ADNS Psy Emergencies

ADNS 5006: Nursing Care of
patients with Psychiatric

Emergencies
NARIMA ZAINAL
Nurse Educator,
Diploma in Nursing, UMMC
Nsg. care of pts with psy. emergencies 1 12/17/2021

Learning outcome:
At the end of this lecture, the students will be able to:-

1. State the roles and responsibilities of staff during the
psychiatric emergencies.
2. Explain the assessments made by the staff to identify
the patients’ problems.
3. State the nursing assessment questions that we need
to ask the patient.
4. Formulate the nursing diagnosis and implement the
nursing action.
Roles and responsibilities of staff
 Do an accurate assessment to provide

appropriate intervention and discharge
planning.

What to observe?
 The observable of the patient – a calm

patient may be highly suicidal, whereas an
agitated patient is not always in danger.
 It is important that nurses consistently
monitor a suicidal patient’s behavior, affect,
and interactions with others.

What to observe?
 The history from the patient – in gathering

the patient’s history, the nurse will identify
self-defeating coping patterns and past
experiences that have negatively affected the
patient’s self-esteem.
 Making note of significant anniversary dates
will help predict a future suicide attempt.

What to observe?
 Information from friends or relatives – nurses obtain

useful information regarding the patient’s history from
friends or relatives.
 Assess how family members and friends feel about the
patient’s suicidal behavior.
 Family members who are angry, disgusted or
frustrated with the self-destructive patient will actually
provoke the patient to complete
a plan of suicide.
What to observe?
 History of suicidal gestures or attempts - the

suicidal attempt is often a way of coping with
painful feelings.
 People who have used this coping in the past
are at greater risk for using it again.

What to observe?
 The mental status examination – disturbance in

concentration, orientation, and memory suggests
possible organic brain syndrome or a severe major
depressive disorder, which reduces the patient’s
impulse control and increase the potential for self-
harm.
 Disturbance in thought processing evidenced in
command hallucinations, places the patient at
greater risk to act destructively.
What to observe?
 The physical examination – always conduct a physical

examination when there are obvious signs and
symptoms of substance abuse e.g., impaired
attention, irritability, euphoria, slurred speech,
unsteady gait (walk), flushed face, psychomotor
agitation, previous suicide attempts (e.g., scars on
wrists), or debilitating medical conditions, including
chronic pain.

What to observe?
 The nurse’s intuition – the nurse’s own

feelings of uneasiness, anxiety, or
unexplained sadness are sometimes the only
clues that a seemingly calm patient will act
on suicidal impulses.

Nursing Assessment Questions
1. Is the patient hopeless? Does the patient see

no prospects for the future? Does the
patient express that there are no solutions
to his/ her problems?
2. Has the patient made a recent suicide
attempt? Are the patient’s suicide attempts
severe or multiple? Does the patient show
impulsivity?
3. Are the suicide attempts increasing in

frequency or lethality? Is the patient obsessing
or fantasizing about suicide or death?
4. Does the patient have insomnia with suicidal
thoughts at night that continue into the early
morning hours?

5. Is the patient anxious? Are there any

symptoms of panic or post traumatic stress
disorder (PTSD)?
6. Does the patient have bipolar disorder, post
partum psychosis or psychotic depression? Is
the patient experiencing pathologic grief,
especially with command hallucinations, guilt,
or other co-occurring conditions (e.g., chemical
dependency, alcoholism, or personality
disorder)?
7. Is there a history of suicide by a relative or

close friend? Is the patient isolated? Does the
patient lack resources and available family?
8. Does the patient have detailed suicidal plans?
Are lethal means available to the client for
suicide, such as gun or other weapon?

9. Did the patient leave a suicide note or give

away valued possessions?
10. Is the patient becoming increasingly
frustrated with therapy, illness or problems? Is
the patient feeling powerless and unable to
learn how to cope?

11. Has the patient been offered Electro convulsive

therapy (ECT) and demonstrated ambivalence over it?
Has the patient interpreted the recommendation as an
admission of failure and hopelessness versus a positive
solution?
A yes answer to any one of these questions suggests
that the patient needs careful assessment by the
treatment team for possible admission with suicide
precautions instituted as per policy.
Nursing diagnosis
 Risk of suicide
 Ineffective coping skills
 Hopelessness
 Powerlessness
 Social isolation
 Loneliness
 Low self-esteem
 Deficient knowledge
Nursing Care of Patients With Psychiatric Emergencies 17 12/17/2021
Nursing outcome
Short term and long term goals for a

potentially suicidal patient include the
following:-
 The patient will be refrain from acting on self-
destructive impulses.
 The patient will discuss feelings of anxiety,
despair, loneliness and worthlessness and the
ways to handle them.
 The patient will discuss various negative thoughts
and ways to reframe thoughts and behavioral
response more constructively.
 The patient will become aware of his competencies
to solve various life problems.
 The patient establishes a reliable social support
network and learns to ask for help when needed.

