NUR 180 Exam 1
Tension building phase
- Abuser has minor episodes of anger and may be verbally abusive - Responsible for some minor physical violence - Victim is tense during this stage and tends to accept the blame for what is happening.
Serious battering phase
-Abuser becomes unbearable; violence occurs -Victim may try to cover up the injury or may look for help
Signs of an abusive personality?
A push for quick involvement Jealously controlling Unrealistic expectations Isolates partner from family and friends Blames others for own problems and mistakes Makes others responsible for his/her feelings Hypersensitive, easily insulted Cruel to animals and children Playful use of force during sex Verbal abuse Enforces rigid sex roles Sudden mood swings History of past battering Threatens violence
Mutism
Able to speak but remains silent
Honeymoon phase
Abuser- may bring gifts, show kindness, apologize, and promise it won't happen again Victim- believes abuse is over, stays in the relationship
Suicidal gestures
Actions that result in little or no injury but communicate the message of suicidal intent
A patient is admitted to the hospital. They are extremely worried about their pets at home. What would you do?
Ask them if there is anyone at home or if there is anyone they can call that will help them take care of their responsilities
If someone states they are going to kill themselves, what should you do?
Ask them if they have a plan what that plan is Figure out how obtainable that plan is
How do you know a client can conversate with you?
Assess to see if they can communicate Can they talk? Can they hear?
What are medications used to manage aggression?
Atypical antipsychotics (Clozapine, Risperdone) Beta Blockers (Propanolol, metoprolol) Antianxiety agents (Buspirone, lorazepam, benzos) Anticonvulsants (Valproic acid.. monitor labs)
Circumstantiality
Describes in too much detail, cannot be selective
What are the principles of mental health care?
Do no harm Accept each client as a whole person Develop mutual trust Explore behaviors and emotions Encourage responsibility Encourage effective adaptation Provide consistency
Suicidal ideation
Expressed thoughts or fantasies with no definite intent—may express ideas directly or symbolically
What are some nontherapeutic communication techniques?
Failure to listen Failure to explore client's point of view Failure to probe Eliciting vague descriptions Giving inadequate answers Parroting Following standard forms too closely Being judgmental Giving advise Being defensive Challenging Giving reassurance Rejecting Using stereotyped responses
When it comes to communication what should you focus on?
Focus on the behavior not the client
Rape/Trauma victim interventions
Give referrals Get them counseling Encourage them to talk about their feelings Be non-judgmental Encourage them to report the incident
Characteristics of a person with machismo? SATA
Has an attitude of male pride Engages in thrill-seeking behaviors Employs competition as his guiding principle Is egocentric Is unable to express emotions except anger and rage Dislikes being gentle or vulnerable Values sexual virility Displays sexist attitude Treats women as objects or commodities Sees women as objects of conquest Insists on being dominant toward girls and women Holds to unwritten law that infidelity by a woman must be avenged Unable to cooperate with women Agrees to sexual use and abuse of women Glorifies war and violence, supports the use of military force Enjoys contact sports Uses aggression to physically solve problems
Assessing illusions or hallucinations?
How many voices (images) do you hear or see? What do the voices say? Images do? Do you recognize and of the voices/images? When did the voices/images start? What was happening in your life? How do you feel about the voices/images?
Hyperalertness
Increased state of alertness or watchfulness (hypervigilance)
Signs and Symptoms of stress
Irritability, difficulty sleeping, sleeping too much, anxiety, guilt, indecisiveness, loss of appetite, sexual relations, and interest in work, isolation, alcohol or drug abuse, inability to concentrate
Silence
Lack of verbal communication for therapeutic reason Therapeutic value: allows client time to think and gain insights
Malpractice
Negligence by a professional person Duty, Breach of duty, Causation, Injury
Victims of violent or abusive acts often suffer from what?
