Psychiatric Emergencies.pptx

Psychiatry

1. PSYCHIATRIC EMERGENCIES NSG 411

2. INTRODUCTION Acute form of alteration in behaviour, emotion or thought requires immediate intervention to safeguard the life of patient by bringing down the behavioural manifestation of and promoting emotional security to the client and others in the environment. Psychiatric emergencies occur in many different situations and settings; acute/stabilized unit, clinical/non-clinical settings, medical/surgical units, in/out patient centres etc.

3. DEFINITION A condition in which the client will have disturbances in thoughts, affect and psychomotor activity that leads to threat either to himself or his existence. It is a stress induced pathological response, which physically endangers the affected individual, disrupts the functional equilibrium of the individual and his environment .

4. OBJECTIVES To safeguard the life of patient To promote emotional security of client and the family members To reduce anxiety To educate the client and his family members the ways of dealing with emergency situation by utilizing adaptive coping strategies and appropriate problem solving.

5. TYPES PSYCHIATRIC EMERGENCIES Suicide & Homicide Aggression & Violence Catatonia Neuroleptic Malignant Syndrome (NMS) Overdose of Alcohol or Drug Abuse Panic Attack Severe Depression . Alcohol Related Emergencies ( seizures , withdrawal , intoxication, amnesia , etc )

6. CLASSICATION This can be discussed from two different perspective Classifications base on severity, they are; Major psychiatric emergencies Minor psychiatric emergencies Classifications base on nature and origin Organic psychiatric emergencies Inorganic Psychiatric Emergencies

7. MAJOR PSYCHIATRIC EMERGENCIES Suicide Aggression and Violent

8. MINOR PSYCHIATRIC EMERGENCIES Grief Reaction Rape Disaster Panic Attack

9. ORGANIC PSYCHIATRIC EMERGENCIES Seizures disorder Status epilepticus Delirium tremens Alcoholic Intoxication Paranoid schizophrenia Thyrotoxicosis Post-Partum Psychosis P riapism (Trazodone [ Desryrel ]-Induced) Hypertensive Crisis (following ingestion of tyramine -containing foods in patients using MAOIs)

10. INORGANIC PSYCHIATRIC EMERGENCIES Origin most of the time are external to the patient and may not involve damage or malfunction of the nervous system. Panic attack Aggression and Violent Behaviour Rape, Incest and Sexual Abuse of child. Suicidal or Homicidal Thought Agoraphobia

11. MEDICAL EMERGENCIES IN PSYCHIATRIC NURSING Delirium due to life threatening conditions Neuroleptic Malignant Syndrome Serotonin Syndrome Over dosages of common psychiatric medications Over dosages and withdrawal from addictive substances

12. SUICIDE Etymology . Latin origins: (sui) self- ( cide ) death. Eighth leading cause of death in men. (Higher than homicide .) Third leading cause of death in adolescents (15 to 24 yr. of age). 55 % of successful suicides employ a firearm. Men succeed more often than women, but women attempt more frequently than men. Very d ifficult to p redict

13. SUICIDE CONT.. Suicide can in any of the following forms; Suicide Attempt: A deliberate action that if carried to completion will result to death if not interrupted. Suicide Gesture: A suicide attempt that is planned to be discovered in an attempt to influence the behaviour of others. Suicide Threat: A warning, direct or indirect verbal or non-verbal, that the person plans to attempt suicide. Complete Suicide: This is suicide that take place after warning signs have been missed or ignored.

14. TYPES Referred Suicide: This type is committed by individuals who withdraw from society. Common in fearful individual, helpless, lonely and having difficulty to form relationship with others. Cultural Suicide: Is called heroic death when individual commit suicide to become hero. Surcease Suicide: This happen in people that have certain illness or chronic pain who commit the suicide to put an end to the suffering. Psychotic Suicide: This is committed as a result of hallucination and delusion experienced by the psychiatric patients

15. PREDISPOSING FACTORS: SUICIDE Hereditary / family history Neurological disturbances History of physical and sexual abuse Low income or Unemployment Mental illness e.g. manic-depression, schizophrenia, neuroses Personal history of suicidal thought .

