. Administer pharmacologic therapy as ordered
vi. Educate patient/significant others
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Expected outcomes/evaluation
a. Level of consciousness
b. Hemodynamic status
c. Breath sounds and pulse oximetry
d. Cardiac rate and rhythm
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References
• Emergency Nurses Association. (2019). Sheehy's
Emergency Nursing-E-Book: Principles and
Practice. Elsevier Health Sciences.
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•Thank you

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Psychiatric psychosocial emergencies

  • 1. Click to edit Master title style 1 Psychiatric/Psychosocial Emergencies
  • 2. Click to edit Master title style 2 Specific Psychosocial Emergencies • Anxiety and Panic Reactions • Bipolar Disorder • Depression • Eating Disorders • Grief • Homicidal or Violent Behavior • Ineffective Coping and Situational Crisis • Psychotic, or Brief Psychotic, Behavior • Suicide or Suicidal Behavior
  • 3. Click to edit Master title style 3 ANXIETY AND PANIC REACTIONS • Anxiety is the body’s natural reaction to stress with a feeling of fear or worry about what will come. Anxiety, which triggers the fight-or-flight response, can be due to situational event or could be a chronic response to ineffective coping skills. Levels range from mild to severe. While panic is a sudden intense fear that sets off severe physical reactions, where there is no hazard or obvious cause. Assessment • Subjective data collection • History of presenting illness/injury/chief complain • Previous episodes • Precipitating events • Measures were already taken by the patient that has helped • Family history of organic disease and anxiety disorder • Occurrence during the developmental cycle
  • 4. Click to edit Master title style 4 Assessment cont.. • Physical ailment causing pain or impairment in function • Impaired communication abilities secondary from stroke, hearing impairment, blindness, or lack of language fluency • Insufficiency of previously used coping pattern • Acute changes in health • Lack of knowledge regarding available resources • Inadequate parenting patterns with maltreatment • Recent life change • Difficulty with sleep • Events causing anger • Passivity in face of threats • The feeling of impending doom, including the sensation of heart attack or chocking • Reports of sexual difficulties, including impotence, lack of desire, dyspareunia
  • 5. Click to edit Master title style 5 Past medical history • Current or preexisting disease/illness • Phobias • Hyperventilation syndrome • Substance use/abuse • Medication • Allergies • Immunization status Objective data collection 1. Physical examination a) general appearance b) inspection c) auscultation d) palpation/percussion 2. Diagnostic procedures (CBC with deferential, serum chemistries, serum and urine toxicology screen, and ECG)
  • 6. Click to edit Master title style 6 Analysis: differential nursing diagnoses/collaborative problems • Anxiety/fear • Impaired gas exchange • Impaired verbal communication • Ineffective individual or family coping • Risk for injury • Deficient knowledge • Disturbed thought processes
  • 7. Click to edit Master title style 7 Planning and implementation/intervention a) Maintain airway, breathing, and circulation b) Provide supplemental oxygen as indicated c) Establish IV access for administration of crystalloid fluids/medications as needed d) Prepare for/assist with medical interventions e) Administer pharmacologic therapy as ordered f) Educate patient/significant others Evaluation and ongoing monitoring i. Decrease in anxiety ii. Hemodynamic status iii. Breath sounds and pulse Oximetry iv. Cardiac rate and rhythm
  • 8. Click to edit Master title style 8 BIPOLAR DISORDER • Also known as manic-depressive illness is a disease characterized by alternating euphoric moods and depressed periods. Affect can be uncertain and labile with mood interchange occurring in minutes, hours, or days or there could be long periods of stability between episodes. When the patient is in a manic state, they can be euphoric, highly social, and/or sexually inappropriate. • Causes of bipolar disorder are unknown but several factors have been associated with the disorder such as biological differences where people with bipolar disorder appear to have physical changes in their brain with the significance of the changes uncertain. Genetics is another associated factor with bipolar disorder with persons who have a first-degree relative more likely to develop the disease.
