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Psychiatric Emergencies - Coggle Diagram
Psychiatric Emergencies
1. Definition of Psychiatric Emergency
Acute disturbance in thought, mood, or behavior that poses immediate risk to self or others.
Nurse = primary manager of the clinical environment.
2. Nursing Assessment Framework: The 3 S’s
1. Safety
– Immediate threats (weapons, hazards).
2. Severity
– Acting out (physical) vs. acting in (suicidal/withdrawn).
3. Source
– Psychiatric illness vs. medical cause (e.g., drugs, hypoglycemia).
3. Common Presentations
Acute agitation/aggression
Suicidal crisis
Acute psychosis (e.g., command hallucinations)
Neuroleptic Malignant Syndrome (NMS) – life-threatening reaction to antipsychotics.
4. Management of Aggression: Crisis Development Model
Stage 1: Anxiety
Goal: Support.
Action: Active listening, offer help.
Stage 2: Defensive
Goal: Directive.
Action: Set firm limits, redirect to quiet area.
Stage 3: Physical Acting-Out
Goal: Safety/containment.
Action: Call security/Code Blue, team restraint (never alone).
Communication Tips
Do: Hands visible, stand at 45°, stay calm.
Don’t: Mirror anger, block exits, touch without warning.
5. Suicidal Crisis Assessment: Lethality Checklist
Plan – Specific method?
Access – Can they reach means?
History – Previous attempts?
6. Managing Acute Psychosis
Acknowledge feeling, not delusion.
Ask about command hallucinations
– “Are the voices telling you to do something?”
Emergency pharmacotherapy: Rapid tranquilization (Benzodiazepine + Antipsychotic).
Nursing alert: Monitor vitals after IM injection.
7. Legal & Post-Crisis Care
Seclusion & Restraints
Last resort,
require physician order
within 15–30 min.
Nursing checks every 15 min:
Circulation, hydration, range of motion, readiness for release.
Documentation Essentials
Precipitating event
Less restrictive measures tried
Patient’s response
Post-Crisis Debrief
Discuss: “What happened?” “How can we prevent this?”
Restores patient’s autonomy and dignity.