Lesson Plan On

Psychiatric Emergencies
SUBMITTED TO, SUBMITTED BY,
MS DEEPTHI MRS RAJANI ACHANTA
LECTURER IINDYEAR MSC NSG
DEPT OF MHN J.M.J. COLLEGE OF NSG
J.M.J. COLLEGE OF NSG
Name of the student teacher : Rajani Achanta

Name of the Guide : ms Deepthi (lecturer)

Subject : Mental Health Nursing.

Unit : VIII Unit.

Name of the Topic : Psychiatric Emergencies.

Group : 3rd year Bsc Nursing Students.

Place : 3rd year Bsc Classroom.

Date :

Time : 8-9 AM

Previous Knowledge : ---

Method of Teaching : Lecture cam Discussion.

Audio visual aids : Black board, OHP, Charts Pamphlets, leaflet.

General Objectives:
By the end of the class the students will acquire adequate knowledge regarding psychiatric emergencies and they will be able to develop
desirable attitude towards the psychiatric emergencies and they will be able to practice in their clinical.

Specific Objectives:
By the end of the class the students will be able to

 Define the term psychiatric emergencies

 Enlist the common psychiatric emergencies
 Explain the initial approach during emergencies
 Define the term suicidal threat
 Enlist the etiological factor of suicidal threat
 Explain the management of suicidal threat
 Define the term violent or aggressive behavior
 Enlist the etiological factors of violent behavior
 Explain the management of violent behavior
 Explain the guidelines to be followed for self protection when handling the aggressive patients
 Define the panic attacks
 Explain in detail the management of panic attacks
 Define term catatonic stupor
 Enlist the signs and symptoms
 Explain in detail the management of catatonic stupor
 Define the term hysterical attacks
 Explain the management of Hysterical attacks
 Define the term Transient situational disturbances
 Explain the management of transient situational disturbances.
 Define the term delirium tremens.
 Explain the management in detail.
 Define the term epileptic furor
 Explain in detail the management of epileptic furor.
 Define the term acute drug-induced extra pyramidal syndrome.
 Explain in detail the management of acute drug induced extra pyramidal syndrome.
 Define the term drug toxicity.
 Enlist the signs and symptoms of drug toxicity.
 Explain the management of drug toxicity.
 Define the term victim of disorder
 Explain the management of victims of disaster.
 Define the term Rape victim.
 Enlist the signs and symptoms of Rape victim.
 Explain the management of Rape victims.
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2min Define the term Definition OHP What are
Psychiatric Psychiatric emergency is a condition where the Teacher explained with the Psychiatric
emergency patient has disturbances of thought, affect and Help of O.H.P students emergencies?
psychomotor activity leading to a threat to his listened care fully
existence (Suicide) or threat to the people in the
environment (homicide). This condition needs
immediate intervention to safe guard the life of
the patient, bring down the anxiety of family
members and enhance emotional security to other
in the environment.
2 min Enlist common Teacher explained with the Pamphlets What are common
Common Psychiatric emergencies.
psychiatric help of pamphlet students Psychiatric
 Suicidal threat
emergencies take down the notes emergencies?
 Violent or aggressive behavior
 Panic attacks
 Catatonic stupor
 Hysterical attacks
 Transient situational disturbance
 Epileptic furor.
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 Acute c drug-induced extra pyramidal
syndrome.
 Drug toxicity
2min Explain the Initial Teacher explained with the Leaflet What are the initial
 Victims of disaster.
approach During help of leaflet students approaches during
 Rape victim.
emergencies. take down the notes emergencies?
Initial Approach During emergency:
 The initial approach to the patient should
be warm, direct and concerned.
 A quick evaluation to identify the nature
of the condition and to institute care on
the basis of seriousness is essential.
 The emergency staff should have basic
knowledge of handling psychiatric
emergencies.
 Medico legal cases need to be registered
separately and informed to the concerned
officer.
 Hospital security must be adequate to
control violent and dangerous patients.
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 History and clinical findings should be
recorded clearly in the emergency file.
 Patient’s condition and plans of
1min Define the term Teacher explained with the OHP What is suicidal
management should be explained in
suicidal threat help of O.H.P students threat?
simple language to the patient and family
listens carefully
members.

