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nurs 211
psych safety (suicide, aggression, abuse)
| Question | Answer |
|---|---|
| any stressful situation can precipitate a ____ | crisis |
| ____ decreases problem solving skills | anxiety |
| anxiety can lead someone to be nonfunctional- what is our goal | getting the person back to the previous level of functioning |
| crisis: there thoughts become what; pt behavior is aimed at the relief of what; | obsessional; anxiety; |
| crisis: some ppl have good ___ to deescalate the crisis | coping skills |
| crisis: this can effect ___ health as well; ppl are in crisis when they have lack of ____ to deal with the stressor; | physicial; resources; |
| crisis: resolution of the crisis promotes what; how does it promote growth | growth; if one works through the stressor they will come out with a better way to handle stress in the future |
| crisis: does it affect everyone; this is precipitated by a specific what; what causes the crisis; are they acute or chronic; can they be resolved positively; can they be resolved negatively; how fast is it resolved | yes; identifiable event; the specific identifiable event; acute; yes; yes; with in a few months |
| crisis: does the event have potential for growth; does it have potential for decline; when person learns new methods of coping that can be utilized when similar ____ recurs; | yes; yes; stressor; |
| crisis: when can this be a dangerous time | person is overwhelmed with out adequate preparation for changes leading to maladaptive coping dysfunctional behaviors- they handle one more thing |
| phases of crisis development: how many phases are there; what is phase one; def phase 2; | 4; exposed to a precipitating stressor; exposed to a precipitating stressor; previous problem solving techniques do not relieve the stressor |
| phases of crisis development: def phase 3; def phase 4; | all internal and external resources are utilized; tension mounts or increases to breaking point |
| phases of crisis development: phase 1: what increases in the phase; previous ___ techniques are utilized | anxiety; problem solving |
| phases of crisis development: phase 2- what continues to increase; why is there feelings of helplessness; | anxiety; when previously effective coping skills are ineffective; |
| phases of crisis development: phase 3- why are all internal and external resources utilized; at this phase new ____ are used; if new problem solving techniques are used with resolution returning to what level of functioning | to resolve the problem and relieve the discomfort; problem solving techniques; higher, lower or previous level of functioning |
| phases of crisis development: phase 4- this happens when there is no resolution from what; what type of anxiety is this; what is disordered; what is labile; behaviors may reflect presence of psychotic thinking | the previous phase; panic level; cognitive functions; labile; lack of sleep |
| crisis of equilibrium response: what are the 3 factors that influence a crisis response; | perception of the event, availability of situational supports, availability of adequate coping mechanisms; |
| crisis of equilibrium response: perception of event- realistic perception of event promotes what; distorted perception of event lessens what skills; | adequate resources to regain equilibrium; problem solving and equilibrium is unresolved |
| crisis of equilibrium response: availability of situational support- what type of type help solve problems; what people might have a hard time getting support | dependable; person overwhelmed and alone with out support |
| crisis of equilibrium response: availability of adequate coping mechanisms- what can divert a crisis; if no success with previous coping mechanisms what feelings can increase | success with previous coping mechanisms;tension and anxiety |
| 6 classes of emotional crisis: class one dispositional crisis- def; | an acute response to an external situational stressor; |
| 6 classes of emotional crisis: class 2 crisis of anticipated life transitions- def; | normal life cycle transitions that may be anticipated but the person may feel lack of control; |
| 6 classes of emotional crisis: 3 crisis resulting from traumatic stress- what are ex of traumatic stress; def; | death, war vets; crisis precipitated by unexpected external stresses over which the person has little or no control, results in being emotionally overwhelmed and defeated; |
| 6 classes of emotional crisis: class 4 maturational/developmental crises- def; these crisis are of what origin; this crisis reflects underlying ___ issues; | crises that occur in resonse to situations that trigger emotions related to unresolved conflicts in a person's life; internal; developmental; |
| 6 classes of emotional crisis: class 5crisis reflecting psychopathology- def; ex of preexisting psychopathology | emotional crisis in which preexisting psychopathology precipitates the crisis or impairs or complicates adaptive resolution; borderline personality, severe neuroses, characterological disorders, schizophrenia |
