MH Exam 3: Chapters 20, 21, & 25
Dissociative (psychogenic) amnesia involves:
-An inability to recall important personal data that is too extensive to be explained by ordinary forgetfulness -Not due to the direct effects of substance use or a general medical condition
what are the treatment modalities for anorexia and bulimia?
-Behavior modification: uses positive reinforcement -Individual therapy -Family therapy -Psychopharmacology
what are the types of somatic disorders?
-Chronic -Anxiety, depression, and suicidal ideations are frequently manifested -Drug abuse and dependence not uncommon
what is conversion disorder?
-A loss of or change in body function resulting from a psychological conflict -Cannot be explained by any known medical disorder or pathophysiology -"classic" conversion symptoms suggest neurological disease and occur following an extreme psychological stress -Often expresses relative lack of concern out of keeping with the severity of the impairment -La belle indifference- may be a clue that the problem is psychological rather than physical -You need to follow all of the medical orders, including giving pain medications -Do not tell them that they are wrong, help them as if their illness was present
what is illness anxiety disorder (hypochondriasis)?
-A preoccupation with the fear of contracting, or the false belief of having, a serious disease -The fear becomes disabling and persists despite reassurance that no organic pathology can be detected -Even in the presence of disease, the symptoms are excessive in relation to the degree of pathology -Anxiety and depression are common, and obsessive-compulsive traits frequently accompany the disorder
what is dissociative (psychogenic) fugue?
-A sudden, unexpected travel away from home or customary workplace -Unable to recall personal identity and assumption of a new identity is common
what are dissociative disorders?
-Disruption in usually integrated functions of consciousness, memory, and identity (like there are walls, one side of brain can remember something and other side can remember something else) -Behavior without full conscious awareness- Splitting off of mental contents from conscious awareness (split personality) -May be an extreme form of defense mechanisms -Estimated prevalence 0.5-1.0%
what is the assessment for bulimia nervosa?
-Episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (binging) -Episode followed by inappropriate compensatory behaviors- purging (self- induced vomiting or misuse of laxatives, diuretics, or enemas) -Associated fasting or excessive exercise may also occur -Most individuals with bulimia are within a normal weight range -Depression, anxiety, and substance abuse are not uncommon -Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalances
what is the psychological trauma associated with dissociative disorders?
-Evidence points to the etiology of DID as traumatic experiences that overwhelm capacity to cope other than by dissociation -Often have experienced severe physical, sexual, or psychological abuse by a parent or significant other in the child's life
what is dissociative identity disorder (DID)?
-Existence of two or more personalities within a single individual -Transition from one personality to another usually sudden, and usually precipitated by severe stress (child that is abused at night and then expected to get up in the morning and go to school like nothing is wrong) -Old name- Multiple personality disorder
what are the victim responses from sexual assault?
-Expressed response pattern -Controlled response pattern: patient is telling you what happened, but is not really reacting- leads to some nurses not believing them because they do not seem affected -Compounded rape reaction: they get mentally ill (probably due to a predisposition) -Silent rape reaction
what are the common characteristics of adult survivors of incest?
-Fundamental lack of trust that arises out of parent-child relationship -Low self-esteem and a poor sense of identity -Disturbed sexual relationships -Promiscuity- extremes
what are the personality characteristics of somatic disorders?
-Heightened emotionality -Strong dependency needs -A preoccupation with symptoms and oneself
how is family therapy used as a treatment for anorexia and bulimia?
-Involves educating the family about the disorder -Assesses the family's impact on maintaining the disorder -Assists in methods to promote adaptive functioning by the client
how is behavior modification used as a treatment for anorexia and bulimia?
-Issues of control are central to the etiology of these disorders -For the program to be successful, the client must perceive that he or she is in control of the treatment -Successes have been observed when the client: •Is allowed to contract for privileges based on weight gain •Has input into the care plan •Clearly sees what the treatment choices are
what are the learning theories thought to cause someone to be abusive?
