Hospital for Mental Health, MOH
Cairo, Egypt
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BASIC SKILLS FOR INPATIENT PSYCHIATRY презентация
Содержание
- 1. BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 2. WHY? Psychiatry started as “inpatient” practice eg
- 3. Outline Admission process Working DD Initial assessments
- 4. Admission process Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 5. Type of admission according to Egyptian
- 6. Working DD Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 7. Cairo, Dec 2014 BASIC SKILLS FOR
- 8. How to set a DD list? Phenomenology
- 9. Cairo, Dec 2014 BASIC SKILLS FOR
- 10. Psychotic ds & Mood ds present the
- 11. Delirium Cairo, Dec 2014 BASIC SKILLS FOR
- 12. Cairo, Dec 2014 BASIC SKILLS FOR
- 13. Cairo, Dec 2014 BASIC SKILLS FOR
- 14. Cairo, Dec 2014 BASIC SKILLS FOR
- 15. Cairo, Dec 2014 BASIC SKILLS FOR
- 16. Cairo, Dec 2014 BASIC SKILLS FOR
- 17. Initial assessments / orders Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 18. All admitted pt to mental health
- 19. Initial orders regards: Vital signs Diet:
- 20. General tips Avoid crystalloids without I /
- 21. Do NOT give conflicting order (
- 22. Labs & Imaging Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 23. Common labs CBC, LFT, KFT, Chemistry, TFT
- 24. CBC & BMP Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 25. QTc Interval Cairo, Dec 2014 BASIC SKILLS
- 26. Management plan Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 27. Acute / Short term Long term
- 28. Followup / Progress notes Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 29. MSE is a part of followup
- 30. Psychopharmacology Cairo, Dec 2014 BASIC SKILLS FOR INPATIENT PSYCHIATRY
- 31. Route of drug delivery Oral Parenteral: IM,
- 32. Unknown pt Who? Recently admitted without proper
- 33. Depot injections Poor Compliance is main indication
- 34. Agitated pt Try know cause: psychotic /
- 35. Discharge plan / arrangement Discharge
WHY? Psychiatry started as “inpatient” practice eg Kraepelin, Khalboum, Bleuler Basic residency tasks Not available in many mental health facilities in Egypt Still current practice is affected by “mind-body” dualism, so
Слайд 1BASIC SKILLS FOR INPATIENT PSYCHIATRY
AHMED ELAGHOURY
Egyptian & Arab Boards in Psychiatry
Abbassia
Слайд 2WHY?
Psychiatry started as “inpatient” practice eg Kraepelin, Khalboum, Bleuler
Basic residency tasks
Not
available in many mental health facilities in Egypt
Still current practice is affected by “mind-body” dualism, so psychiatrists may work in poor-facility hospitals deprived from other medical services / coverage ie depend on their skills in inpatient care
Still current practice is affected by “mind-body” dualism, so psychiatrists may work in poor-facility hospitals deprived from other medical services / coverage ie depend on their skills in inpatient care
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 3Outline
Admission process
Working DD
Initial assessments / orders
Management plan
Followup / Progress notes
Psychopharmacology
Discharge plan
/ arrangement
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 5
Type of admission according to Egyptian MHA
Source / Through
Supervisor psychiatrist: responsible
Accurate
record of date and time with clear physician name
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 7
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Donnely T & Giza C:
Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Слайд 8How to set a DD list?