| 6 classes of emotional crisis: class 6 psychiatric emergencies- def; ex | crisis situations with general functioning severely impaired and the person is incompetent or unable to assume personal responsibility; acutely suicidal person, drug overdose, reactions of hallucinogenic drugs, acute psychoses, uncontrollable anger, |
| crisis intervention: this is designed to provide rapid assistance for what individuals; focus on supporting the person to restore them to what level of functioning; what is therapist role; | individuals with urgent need; precrisis level or higher; to mobilize resources needed to resolve crisis |
| crisis intervention:are lengthy psychological inerpretations appropriate for crisis intervention; does it take place in inpatient of outpatient; what type of support system does a person need in order to be able to go home; | no; both; stable; |
| crisis intervention: adaptive changes leads to what; the person should experience some degree of relief by how many interactions | resolution and growth; from the 1st interaction |
| phases of interaction: role of the nurse in phase 1; phase 2; phase 3; phase 4 | assessment; planning of therapeutic interventions; intervention; evaluation of crisis resolution and anticipatory planning |
| crisis interventions phase 1 assessment: crisis can occur where in the hospital; gather information regarding what; client describe what event; assess ___ and ___ status | every unit; the precipitating stressor and resulting crisis; event leading to the crisis; physical and mental |
| crisis interventions phase 1 assessment: why assess physical; assess what for safety; assess what about support; determine precrisis level of ____ | look for weapons, skin issues, underwite; suicide attempts; if they have any; functioning |
| crisis interventions phase 1 assessment: assess perception o fwhat; assess use of what; what dx is identified in this step | personal strengths and weakness; substances; nursing Dx |
| crisis intervention nursing dx: this should reflect what; ex of nursing dx | the immediacy of the crisis situation; ineffective coping, anxiety, disturbed thought processes, risk for self-or other directed violence, rape-trauma syndrome, post trauma syndrome, fear |
| crisis interventions phase 2 planning: select appropriate nursing actions for what; what are established: what is the goal for resolving the crisis; what is taken into consideration when planning | the nursing dx; goals; to return pt to precrisis level of functioning; the type of crisis, the individual's strengths and available resources |
| crisis interventions phase 3 interventions: planning in phase 2 is what; interventions are the focus of what; use ____ oriented approach; focus on what problem; | implemented; the nursing crisis intervention; reality; the current one |
| crisis interventions phase 3 interventions: why do we remain with the person experiencing a panic attach; promate an atmosphere to verbalize what; discourage what; | they are at risk for physical s/s - increased hr etc; true feelings; lengthy explanations or rationalizations |
| crisis interventions phase 3 interventions: establish firm limits on what behavior; help client determine what stressor ___ the crisis; | aggressive, destrucptive behavior; precipitated |
| crisis interventions phase 3 interventions: guide the client through what; client needs the confront the source ofwhat; coping mechanisms are ultimately whose choice | problem solving process; the problem; the clients |
| phase 4 evaluation- eval what; what is done to determine if the stated obhective what achieved; | the crisis resolution; reassessment; |
| phase 4 evaluation: can the client describe a plan of action for dealing with what; review what; anticipate what | stressors such as the current problem; what has been learned; how the client will respond in the futre |
| suicide: is it a behavior; __% of ppl who attempt have mental disorder; it is the 3rd leading cause of what | yes; 95%; cause of death |
| suicide: do ppl give clues and warnings of suicide; do most want to be saved; most suicidesoccur within how many months after improvement; is it inherited; does a close family member doing it increase the risk; what is the leading cause of death; | yes; yes; 3 months; no; yes: gunshots; |
| suicide: risk factors- single/divorced or married twice as likely to commit suicide; | single; |
| suicide: risk factors- who is most likely to attempt suicide women or men; women commit suicide how most often; who succeeds most often women or men; what do men use to commit suicide; | women; by overdose; men; gen |
| suicide: risk factors- who is least likely to seek help men or women; | mne; |
| suicide: risk factors- what age most common; what age are women most at risk; who is at greatest risk of all age/gender/race | 40-50 yrs and 65 yo; throughout life and declines after 65 yo; white males >80yo |
| suicide: risk factors- what are the factors that put adolescenes at risk | impulsive and high risk seekers, access to lethal weapons substance abuse, untreated mood disorders |
