精神科急診及危機(jī)干預(yù)課件

精神科急診及危機(jī)干預(yù)ppt課件匯報(bào)人：xxx20xx-03-15目錄精神科急診概述危機(jī)干預(yù)基本概念精神科急診評(píng)估與診斷藥物治療在精神科急診中應(yīng)用非藥物治療方法探討預(yù)防措施與康復(fù)支持體系建設(shè)精神科急診概述010102定義精神科急診是指在短時(shí)間內(nèi)對(duì)精神疾病患者進(jìn)行緊急評(píng)估、干預(yù)和治療的服務(wù)。特點(diǎn)突發(fā)性、緊急性、高風(fēng)險(xiǎn)性、多學(xué)科協(xié)作性。定義與特點(diǎn)精神疾病急性發(fā)作自sha、自傷行為患者因情緒低落、自我價(jià)值感降低等原因出現(xiàn)自sha、自傷意念或行為。暴力、攻擊行為患者受幻覺(jué)、妄想等癥狀影響，出現(xiàn)暴力、攻擊他人或破壞財(cái)物的行為。如精神分裂癥、雙相情感障礙等疾病的急性發(fā)作。藥物過(guò)量或中毒患者因誤服、過(guò)量服用精神藥物或其他物質(zhì)導(dǎo)致中毒。常見(jiàn)精神科急診情況以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書(shū)書(shū)寫(xiě)制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.快速評(píng)估、及時(shí)干預(yù)、確保安全、多學(xué)科協(xié)作。接診→初步評(píng)估→緊急處理→進(jìn)一步評(píng)估與治療→轉(zhuǎn)診或住院。處理原則處理流程急診處理原則與流程危機(jī)干預(yù)基本概念02危機(jī)分類(lèi)根據(jù)危機(jī)來(lái)源可分為發(fā)展性危機(jī)、境遇性危機(jī)和存在性危機(jī)；根據(jù)危機(jī)影響的程度可分為一般危機(jī)和嚴(yán)重危機(jī)。危機(jī)定義指?jìng)€(gè)體面臨突然或重大生活事件，無(wú)法用通常解決問(wèn)題的方法來(lái)解決時(shí)所出現(xiàn)的心理失衡狀態(tài)。危機(jī)定義及分類(lèi)緩解或消除危機(jī)情境對(duì)個(gè)體的影響，預(yù)防或減輕未來(lái)可能出現(xiàn)的心理問(wèn)題，提高個(gè)體的心理應(yīng)對(duì)能力。迅速確定要干預(yù)的問(wèn)題，強(qiáng)調(diào)以目前的問(wèn)題為主，并立即采取相應(yīng)措施；必須有其家人或朋友參加危機(jī)干預(yù)；鼓勵(lì)自信，不要讓當(dāng)事者產(chǎn)生依賴(lài)心；把心理危機(jī)作為心理問(wèn)題處理，而不要作為疾病進(jìn)行處理。危機(jī)干預(yù)目標(biāo)危機(jī)干預(yù)原則危機(jī)干預(yù)目標(biāo)與原則危機(jī)干預(yù)策略主要包括明確問(wèn)題、保證安全、提供支持、可變通的應(yīng)對(duì)方式、制定計(jì)劃等步驟。危機(jī)干預(yù)方法包括認(rèn)知行為療法、心理動(dòng)力療法、家庭治療等多種方法，根據(jù)個(gè)體情況選擇合適的方法進(jìn)行干預(yù)。同時(shí)，在干預(yù)過(guò)程中需要關(guān)注個(gè)體的情緒變化，提供情感支持，幫助個(gè)體恢復(fù)情緒穩(wěn)定。危機(jī)干預(yù)策略與方法精神科急診評(píng)估與診斷0303攻擊風(fēng)險(xiǎn)評(píng)估量表評(píng)估患者的攻擊性和暴力行為風(fēng)險(xiǎn)。01簡(jiǎn)明國(guó)際神經(jīng)精神訪談（MINI）用于快速篩查精神障礙，如抑郁癥、焦慮癥等。