-Learning theory: children learn to behave by imitating their role models -Individuals who were abused as children are more likely to behave in an abusive manner as adults
what are the psychological factors affecting other medical conditions?
-Medical condition adversely affected by psychological or behavioral factors -Specify severity- mild to severe
how is psychopharmacology used as a treatment for anorexia and bulimia?
-No medications are specifically indicated for eating disorders -However, antidepressant medications have been helpful for associated symptoms such as anxiety and depression
what is the background assessment data for child abuse?
-Physical abuse: any physical injury as a result of punching, biting, shaking, throwing, stabbing, choking, hitting, burning, or otherwise harming a child -Emotional abuse: pattern of behavior results in serious impairment of the child's social, emotional, or intellectual functioning -Behavioral indicators: extreme behaviors, delayed emotional development, suicidal ideation, and lack of attachment to parent -Physical and emotional (child has no support) neglect (indicators of neglect are stealing money or food and hygiene) -Sexual exploitation of a child -Incest -Indicators of sexual abuse: sudden increase in nightmares or bedwetting, unusual sexual knowledge esp under age 12, running away from home, and family is secretive and isolated
what are somatic symptom (somatoform) disorders?
-Physical symptoms suggesting medical disease without demonstrable pathophysiological mechanism AND evidence that psychological factors are major cause -5-7% prevalence -Severe anxiety is repressed (or removed from conscious awareness) and expressed by physical symptoms
what are the psychological theories thought to cause someone to be abusive?
-Psychodynamic (psychoanalytic) theory: unmet needs for satisfaction and security result in a poor self-concept -Aggression and violence may supply the individual with a dose of power and prestige that boosts the self-image -Learning theory
what is the background assessment data for sexual assault?
-Rape is an act of aggression, not passion -It is identified by the use of force and executed against the person's will: acquaintance (date) rape, marital rape, statutory rape- age of consent -Profile of the victimizer -Many report growing up in abusive homes. -Age: 25-44 (most common) -Many are married or cohabitating -Rape may be more common in cultures that encourage male superiority- evidence is conflicting
Nursing diagnoses for the client who has been abused may include:
-Rape-trauma syndrome -Powerlessness -Risk for delayed development
what are the indicators of neglect in children?
-Stealing food or money -Hygiene
what are the indicators of sexual abuse in children?
-Sudden increase in nightmares or bedwetting -Unusual sexual knowledge esp under age 12 -Running away from home -Family is secretive and isolated
what are the other nursing concerns for sexual assault?
-Tending to physical injuries- first priority after immediate safety -Providing security (staying with the client) -Assisting the client to recognize options -Promoting trust -Reporting to authorities when there is "reason to suspect" child abuse or neglect
what is the assessment for anorexia nervosa?
-Weight loss is extreme, usually more than 15% of expected weight -Other symptoms include hypothermia, bradycardia, hypotension, edema (abdominal area- less protein in blood), lanugo (seen in younger people; fine hair that newborns have), and metabolic changes -If recovery not achieved earlier in life, as illness progresses cardiac and GI disease common -Cardiac arrythmia and heart failure -Gastroparesis: slowed gastric emptying and GI motility; gallbladder and liver disease (gastroparesis and liver disease have been shown to improve in most cases after recovery of healthy eating) -Amenorrhea is typical and may even precede significant weight loss -There may be an obsession with food -Often compulsive exercise -Preoccupied with appearance -Feelings of anxiety and depression are common
An air traffic controller suddenly develops blindness. All physical findings are negative. The client's history reveals increased anxiety about job performance and fear about job security. What nursing interventions are indicated?
-assist with ADLs -encourage expression of feelings -teach relaxation techniques -assist with the identification of anxiety related to job security and performance
what are the types of disturbances in recall?