| suicide: risk factors- do religious ppl have increased or decreased risk; what ethnic group have highest risk for suicide; who is at highest risk very rich, poor or mod; what careers have high risk | decreased risk; whites; richest and lowest class; physicians, artists, dentists, law enforcement, lawyers, insurance agents |
| suicide: risk factors- 90% with successful suicide have a dx of what; suicide risk increases in the early tx with what meds | mental disorder; antidepressants; |
| suicide: risk factors- what type of psychosis increases the risk; what age a gays is there a high rate; | command hallucinations; youth; |
| suicide: risk factors- deficiency in what neurotransmitter increases the risk; | serotonin; |
| suicidal assessment: what is assessed; what questions are asked to determine if it is a threat; | demographics, psychiatric dx, med dx; do you have a plan, any previous attempt; |
| suicidal assessment: what life events can lead to it; what hx is relevant; what are some life stages issues | adverse life events, precipitating stressor, depression; what is their coping to situations- do they have dysfunctional responses due to numerous failures; decreased ability to tolerate losses and disappointments during developmental stages |
| suicidal assessment: what type anxiety do they have; what depression do they have; what type of isolation; what is their daily function; do they have resources; | high or panic; severe; hopeless; not good at any activity, poor hygiene; no |
| suicidal assessment: what are their coping strateges; do they have any sig others; what is their lifestyle; | predominantly destructive; only one or none; unstable; |
| suicidal assessment: what is alcohol or drug use; are there previous suicide attempts; are they disorganized; are they hostile | continual abuse; yes; yes; yes |
| suicidal assessment: what is an easy way to remember this | plaid pals |
| plaid pals: P= ___; L=__; A=____; I=___; D=__; | is there a plan; lethality- could they die with this plan; availability- means to carry out the plan; illness- mental or physical;depression- chronic/situation |
| plaid pals: P=___; A=___; L=____; S=___ | previous attempts-lethality, recent; alone-do they have a support system, partner, are they alone; loss-death, job, relationship; substance abuse- |
| suicide: ex of nursing dx ; what are some short term goals | risk for suicide related to feelings of hopelessness and desperation, hopelessness related to absence of support systems and perception of worthlessness; will experience no physical harm to self, will set realistic goals for self, express optomisn |
| suicide: what are interventions neededto prevent client injury | 1:1 observation, room cleared of potential weapons, remove all clothing and place a patient in gown, remove all personal belongings from persons reach, room close to nursing station, do not assign private room, accompany pt to BR |
| nursing DX for suicide: Risk for suicide - what is goal; what is special care when administering meds; how often should rounds occur | client will not harm self; check for cheeking and under the tongue; q15m and in irregular intervals; |
| evaling the suicidal client: is this ongoing; after immediate crisis is resolved extended ____ may be needed; | yes; psychotherapy; |
| suicide: what are long term goals; | develop and maintain a more positive self concept, learn more effective ways to express feelings to others, achieve successful interpersonal relationships, feel accepted by others and achieve a sense of beloning |
| outpatient/discharged suicidal client interventions: when may they not be hospitalized; what are 2 important guidelines when pt is not being hospitalized; | if they are a low risk for suicide; never leave pt alone must be at home with family, establish a written no-suicide contract with client |
| outpatient/discharged suicidal client interventions: family/friends need to ensure what is safe; what appointments should be kept daily; | home; conseling; |
| anger/aggression: is it a normal human emotion when handled appropriately;serves as what type of signal; how can it provide a positive force; triggers what SNS response | yes; a warning signal and alerts to potential threat or trauma; to solve problems and make decisions; fight or flight |
| anger/aggression: when is it problematic; | when not expressed or expressed aggressively; |
| key points of anger: is it a primary emotion; it is an automatic inner response to what; the physiological arousal instills what;what is learned; can anger come under personal control | no; hurt, frustration or fear; feelings of power and gnerates preparedness; how one expresses anger; yes |
| def anger: what physical problems can it precipitate; what mental health problems can it precipitate if turned inward | migraines, ulcers, colitis, coronary artery disease; depression, low self esteem |
| def anger: is it neg or pos when linked with aggression; what type of behavior occurs when suppressed anger becomes resentment; | neg; passive aggressive; |
| def anger: arousal of the SNS- what happens to HR and BP; what happens to glucose; what happens f anger is not resolved over the years | increases; increases; can lead to illness over time |