Suicidal Threat:
This is most common emergencies. Suicide is a
4min Enlist the type of deliberate self harm and is defined as an Charts What are is the
Teacher explains with the
etiological factors. intentional act of killing oneself. etiology of suicidal
help of chart students
listens carefully threat

Etiology:
Psychiatric Disorders:
 Major depression
 Schizophrenia
 Drug or alcohol abuse
 Dementia
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 Delirium
 Personality disorder
Physical disorders:
 Patients with incurable or painful physical
disorder like cancer or aids.
Psychosocial factors:

 Dowry harassment
 Loss of loved object
 Isolation and alienation from social
groups
 Financial and occupational difficulties
Risk factors for suicide:
 Age
Males above 40 yrs of age
Female about 55 yrs of age.
 Sex
 Men have greater risk of completed
suicide
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 Suicide is three times more common in
men than in women.
 Women have higher rate of attempted
suicide.
3min Explain the Teacher explained with the Blackboard What is the
 Being unmarried, divorced, widowed, or
management of help black board students management of
separated.
suicidal threat take down the notes suicidal threat?
 Having a definite suicide plan
 History of previous suicidal attempts
 Recent loss

Management:
 Be aware of certain signs which may
indicate that the individual may commit
Suicide, Such as:
 Suicidal threat
 Writing farewell letters.
 Giving away treasured articles
 Making a will
 Closing bank accounts.
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 Appearing peaceful and happy after a
period of depression.
 Refusing to eat drink, maintain personal
hygiene.
2.Monitoringthe patient’s safety needs:
 Take all suicidal threats or attempts
seriously and notify a psychiatrist
 Search for toxic agents such as
drugs/alcohol
 Do not leave the drug tray within reach of
the patient; make sure that the some daily
medication to swallow.
 Remove sharp instruments such as belts,
neckties.
 Do not allow the patient to bolt his door
on the inside, make sure that somebody
accompanies him to the bathroom.
 Patient should be kept in constant
observation and should sure that
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somebody accompanies him to the
bathroom and never leave alone
 Patient should be having good vigilance
especially during morning hours.
 Spend time with him, talk to him, and
allow him to ventilate his feelings.
 Encourage him to talk about his suicidal
plans methods.
 If suicidal tendencies are very severe,
sedation should be given as prescribed
 Encourage verbal communication of
suicidal ideal as well as his/her fear and
depressive thoughts. A ‘no suicidal’ pact
1 min Define violent or OHP What is violent or
may be signed, which is written
aggressive Teacher explains with the aggressive
agreement between the patient and nurse,
behavior. help of O.H.P students take behavior?
the patient will not act on suicidal
down the notes
impulses, but will approach the nurse to
talk about them.

2 min Enlist the  Enhance self esteem of the patient by Black board What are the
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etiological factors focusing on this strengths rather than Teacher explains with the etiologies factors of
weakness. His positive qualities should be help of black board violent behaviors?
emphasized with realistic praise and students take down the
appreciation. This fosters a sense of self notes.
worth and enables him to take control of
his life situation.

Violent or Aggressive behavior:

Definition:
5 min Explain the Black board What is the
Teacher explains with the
This is a severe form of aggressiveness. During
management of help of black board management of
this stage, patient will be irrational, uncooperative
violent behavior students take down the violent behavior?
delusional and assaultive.
notes

Etiology:
Organic psychiatric disorders like
 Delirium, dementia, wernicke-korsakoff’s
psychosis.
 Other psychiatric disorders like
schizophrenia, depression, with drawl,
from alcohol and drugs, epilepsy, acute
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stress reaction, panic disorder and
personality disorders.

Management:
 An exited patient is usually brought tied
up with a rope a rim chains, the first step
should be to remove the chains.
 A large proportion of aggression and
violence is due to the patient feeling carry
out complete physical examination.
 Send blood specimen for hemoglobin,
total cell count etc.
 Look for evidence of dehydration and
malnutrition. If there is severe
dehydration IV drip may be started.
 Have less furniture in the room and
remove sharp instruments, ropes, glass
items, ties, strings match boxes etc.
 Keep environmental stimuli, such as
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lighting and noise levels to minimum.
 Stay with the patient as hyperactivity
increases reduce anxiety level and foster a
feeling of security.
 Humiliated at being tied up in this
manner.
 Talk to the patients and see if her
responds firm and kind approach by the
nurse is essential.
 Usually sedation is given. Common drugs
used are diazepam 10-20mg IV,
haloperidol 10-20mg, chlorpromazine 50-
100mg.
 Once the patient is sedated, collect history
carefully form relatives, rule out the
possibility of organism-pathology.