-localized amnesia -selective amnesia -generalized amnesia
a client diagnosed with somatic symptom (somatization) disorder is most likely to exhibit which personality disorder characteristic? 1. experiences intense and chaotic relationships with fluctuating attitudes toward others 2. socially irresponsible, exploitative, guiltless, and disregards rights of others 3. self-dramatizing, attention seeking, over gregarious, and seductive 4. uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange
3
A client with dissociative identity disorder suddenly begins to speak with a child's vocabulary and voice. What is the most therapeutic response? 1. You must be feeling very needy 2. I wonder why you are not acting your age 3. Can you tell me what is happening? 4. This behavior keeps you from working on your problems.
3 (making observations is also correct in this situation)
A client treated for Somatic Symptom Disorder has an upsetting phone conversation with her partner and subsequently requests a PRN analgesic. She says "My head is killing me, I know there's a brain tumor in there somewhere". Tests have shown no tumor. What is the best response? 1. You have no brain tumor, it is your anger toward your partner. 2. I'll get vital signs and call the physician 3. You must try not to rely on pain pills to solve your problems. 4. I'll get your medication and then let's talk about what just happened.
4
A battered woman presents to the ED with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. The priority nursing intervention is: A) tending to the immediate care of her wounds B) providing her with information about a safe place to stay C) administering the prn tranquilizer ordered by the physician D) explaining how she may go about bringing charges against her husband
A
A school nurse notices bruises and scars on a child's body. The nurse suspects that the child is being physically abused. How should the nurse proceed with this information? A) as a health-care worker, report the suspicion to child protective services B) check Jana again in a week and see if there are any new bruises C) meet with Jana's parents and ask them how Jana got the bruises D) initiate paperwork to have Jana placed in foster care
A
Lorraine has been diagnosed with Somatic Symptom Disorder. Which of the following symptom profiles would you expect when assessing Lorraine? A. Multiple somatic symptoms in several body systems B. Fear of having a serious disease C. Loss or alteration in sensorimotor functioning D. Belief that her body is deformed or defective in some way
A
The Maudsley approach to treatment of adolescents with anorexia nervosa advances which of the following fundamental concepts? a. family should be actively involved in each phase of treatment. b. parents should be prohibited from involvement in helping their child eat more because there are often control issue. c. adolescents need to work on developing healthy self-identities before they can begin to gain weight. d. individual psychotherapy is the most effective treatment for adolescents with anorexia nervosa.
A
The ultimate goal of therapy for a client with DID is: A. integration of the personalities into one. B. for the client to have the ability to switch from one personality to another voluntarily. C. for the client to select which personality he or she wants to be the dominant self. D. for the client to recognize that the various personalities exist.
A
Joanne presents in the emergency department with complaints of suicidal ideation. The following date is collected by the nurse. Which of these assessment findings suggest that bulimia nervosa might be a health problem? Select all that apply. a. Joanne's parotid glands appear enlarged. b. Joanne's teeth have a "moth eaten" pattern of tooth decay. c. Joanne reports that she takes laxatives daily. d. Joanne's weight is within the expected range.
A, B, C, D
A young woman who has just undergone a sexual assault is brought into the ED by a friend. The priority nursing intervention would be: A) help her to bathe and clean herself up B) provide physical and emotional support during evidence collection C) provide her with a written list of community resources for survivors of rape D) discuss the importance of a follow-up visit to evaluate for sexually transmitted diseases
B
In establishing trust with Ellen, a client with the diagnosis of DID, the nurse must A. try to relate to Ellen as though she did not have multiple personalities B. listen non-judgmentally and respond empathetically when Ellen transitions to different identity states C. ignore behaviors that Ellen attributes to her sub-personalities D. Explain to Ellen that he or she will work with her only if she maintains the status of the primary personality
B
Jana, age 5, is sent to the school nurse's office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that Jana has numerous bruises on her arms and torso, in various stages of healing. She also notices some small scars. Jana's abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse suspects that: A) Jana is experiencing physical and sexual abuse B) Jana is experiencing physical abuse and neglect C) Jana is experiencing emotional neglect D) Jana is experiencing sexual and emotional abuse
B
Jane is hospitalized on the psychiatric unit. She has a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with Jane's diagnosis? a. binging, purging, obesity, hyperkalemia b. binging, purging, normal weight, hypokalemia c. binging, laxative abuse, amenorrhea, severe weight loss d. binging, purging, severe weight loss, hyperkalemia
B
John has sought help for his concern that he is binge eating, and he feels it has "gotten out of control." He asks the nurse what can be done to help him. Which of the following is the most accurate response? a. "There is nothing that can be done." b. "There are some medications and psychological treatments that have demonstrated effectiveness in reducing binge eating behaviors." c. "The primary problem is obesity. I can help you set up a calorie-restricted diet." d. "There are medications that can help with weight loss, but there are no medications effective for reducing binge eating."