  • 9. Click to edit Master title style 9 Bipolar disorder cont.. • About 2.8% of the population in the U.S has bipolar disorder with symptoms always showing by the age of 25 years. An estimated 4.4% of U.S adult is experiences bipolar disease at some point in their life. • Bipolar disorder assessment includes mental status evaluation as well as an assessment of appearance, affect/mood, thought content, perception, suicide/self- destruction, violence/ aggression, judgment/insight, cognition, and physical health. Bipolar is mostly diagnosed based on the patient’s history and clinical assessment, laboratory studies are necessary to rule out other causes of signs and symptoms of the patient and having baseline tests before starting treatment.
  • 10. Click to edit Master title style 1 0 Assessment Subjective data collection 1. history of presenting illness/injury/chief complain a) previous manic and/or depressive episodes b) sleep pattern disturbances (with the patient frequently feeling he/she requires very little sleep) c) Rapid onset of symptoms usually during 2 weeks d) labile emotions; euphoria and depression e) Noncompliance with prescribed medication regimen (e.g., lithium, divalproex sodium [Depakotel], carbamazepine [Tegretol], clonazepam [klonopin]) may be precipitant.
  • 11. Click to edit Master title style 11 Assessment cont.… 2. Past medical history a) current or preexisting diseases/illness i. Repeated cycles of mania and depression, ii. Infections iii. Endocrine disorders iv. Neoplastic disorders b) Substance and/or alcohol use/abuse c) Medications d) Allergies e) Immunization status Objective data collection • It entails the physical examination and diagnostic procedures. Physical examination starts with general appearance examination where the level of consciousness, behavior, affect: hallucinations, a flight of ideas; sadness, hygiene (poor, unkempt appearance or grandiose and bright clothing), and moderate to severe distress/discomfort
  • 12. Click to edit Master title style 1 2 Assessment cont.… • In inspection we inspect for; a) Rapid and pressured speech, or low and depressed speech patterns b) Grandiose context to speech or monotone voice c) Intact intellect d) Hyperactivity/hypoactivity • Diagnostic procedures include; CBC with differentials, ESR, Serum chemistries (including glucose, BUN, creatinine), Serum and urine toxicology screen and drug levels, serum alcohol levels, thyroid function tests, urinalysis (pregnancy test in female patients of childbearing age), and ECG. Analysis: differential nursing diagnoses/collaborative problems • Disturbed thought processes • risk of injury • disturbed sensory perception; visual or auditory • noncompliance
  • 13. Click to edit Master title style 13 Planning • Maintain airway, breathing, and circulation • Provide supplementary oxygen as indicated • Establish IV access for administration of crystalloid fluids/medications as needed • Prepare for/assist with medical interventions i. Institute cardiac and pulse oximetry monitoring ii. Acknowledge thought disorder and orient to reality if the patient is delusional. iii. Provide safety by restrains per institutional policy, as necessary, and by continuous observation. iv. Treatment of injuries sustained as a result of psychotic behavior. v. Removing all elements or objects which may cause harm to the patient or others. vi. Treat any medical problems that may have developed due to malnutrition (e.g. dehydration and electrolyte imbalance.) vii. Work with the health care team to make appropriate disposition to a supportive environment.