2 min Explain the  In particular check for history of Teacher explains with help What is the guide
guidelines for self convulsion, fever, recent intake of of black board students Black board line to be followed
protections when alcohol, etc. take down the notes. in handling the
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handing an  Redirect violent behavior with physical aggressive patients?
aggressive patient outlets such as exercise, outdoor activities.
 If the patient is not calmed by talking
down and refuses medications, restraints
may become necessary.
 Follow application of restraints, observe
patient every 15 minutes to ensure that
nutritional and elimination needs are met.
Also observe for any numbness, tingling
or cyanosis in the cutrimitia. It is
important to choose the least restrictive
alternative as far as possible for these
patients.

Guidelines for self protection when handing an

aggressive patient:
 Never see a potentially violent person
3 min define the term
alone.
panic attacks. OHP What is meant by
 Keep a comfortable distance away from Teacher explains with the panic attacks?
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the patient. help of OHP and students
 Be prepared to move, a violent patient can take down the notes.
strike out suddenly.
 Maintain a clear exit route for both the
staff and patient
3 min Explain in detail the OHP
 Be sure that the patient has no weapons, in
management of Teacher explains with the What is the
his possession before approaching him
panic attacks help of OHP and students management of
 If patient is having a weapon ask him to
take down the notes. panic attacks?
keep it on table or floor rather than
fighting with him to take it away.
 Keep something like pillow, mattress or OHP
1min Define the term blanket wrapped around arm between you Teacher explains with the
catatonic stupor. and the weapon. help of OHP and students What is catatonic
 Distract the patient momentarily to take down the notes. stupor?
remove the weapon.
 Give prescribed antipsychotic
2 min Enlist the signs and
medications.
OHP What are the signs
symptoms Teacher explains with the
help of OHP and students and symptoms of
Panic attacks:
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Episodes of acute anxiety and panic can occur as take down the notes. catatonic stupor?
a part of psychotic or neurotic illness.
The patient will experience palpitations,
2 min sweating, tremors, and feelings of choking, chest
Explain in detail the Black board
pain, nausea, abdominal distress, and fear of
management of What is the
dying, paraesthesias, chills or hot flushes.
catatonic stupor. Teacher explains with help management of
of black board students catatonic stupor?
Management:
take down the notes.
 Give reassurance first.
 Search for causes.
 Diazepam 10mg or lorazepam 2mg may
be administered.
2 min
Define the term Catatonic stupor:
Hysterical attacks Stupor is a clinical syndrome of akinesia and
mutism but with relative preservation of Black board What are the
conscious awareness Teacher explains with help hysterical attacks?
of black board students
Sign/Symptoms: take down the notes.
It is associated with catatonic signs and
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symptoms. The various signs include mutism,
negativism, stupor, ambitendency, echolalia,
chopravia, automatic obedience, posturing,
mannerisms, stereotypes etc.
3 min
Explain the Black board
Management:
management of What is the
 Ensure patent airway
Hysterical attacks management of
 Administer IV fluids
Teacher explains with help Hysterical attacks?
 Collect history and perform of black board students
physical examination take down the notes.
 Draw blood for investigations
before starting any treatment
Other care is same as that for an
unconscious patient. Black board
2 min What is transient
Define the term situational
transient situational Teacher explains with help disturbance?
Hysterical Attacks: of black board students
2 min A hysteric may mimic abnormality of any function, take down the notes.
Explain the which is under voluntary control. The OHP
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management of  Hysterical fits
transient situational  Hysterical ataxia
disturbance.  Hysterical paraplegia. Teacher explains with the
help of OHP and students
All presentations are marked by a dramatic quality take down the notes.
and sadness of mood.
OHP
1 min Define the term What is the term

delirium tremens. Teacher explains with the delirium tremens

Management: help of OHP and students
Hysterical fit must be distinguished from genuine fit.
take down the notes.
2 min Explain the A hysterical symptom can cause panic among What is the
relatives, explain to the relatives the psychological management of
management in det
nature of symptoms. delirium tremens
ail.
Reassure that no harm would come to the patient. OHP
- Help the patient realize the meaning of
Teacher explains with the
symptoms, and help him find alternative ways
help of OHP and students
of coping with stress.
take down the notes.
- Suggestion therapy with IV Pentothal may be
helpful in some cases. What is epileptic
1 min
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Transient situational disturbances: Black board furor.
Define the term These are characterized by disturbed feelings and
epileptic furor. behavior occurring due to overwhelming external Teacher explains with the
1 min stimuli. help of black board and
students take down the Black board What is the
Explain in detail the Management:
notes. management of
- Reassurance.
management of epileptic furor.
- Mild sedation if necessary.
epileptic furor
1 min - Allaying the patient to ventilate his/her Teacher explains with the
feelings. OHP
help of black board and
- Counseling by an understanding professional
students take down the What is the drug
notes. induced extra
pyramidal
Teacher explains with the syndrome
2 min Delirium Tremens:
help of O.H.P and students
This is an acute condition resulting from OHP
with drawls of alcohol. take down the notes