PTSD
Myths about suicide
People who talk about it will not commit suicide One does not need to take a suicide threat seriously A failed suicide attempt is a manipulative behavior People who are really serious about suicide give no clues It is harmful to discuss the subject of suicide Only psychotic or depressed people commit suicide Suicide occurs only in the poor Young children never commit suicide When people show signs of an improved mood, the threat of suicide is over
Suggesting
Presenting alternative ideas for client's consideration relative to problem solving Therapeutic value: increases client's perceived options or choices
Focusing
Questions or statements that help client expand topic Therapeutic value: allows client to discuss central issues keeps communication process goal directed
Chronic stress
Represents a sustained or perpetual demand, threat, or pressure, that is harmful to health because it wears on individuals continuously. Can stem from long-term stressors such as chronic occupation stress, relationship, or financial stress Often associated with a loss of hope that the situation can improve
Suicidal attempts
Serious self-directed actions with the intent to end one's life
Flight of ideas
Shifts rapidly between unrelated topics
Primary prevention of stress
Stress management and reduction techniques, Counseling, Health education, Family enhancement, Social support enhancement and network building, Wellness programs
What's included in a suicide assessment?
Suicide ideation (thoughts) History of suicide attempts Present suicide plan Availability of items to carry out plan Substance use or abuse Level of despair Ability to control own behavior
What are the cycles of domestic violence
Tension building Serious battering incident Honeymoon
Completed suicide
The successful ending of one's life
Tertiary prevention of stress
Treatment and recovery from stress related illnesses, Counseling services, Employee assistance programs. Help them live a therapeutic lifestyle
What is the first thing you should do when you meet a mental health patient?
Try to get them to trust you
Theme identification
Underlying client issues or problems that emerge repeatedly during caregiver-client relationship Therapeutic value: allows caregiver to promote client's exploration and understanding of important problems
Comatose/unconscious
Unresponsive to any verbal or painful stimuli
Parasuicidal behavior
Unsuccessful attempts with a low likelihood of success
Secondary prevention of stress
Using screening tools to determine stress levels.
Therapeutic communication
Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.
Is light stress good for cognition?
Yes
Domestic violence
abuse and battering within a family
Common unpleasurable emotional responses
aggression, agitation, ambivalence, anxiety, depression, fear
Coping
alleviating stress using emotional, cognitive, or behavioral methods being action oriented toward a goal of changing a situation abstract thoughts based on past experiences to reduce stress
Broad openings
allowing the client to take the initiative in introducing the topic Therapeutic value: indicates acceptance by caregiver and value of client's initiative
PTSD
an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience
Stress
an internal or external even or demand of life experienced by the individual that is perceived and appraised for scope and meaning on a continuum to determine whether resources and abilities for management are available, exceeded, or exhausted
What are the interrelated concepts for stress?
anxiety coping functional ability family dynamics cognition mood and affect perfusion sexuality sleep Immunity
What are some problems with communication?
aphasia dyslexia speech clustering
What are some things you need to do if your patient has alzheimers?
approach from the front use normal tone of voice face them maintain distance of 1-1.5 ft minimize hand movement don't frighten avoid high sensory levels/places maintain eye contact/smile use simple words/statements allow time for response repeat important info ask one question at a time conflict = distract/remove
Sharing perceptions
asking client to verify caregiver's understanding of client's message Therapeutic value: conveys understanding to client and can clear up confusing communication
Alert
awake and responsive, oriented to time, place, and person
Somatic symptoms of child abuse?
