Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments
Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.
- Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients
- Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients
- Review the Learning Resources concerning emergency psychiatric medicine. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
- Consider a case where your adult client had a psychiatric emergency. (Note: If you have not had an adult client with a psychiatric emergency, ask your preceptor to describe one of their clients with a psychiatric emergency to use as an example for this Discussion.)
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit! Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
By Day 3
- Briefly describe the case you selected.
- Explain how you would treat the client differently if he or she were a child or adolescent.
- Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.
- Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments
By Day 6
Respond to at least two of your colleagues by recommending at least one additional way you would treat a child or adolescent client differently than you would an adult and at least one additional way you would address the legal and ethical issues involved.
Treatment of Psychiatric Emergencies in Children versus Adults
There are significant differences when dealing with children and adolescents versus adults, even though there are many approaches to emergencies that are similar. A psychiatric emergency is a disturbance of mood, behavior, or thought which may lead to harm to the individual or others if untreated (Sadock, Sadock, & Ruiz, 2014). In both pediatric and adult psychiatric emergencies, the clinician must ensure the safety of everyone involved (Chun, Katz, Duffy, 2014). As clinicians, one has to be able to recognize a clinical emergency and respond with the level of expediency and urgency that the situation determines is clinically appropriate. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Briefly describe the case you selected
The patient is an 18years old Hispanic female presented with a suicide attempt by cutting her left wrist. Patient reports that she had arguments with her boyfriend throughout the week and was feeling severely depressed with suicidal ideation. Patient reports that she drove and cut her wrist in the car and her boyfriend rushed her to our hospital emergency room. She has a 7months old child without a support system except for the boyfriend that mistreats her. Patient has lost appetite, difficulty sleeping and feeling hopelessness and worthlessness. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Explain how you would treat the client differently if he or she were a child or adolescent.
The treatment of adult psychiatric emergency is the same as adolescents, in which as clinician l will still do the assessment and evaluation by using assessment tools appropriate for the patients presented problems. The difference here is that for adults, there is no need for interviewing the guardians as you will do with children or adolescents. A violent adult requires a different approach than a child/adolescent. With an adult, we may require stronger people to restrain the patient to administer the medication. For suicidal patients, adults have more experience and are more knowledgeable about different plans for suicide.as such, for any suicidal ideation for an adult or a child should be taken seriously and treated differently. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case
Ethically children and adolescent deserve respect for their autonomy rights. However, parents must consent to treatment and the health care provider treating the child should make every reasonable effort to obtain and document informed consent. ( American Academy of Pediatrics, 2015). Also as a Nurse Practioner its legal when working on a patient who presents with the severe risk for harm to self or others, confidentiality requirements no longer apply. The NP may disclose information gathered by patients to caregivers, and they may obtain information from others (friends, family, caregiver, school personnel, and counselors) without obtaining consent from the patient or guardians (Chun, Katz, and Duffy, 2014). Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
American Academy of Pediatrics. (2015). Consent for emergency medical services for children and adolescents. Pediatrics, 128(2), 427-433. doi:10.1542/peds.2011-1166
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th Ed.). Philadelphia, PA: Wolters Kluwer
Chun, T., Katz, E. & Duffy. (2014). Pediatric mental health emergencies and special health care needs. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792398. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
The PMHNP should consider any situation in which an individual present with thoughts, feelings, and actions requiring immediate therapeutic intervention as a psychiatric emergency. The focus of this post is to describe the treatment of an adult patient who presented at the field training site with an emergency situation. The documentation includes the explanation of the different approaches the PMHNP should utilize and any legal or ethical issues to consider in treating the patient if she is child or adolescent. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Briefly Describe the Case you Selected
RI is a 45 years old African American female who came for an unscheduled visit to the clinic for psychiatric treatment with her nineteen years old daughter. She lives with her children and husband. She sat in a fetal position, holding her head and crying. Her daughter reports that her younger sister is violent and had knocked one of her teeth out. She also said that sister has gone to jail and lives with them now. Patient confirmed that her younger daughter has legal problems. The patient is anxious that her younger child living in the family is a safety issue for the rest of the family. She reported poor appetite and not drinking. When she spoke, she utters one word at a time in a low voice. She denies hallucination. She walked in independently with her facing the ground. She is guarded with her emotion; her voice is soft, has delayed speech, content is appropriate, denies SI, HI. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments. Judgment and insight are good. The patient hair is short, dyed with golden and pink color and shaped into a style. The mood is dysphoric, affect is blunted, memory and concentration are fair. When discussing her mode of transportation to the GW Emergency Department (GWED), she said that her husband would not answer the phone until around 11 am during break time. The patient is in support not to drive self to the hospital. Alert and oriented x 4. Diagnosis- Bipolar Disorder, current depression, severe; PTSD. The patient agreed to the recommendation to go to GWED for evaluation and possible inpatient hospitalization. Plan of Care includes referral to GWED for stabilization. Placing a call to the ER and giving the ED psychiatrist report.