Phenomenology
Age of onset
OCD: onset, course, duration
Risk
factors: 3Ps
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 9
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Byrne P & Byrne N:
Psychiatry : clinical cases uncovered. 2008, Wiley-Blackwell
Слайд 10Psychotic ds & Mood ds present the same
Cairo, Dec 2014
BASIC SKILLS
FOR INPATIENT PSYCHIATRY
ICD 10 symptom checklist, WHO 1994
Слайд 11Delirium
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Donnely T & Giza C:
Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Слайд 12
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Donnely T & Giza C:
Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Слайд 13
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Donnely T & Giza C:
Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Слайд 14
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Donnely T & Giza C:
Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Слайд 15
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Donnely T & Giza C:
Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Слайд 16
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Donnely T & Giza C:
Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Слайд 18
All admitted pt to mental health hospitals should be assessed by:
Security
/ Nurse aide / Nurse
Internal medicine
Clinical psychology
Social worker
Neuro exam:
Cognitive
Gait
Motor
CNs: (2, 3, 4 , 6), 7, (9, 10, 11)
DTRs: bi, tri, ankle, knee / Superficial: plantar
Coordination
Stretch signs
Internal medicine
Clinical psychology
Social worker
Neuro exam:
Cognitive
Gait
Motor
CNs: (2, 3, 4 , 6), 7, (9, 10, 11)
DTRs: bi, tri, ankle, knee / Superficial: plantar
Coordination
Stretch signs
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 19
Initial orders regards:
Vital signs
Diet: regular / diabetic / cardiac / easy
to chew & swallow
Elimination: stool & urine
Activity: with help / walking stick etc
Precautions against: Fall / Aspiration / Seizures / VTE
ECG / Labs / Imaging
Elimination: stool & urine
Activity: with help / walking stick etc
Precautions against: Fall / Aspiration / Seizures / VTE
ECG / Labs / Imaging
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 20General tips
Avoid crystalloids without I / O monitor
Avoid D5W without thiamine
PRN
medications: as needed
STAT medications: you must attend
qHS medications: at bedtime
STAT medications: you must attend
qHS medications: at bedtime
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 21
Do NOT give conflicting order ( 2 connected orders in same
phrase) eg
PRN Chlorpromazine 50mg IM if BP ≥ 90 / 60
Monitor pt meals, except when sedated / confused
[ - PRN Chlorpromazine 50mg IM – Notify if BP ≤ 90 / 60 ]
[ - PRN haloperidol 10 IM – Do NOT exceed 50mg / d]
[ - Notify if RBG ≥ 200 mg / dl]
[-Monitor pt meals –Notify if pt is oversedated – Notify if meals are left as same]
PRN Chlorpromazine 50mg IM if BP ≥ 90 / 60
Monitor pt meals, except when sedated / confused
[ - PRN Chlorpromazine 50mg IM – Notify if BP ≤ 90 / 60 ]
[ - PRN haloperidol 10 IM – Do NOT exceed 50mg / d]
[ - Notify if RBG ≥ 200 mg / dl]
[-Monitor pt meals –Notify if pt is oversedated – Notify if meals are left as same]
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 23Common labs
CBC, LFT, KFT, Chemistry, TFT
PRL
Vit D3 & B12
Hepatitis viral markers
/ HIV
Tumor markers
Immune profile
Tumor markers
Immune profile
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 25QTc Interval
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Quick LabRef app. Nika
Informatics, 2014
Слайд 27
Acute / Short term
Long term
Durations
Scales / outcome measures
Cairo, Dec 2014
BASIC
SKILLS FOR INPATIENT PSYCHIATRY
Слайд 29
MSE is a part of followup note
Nurse’s observation
Ward behaviors toward staff
/ other pts
Side effects of medications
Trace initial target symptoms
Examples & discussion
Side effects of medications
Trace initial target symptoms
Examples & discussion
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 31Route of drug delivery
Oral
Parenteral: IM, IV
Enteral: NGT, G tube, PR
Inhalational
Sublingual
Cairo,
Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 32Unknown pt
Who?
Recently admitted without proper data regards previous mental / medical
/ drug Hx
Pt in other health facilities
Drug naïve pt
What to do?
Avoid depot inj at start
Avoid frequent daily dosing
Avoid high doses
Start low & go slow
Pt in other health facilities
Drug naïve pt
What to do?
Avoid depot inj at start
Avoid frequent daily dosing
Avoid high doses
Start low & go slow
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 33Depot injections
Poor Compliance is main indication
Start during inpatient stay: at least
2 wks before discharge
Oral first
Challenge doses
Oral first
Challenge doses
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 34Agitated pt
Try know cause: psychotic / not
Containment & calming down
Follow predetermined
protocol: drugs & how to after monitor?
Eg Haloperidol , Olanzapine, Zuclopentixol inj
Eg BZD inj
Try avoid IV inj esp in poor facility hospitals
Keep alert to oversedation: dehydration, hypoglycemia, aspiration, constipation etc
Eg Haloperidol , Olanzapine, Zuclopentixol inj
Eg BZD inj
Try avoid IV inj esp in poor facility hospitals
Keep alert to oversedation: dehydration, hypoglycemia, aspiration, constipation etc
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
Слайд 35Discharge plan / arrangement
Discharge summary
Final diagnosis
Drug treatment
OPD appointments
Special precautions to pt
/ family
Rehab arrangements
Keep contacts of critical pts, esp in poor-record systems
Rehab arrangements
Keep contacts of critical pts, esp in poor-record systems
Cairo, Dec 2014
BASIC SKILLS FOR INPATIENT PSYCHIATRY