Nursing Planning and Implementation
 The planning of care and intervention is based

on the assessment of risk factors.
 Family members should also be included in
the plan. It gives the patient hope that he is
not alone.
 The presence of a psychiatric disorder would
require the inclusion of appropriate nursing
approaches (e.g caring for depression)
 The care plan or interventions must be
appropriate to the age, gender and cultural
background of the patient.
 During the acute suicidal crisis, the nurse can
implement specialized milieu therapy,
appropriate psychobiological interventions,
counseling, case management and health
education.

Specialized Milieu Therapy – General
Precaution for a suicidal patient
Continuous nursing observation on a one-to-one basis

Use restraint if warranted
Continuous assessment of risk
Ensure hazard-free environment
Monitor mood, thoughts and behavioral every 15-30
minutes
Supervise medication intake
Maintain a physical distance
Explain all of the above precautions and the reasons of
doing so
Guidelines for a Hazard-free
Environment for suicidal patients
Search the patient and his bedside locker for harmful

objects regularly
Remove potentially harmful objects from the
patient’s belonging in front of the patient
Do not leave a patient alone in a room
Do not use metallic utensils and cutlery for meals
Keep the pantry and utility rooms of the ward
locked.

 Glass panes should be unbreakable. Windows should be
kept locked and grilled
 Bathrooms should not be locked
 Electrical cords should be kept to a minimal length
 Ensure that visitors do not carry or leave harmful objects in
the patient’s locker
 Medication cupboards/trolley should not be left
unattended and should be locked when not in use.

Psychobiological Interventions
ECT (Electro convulsive therapy) is the treatment of
choice for an actively suicidal patient especially in a
person with a diagnosis of a depressive or psychotic
disorder.
Antidepressants (SSRI) are prescribed for patients
with depressive and anxiety disorders.
Antipsychotic drugs (atypical) may be considered for
psychotic patients.
Anti anxiety agents may help to control anxiety and
insomnia.

Counselling
 The nurse establishes a working relationship

with the patient and encourages him to solve
problems in a realistic manner
 The nurse may follow up with the patient
closely after he is discharged from the
hospital.

Case management
The nurse helps the patient to recognize the support

system available to him.
Health education
The nurse provides information about the psychiatric
diagnosis, if any, and the need for treatment,
maturational crisis, coping and communication skills
and various community resources available.
Includes the family members and friends.

Nursing evaluation
The nurse observes whether the patient is able to

talk about his thoughts and feelings freely and
readily, and is able to use problem-solving methods
and the social support system.
The nurse constantly monitors any sudden change in
mood and behavior as it may indicate a suicidal
intent.
The nurse looks for depressive symptoms in patients
with schizophrenia especially when they are
recovering.
MHN Topic 7a 29 12/17/2021

ADNS Psy Emergencies

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ADNS 5006: Nursing Care of

patients with Psychiatric

Nsg. care of pts with psy. emergencies 1 12/17/2021

At the end of this lecture, the students will be able to:-

 Do an accurate assessment to provide

Nsg. care of pts with psy. emergencies 3 12/17/2021

 The observable of the patient – a calm

Nsg. care of pts with psy. emergencies 4 12/17/2021

 The history from the patient – in gathering

Nsg. care of pts with psy. emergencies 5 12/17/2021

 Information from friends or relatives – nurses obtain

 History of suicidal gestures or attempts - the

Nsg. care of pts with psy. emergencies 7 12/17/2021

 The mental status examination – disturbance in

 The physical examination – always conduct a physical

Nsg. care of pts with psy. emergencies 9 12/17/2021

 The nurse’s intuition – the nurse’s own

Nsg. care of pts with psy. emergencies 10 12/17/2021

1. Is the patient hopeless? Does the patient see

3. Are the suicide attempts increasing in

Nsg. care of pts with psy. emergencies 12 12/17/2021

5. Is the patient anxious? Are there any

7. Is there a history of suicide by a relative or

Nsg. care of pts with psy. emergencies 14 12/17/2021

9. Did the patient leave a suicide note or give

Nsg. care of pts with psy. emergencies 15 12/17/2021

11. Has the patient been offered Electro convulsive

Short term and long term goals for a

Nursing Care of Patients With Psychiatric Emergencies 19 12/17/2021

 The planning of care and intervention is based

Nursing Care of Patients With Psychiatric Emergencies 21 12/17/2021

Continuous nursing observation on a one-to-one basis

Search the patient and his bedside locker for harmful

Nursing Care of Patients With Psychiatric Emergencies 23 12/17/2021

Nursing Care of Patients With Psychiatric Emergencies 24 12/17/2021

Nursing Care of Patients With Psychiatric Emergencies 25 12/17/2021

 The nurse establishes a working relationship

Nursing Care of Patients With Psychiatric Emergencies 26 12/17/2021

The nurse helps the patient to recognize the support

Nursing Care of Patients With Psychiatric Emergencies 27 12/17/2021

The nurse observes whether the patient is able to

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