Explain How you Would Treat the Client Differently if He or She Were a Child or Adolescent
As with adult evaluations, the child or adolescent’s safety should be established and ensured first before proceeding with an interview. In treating the child or adolescent in the with the same psychiatric symptoms, the writer will ask the parent to take the child or adolescent to the emergency department for treatment. Sadock, Sadock, and Ruiz (2014) noted that hospitalization is necessary when a child who dissociates is self-destructive. In the USA, emergency departments provide care for individuals during acute mental health crises. Chun, Katz, and Duffy (2013) supported that criteria for immediate referral of children and adolescents for an inpatient psychiatric admission include severely hopeless, ongoing agitation, inability to engage in discussion around safety planning, and inadequate support system/ability to adequate monitoring and follow-up. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Explain any Legal or Ethical Issues you Would Have to Consider When Working With a Child or Adolescent Emergency Case
The PMHNP faces ethical challenges when providing services to a minor. State laws governing consents for treatment and commitment procedures are not universal. Hem, Molewijk, and Pedersen (2014) argued it is ethically challenging for the health professionals to stop including the parents in the treatment, after consenting because their child turns sixteen and refuses for the providers to include the parents in the care. The provider at the same time was holding the parents accountable for the admission cost of treatment. The PMHNP should facilize self with the state laws in the areas of his or her practice. In Washington DC, if the parent refuses to send the child to the hospital, the PMHNP must insist and emergency petition (FD12) the patient. The receiving hospital should contact the parent to come and sign voluntary admission papers and notifies the child protective services if not in contact with the parents or they are refusing to come. Also, the Title 22A DCMR authorized the PMHNP to provide emergency mental health services after the receipt of “Emergency Opinion,” except if a religious belief is a basis for the refusal of treatment (DC Department of Mental Health, n.d.). Emergency opinion is a written opinion from the referral provider that delaying treatment due to unviable consent is likely to result in serious injury to the patient. In DC, also a person under 18-year-old who seeks or receives mental health services can lawfully consent to and make treatment decisions.
Minors and adults with mental health problems are increasingly being evaluated and treated by both the PMHNP outpatient clinics and emergency department. In the office setting, the level of care determines when to send patients to the emergency room.
Chun, T. H, Katz, E. R., & Duffy, S. J. (2013). Pediatric
mental health emergencies and special health care needs.
Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24093903
DC Department of Mental Health. (n.d.). DMH rules-consent to treat. Retrieved
Hem, M. H., Molewijk, B., & Pedersen, R. (2014). Ethical challenges in
connection with the use of coercion: A focus group study of health care personnel in mental health care. BMC Medical Ethics, 15. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-56498-001&site=eds-live&scope=site
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan &
Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry(11th ed.). Philadelphia, PA: Wolters Kluwer.
Emergency psychiatric case
Rachel a 28-year-old Caucasian was brought to the facility presenting with tachycardia, hypertension, agitation which progressed to altered consciousness levels and difficulty in breathing. The parents had brought the drug bottle that they assumed must have been the cause of the presenting symptoms. Rachel had been diagnosed with Major Depressive Disorder six months ago. She had been in and out of the mental health institutions for the treatment of depression due to lack of drug adherence. Two weeks before being brought as an emergency case, Rachel had been discharged home from the mental facility and had a significant improvement. The father reports that Rachel started presenting with fatigue, sadness, having negative thoughts about life and inability to do anything constructive following her ex-boyfriend’s visit. Rachel reported being tied of men and she wished she could live without men around her. The following day Rachel took all of her tricyclic antidepressants which lead to emergency psychiatric care. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Difference in management
If Rachel was a child or an adolescent, the assessment could have been performed differently. The assessment of the child and adolescents differs with that of the adults. The children are unable to provide clear history basing on the age and the developmental stage (Kola, Kola, Petrela, and Zaimi, 2013). The assessment of child and adolescents involves inquiring of information from various sources such as the teachers, parents. The children usually show few warning signs towards suicide attempts as compared to the adults. The child specific screening tools should be used for the interviews following management of the life threatening symptoms. The assessment period should be shorter and the questions should be shorter depending with the child’s cognitive functions. Other than interviewing the child, the health care professional should also interview the child’s caregivers, parents, family and teachers (Jans, Taneli, and Warnke, 2015). In case the child had taken an overdose of medications, the antidote that is used for the adults is the same that will be used for the child with the difference in terms of dosage. The suicide attempts are common among the young adults and the health care professionals would manage Rachel as inpatient case. On the other hand, the child may be managed in the outpatient department following assessment of the family, social and environmental factors (Wolfe, Foxwell, Kennard, 2014). Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Maintaining confidentiality of the child’s information is of great importance just like that of the adults. The healthcare worker should therefore explain the various situations under which the confidentiality can be breached. The informed consent should also be signed when managing both the child and the adult. If the child has not met the age to consent to make his/her medical decisions, the parents can sign the informed consent. The parents and the child may refuse medical services. In this case, the nurse can intervene by managing the client’s condition if the laws and regulations of their state allows.
