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Chap 23 Psychiatric
| Question | Answer |
|---|---|
| Behavior | How a person functions or acts in response to his or her environment |
| Adjustment | People learn to adapt to a variety of situations in daily life |
| Behavioral crisis | The point at which a persons reactions to events interfere with activities of daily living: this becomes a psychiatric emergency |
| Mental health problem | If interruption of daily routine tends to recur on a regular basis Abnormal or disturbing pattern of behavior lasting for at least a month |
| Psychiatric emergency | An emergency in which abnormal behavior threatens a persons own health and safety or the health and safety of another person Example: When a person becomes agitated, violent, suicidal, homicidal or has a psychotic episode |
| Psychiatric disorder | Illness with psychological or behavioral symptoms and or impaired in functioning caused by social, psychological, genetic, physical, chemical or biologic disturbance |
| Two basic categories of diagnosis | Organic (physical) Functional (psychological) |
| Organic Brain Syndrome (OBS) | Temporary or permanent dysfunction of the brain caused by disturbance in the physical or physiologic functioning of the brain tissue |
| Causes of organic brain syndrome | Sudden (acute) illness, recent head trauma, seizure disorders, drug and alcohol intoxication, overdose or withdrawal, brain diseases, meningitis |
| Causes of Altered Mental Status | Low blood glucose, lack of oxygen, inadequate blood flow to the brain, excessive heat or cold |
| Functional Disorder | A disorder in which there is no known physiologic reason for the abnormal functioning of an organ or organ system (example: anxiety, depression, schizophrenia) |
| Safety guidelines for a behavioral crisis 1/2 | Assess the scene Spend extra time Have a plan of action Identify yourself calmly Be direct Stay with the patient |
| Safety guidelines for a behavioral crisis 2/2 | Encourage purposeful movement Express interest in the patient's story (do not play along with auditory/visual disturbances) Do not get too close Avoid fighting with the patient Be honest and reassuring Do not judge |
| Psychogenic Circumstances | Death of a loved one, severe depression, history of mental illness, threats of suicide |
| Reasons for behavioral state? | Central Nervous System (CNS) problems, hypoglycemia, hallucinogen drugs and psychogenic circumstances |
| Psychosis | A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality |
| Causes of Psychotic Episodes | Mind altering substances, intense stress, delusional disorders, schizophrenia |
| Schizophrenia symptoms | Delusions, hallucinations, lack of interest in pleasure, erratic speech |
| Risk factors for suicide 1/2 | Depression Previous suicide attempt Current expression of wanting to commit suicide Family history Older than 40 Recent loss |
| Risk factors for suicide 2/2 | Chronic illness Feeling anxious, agitated, angry, reckless or aggressive Financial setback, social embarrassment Substance abuse Children of alcoholic or abusive parent Withdrawal |
| Agitated Delirium | Condition of disorientation, confusion, and possible hallucinations coupled with purposeless, restless physical activity |
| Symptoms of Agitated Delirium | Paranoia Disorientation Dissociation Hyper-aggression Tachycardia Hallucination Diaphoresis Incoherent speech or shouting |
| When to involve law enforcement? | If you are called to assist a patient in a severe behavioral crisis or psychiatric emergency |
| Assessing level of danger with a violent patient | History of violent behavior Posture, standing, tense, rigid Scene, lethal objects Vocal activity, loud, obscene, erratic speech patterns Physical activity, tense muscles, clenched fists, glaring eyes, pacing |
| Activities of Daily Living | The basic activities a person usually accomplishes during a normal day, such as eating dressing and bathing |
| Altered Mental Status | A change in the way a person thinks and behaves that may signal disease in the central nervous system or elsewhere in the body |
| Depression | A persistent mood of sadness, despair, and discouragement May be a symptom of many different mental and physical disorders, or it may be a disorder on its own |
| Excited Delirium | A serious behavioral condition in which a person exhibits agitated behavior combined with disorientation, hallucinations, or delusions Also called Agitated Delirium or Exhaustive Mania |
| Positional Asphyxia | Restriction of chest wall movements and or airway obstruction Can rapidly lead to sudden death |
| Posttraumatic Stress Disorder (PTSD) | A delayed stress reaction that develops after a horrifying ordeal that involved physical harm or the threat of physical harm |
| Schizophrenia | A complex, difficult-to-identify, mental disorder whose onset typically occurs during early adulthood symptoms typically become more prominent over time and include delusions, hallucinations, a lack of interest in pleasure and erratic speech |