B
Kate is an 18 year old freshman at the state university. She was extremely flattered when Don, a senior star football player, invited her to a party. On the way home, he parked the car in a secluded area by the lake. He became angry when she refused his sexual advances. He began to beat her and finally raped her. She tried to fight him, but his physical strength overpowered her. He dumped her in the dorm parking lot and left. The dorm supervisor rushed Kate to the emergency department. Kate says to the nurse, "It's all my fault. I shouldn't have allowed him to stop at the lake." The nurse's best response is: A) "yes, you're right. you put yourself in a very vulnerable position when you allowed him to stop at the lake" B) "you are not to blame for his behavior. you obviously made some right decisions, because you survived the attack" C) "there's no sense looking back now. just look forward, and make sure you don't put yourself in the same situation again" D) "you'll just have to see that he is arrested so he won't do this to anyone else"
B
Lorraine, a client diagnosed with Somatic Symptom Disorder, states, "My doctor thinks I should see a psychiatrist. I can't imagine why he would make such a suggestion?" What is the basis for Lorraine's statement? A. She thinks her doctor want to get rid of her as a client B. She does not understand the correlation of symptoms and stress C. She thinks psychiatrists are only for "crazy" people D. She thinks her doctor has made an error in diagnosis
B
Nancy, age 14, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refuses to eat. What is the primary nursing diagnosis for Nancy? a. complicated grieving. b. imbalanced nutrition: less than body requirements. c. interrupted family processes. d. anxiety (severe).
B
Nurse Jones is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? a. "You know that if you don't eat, you will die." b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." c. "You might as well leave if you are not going to follow your therapy regimen." d. "You don't have to eat if you don't want to. It is your choice."
B
Sharon, a woman with multiple cuts and abrasions, arrives at the emergency department with her three small children. She tells the nurse that her husband inflicted these wounds on her. She says, "I didn't want to come. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The best response by the nurse is: A) "how often does he drink too much?" B) "it is not your fault. you did the right thing by coming here." C) "how many times has he done this to you?" D) "he is not a good husband. you have to leave him before he kills you."
B
The ultimate goal of therapy for a client with DID is most likely achieved through: A. Crisis intervention and direct association B. Psychotherapy and hypnosis C. Psychoanalysis and free association D. insight psychotherapy and dextroamphetamines
B
Which of the following ego defense mechanisms describes the underlying psychodynamics of somatic symptom disorder? A. Denial of Depression B. Repression of anxiety C. Suppression of grief D. Displacement of anger
B
A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. "Don't worry. The dietician will ensure you don't get too many calories in your diet." b. "Don't worry about your weight. We are going to work on other problems while you are in the hospital." c. "I understand that your are concerned about your weight, and we will talk about the importance of good nutrition; but for now, I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. "You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital, because we know that is important to you."
C
Lorraine, a client diagnosed with Somatic Symptom disorder, tells the nurse about a pain in her side. She says she has not experienced it before. which is the most appropriate response by the nurse? A. "I don't want to hear about another physical complaint. You know they are all in your head. It's time for group therapy now." B. "Let's sit down here together and you can tell about his new pain you are experiencing. You'll just have to miss group therapy today." C. I will report this pain to you physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time." D. "I will call you physician and see if he will order a new pain medication for your side. The one you have now doesn't seem to provide relief. Why don't you get some rest for now?"
