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36 Cards in this Set
- Front
- Back
Identify the sequence of questions that will help you develop a decision strategy for psychiatric assessment of a patient with behavior disorders
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Is pt stable/unstable? Does pt have serious med condition causing behavior? If not result underlying med cond, is it psychiatric or functional? What is dx & severity? Is psych consult necessary? When should pt be forcibly detained for emergency evaluation?
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Discuss your approach and possible use of physical restraints with the following: Violent behavior
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demands immediate restraint. Hospital security forces and police are best equipped and trained to subdue violent pts with least chance of staff or patient injury
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PSYCH EM
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PSYCH EM
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When should a pt be restained
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Patients displaying violent behavior or threatening violent behavior
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How would you approach patients displaying violent behavior or threatening violent behavior
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restrain, remove potential weapons like belts etc., approached cautiously with nonthreatening attitude & adequate security nearby,
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How do you approach the patient expressing suicidal ideation
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remove dangerous objects, supervision, not allowed to leave ED before medical or psychiatric evaluation
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How should you approach Restraint and Seclusion of a pt
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limit use of restraints or seclusion to situations where less restrictive interventions have failed and clinical appropriateness is clearly justified
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Define restraint
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any device including manual holds that is attached or adjacent to pt's body that cannot be removed easily and restricts freedom of movement or normal access to one's body
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Define seclusion
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involuntary confinement of a person in a room or area so that the person is physically prevented from leaving
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Who can order restraints
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only licensed independent practitioners (LIPs) can order. However often LIP is not present when need is determined. Trained caregivers may institute restraint but LIP must perform face-to-face eval within 1 h of restraint use
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What are the restriction or time limits when using restraints
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1 h for children younger than age 9, 2 h for individuals aged 9 to 17 years, and 4 h for individuals aged 18 and older.
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How often should a pt be evaluated while in restraints or seclusion
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continuous monitoring is required. Those in restraints require evaluation every 15 min to check for signs of injury
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Are soft restraints Kosher for the truly violent pt
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Soft restraints should never be used on a truly violent patient
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What's the rule about handcuffs
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if pt is brought to ED in handcuffs, they should remain in handcuffs until threat of violence and medical condition are assessed
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Identify possible life-threatening medical conditions that may present as a psychiatric disorder
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meds, drugs, etoh, hypoglyc., CNS, psychosocial, cardiac
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Discuss the incidence of domestic violence to women
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5 million visits yr to ED do to IPVA. 4-15% women seen because of sx related to IPVA, with 2-4% presenting acute IPVA. 50%+ of women seen in EDs have experienced IPVA some time in their lives
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What you can do to help the battered patient
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recognize, validate, assess, refer, document
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Identify the two classes of drugs that are the most useful in the emergency setting when managing psychiatric behavior disorders
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Antipsychotic and anxiolytic
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List the behavioral features that are targeted for rapid tranquilization of a patient.
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Used to control agitated or psychotic behavior that constitutes and imminent danger to the pt or others
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Identify the class of drugs preferred for the treatment of agitation due to cocaine intoxictaion or alcohol withdrawal.
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Anxiolytics such as benzodiazepines or lorazepam
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List the three predictors of violence when evaluating a patient
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Past hx of violent behavior, organic or functional cause
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Identify two diseases that are most likely involved in a patient with violent behavior
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hypoglycemia, drug / alcohol abuse or withdrawal.
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List five ancillary tests that should be considered in the evaluation of the violent patient and what you are looking for with each of them.
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labs, toxicology screening, electrocardiograms, CT and LP
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List the three phases in the prodrome of violence,
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anxiety, defensiveness, physical agression
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Be familiar with the indications and guidelines in the use of physical restraints.
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When pt has potential to harm themselves or others or who will compromise their medical care
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Know what needs to be reflected in the medical chart when physically restraining a violent patient.
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Written order with type restraint, reason, time limit. Limit 1h for children <9. 2H ages 9-17, 4h for 18+. Must have continuous monitoring, require eval every 15 minutes
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Describe the single best way to handle a violent patient or curtail potential violence in the ED
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Recognizing prodromes of violence and phases of escalation and dealing with each one appropriately
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Describe important components of the mental status examination that should be utilized in the emergency department
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distinguish functional from organic disorders. components include LOC, spontaneous speech, behavioral observation, physical appearance, relaying info, attention, language comp
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Give examples of how these components can be assessed.
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ask: PPTE, recent memory (name 3 object 5 min. later) remote mem (hx ?'s) mental calculation, focal neurologic deficits
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Idnetify risk factor catagories for suicide
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marital status, job status, relationships, fam hx, health - physical, mental, suicidal ideations / attempts,
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Discuss the use of drug overdose as a means of attempting suicide.
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majority of all contemporary suicide attempts, tend to parallel prevailing rx patterns,
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Discuss the relative risk of violent means for attempting suicide
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considered serious and a high-risk factor for future attempts
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Explain what is meant by "secondary gain" as related to suicide attempts
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attempt to meet another need other than death such as attention, or plea for emotional help.
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Describe the typical adolescent who commits suicide
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hx of substance abuse, disruptive disorders, anxiety, mood disorder, schizophrenia, gender ID concerns
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Explain how to use a "no harm contract"
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verbal or written agreement in which suicidal pt is asked to agree not to harm or kill themself for a period of time.
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describe the general rule in determining suicide risk as it pertains to men and women
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men are 2-3x's more likely to complete suicide where women are 2-3x's more likely to attempt suicide
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