bad grades unexplained injury UTI's malnutrition
Examples of psychological/emotional stressors
birth of child caregiving change in health status death of close family member or friend diagnosis of terminal illness divorce failing an exam loss of job marriage parenting physical disability relationship problems
Disorders of thinking
blocking flight of ideas loose associations perseveration delusions obsession phobias preoccupations amnesia confabulation
Lethargic
can be verbally aroused, shows decreased wakefulness, may have periods of excitability alternating with periods of drowsiness
Examples of physiological stressors
cancer copd dementia DM Organ failure MI Acute and chronic pain Traumatic injury
Neologism
coins new words and definitions
Machismo
compulsive masculinity evidenced by preoccupation with physical strength and athletic prowess, attempts to demonstrate daring, or violent and aggressive behaviors
Therapeutic listening skills
concentrate on the speaker and message keep distractions to a minimum Change the setting if needed Assess nonverbal communications Listen objectively without judgement Discover words that trigger emotional responses Use eye contact and body language that is culturally appropriate Do not interrupt Jot down notes if needed Do not assume that you understand anothers thoughts Clarify any message about which you are unsure
What are motivations for suicide
cry for help refusal to accept a diminished quality, style, or pace of life Need to affirm the soul To relieve distress Preoccupied with suicide To exercise control
child abuse
deliberate action that is harmful to a child's physical, emotional, or sexual well-being
Reflection
directing back the client's ideas, feelings, questions, and content Therapeutic value: Validates caregiver's understanding of what client is saying and signifies empathy, interest, and respect for client
Humor
discharge of energy through comic enjoyment Therapeutic value: can promote insight by making conscious repressed material, resolving paradoxes, tempering aggression, and revealing new options, is socially acceptable form of sublimation
When women get pregnant we see an increase in what?
domestic violence
Common pleasurable emotional responses
euphoria, exaltation
For any patients make sure you don't provide this?
false reassurance
Characteristics of victims
feels captive in the system (family, group, community) Blames self for problems leading to abuse Has low self-esteem, feels self as unworthy Feels helpless and powerless to change the situation Is financially, emotionally, or physically dependent on the abuser Unable to see a future without abuse Is depressed
Mental status exam
general description- appearance, speech, motor Emotional state- mood, affect Experiences- perceptions Thinking- thought content Sensorium- LOC, memory, concentration level
Common inappropriate emotional responses
labile, inconsistent, flat
Blocking
loses train of thought, stops speaking because of unconscious block
Abuse
physical or emotional harm to someone **Once confirmed you must report** Get patient alone so you can talk to them
Battering
repeated physical abuse of someone, usually a woman, child or elder
Restating
repeating the main idea expressed Therapeutic value: indicates that caregiver is listening and validates, reinforces, or calls attention to something important that has been said
Echolalia
repeats last word heard
Perseveration
repeats single activity, cannot shift from one topic to another
Verbigeration
repeats words, phrases, sentences several times over
Stuporous
responds only to strong physical stimuli; falls asleep if not stimulated
Somatic symptoms of being bullied?
self harm - cutting constant stomachache or headache
Episodic acute stress
self inflicted stress Most common in type A personalities They may always be in a hurry or irritable or constantly worry
Informing
skill of information giving Therapeutic value: helpful in client education about relevant aspects of well being and self care
Loose associations
speaks constantly, shifting between loosely related topics
Pressured speech
speech becomes fast, loud, rushed, and emphatic
Mania
state of extreme excitement, elation, activity, and agitation
Empathy
the ability to understand and share the feelings of another
Suicide
the act of intentionally taking one's own life
Clarification
the act of making clear or understandable Therapeutic value: helps to clarify feelings, ideas, and perceptions of client and provides explicit correlation between them and client's actions
Cognition
the mental activities associated with thinking, knowing, remembering, and communicating
Acute stress
the most common type of stress and typically occurs for a short period of time. Occurs in reaction to a real or perceived threat, demand, or pressure. Resolution of the stressor leads to elimination of the stress response
Elder abuse
the physical or psychological mistreatment or neglect of elderly individuals
Listening
the process of receiving, constructing meaning from, and responding to spoken and/or nonverbal messages Therapeutic value: nonverbally communicates caregiver's interest and acceptance
Signs and symptoms of elder abuse?
unexplained bruising malnourished will shy away lower hygiene levels
Suicidal threats
verbal or written expressions of intent without actual actions
Drowsy/Somnolent
wakens with strong verbal stimuli; falls asleep if left undisturbed