Jans, T., Taneli, Y., and Warnke, A. (2015). Suicide and self-harming behavior. In: Rey JM, editor. IACAPAP e-Textbook of Child and Adolescent mental health, Geneva. International Association for Child and Adolescent Psychiatry and Allied Professions ,4: 1-34.
Kola, V., Kola, E., Petrela, E., and Zaimi, E. (2013). Trends of attempted suicide in Albarian children and adolescents. Archives of Psychiatry and Psychotherapy, 4: 39-44. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Wolfe, K.L., Foxwell, A., Kennard, B. (2014). Identifying and treating risk factors for suicidal behaviors in youth. International Journal of behavioral consultation and therapy, 9(6): 11-14.
Just like medical emergencies, psychiatric emergency is an acute mental problems that need to be dealt with immediately to prevent more damages. Murtaza et al (2018), the American Psychiatric Association defines a psychiatric emergency as “an acute disturbance in thought, behavior, mood, or social relationship, which requires immediate intervention as described by the patient, family, or social unit”. The following are some of the mental problems that need immediate evaluation and treatments, suicidal behaviors, agitation, psychosis, mania, substance use, and anxiety. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
SELECTED CASE: For this discussion, I selected a case that I witnessed last semester during the course NURS 6650. This particular case involved a Black American male veteran that leave alone, came in through the Emergency room for suicide ideation. The patient came in by himself, stating that he had been having this thought for the past two days, that he is better off dead than living, and he planned to kill himself with his gun at home. But each time the thought come through his mind, he could not carry it out when he thinks about his aged mother, who need his help to survive. The patient past psychiatric history include, Major Depressive Disorder (MDD) and Alcohol dependence.
TREATMENT: Margret & Hilt (2018), there are no medications to primarily treat suicidality or self-harm behaviors. Even though, there is no medication approved yet for suicide ideation, the patient was admitted into the hospital for proper monitoring, due to the fact that the patient leave alone, with a gun in the house, which he had admitted to be the weapon he planned to kill himself with. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
CHILD OR ADOLESCENT TREATMENT: The treatment might be different if this patient happened to be child or adolescent that leave with his/her parents at home. First and foremost, there will be need to get the parents consent before an admission can even start. In case of a child or adolescent that leave with parents thorough evaluation of the stressors need to be done, by making sure the problem is not coming from the parents themselves. Margret and Hilt (2018), Emotional abuse and neglect: repeated patterns of behaviors by caregivers that convey worthlessness, unwantedness, or value placed only when meeting other’s needs. Neglect can be physical, emotional, medical, safety, and educational as determined comprehensively.
If after abuse has been rule out as the cause of the suicide and home is adjudge to be safe, then it will not be necessary to admit the patient. The patient can be managed as an outpatient care. Sadock et al (2014), when the child is brought to the emergency room, a detailed and spontaneous account of the injury should be obtained promptly from parents or other caregivers before secondary details and rationalizations cloud the information provided. It is paramount for the clinician to obtain necessary information from both the child and parents. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
LEGAL/ETHICAL ISSUES: The common legal/ethical issues to be considered when dealing with children and adolescents are Confidentiality and Parent consent. The clinician needs to be well abreast of the laws in his/her jurisdiction as it relate to children and adolescents. An Emancipation minor in some States does not need a parent consent for care, and clinician are not obligated to divulge his/her medical history to his/her parents without proper consent from the Emancipated minor. Murtaza et al (2018), a successful managed psychiatric emergency results in a solid physician-patient rapport and a concomitant improvement in the patient’s symptoms, as well as improved ability to report accurate history and participate in treatment planning. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters.
Murtaza, S., Aoshima, A., Saunders, J., Shah, A.A., & Moukaddam, N. (2018). Treatment of psychiatric emergencies. Psychiatry Annals, 48(1), 28-35. Retrieved from the Walden University Library databases. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Margret, C.P., & Hilt, R. (2018). Evaluation and management pf psychiatric emergencies in children. Pediatric Annals, 47(8), 328-333. Retrieved from the Walden University Library databases.
Moukaddam, N. Shah, A., & Shah, A.A. (2018). Emergency psychiatric: How far have we come? Psychiatric Annals, 48(1), 63-68. Retrieved from the Walden University Library databases.