  • 14. Click to edit Master title style 1 4 Planning cont.… • Administer pharmacologic therapy as ordered a) Lithium b) Anticonvulsant c) Antipsychotic agents d) Antianxiety agents • Educate patient/significant others a) Refer patient to crisis intervention nurse or psychiatrist for evaluation. b) Instruct the patient on the importance of taking prescribed medication. Evaluation and ongoing monitoring • Hemodynamics • Cardiac rate rhythm
  • 15. Click to edit Master title style 15 DEPRESSION • It consists of specific alterations in mood, often accompanied by negative self-concept, physical changes, along with changes in activity and interest levels. Depression is suspected when at least five of the following characteristics last for more than 2 weeks: loss of interest in usual activities, depressed mood, increase or decrease of appetite with weight change, insomnia or hypersomnia, fatigue, psychomotor agitation or retardation, decreased ability to think recurrent thoughts of death or feelings of worthlessness. Symptoms of clinical depression are distinct from those that may occur in situational events such as in bereavement, medical conditions, or substance abuse. • Causes of depression ranges from biological to circumstantial with the common causes being; family history, early childhood trauma, life circumstances, brain structure, drug use, and certain medical conditions such as chronic illness, insomnia, chronic pain, and attention-deficit hyperactivity disorder(ADHD). • Depression is the leading cause of disability in the U.S.A for persons aged 15-44.3 years and it affects more than 16.1 million American adults (about 6.7% of the population)
  • 16. Click to edit Master title style 1 6 Assessment • Subjective data/ collection 1. History of presenting illness/injury/chief complain a) Precipitating events b) Depressed affect and loss of interest in diversional activities and social relationship c) Fatigue and insomnia or hypersomnia d) Somatic complains (low back pain, fatigue, and headaches) e) Weight changes (i.e. loss or gain) f) Psychomotor agitation or retardation g) Difficulty in concentration h) Recurrent suicidal thoughts i) Feeling of worthlessness
  • 17. Click to edit Master title style 17 Assessment cont.… j) Increased substance abuse (alcohol, prescription drugs, or OTC drugs use) k) Situational crisis 1. postpartum depression 2. loss of significant other or support system, 3. acute health changes, 4. chronic illness resulting from perpetual strains of long-term treatment regimens 5. separation from spiritual or cultural background 6. changes in role performance, occupational status, and power base j) Occurrence during the development cycle i. Children may show hyperactivity, enuresis, or regressive behavior
  • 18. Click to edit Master title style 1 8 ii. Adolescents may present as the result of delinquency or injuries related to trauma; they may be cynical, detached, angry, hostile, disillusioned, and lonely; there may also be sexual promiscuity, acting-out behavior, alcohol and drug abuse iii. Adults, including elderly, may have symptoms similar to adolescents; they may have poor hygiene; and they may relay loss or interest in social life, decreased sexual activity and inability to concentrate. j) Toxic ingestion 2. Past medical history a) Current or preexisting disease/illness (depression including a family history of depression and illnesses necessitating prolonged and painful treatment regimens or that doesn’t have a cure) b) An injury that has caused debilitation/ chronic pain c) Medications d) Allergies e) Immunization status
  • 19. Click to edit Master title style 1 9 Objective data collection I. Physical examination which entails 1. General appearance a. Level of consciousness, behavior, affect: quiet and withdrawn demeanor, restricted affect [limited emotional expression], dysphoric mood b. Slowed gait c. Unkempt poor hygiene d. Moderate to severe distress/discomfort II. Diagnostic procedures include; i. thyroid function test ii. serum and urine toxicology screen iii. serum alcohol level iv. urinalysis; pregnancy test in female patients of childbearing age v. brain CT scan or MRI vi. ECG.
  • 20. Click to edit Master title style 2 0 Analysis: differential nursing diagnosis/collaborative problems a) Impaired verbal communication b) Ineffective coping c) Risk of injury d) Deficient knowledge e) Disturbed through processes