02自sha意念與行為評(píng)估量表評(píng)估患者的自sha風(fēng)險(xiǎn)。初步評(píng)估與篩查工具ICD-11診斷標(biāo)準(zhǔn)根據(jù)世界衛(wèi)生zu織制定的《國(guó)際疾病分類(lèi)》第十一版（ICD-11）進(jìn)行診斷。鑒別診斷要點(diǎn)區(qū)分器質(zhì)性精神障礙、精神活性物質(zhì)所致精神障礙、精神分裂癥等。DSM-5診斷標(biāo)準(zhǔn)根據(jù)美國(guó)精神醫(yī)學(xué)學(xué)會(huì)制定的《精神障礙診斷與統(tǒng)計(jì)手冊(cè)》第五版（DSM-5）進(jìn)行診斷。診斷標(biāo)準(zhǔn)及鑒別診斷要點(diǎn)綜合評(píng)估患者的自sha、攻擊、暴力、逃跑等風(fēng)險(xiǎn)，制定相應(yīng)的干預(yù)措施。建立患者信息報(bào)告制度，及時(shí)發(fā)現(xiàn)和處理潛在風(fēng)險(xiǎn)。同時(shí)，加強(qiáng)與家屬的溝通，共同關(guān)注患者的病情變化。風(fēng)險(xiǎn)評(píng)估與預(yù)警機(jī)制預(yù)警機(jī)制風(fēng)險(xiǎn)評(píng)估藥物治療在精神科急診中應(yīng)用04選擇原則01基于患者病情、年齡、軀體狀況及藥物特性進(jìn)行綜合評(píng)估。02常用藥物如苯二氮卓類(lèi)藥物，具有抗焦慮、鎮(zhèn)靜、催眠和抗驚厥等作用。03注意事項(xiàng)需關(guān)注患者呼吸、循環(huán)等生命體征，避免過(guò)量使用導(dǎo)致呼吸抑制等不良反應(yīng)?？焖冁?zhèn)靜藥物選擇及注意事項(xiàng)01使用指南根據(jù)患者病情選擇合適的抗精神病藥物，如第一代或第二代抗精神病藥。02劑量調(diào)整根據(jù)患者病情和藥物反應(yīng)進(jìn)行個(gè)體化劑量調(diào)整。03副作用處理針對(duì)可能出現(xiàn)的錐體外系反應(yīng)、內(nèi)分泌紊亂等副作用，采取相應(yīng)的預(yù)防和治療措施?？咕癫∷幬锸褂弥改虾透弊饔锰幚硭幬锵嗷プ饔米⒁獠煌幬镏g的相互作用，避免不良反應(yīng)的發(fā)生。聯(lián)合用藥策略在單一藥物治療效果不佳時(shí)，可考慮聯(lián)合使用不同作用機(jī)制的藥物，以增強(qiáng)療效。不良反應(yīng)預(yù)防通過(guò)定期監(jiān)測(cè)、及時(shí)調(diào)整藥物劑量等方式，降低不良反應(yīng)的發(fā)生風(fēng)險(xiǎn)。同時(shí)，加強(qiáng)患者教育，提高患者對(duì)藥物治療的依從性和自我管理能力。聯(lián)合用藥策略和不良反應(yīng)預(yù)防非藥物治療方法探討05建立信任和安全感通過(guò)傾聽(tīng)、關(guān)注、同理心等技巧，與患者建立信任關(guān)系，使其感到安全和被關(guān)注。情緒穩(wěn)定化技術(shù)運(yùn)用放松訓(xùn)練、呼吸調(diào)整、正念冥想等方法，幫助患者緩解緊張、焦慮等負(fù)面情緒。認(rèn)知行為療法引導(dǎo)患者識(shí)別和改變不良思維模式和行為習(xí)慣，增強(qiáng)自我調(diào)控能力。心理治療技巧在急診中應(yīng)用ECT適應(yīng)癥包括嚴(yán)重抑郁、躁狂、精神分裂癥等精神疾病，尤其是藥物治療無(wú)效或不能耐受藥物副作用的患者。其他物理治療方法如重復(fù)經(jīng)顱磁刺激（rTMS）、迷走神經(jīng)刺激（VNS）等，也在精神科急診中得到應(yīng)用。電休克治療（ECT）簡(jiǎn)介通過(guò)電流刺激大腦產(chǎn)生抽搐和意識(shí)喪失，達(dá)到治療精神疾病的目的。物理治療如電休克等介紹和適應(yīng)癥分析家庭成員的理解、支持和陪伴對(duì)患者的