Transcript Behavioral Emergencies

Chapter 24
Behavioral Problem
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 Situation in which a person exhibits “abnormal” behavior
 Behavior that is unacceptable or intolerable to the patient,
family, or community
 Patients may exhibit
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Anxiety
Panic
Agitation
Bizarre thinking & actions
Can pose a danger to themselves through suicidal or selfinjurious acts, or to others through violent acts or actions
whose consequences they may be incapable of
understanding
Behavioral Change
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 Common reasons why behavior changes
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Low blood sugar
Hypoxia
Inadequate blood flow to the brain
Head trauma
Mind altering substances
Psychogenic substances
Excessive cold or heat
Infections of the brain or its coverings
Seizure disorder
Toxic ingestion
Drug or alcohol overdose
Assessment
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 Make sure it is a behavior not a physical emergency
 Pay Attention to:
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General appearance
Speech
Skin
Posture or gain
Orientation
Memory
Awareness
Body language
Perception
Mood
Judgment
How to tell
physical/behavior
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 Onset of symptoms relatively sudden or has been
developing over time
 Hallucinations are visual not auditory
 Memory loss or impairment in most behavior
problems
 Pupils are dilated, constricted, or unequal
 Excessive salivation
 Incontinent
 Unusual odors on breath
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Anxiety
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State of painful uneasiness about impending problems
Characterized by agitation & restlessness
Most common emotion
Panic Attack
 Show intense fear, tension or restlessness
 Hyperventilate
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Dizziness
Tingling around mouth & fingers
Spasms of hands & feet (carpel pedal spasms)
Tremors
Irregular heartbeat
Palpitations
Diarrhea
Feeling of choking
Phobias
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 Closely related to anxiety
 Irrational fears of things, places, or situations
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Tense & restless
Wring their hands & pace
Tremors
Tachycardia
Irregular heartbeat
Dyspnea
Sweating
Diarrhea
Depression
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 Most common
psychiatric condition
 Characterized by:
 Deep feelings of
sadness,
worthlessness, &
discouragement
 Factor in 50% of
suicides
 May cause other psychological
disorders
Sad appearance
Crying spells
Listless
Apathetic
Helpless
Hopeless
Withdrawn
Pessimistic
Appetite loss
Sleeplessness
Fatigue
Despondence
Severe restlessness
“No one understands”
“problems can’t be solved”
 Want to be left alone
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Bipolar Disorder
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 Manic depressive disorder
 Swing to opposite sides of the mood spectrum
Paranoia
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 Highly exaggerated of unwarranted mistrust or
suspicion
 Hostile & uncooperative
 “out to get them”
Psychosis
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 Out of touch with reality
 Lives within his own world
 Angry or belligerent or withdrawn
 May only talk to voices inside of head
 Mind altering drugs common cause
Schizophrenia
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 Group of mental disorders
 Debilitating distortions of speech, & thoughts
 Bizarre delusions
 Hallucinations
 Social withdrawal
 Lack of emotional expressiveness
 Rarely goes to multiple personality disorder
Suicide
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 Willful act designed to end one’s life
 Males are 4X more likely to die, but women make 3X
more attempts
 55% done with firearms
 Unsuccessful attempts: drug ingestion, wrist
slashing
 8th leading cause of death in US in males
 3rd leading cause in ages of 15-24
 ½ that succeed have tried before
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 Common ways
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Gunshot
Hanging
Poisoning by ingestion
Carbon monoxide poisoning
 Many victims make last minute attempt to
communicate their intentions
 Every suicidal act or gesture should be taken
seriously, & the patient should be transported for
evaluation
Risk Factors
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 History of depression
 Previous attempts
 Family history of child
abuse
 Feelings of hopelessness
 Unwillingness to seek
help
 Feeling of being isolated
 History of impulsive
 Inability to access mental
health care
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Recent loss of loved one
15-24 years old
Alcohol or drug use
Divorced or widowed
Gives away personal
belongings
Psychosis with depression
Homosexuality
Major physical stress
Suicide of same-sex partner
Expression of clear plan
Availability of mechanism to
carry out plan
Agitated Delirium
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 Excited delirium
 Mental & physiological response
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Unusual strength & endurance
Tolerance of pain
Agitation
Hostility
Frenzied & bizarre behavior
Hot & diaphoretic skin
Unusual speech
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 May be associated with drug use
 Difficult to determine between violence & agitated
delirium
Violence to others
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 Wants to fight with others
 Signs
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Nervous pacing
Shouting
Threatening
Cursing
Throwing objects
Clenched teeth and/or fists
Basic Principles
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 Every person has
limitations
 Right to his feelings
 Has more ability to
cope with crisis than he
might think
 Emotional disturbance
when disaster or injury
strikes
 Emotional injury hurts
just as much as physical
 Don’t just “get better”
 Culture differences
have meaning
Techniques
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 Approach slowly &
with caution
 Engage in active
listening
 Be supportive &
empathetic
 Limit interruptions
 Respect pt’s space
 Limit physical touch
 Avoid any action that
may be interpreted as
threatening
 Avoid questions or
statements that may be
taken as threatening
Techniques
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 Speak calmly
 Maintain distance
 Seek cooperation
 Maintain eye contact
 No quick movements
 Respond honestly
 Don’t threaten or
belittle
 Plan escape route
 Don’t play along
 Involve trusted family
members
 Be prepared to spend lots
of time
 Never leave alone
 Avoid restraints
 Don’t force to make
decisions
 Encourage the patients
 Get rid of gawkers
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 Scene size up
 Primary assessment
 Secondary assessment
 treatment
 Reassessment
Restraints
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 Should be avoided
 May require police authorization
 Doctors orders
 Don’t restrain in prone position
 Guidelines (pg 872)
Legal considerations
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 Consent
 Refusal of care
 Using unreasonable force
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Size & strength of patient
Type of behavior
Mental state
Method of restraint
 Document & have a witness