What is the

Management: management of

- Keep the patient in a quiet and safe drug induced extra

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environment. Teacher explains with the pyramidal
Define the term - Sedation is usually given with diazepam 10 help of O.H.P and students syndrome.
1 min acute drug-Induced mg or lorozepam 4mg IV, followed by oral take down the notes
extra pyramidal administration. Black board

syndrome. - Maintain fluid and electrolyte balance.

- Reassure patient and family.
What is drug
Explain detail the Epileptic furor: toxicity.
2 min Following epileptic attack patient may Teacher explains with the Black board
management of
Behave in q strange manner and became excited help of black board and
acute drug induced
violent.
extra pyramidal students take down the

syndrome. notes
1 min Management: What are the signs
- Sedation: inj Diazepam 10mg w (or) Inj Black board and symptoms of
Teacher explains with the
luminal 10mg. IV followed by oral anti
help of black board and drug toxicity?
convulsions.
students take down the
- Haloperidol 10mg IV.
Define the term notes What is the

drug toxicity management of

drug toxity?
Acute drug – induced extra pyramidal syndrome:
Antipsychotics can cause a variety of Teacher explains with the
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movement related side-effects, Collectively known’s help of black board and
1 min extra pyramidal syndrome (EPS) students take down the
Enlist the signs and notes O.H.P
symptoms of drug
toxicity. Management:
- The drug should be stopped immediately.

Explain the - Rx is symptomatic can includes cooling the What is meant by

2min management of patient, maintaining fluid and electrolyte Teacher explains with help rape victim?
balance and treating intevcuwent infections.
drug toxicity of O.H.Pstudents take
- Diazepam can be used to for muscle stiffness.
down the notes.
- Dantrolenc, a drug used to treat malignant
hyperthermia, bromocriptinc, amantadine and
L-dopa have been used. O.H.P

What is the
Drug toxicity: management for
Drug over dosage may be accidental or Rape victim?
Define the term
suicidal. In either ease all attempts must be. Mode to
rape victim Teacher explains with help
find out the drug consumed. A detailed history should
of O.H.P students take
be collected.
down the notes.
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S/S:
Drowsiness, vomiting, abdominal pain, confusion,
Explain the blurred vision, acute circulatory failure, stupor and
management of coma, gone valise convulsions, oliguia and death.

Rape victim
Management:
- Administer
- Start IV line
- Assess for cardiac arrhythmias
- Refer for hem dialysis
- Administer anticonvulsants
- Features in these people.

Rape victim:
Rape is a perpetuation of an act of sexual intercourse
with a female against her will and consent.
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Management:
 Be supportive, reassuring and
nonjudgmental.
 Physical examination for any injuries.
 Give morning after pill to prevent possible
pregnancy.
 Send samples foes STD and HIV
infections.
 Explain to the patients the possibility of
PTSD, sexual problems like raiginisms
and anorgasmia which may appear later

SUMMARY:
 Psychiatric emergencies.
 Definition.
 Common psychiatric emergencies.
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 Initial approach during emergency.
 Definition.
 Etiological factors.
 Signs and symptoms of each psychiatric
emergencies.
 What is the management for each psychiatric
emergency.
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Assignment:

What are the common psychiatric emergencies and explain two in detail with management.

Conclusion:
 Psychiatric emergency is a condition which needs immediate intervention to safeguard the life of the patient, bring down the anxiety of
family members and enhance emotional security to other in the environment. I thank Madam Deepthi for giving me Opportunity to complete my
teaching practice.

Bibliography:

 R. Sreevani, a textbook of Mental Health Nursing psychiatric Nursing 2nd volume 3rd edition Jaypee publications Page No – 253.
 Bimila Kapoor 1994 a text book of psychiatric Nursing volume II 11th edition’s Kumar Publications.
 Ram Kumar Gupta “Mental and Health Nursing VICA’s and company Medical Publication 10th edition page no – 286.
 Mary werghese essentials of psychiatric and Mental health nursing 3rd edition Page no 256.