| aggression: def; ex; the behavior is meant to ___ ; they are often __ | a behavior intended to threaten or injure the victim's security or self esteem; to assault or attack persons or objects can be words, physical force or weapons; punish; vengegul |
| predisposing factors to anger/aggression: modeling- this is the strongest form of what; children model whom; physically abused children become physically abusive ____; what stimuli can lead to aggressive behavior | learning; behaviors of parents/caregivers; adults; television, video game violence |
| predisposing factors to anger/aggression: operant conditioning- this occurs when a specific ___ is reinforced; what are the 2 types; def positive; ex | behavior; positive and negative; pleasurable or rewarded behavior; temper tantrum leads to getting what child wants |
| predisposing factors to anger/aggression: operant conditioning- def neg; ex neg | strengthens a behavior bc negative condition is stopped or avoided as consequence of the behavior; driving in heavy traffic is neg, we leave home early to avoid it |
| predisposing factors to anger/aggression: neurophysiological disorders- ex; what meds can decrease behaviors | epilepsy, tumors in brain, trauma to brain, encephalitis; anticonvulsant meds |
| predisposing factors to anger/aggression: biochemical factors- what hormonal dysfunction; what neurotransmitters may facilitate or inhibit aggressive impulses; | cushing or hyperthyroidism; epi, norepi, dopamine, acetycholine, serotonin |
| predisposing factors to anger/aggression: socioeconomic factors- there is an increased violence in what class; why increase in violence in this class; | poverty; lack of resources, separation of families, alientation, discrimination and frustration |
| predisposing factors to anger/aggression: environmental factors- why might physical crowding cause this; does extreme heat increase or decrease aggression; what doe ETOH do; | due to increased contact and decreased defensible space; decrease it; increase violent behaviors; |
| what behaviors are associated with anger | frowning, clenched fists, clenced teeth, low pitch verbal, yelling and shouting, easily offended, defensive response to criticism, passive-aggressive behaviors, intense discomfort, state of tension, emotional over control |
| anger: this is a stage of the ___ process; if someone becomes fixed in this stage what does that lead to; why may one deny anger as a feeling; client needs to recongnize true feelings and know that anger is acceptable if expressed how | grieving; depression; bc of negative implications; appopriatey |
| what behaviors are associated with aggression | pacing, restlessness, tense facial expression and body language, verbal and physical threat, loud voice, shouting, arguing, threats of homicide or suicide, increased agitation with overreaction to environmental stimuli, panic anxiety, disturbed thoughts, |
| aggression: can arise from what; what are the 3 classes; ex of mild; ex of mod; ex of extreme; | anger, anxiety, guilt, frustration, or suspiciousness; mild, mod, extreme; sarcasm; slamming doors; physical acts of violence against others |
| anger: assessment- what is the goal in management of aggressive/violent behaviors; safety of whom is nurse's priority; what are 3 factors to assess for potential violence | prevention; client and others; past hx of violence, client dx, current behavior |
| anger: assessment- what dx are associated with violence; what dx have risk of violence; | schizophrenia, major depression, bipolar disorder, and substance use disorder; dementia, antisocial, borderline personality intermittent explosive personality; |
| anger: assessment- a client's threatening behavior may be an overreaction to feeling what; does aggression rarely occur suddenly or unexpectedly; | impotence, helplessness, feelings humiliation; yes; |
| anger: assessment: prodromal syndrome- def; these behaviors should be addressed how | characterized by anxiety and tension, verbal abuse and profanity and increasing hyperactivity; emeregent with immediate attention |
| anger/aggression nursing dx: complicated grieving r/t; ineffective coping r/t; risk for self-directed violence r/t; | loss; negative role modeling and dysfunctional family system; having been nurtured in an atmosphere of violence; |
| anger/aggression nursing dx: outcome- the client should recognize angry feelings and seek out whom to talk to; they can take responsibility for what; the control exert what kind of control over feelings; they will not cause harm to whom | staff/support person; own feelings; internal; themselves or others; |
| anger/aggression planning: ineffective coping- client will be able to recognize what; they should be able to ___ before losing control; what are intervention | anger; take responsibility; remain calm, do not touch client. write feelings of anger in a diary, assist with finding the true source of the anger, assist with alternate ways of tension release, |