  • 21. Click to edit Master title style 2 1 Planning and implementation/interventions a. Maintain airway, breathing, circulation b. Provide supplemental oxygen as indicated c. Establish IV access for administration of crystalloid fluids/medications as needed d. Prepare for/assist with medical interventions 1) Institute cardiac and pulse oximetry monitoring as indicated 2) Convey attitude of acceptance 3) Encourage patient to identify feelings 4) Assist patient in recognizing causes and effects of depression 5) Place patient in safe and observable area 6) Determine whether poison ingestion has occurred and treat: gastric lavage, activated charcoal e. Administer pharmacologic therapy as ordered f. Educate patient/significant other
  • 22. Click to edit Master title style 2 2 Evaluation and ongoing monitoring a. Improvement in depression b. Hemodynamic monitoring c. Breath sounds and pulse oximetry d. Cardiac rate and rhythm
  • 23. Click to edit Master title style 2 3 EATING DISORDERS • Eating disorders are mental illnesses characterized by abnormal eating habits, which affect a person’s physical and/or mental health negatively. The actual cause of eating disorders is unknown but several factors have been associated with eating disorders which include; genetics, biological, behavioral, psychological, and social factors. • Eating disorders are among the deadliest mental illnesses only second to opioid overdose and it has a prevalence of at least 9% globally with about 9% of the U.S population developing an eating disorder in their lifetime. 88% of all eating disorder admissions are females with the admitting diagnoses including- unspecified (39%), anorexia nervosa (34%), bulimia nervosa (21%), pica (6%) and psychogenic vomiting (2%)
  • 24. Click to edit Master title style 2 4 Assessment 1. Subjective data collection a. History of presenting illness/chief complain (appetite and weight changes, exercise patterns, pain, vomiting, and diarrhea) b. Past medical history i. Current/preexisting diseases/illness (psychological disorders, and anorexia/bulimia) ii. Substance and/or alcohol use/abuse iii. Laxative and/or diet pill use iv. If a female of childbearing age ask about the last normal menstrual period date v. Current medications (prescription or OTC/herbal) vi. Allergies vii. Immunization status
  • 25. Click to edit Master title style 2 5 2. Objective data collection A. Physical examination i. General appearance: level of consciousness, possible depression, possible hypotension, tachycardia, orthostasis, and moderate to severe distress/discomfort ii. Inspection: thinness, dry and brittle hair, yellow skin, erosion of tooth enamel, and cardiac dysrhythmias on the monitor iii. Palpation/percussion: diminished deep tendon reflexes, cool and dry skin with poor skin turgor
  • 26. Click to edit Master title style 2 6 Diagnostic procedures • CBC with differential • Serum chemistries including glucose, BUN, and creatinine • ABGs (metabolic alkalosis with prolonged vomiting and metabolic acidosis with laxative abuse) • ESR • Serum and urine toxicology screen • Pregnancy test in female patients of childbearing age • Thyroid function tests • ECG
  • 27. Click to edit Master title style 27 Analysis: differential nursing diagnosis/collaborative problems a. Imbalanced nutrition: less than body requirements b. Situational/ chronic low self-esteem Planning and implementation/interventions a. Maintain airway, breathing, circulation b. Provide supplemental oxygen as indicated c. Establish IV access for administration of crystalloid fluids/medications as needed d. Prepare for/assist with medical interventions e. Administer pharmacologic (electrolyte replacement) therapy as indicated f. Educate patient/significant others the importance of a nutritionally balanced diet • Evaluation and ongoing monitoring a. Hemodynamic status b. Cardiac rate and rhythm
  • 28. Click to edit Master title style 2 8 GRIEF • Grief is the normal process of reacting to a loss (physical, social, or occupational) with death being the most significant loss type. Other losses include changes in health, body function, body parts, mental acuity, self- image, relationships, economic security, independence, material possessions, and home. In emergency care, setting it might affect patients who have survived when others have perished or by family members who must cope with the sudden loss of a loved one. Acceptance, comprehension of the loss, and the process of detaching oneself often begin in the emergency care setting. Stages of grief start with denial or isolation followed by anger, then bargaining, depression and later acceptance of the loss although not always in that order.