| Which of the following is a normal reaction to a crisis situation? | Feeling blue after the break up of a long-term relationship |
| T or F Most people with a mental illness are dangers | False |
| If an abnormal or disturbing pattern of behavior lasts for at least ________ it is regarded as a matter of concern from a mental health standpoint | 1 month |
| An altered mental status may arise from? | Inadequate blood flow to the brain |
| Agitation | A behavior that is characterized by restlessness and irregular physical activity |
| You should request the assistance of a ____________when a mentally impaired patient refuses to go to the hospital | Law enforcement officer |
| When restraining a patient without an appropriate order, legal actions may involve charges of? | Battery |
| When restraining a patient on a stretcher, it is necessary to constantly reassess the patients ______ | Respiration and Circulation status |
| Urinary Tract Infections can cause behavioral changes in? | Elderly patients |
| Chronic Depression | A persistent feeling of sadness or despair May be a symptom of mental or physical disorder |
| Any time you encounter an emotionally depressed patient you must consider the possibility of? | Suicide |
| When a patient is not mentally competent to grant consent the law assumes that there is? | Implied consent |
| Dissociative PTSD | This occurs when the person attempts to find an escape from constant internal distress or a particularly disturbing event |
| What are the 3 major areas you should consider in evaluating the possible source of a behavioral crisis? | Improper functioning of the CNS Hallucinogens / drugs or alcohol Significant life changes, symptoms, or illness caused by a mental disorder |
| Reflective listening | A technique used by mental health processionals to gain insight into a patients thinking It involves repeating, in question form, what the patient has said, encouraging the patient to expand on their thoughts. |
| 5 factors to consider when dealing with a potentially violent patient? | History Posture The scene Vocal activity Physical activity |
| How should you proceed to a call of a neighbor "acting bizarre"? | This is a broad description. Assume the patient is a danger for your own and their own safety. Do not enter the scene until police have deemed it safe. Stage 1-2 blocks away, then approach after given the clear. |
| Other than an underlying behavioral health condition, what other conditions can affect a person's behavior? | A multitude of factors can affect a person's behavior: Hypoxemia (low blood oxygen) Hypoglycemia (low blood sugar) Metabolic disorders Drug/Alcohol related Stress Head Trauma/Brain Tumors |
| What should your IMMEDIATE concern be for a patient that presents: "Acting bizarre" Sad, withdrawn Conscious/alert Normal/strong/deep respirations Normal pulse, skin pink/moist | Personal safety when dealing with any patient, especially ones displaying abnormal/bizarre behavior. This patient always has the potential to become violent. Be cautious Be patient Be alert |
| How should you proceed with your assessment? "Acting bizarre" because of life stress. Wife died, job on the line, no one listens | Patient states "I have a lot of problems, but no one listens to me." An important tool to use is: Listening. Listen to the patient as it may give clues to the underlying cause of his behavior. Be reassuring and empathetic |
| What is your field impression for a patient that presents: "Acting bizarre" because of life stress. Wife died, job on the line R: 16 per min adequate P: 88bpm, strong/reg BP: 144/84 O2: 98% room air | Field impression is based on Physical assessment Medical history Chief complaint Patient lost his wife, motivation, job is threatened. He's experiencing an Acute Emotional Crisis |
| What care can you provide to a patient that presents: "Acting bizarre" because of life stress. Wife died, job on the line R: 16 per min adequate P: 88bpm, strong/reg BP: 144/84 O2: 98% room air | Patient should not be left alone Being severely depressed puts them at high-risk of suicide Provide emotional support and active listening until you can be relieved. |
| Should you perform a physical assessment despite the patient saying no? | Although severely depressed, they are still conscious and alert and not displaying psychotic behavior (eg, hallucinations). He has the legal right to refuse. |
| What factors should you consider before transporting a patient with a behavioral health emergency? | Patient is currently calm, but could become violent. If the patient needs transport, ask law enforcement to ride with you. |
| If the patient does not answer your questions should you continue to encourage them to talk? | If the patient wants to talk, encourage them. If they do not, do not force them to do so. Stay alert, be patient/empathetic, monitor vitals. |
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cmoney833
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