16. History of Alcoholism & Drug Abuse. Sever physical illness in the elderly e.g. Ca. Recent bereavement, separation, loss. Previous Suicidal Attempts. Personality problems i.e. Cyclothymic, Antisocial. Poor social support, living alone, unemployed, single. Other symptoms: Agitation, Insomnia, Guilt, Male, Older age, Divorced , Suicidal threats. PREDISPOSING FACTORS: SUICIDE

17. SUICIDE: SIGNS AND SYMPTOMS Warning Signs include: Persons making will Getting his or her affairs in order Suddenly visiting friends or family members Buying instruments of suicide like a gun, hoes, rope, pills or other forms of medications A decline or dramatic improvement in mood or writing a suicide note. Verbal expression e.g. “life is meaningless” “is better I die”

18. WAYS OF COMMITTING SUICIDE Taking of poison such as drug complication. Falling from height Shooting oneself Hanging Electrocution Cutting of throat Drowning Jumping from a moving vehicle

19. GENERAL MANAGEMENT Management of the client is carried out with the following main guidelines; Assessment Intervention Nursing management

20. NURSING ASSESSMENT Family health history and status Communication pattern within the family Psychological status of the patient History of substance abuse, choice of vocation Religious orientation Comfortable level with decision making about long range goals Degree of anxiety, depression and sleep disturbance Patients perception of present health problem or crisis Sexual dysfunction

21. NURSING DIAGNOSIS R isk for self-directed violence related to feelings of desperation Ineffective individual coping strategies Helplessness related to absence of support systems and perception of worthlessness Marked depression related to guilt feeling ,dejection ,self-occlusion Disturbed sleep pattern Impaired communication Low self-esteem Decreased interest in personal, social, inter-personal, spiritual, financial activities Imbalance nutrition intake and physical appearance

22. PLANNING Develop a nursing care plan on identified problems. Contact helping hands for active management T riage and approach each case base on severity. A ssemble the equipment needed The vocal person/team leader should maintain calmness when communicating with the client. Explain the roles and involvement of family members to them in a clear term and language

23. IMPLEMENTATION Create a safe and therapeutic environment Remove all dangerous objects from the patient’s environment Open and utilize a suicidal caution care Staff member should make frequent short contacts with the patient to reassure the patient without stiffing independence Limit the number of staff members interacting with the patient to provide continuity of care and increase the patient’s sense of security etc. Spend time with the patient during each shift to establish a trusting relationship

24. AGGRESSION AND VIOLENT BEHAVIOURS: PREDISPOSING FACTORS Instinctual origin Interference with or blockage of a goal Negative emotions leading to irrational behaviour Competitive and success-oriented society inequalities in relationship Reducing impulse due to psychiatric condition e.g. bipolar disorder Temporal lobe epilepsy Psychoactive substance abuse

25. SIGNS AND SYMPTOMS Warning Signs include: Increase pulse, respiration and blood pressure. Increase in muscle tone Change in body posture, clenched fists Changes in eyes, e.g. eye brows lower or eyelids tense Lips pressed together. Twitching Sweating

26. ASSESSMENT History or evidence of aggression and violence Evidence of central nervous system (CNS) lesion or dysfunction History of substance abuse Disturbance in thought process as in the cases of major depressive episode, bipolar disorder, post traumatic stress disorder and schizophrenia Delusion Sensory impairment

27. PLANNING AND IMPLEMENTATION Implementation of the care plan require a limited time and quick decision making process to prevent the situation from moving beyond control. Development of a nursing care plan on identified problems should be considered to guide execution of the plan. Individual victim should be treated with understanding & gentleness as possible: Adequate security. Raise of alarm. Availability of more staff. C lear prevention policy to all. Remain calm, non-critical. Use minimum force with adequate numbers of staff.

28. Talk pt. down. Physical restrain when necessary. Medication: T ypical :- Major Tranquilizer . Chlorpromazine 50-100mg im . Droperidol 10-20mg im or iv. . Clopixol Aquaphase 50-100mg im Atypical: Risperidone 4mg Or Zyprexia 10mg im . Others: Diazepam 5-20mg depending on the severity MEDICAL MANAGEMENT CONT..

29. Establish basic trust and rapport with patient Use calm reassuring approach Admission into an open ward close to nurses’ station Remove potential weapons from environment Determine appropriate behavioural expectations for expression of anger Search patient and belonging for weapons Detailed assessment/history taking Limit access to frustrating situation until patient is able to express anger in an adaptive manner IMPLEMENTATION

30. IMPLEMENTATION Monitor potential for inappropriate aggression and intervene to prevent patient from losing control Avoid sedation Open and utilize a Caution Card (HCC) especially for those with homicidal tendency Unobtrusive observation Encourage patient to seek assistance of nursing staff or responsible others during period of increased tension Ensure that patient takes his drugs and record accordingly

31. EVALUATION Evaluation should focus on; The level of recovery Presence or absence of residual symptoms I nterest in rehabilitation plan Presence or absence of causative factors in the home front. Discuss any appearances of such with family members and possible solution Level of understanding of the family and readiness for acceptance. If there is legal implication, refer to the social worker.

32. THANKS FOR LISTENING!!!