| anger/aggression nursing dx: risk for selfdirecting or other directed violence- client will not harm whom; client will do what instead of hit; what are behaviors assocc. with prodromal syndrome | self or others; verbalize anger; attempt to defuse anger with least restrictive means, ensure sufficient staff isavailable to assist with potentially violent situation |
| de-escalation techiques: talk how; never positive self how; what physical outlet: what meds; call for what; what to use if talking down is not successful | down; w/o easy exit from room; punch pillow; voluntary if threat to self or others reassess situation; assistance to remove others from the immediate area; restraints |
| restraints: follow who's policy; how many ppl; this is the last ___; an in-person eval by physician with/in ___ hours of initiation; new order for restraints required every __hours for adults and every ___ hours for kids; 1:1 for how many hours; | facilities; 5; resort; 1 hour; 4 hours and 1-2 hours; 1st; |
| restraints: after 1:1 how is pt monitored; what is assessed q15m; | by audio and visual monitoring; circulaton, nutrition, hydration, elimination;t |
| chemical restraints: this is rapid ___; what meds | tranquilization; Haldol, Ativan, thorazine, apsine, zyprexa, geodon |
| eval anger/aggression: reassess to determine what; | success of nursing intervnetions in achieving care objectives; |
| anger/aggression core documentation when in restraints: | admission screening, minutes of physical restrain, minutes of seclusion, justification for multiple antipsychotic meds, post discharge care plan, patient strengths, substance use |
| abuse: who is the abuser; what is wastly underreported in US; many abusers are victims of ____ | men and women; rape; abuse |
| abuse predisposing factors: neurophysiological-what areas of the brain are associated with aggressive behaviors; | temporal lobe, limbic system, amygdaloid nucleus; |
| abuse predisposing factors: biochemical- what neurotransmitters play a role; | norepi. dopamine, serotonin; |
| abuse predisposing factors: how does psychodynamics play a role; how does learning theory play a role; socio cultural theories play are role | unmet needs for satisfaction and security lead to aggression and violence; imitate role models, usually parents; products of one's culture and social structure |
| intimate partner violence: battering- def; leads to what feelings in the victim; more common in men or women; what age most common; | a pattern of power andcontrol through physical/sexual violence or threat of violence of an intimate partner; fear intimidation; women; 20-24; |
| intimate partner violence: profile of the victim- they have low what; they grew up in what type of home; they are isolated from what; def learned helplessness phenomenon; | self esteem; abusive; family and support system; progressive inability to act on her own behalf; |
| intimate partner violence: profile of victimizer- self esteem low or high; they are pathologically ___; how do they have a dual personality; they have high or low stress; they consider ___ as a possession; insults and humiliates whom; who becomes pawns | low; jealous; one to partner and one to rest of the world; high; spouse; spouse; children |
| cycle of battering: phase 1 the tension building phase- woman senses the man's tolerance for ___ is declining; be becomes angry with little __; after anger he will quickly do what; woman caters to what to keep peace; does battering occur in this phase | frustration; provoking; apologize for lashing out; needs; minor |
| cycle of battering: phase 1 the tension building phase- she denies what; she rationalizes what; as battering becomes more intense she does what; the withdrawal is seen as what to him; how long does this phase last | her anger; his behavior; withdraws; rejection and escalates his anger; weeks to months and years |
| cycle of battering: phase 2 acute battering phase- this is the longest or shortest phase; most or least violent phase; how long does it last; abuser justifies what; after incident abuser cannot understand what | shortest; most; 24 hours; his behavior; what happened; |
| cycle of battering: phase 2 acute battering phase- women feel their only option is to find what; is beating severe; help is sought when; | a safe place to hide; yes; only when severe injury or a woman fears for her childs life |
| cycle of battering: phase 3 calm,loving, respite phase: aka __ phase; batterers behaviors change how; the baterer promises what | honeymoon; they become extremely loving, kind and contrite; it will never happen again; |
| cycle of battering: phase 3 calm,loving, respite phase: he plays on her feelings of what; does the cycle start over | guilt and that she has learned her lesson; yes |
| why do women stay in abusive relationships: fear of what; for the children fear of losing what; what other reasons; | retaliation- he will kill her and kids; custody; finances |
| abuse: Nursing dx- powerlessness: r/t what; what is outcomes | cycle of battering evidenced by verbalization of theattack; immediate attention to physical injuries, verbalizes assurance of immediate safety, discusses life situation with nurse, can verbalize choices and receive assistance |
Created by:
jmkettel
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