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Flashcards in Psychiatric Emergencies Deck (96)
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1

Factors Associated with Violence

Male
History of violence
Drug or ETOH abuse

2

Signs of Impending Violence

Provocative behavior
Angry demeanor
Loud, aggressive speech
Tense posturing
Frequently changing body position
Aggressive acts

3

Management of Potentially Violent Patients

Remove patient from contact with other patients
Expedite evaluation

4

Verbal Techniques for Angry Patients

Address violence directly
Set limits
Do not be provocative
Be honest and straightforward
Calm and soothing tone of voice
Concise, simple language
Offer choices and optimism
Stand at least 1 arms length away
Identify feelings and desires
Take all threats seriously
Protect yourself

5

Indications for Physical Restraints

Imminent harm to others
Imminent harm to self
Significant disruption of important treatment or damage to environment
Continuation of effective, ongoing behavior treatment plan

6

Use of Physical Restraints

Follow protocol
5 person restraint team
1 must be female
Monitor closely: position changes, respirations, avoid aspiration
DOCUMENT

7

3 Classes of Medications for Chemical Restraints

Benzodiazepines
1st generation antipsychotics
2nd generation antipsychotics

8

What class of medication is preferred when sedating patients with an unknown cause of agitation?

Benzodiazepines

9

Benzodiazepines Used in Chemical Restraint

Lorazepam
Midazolam

10

SE of Benzodiazepines

Respiratory depression

11

1st Generation Antipsychotic Agents

Haloperidol
Droperidol

12

SE of First Generation Antipsychotics

QT prolongation
Potential for causing dysrhythmias

13

When should 1st generation antipsychotics be avoided?

Alcohol withdrawal
Benzodiazepine withdrawal
Other withdrawal symptoms
Anticholinergic toxicity
Patients with seizures
Pregnant/lactating females

14

Second Generation Antipsychotic Agents

Olanzapine (Zyprexa)
Rispiradone (Risperdal)
Ziprasidone (Geodon)

15

Benefits of 2nd Generation Antipsychotics

Less sedation
Fewer extrapyramidal SE

16

Downside of 2nd Generation Antipsychotics

Less experience

17

When should a 1st or 2nd generation antipsychotic be used in violent patients?

Agitated patients with a known psychiatric disorder

18

Legal Considerations for Restraining Patients

Coworker agree with assessment and treatment
Reasons for restraint clearly documented
Duty to Warn

19

Post-Restraint Medical Evaluation

Complete set of vitals
Mental status and neuro exams
Blood glucose
R/O acute medical condition

20

Presentation of AIDS Encephalopathy

Change in mental status
Abnormal neurologic exam

21

Most Common Etiologies of AIDS Encephalopathy

Toxoplasmosis encephalitis
Primary CNS lymphoma
Progressive multifocal leukoencephalopathy
HIV encephalopathy
CMV encephalopathy

22

CD4 Count 500+ with CNS Lesions

Benign and malignant brain tumors
Metastases

23

CD4 Count 200-500 with CNS Lesions

HIV associated cognitive and motor disorders
Usually not focal lesions

24

CD4 Count Less than 200 with CNS Lesions

Opportunistic infections
AIDS-associated tumors

25

Define Psychosis

Disturbance in the perception of reality, evidenced by hallucinations, delusions, or thought disorganization

26

What disorders does psychosis occur?

Schizophrenia
Bipolar mania
Major depression with psychotic features
Schizoaffective disorder
Alzheimer's disease
Delirium
Substance induced psychotic disorder
Delusional disorder
Psychosis secondary to a medical condition

27

Evaluation in Psychosis

Mini-mental
Observation of patient in general
Vitals
PE
Chem panel
CBC
Thyroid functions
UA
Drug screen

28

Adverse Effects of Cocaine Use

Anxiety
Irritability
Panic attacks
Suspiciousness
Paranoia
Grandiosity
Impaired judgement
Delusions
Hallucinations

29

Physical Symptoms of Cocaine Use

Tachycardia
HTN
Hyperthermic
Diaphoretic
Dilated pupils
Hyper-reflexia
Resting tremor

30

Withdrawal Symptoms of Cocaine

Depression
Anxiety
Fatigue
Difficulty concentrating
Craving cocaine
Increased sleep
Increased appetite
Arthralgias
Tremor
Chills