CEN Mental Health Emergencies Review: Emergency Nursing Guide to Psychiatric Crises,
Assessment & Crisis Care
aggression/violence at risk - correct answer ✔✔history of abuse, alcohol or drug intoxication,
delusions of persecution, acute mania
aggression/violence s/s - correct answer ✔✔pacing, loud voice, clenched fists
aggression/violence tx - correct answer ✔✔always be aware of personal safety (clear exit plan);
keep unobstructed access, calm patient through empathetic yet firm verbal means, appear calm
unthreatened, in control; speak calmly; avoid confrontation. Priority is safety, exit and scream
for help. Call security, and report threats to law enforcement
anxiety - correct answer ✔✔a feeling of nervousness about an imminent event or something
with an uncertain outcome
situational crisis - correct answer ✔✔anxiety due to a life event such as a sudden illness, injury,
or death of a family member; grieving varies by culture, personality, and coping skills
stages of grief seen in the ER - correct answer ✔✔shock and denial, anger, and bargaining
(allowing family presence decreases denial and anger)
panic attack - correct answer ✔✔abrupt onset of intense fear
panic attack s/s - correct answer ✔✔sensation of choking or breathlessness, palpitations, chest
pressure, trembling, paresthesia, feeling of "going insane"
situational and panic attack tx - correct answer ✔✔maintain a calm appearance, use
therapeutic communication, provide a supportive (non-judgemental) environment, and show
, acceptance, encourage slow breathing, reassure patient they are "not crazy"; administer benzos
as ordered
PTSD s/s - correct answer ✔✔re-experiencing the traumatic incident (flashbacks, nightmares),
avoidance behaviors, difficulty concentrating, hyper arousal and hyper-vigilance (startle, tense)
PTSD tx - correct answer ✔✔provide a low stimulus environment
bipolar disorder - correct answer ✔✔chronic, recurring cycles of depression and elation (mania)
bipolar disorder s/s - correct answer ✔✔major depressive episode followed by inappropriate
elation, increased energy (highest risk of harming themselves and others) and insomnia,
pressured speech, grandiose notions, poor judgement, racing thoughts, impulsivity, risk-taking
behaviors, promiscuity
bipolar disorder tx - correct answer ✔✔provide safety, minimize external stimuli
bipolar disorder medications - correct answer ✔✔Lithium to control severe mood swings;
Carbamazepine (Tegretol)
lithium toxicity - correct answer ✔✔SAD LITH
S: seizures
A: Ataxia
D: dystonia (muscle contractions)
L:Lethargy/Leukocytosis
I: Insipidus (DI)
T: tremors
Assessment & Crisis Care
aggression/violence at risk - correct answer ✔✔history of abuse, alcohol or drug intoxication,
delusions of persecution, acute mania
aggression/violence s/s - correct answer ✔✔pacing, loud voice, clenched fists
aggression/violence tx - correct answer ✔✔always be aware of personal safety (clear exit plan);
keep unobstructed access, calm patient through empathetic yet firm verbal means, appear calm
unthreatened, in control; speak calmly; avoid confrontation. Priority is safety, exit and scream
for help. Call security, and report threats to law enforcement
anxiety - correct answer ✔✔a feeling of nervousness about an imminent event or something
with an uncertain outcome
situational crisis - correct answer ✔✔anxiety due to a life event such as a sudden illness, injury,
or death of a family member; grieving varies by culture, personality, and coping skills
stages of grief seen in the ER - correct answer ✔✔shock and denial, anger, and bargaining
(allowing family presence decreases denial and anger)
panic attack - correct answer ✔✔abrupt onset of intense fear
panic attack s/s - correct answer ✔✔sensation of choking or breathlessness, palpitations, chest
pressure, trembling, paresthesia, feeling of "going insane"
situational and panic attack tx - correct answer ✔✔maintain a calm appearance, use
therapeutic communication, provide a supportive (non-judgemental) environment, and show
, acceptance, encourage slow breathing, reassure patient they are "not crazy"; administer benzos
as ordered
PTSD s/s - correct answer ✔✔re-experiencing the traumatic incident (flashbacks, nightmares),
avoidance behaviors, difficulty concentrating, hyper arousal and hyper-vigilance (startle, tense)
PTSD tx - correct answer ✔✔provide a low stimulus environment
bipolar disorder - correct answer ✔✔chronic, recurring cycles of depression and elation (mania)
bipolar disorder s/s - correct answer ✔✔major depressive episode followed by inappropriate
elation, increased energy (highest risk of harming themselves and others) and insomnia,
pressured speech, grandiose notions, poor judgement, racing thoughts, impulsivity, risk-taking
behaviors, promiscuity
bipolar disorder tx - correct answer ✔✔provide safety, minimize external stimuli
bipolar disorder medications - correct answer ✔✔Lithium to control severe mood swings;
Carbamazepine (Tegretol)
lithium toxicity - correct answer ✔✔SAD LITH
S: seizures
A: Ataxia
D: dystonia (muscle contractions)
L:Lethargy/Leukocytosis
I: Insipidus (DI)
T: tremors