Treatment of Psychiatric Emergencies in Children Versus Adults
A psychiatric emergency encompasses psychotic episodes including agitation, aggression and violent behavior that accompany psychiatric, medical disorders or behaviors (Patel, Sethi, Barnes, Dix, Dratcu, Fox & Wilson-Jones, 2018). Both adult and child psychiatric emergency is a major concern for healthcare practitioner. Child and adolescent pose a significant burden approaching a projection of one among the five leading causes of disability by 2020 (Margret & Hilt, 2018). Verbal and non-verbal collaborative approaches are effective in treating psychiatric emergency in both populations (Pata el, Sethi, Barnes, Dix, R., Dratcu, Fox & Wilson-Jones, 2018). Practitioners must follow consensus guidelines and age-appropriate interventions in managing psychotic emergencies. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Psychiatric Emergency of a 36-year-old Adult Male
A 36-year-old Hispanic male was brought to the emergency department in the acute psychiatric hospital by a police officer due to aggression and explosive outburst. The patient was physically assaultive to his parents, threatening to kill them and kill himself. The parents called local police who filed a warrant on the patient, and he was checked into the hospital. At the intake, the patient became violent threatening to hit intake staff and refused to come to the unit. Code white (Psychiatric Emergency Code) was called. The staff and police restrained the patient, handcuffed and brought him to the unit. He was secluded in the unit, and emergency medication was administered to calm him down, induce sleep and decrease psychosis. Evidence shows that de-escalation and rapid tranquilization are the verbal and non-verbal collaborative measures that have yielded positive results in stabilizing patients during a psychiatric emergency (Patel, Sethi, Barnes, Dix, R., Dratcu, Fox & Wilson-Jones, 2018). Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Treatment of Child and Adolescent Psychiatric Emergencies
Psychotic episodes in children and adolescent can be related to developmental age, adaptive abilities, drug-induced or comorbid conditions (Margret & Hilt, 2018). Children or exhibiting adolescent agitation or aggressive behavior should be approached in a calm and non-threatening manner by a nonjudgmental adult (Sadock, Sadock, & Ruiz, 2014). This case presents two levels of emergencies and decisions. A warrant may not have been filed in the patient if he is a child or adolescent, and the parents’ consent to treatment. The second level of decision is the patient’s emergency during admission. There is a high likelihood that children and adolescents can be harmed by physical restraint and medications, unlike an adult. The practitioner should be aware of all the reasons that may contribute to aggression during admissions such as separation anxiety or fear of stranger (Sadock, Sadock, & Ruiz, 2014). Verbal de-escalation could have been used to debrief and decrease the anxiety of the patient. The patient could be calmly approached by staff. Then if the patient is a child, the parents could be asked to accompany him to the unit. Right in the unit, the nurse could talk to the patient on 1:1 in the quiet room. Oriented to the unit/room, introduction to peers/staff and contingency contract can resolve the situation. Evidence-based information shows that environmental modification, verbal interventions such as the provision of calm milieu are the first-line efficacious approach in managing a psychiatric emergency in children and adolescents (Margret & Hilt, 2018).
Legal or Ethical Consideration during Child or Adolescent Emergency Case.
It is important for the practitioner to consider the developmental level, psychosocial and neurodevelopmental conditions that may contribute to a child or adolescent psychiatric emergency (Sheridan, Sheridan, Johnson, & Marshall, 2017). A thorough assessment is needed to rule out medical conditions and to direct appropriate intervention in the absence of psychiatric disorder (Sheridan, Sheridan, Johnson, & Marshall, 2017). Due to the fragility of children and adolescent the practitioner should strive to limit the use of physical or chemical restraints and make referrals to available specialized services such as psychotherapy to prevent psychiatric emergency and its burden (Sheridan, Sheridan, Johnson, & Marshall, 2017). Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Margret, C. P., & Hilt, R. (2018). Evaluation and Management of Psychiatric Emergencies in Children. Pediatric Annals, 47(8), e328–e333. https://doi-org.ezp.waldenulibrary.org/10.3928/19382359-20180709-01
Patel, M. X., Sethi, F. N., Barnes, T. R. E., Dix, R., Dratcu, L., Fox, B., … Wilson-Jones, C. (2018). Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. Journal of Psychopharmacology, 32(6), 601–640. https://doi-org.ezp.waldenulibrary.org/10.1177/0269881118776738. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Sheridan, J. S., Sheridan, D. C., Johnson, K. P., & Marshall, R. D. (2017). Can’t We Just Get Some Help? Providing Innovative Care to Children in Acute Psychiatric Crisis. Health & Social Work, 42(3), 177–181. https://doi-org.ezp.waldenulibrary.org/10.1093/hsw/hlx025. Treatment of psychiatric emergencies in children versus adult sample essay discussion assignments.