Psychiatric Emergencies:

Excitement

Out line:

Definition of Excitement

Etiology

1 -Psychological disorderA- Psychotic disorder

B- Neurotic disorder

C- Sociopathic personality disorder II- Organic disorder

1 -Acute 2 -Chronic

III- Substance abuse:

Clues of excitement

Treatment of excited patient

Nursing intervention

Definition:Excitement is general psychomotor overactivity i.e excessive motor and psychic activity leading to behavior disorder, where the patient may hurt himself and\ or other.

Etiology:Excitement occurs in many mental disorder. Some of these are as follows:

I- Psychological disorder (primary mental disorder):

II- Organic disorder (secondary mental disorders):

1 -Acute organic reaction type (delirium).

2 -Chronic organic reaction type (dementia).

III- Substance abuse:

Excitement as a symptom can be observed or detected in the following:

a- Intake of stimulant e.g cocain & amphetamine , alcohol

b- During the withdrawal period , when substance which is abused bgins to

subside.

A- Psychotic disorder: a- Schizophrenia: excitement may occur in any

type, particular the catatonic one ( catatonic excitemen) .

b- Mania: especially in acute mania. c- Mania and depressive state.

B- Neurotic disorder: Conversion reaction type: It may present itself

with excitement. Investigation show an unconscious motive which enables the patient to escape from some stress ( difficulty ) or to gain some advantage. The characteristic features are similar to those with hysterical fit.C- Sociopathic personality disorder

Clues of excitement:I- The verbal clues are:

1 -Verbal threats toward real or imagined objective. 2 -Intrusive demand for attention.

3 -Loud voice with pressure or ralk or speech. 4 -Colourful language & sometimes obscene.

5 -Argumentative. 6 -Witty words.

II- Nonverbal clues are:A- Motor: ( behavioral ):

1 -Pacing. 2 -Inability to sit still.(restlessness). 3 -Jaw tightening & pounding fists.

4 -Increased respiration. 5 -Staring or lack of eye contact.

6 -Flushed face.

B- Affect:

1 -Tension & angry facial expression.

2 -Hostility.

3 -Irritability.

4 -Extreme anxiety.

C- Level of consciousness:

1 -confusion.

2 -Disorientation.

Treatment of excited patient: a- Mechanical restraint or seclusion.

b- Chemical restraint. *The primary indication for restraints is control of

violent behavior, either self- directed or directed toward others, that cannot be controlled by medication or psychosocial techniques.Mechanical restraint:

*Restrain involves the use of mechanical or manual device to limit the physical mobility of the patient.Types of restraints:

Common types of mechanical restraints include:

1 -Wrist & ankle cuffs. 2 -Sheets restraints or blanket.

3 -Strait – jackets.

Nursing intervention related to mechanical restraints:

1- Obtain a physician s order to use a physically restrictive intervention. The procedure should be carried out quickly, firmly and efficiently.

2- Physical restraints require four staff members behind one team leader who gives direction for action. All staff should appear calm, helpful and non-provocative.

3- To restrain a patient a blanket is useful. Approach the patient from the opposite sides with the blanket opened between you. Wrap him in the blanket and carry him to his\ her room to put him in his bed. Then, restrain the patient by tying hands and feet with a sheet or towel or a straight jacket for short period until drug act. The restraint should not be too loose or too tight.

4- If he is fighting with another patient and you wish to separate them, go behind him and put your arms round his waist. Your colleague does the same with the other patient and you can draw them apart.

5- The leader informs the patient in a matter of fact manner the reason for the procedure and also that he will be allowed to mix with others when he has more control of himself.

6- Administer the medication – short acting- major tranquilizer should be given e.g Separin, Neurazine I.M.

7- Provide patient with a private yet adequately supervised environment to preserve the patients sense of dignity.

8- Never let the patient feel that he is being punished, attend to his needs as usual.

9- Monitor skin condition of restraint sites e.g. color, temperature and sensation.

10- Remove restraint gradually ( that is, one at a time if four- point restraints ) as self- control increase.

11- After restraint, never remind the patient about the incident.

12- Provide opportunity to express his feeling.

13- Document events leading up to need for restraints, exact time of it summary of patients response to restraints and relief period.

14- Instruct the patient about early signs and symptoms of escalating behavior ( signs of mounting tension ).