  • 29. Click to edit Master title style 2 9 Assessment 1. Subjective data collection A. History of presenting illness/injury/chief complain i. Identifies whether the loss is real or threatened ii. Describes attempts to resolve situations that have been successful or unsuccessful iii. Somatic complains (abdominal pains, vague symptoms similar to now- deceased family member/friend) iv. Syncope B. Past medical history i. Current or preexisting diseases/illness (cardiovascular disease, pulmonary disease) ii. Medications iii. Allergies
  • 30. Click to edit Master title style 3 0 Assessment cont.… 2. Objective data collection A. Physical examination • General appearance (level of consciousness, behavior, affect, agitation, withdrawn, tachypnea, tachycardia, and mild to moderate distress/discomfort) B. Diagnostic procedures i. Thyroid function test ii. Serum and urine toxicology screen iii. Serum alcohol level iv. ECG v. Urinalysis of a female of childbearing age for a pregnancy test Analysis: differential nursing diagnoses/collaborative problems 1. Anticipatory/dysfunctional grieving
  • 31. Click to edit Master title style 31 Planning and implementation/interventions 1. Maintain airway, breathing, and circulation 2. Provide supplemental oxygen as indicated 3. Establish IV access for administration of crystalloid fluids/medications as needed 4. Assist with medical interventions a) Institute cardiac and pulse oximetry monitoring b) Appear confident and establish trustworthy relationship c) Escort into private room d) Facilitate discussion of concerns, worries and feelings e) Provide periodic updates f) Seek assistance from health care members team g) Call other persons in social network for support h) Actively listen to responses i) Evaluate survivors coping ability and express confidence in their coping ability
  • 32. Click to edit Master title style 3 2 HOMICIDAL OR VIOLENT BEHAVIOR • Violence is an assault on a person/object with intent to harm or destroy while homicide is violence to kill another human being. Violence is the acting out of emotions of fear or anger to achieve the desired goal/s. during violence or homicide, a high level of panic might be experienced leading to loss of reasoning ability leading to the use of violence as a self-defensive mechanism to protect self or loved ones when a person feels attacked emotionally or physically. Patients could be the victim or the attacker. • Causes of violence can be secondary to psychosis, antisocial behavior, or organic diseases. • Violent behavior is becoming increasingly common in the emergency department and is imperative that personnel take measures to protect themselves and their patients from any form of harm
  • 33. Click to edit Master title style 33 Assessment 1. Subjective data collection A. History of presenting illness/injury/chief complain i. Precipitating events ii. Substance and/or alcohol use/abuse iii. Previous homicidal or violent behavior iv. Suicidal thoughts v. Child maltreatment vi. Preoccupation with sexual thoughts and fantasies vii. Childhood history of enuresis, fire setting, cruelty to an animal, fighting, and school problems B. Past medical history i. Current or preexisting diseases/illness (psychosis, organic disease e.g. temporal lobe epilepsy and head injury) ii. Medications iii. Allergies iv. Immunization status
  • 34. Click to edit Master title style 3 4 Assessment cont.… 2. Objective data collection A. Physical examination i. General examination (level of consciousness, behavior, affect, agitation, tachycardia, hypertension, moderate to severe distress) ii. Inspection (possible obvious injuries, skin color, cardiac dysrhythmias on monitor) iii. Palpation (skin diaphoretic) B. Diagnostic procedures i. CBC with differential ii. Serum chemistries iii. Serum and urine toxicology screen iv. serum alcohol level v. ECG
  • 35. Click to edit Master title style 35 Analysis: differential nursing diagnoses/collaborative problems i. Ineffective coping ii. Disturbed thought processes iii. The risk for self-directed or other-directed violence iv. Risk for injury v. Anxiety/fear Planning and implementation/interventions i. Maintain airway, breathing, and circulation ii. Provide supplemental oxygen iii. Establish IV access for administration of crystalloid fluids/medications as needed iv. Prepare for/assist with medical interventions
