Clinical Tip: Compile medical history for psych patients
Compile medical history for psych patients
Underlying condition might be cause
A patient walked into Children's Hospital Boston's ED hyperventilating, with a known history of anxiety and depression. The triage nurse assumed that the hyperventilation was due to the patient's anxiety disorder and instructed her to "calm down and take slow deep breaths" into a paper bag.
"Later on, upon clinical exam, the nurse auscultated the patient's breath sounds, and, much to her surprise, heard tight inspiratory and expiratory wheezing throughout," says Denise Downey, RN, MSN, CPEN, nurse educator for emergency services. "The patient forgot to mention her new asthma diagnosis and recent intensive care unit admission for status asthmaticus. Her anxiety was triggered by the fact that she couldn't breathe."
Another teen-ager presented to triage with a complaint of suicidal ideation and was immediately escorted back in to a "safe" treatment room. At that point, ED nurses learned that she also was having chest pain since earlier that morning.
"The nurse decided to place the patient on the cardiac monitor and was stunned to see ventricular tachycardia dancing across the screen," says Downey. "The medical team was summoned immediately to the bedside to stabilize the patient."
Avoid any biases
Pediatric patients who present to the ED with a known psychiatric history or complaint must always be medically cleared, advises Downey.
"If the nurse expects that the patient will require a mental health evaluation, the nurse might overlook or ignore any physical complaints that the patient might have," says Downey. "I don't believe this is due to a lack of training to spot medical emergencies -- rather, the nurse's dismissive attitude of 'Oh, they're just here for a psych eval.'"
Ask all mental health patients about their medical history, regardless of their presenting complaint. "As with any patient that presents to the ED, assess airway, breathing, and circulation regardless of the presenting complaint," says Downey. "Most importantly, the nurse must not have any biases toward the care and treatment of mental health patients."
A patient walked into Children's Hospital Boston's ED hyperventilating, with a known history of anxiety and depression.Subscribe Now for Access
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