  • 36. Click to edit Master title style 3 6 INEFFECTIVE COPING AND SITUATIONAL CRISIS • Ineffective coping occurs when an individual is unable to solve problems and deal with internal or external stressors where the events may be unexpected or anticipated situations with unanticipated consequences. A situational crisis begins after a period of shock with a heightened emotional response followed by an inability to function. The situational crises may give rise to behaviors that include alcohol intake, drug abuse, and suicidal, homicidal, or criminal behavior. Assessment 1. Subjective data collection A. History of presenting illness/injury/chief complaint i. Precipitating event or change in the previous level of functioning ii. Recent loss or change of body appearance iii. Persistent/sudden/recent stressor (new employment, new geographical location, frequent illness/accidents or demands of school/job/family) iv. Maturational crisis of patient or family member v. Ingestion of substance to alter the mood vi. Reliance on ineffective or inappropriate coping strategies vii. Natural disaster
  • 37. Click to edit Master title style 37 Assessment cont.… B. Past medical history i. Current or preexisting diseases/illness (pulmonary disease, diabetes, or cardiovascular disease) ii. Substance or alcohol abuse iii. Medications iv. Allergies v. Immunization status Objective data collection A. Physical examination i. General appearance (level of consciousness, behavior, affect, agitation, tremors, tenseness, altered affect, altered thought process, hygiene, and moderate to severe distress) ii. Inspection ( tremors, diminished impulse control, and evidence of physical violence or self-destructive behavior)
  • 38. Click to edit Master title style 3 8 B. Diagnostic procedures ( CBC with differentials, serum chemistries, serum and urine toxicology screen) Analysis: differential nursing diagnoses/collaborative problems i. Ineffective individual or family coping ii. Situational low self-esteem iii. Disturbed thought process iv. Dysfunctional grieving v. Anxiety/fear vi. Ineffective health maintenance Planning and implementation/interventions i. Maintain airway, breathing, and circulation ii. Provide supplemental oxygen as indicated iii. Establish IV access for administration of crystalloid fluids/medications as indicated iv. Prepare for/assist with medical interventions a. Institute cardiac and pulse oximetry monitoring b. Assist patient to identify precipitating event
  • 39. Click to edit Master title style 3 9 c. Assist patient to identify measures to resolve problem with usual method of coping d. Help patient to define and clarify realistic options e. Structure priorities for problem-solving interventions f. Provide time and opportunity for communication and support the patient in seeking assistance in the emergency department g. If thought processes are disturbed, protect patient from harm v. Administer pharmacologic therapy as ordered vi. Educate patient/significant others Evaluation and ongoing monitoring i. Decreased agitation, tenseness ii. Hemodynamic state iii. Breath sounds and pulse oximetry iv. Cardiac rate and rhythm
  • 40. Click to edit Master title style 4 0 H. PSYCHOTIC, OR BRIEF PSYCHOTIC, BEHAVIOR Psychotic behavior results from a pathologic process that is acute or chronic with distorted perceptions, disorganized thinking, impaired judgment, impaired decision-making, and regression. Manifestation occurs in the areas of effect, behavior, perception, and thinking. Behaviors exhibited may include acting-out, impulsiveness, and psychomotor retardation, or agitation. Other psychotic behavior changes include changes in perception such as illusions, hallucinations, and depersonalization. Impaired thinking manifests with delusions, loose association, and incoherence. Psychoses can be functional or organic with the functional types include schizophrenia, mania, psychotic depression, and brief reactive psychosis. Organic psychoses include dementia, delirium, and toxic drug-induced psychosis.
  • 41. Click to edit Master title style 4 1 Assessment • Subjective data collection 1. History of present illness/injury/chief complain i. Schizophrenia: familial history and onset before age 45 years (bizarre behavior, delusions, auditory hallucinations, and paranoia) ii. Mania ( previous episodes, decreased need for sleep, increased physical ability, paranoia may be present, impulsive and flamboyant behavior, euphoria and unrealistic plans or thoughts) iii. Psychotic depression (loss of energy and pleasure, possible command hallucinations, agitation, lack of communication with others, psychomotor retardation, decreased ability or desire to care for self) iv. Delirium (organic disorders must be ruled out) v. Dementia
  • 42. Click to edit Master title style 4 2 Assessment cont.…. 2. Past medical history i. Current or preexisting diseases/illness (known psychiatric disorder) ii. Substance and/or alcohol use/abuse iii. Medications iv. Allergies v. Immunization status Objective data collection A. Physical examination i. General appearance (level of consciousness, behavior, affect, presence of hallucinations, possible tachycardia, hypertension, tachypnea, and severe distress/discomfort) ii. Inspection
  • 43. Click to edit Master title style 4 3 Assessment cont.…. Diagnostic procedures i. CBC with differential ii. Serum chemistries including glucose, BUN, and creatinine iii. Serum and urine toxicology screen iv. Urinalysis: leukocytes present if infection, pregnancy test in female patients of childbearing age v. Thyroid function tests vi. Venereal Disease Research Laboratories (VDRL) or rapid plasma regain (RPR) test vii. ABGs viii. Stool for occult blood ix. Lumbar puncture: cerebral spinal fluid analysis x. ECG xi. Head CT scan
  • 44. Click to edit Master title style 4 4 Analysis: differential nursing diagnoses/collaborative problems i. Disturbed sensory perception: visual or auditory ii. Impaired verbal communication iii. Risk for injury iv. Ineffective coping Planning and implementation/interventions i. Maintain airway ii. Provide supplemental oxygen as indicated iii. Establish IV access for administration of crystalloid fluids/medications as needed iv. Prepare for/assist with medical interventions; a. Maintain airway, breathing and circulation. b. Orient patient to reality (time, place, person) c. Provide safety per institution policy d. Orient patient with respect to hallucinations or delusion
  • 45. Click to edit Master title style 4 5 e. Provide atmosphere for open and objective communication f. Treat injuries sustained due to psychotic behaviors g. Calm the patient h. Work with healthcare team to make appropriate disposition to protective environment. v. Administer pharmacologic therapy as prescribed vi. Educate patient/significant other Evaluation and ongoing monitoring i. Decrease in hallucinations ii. Hemodynamic status iii. Breath sounds and pulse oximetry iv. Cardiac rate and rhythm
  • 46. Click to edit Master title style 4 6 SUICIDE OR SUICIDAL BEHAVIOR Suicidal behavior includes acts of self-harm, suicidal ideation or intention, attempted suicide, and thoughts or behaviors that indicate a risk of suicide. Suicide is the tenth leading cause of death in the U.S and suicide attempts are responsible for a significant number of mental health-related emergency department admission. The highest number of suicides are committed among the following age groups; 45-64 years, 85 years and over, and 15- 24 years. Females have the largest suicide percentage with 92% and men 8% whereas the ratio of men to women persons who die due to suicide is 4:1. Patients who come to the emergency department may require immediate intervention for life-threatening situations, depending on methods used to self-harm with the patients exhibiting suicidal behavior frequently experiencing depression and/or anxiety.
  • 47. Click to edit Master title style 47 Assessment 1. Suicide screening tools are used as part of the assessment process for emergency department patients who present with behavioral health complaints or disorders. 2. Subjective data collection A. History of presenting illness/injury/chief complain i. Precipitating factors ii. Family history of suicide attempt or succeeding in suicide iii. Newly diagnosed disease with body changes iv. Substance and/or alcohol use/abuse v. Signs of depression vi. Prior psychiatric history vii. Previous suicide attempts viii. Presence of impulsive, violent temperament
  • 48. Click to edit Master title style 4 8 Assessment cont.… B. Past medical history i. Current or preexisting disease/illness ii. Substance use/abuse iii. Medication iv. Allergies v. Immunization status 3. Objective data collection i. Physical examination (general appearance, inspection, and palpation/percussion) ii. Diagnostic procedures (serum and urine toxicology screen, serum alcohol level, ECG, cerebrospinal fluid 5-hydroxy indole acetic acid, urinalysis; pregnancy test in a female patient of childbearing age)
  • 49. Click to edit Master title style 4 9 Analysis: differential nursing diagnoses/collaborative problems i. Ineffective coping ii. The risk for violence: self-directed iii. Disturbed thought process Planning and implementation/interventions i. Maintain airway, breathing, and circulation ii. Provide supplemental oxygen as an indication iii. Establish IV access for administration of crystalloid fluids/blood products/medications as needed iv. Prepare for/assist with medical interventions v. Administer pharmacologic therapy as ordered vi. Educate patient/significant others
  • 50. Click to edit Master title style 5 0 Expected outcomes/evaluation a. Level of consciousness b. Hemodynamic status c. Breath sounds and pulse oximetry d. Cardiac rate and rhythm
  • 51. Click to edit Master title style 51 References • Emergency Nurses Association. (2019). Sheehy's Emergency Nursing-E-Book: Principles and Practice. Elsevier Health Sciences.
  • 52. Click to edit Master title style 5 2
  • 53. Click to edit Master title style 53 •Thank you