C
Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. In the interview, Sharon tells the nurse, "He's been getting more and more violent lately. He's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. I was getting scared. So I just finally told him I was going to take the kids and leave. He got furious when I said that and began beating me with his fists." With knowledge about the circle of battering, what does this situation represent? A) Phase I: Sharon was desperately trying to stay out of his way and keep everything calm B) Phase I: a minor battering incident for which Sharon assumes all the blame C) Phase II: the acute battering incident that Sharon provoked with her threat to leave D) Phase III: the honeymoon phase where the husband believes that he has "taught her a lesson and she won't act up again"
C
Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? a. bradycardia b. amenorrhea c. tolerance d. convulsions
C
Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belviq) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Carbamazepine (Tegretol)
C
Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. tachycardia, hypertension, hyperthermia b. bradycardia, hypertension, hyperthermia c. bradycardia, hypotension, hypothermia d. tachycardia, hypotension, hypothermia
C
Lucile has a diagnosis of Illness Anxiety Disorder. which of the following symptoms would be consistent with this diagnosis? A. complains of a multitude of incapacitating physical symptoms B. manifests with pseudo-seizures or pseudocyesis C. takes substances to induce vomiting in order to convince the nurse that she needs treatment D. expresses persistent fears of having life-threatening disease E. all of the above
D
Nursing care for client with somatic symptom disorder would focus on helping the client to: A. Eliminate the stress in his or her life B. Discontinue his or her numerous physical complaints C. Take his or her medication only as prescribed D. learn more adaptive coping strategies
D
A school nurse notices bruises and scars on a child's body, but the child refuses to say how she received them. Another way in which the nurse can get information from the child is to: A) have her evaluated by the school psychologist B) tell her she may select a "treat" from the treat box if she answers the nurse's questions C) explain to her that if she answers the questions, she may stay in the nurse's office and not have to go back to class D) use a "family" of dolls to role-play the child's family with her
D
A woman who has a long history of being battered by her husband is staying at the woman's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return home and marriage. The best response by the nurse to the woman's decision is: A) "i just can't believe you have decided to go back to that horrible man" B) "i'm just afraid he will kill you or the children when you go back" C) "what makes you think things have changed with him?" D) "i hope that you have made the right decision. call this number if you need help"
D
A woman who was sexually assaulted 6 months ago by a man with whom she was acquainted has since been attending a support group for survivors of rape. From this group, she has learned that the most likely reason the man raped her was: A) because he had been drinking, he was not in control of his actions B) he had not had sexual relations with a girl in many months C) he was predisposed to become a rapist by virtue of the poverty conditions under which he was reared D) he was expressing power and dominance by means of sexual aggression and violence
D
Ellen has a history of childhood physical and sexual abuse. She was diagnosed with Dissociative Identity Disorder (DID) 6 years ago. She has been admitted to the psychiatric unit following a suicide attempt. The primary nursing diagnosis for Ellen would be: A. disturbed personal identity related to childhood abuse B. disturbed sensory perception related to repressed anxiety C. impaired memory related to disturbed thought processes D. risk for suicide related to unresolved grief
D
what are the psychosocial issues of eating disorders?
Eating behaviors are influenced by: -Society -Culture -also have influenced what is considered desirable in the human body
how is individual therapy used as a treatment for anorexia and bulimia?
Helpful when underlying psychological problems are contributing to the maladaptive behaviors
what is depersonalization-derealization disorder?
Persistent feelings of •Unreality •Detachment from oneself or one's body •Observing oneself from outside the body
what is the planning/implementation for anorexia and bulimia?
Self-esteem and positive self-image are promoted in ways that relate to aspects other than appearance
what is refeeding syndrome?
Serious physiologic syndrome occurs when person in starvation begins to eat (can cause cardiac problems)
what are the outcomes for anorexia and bulimia?
The client: •Verbalizes ways in which he or she may gain more control of the environment and thereby reduce feelings of helplessness •Expresses interest in welfare of others and less preoccupation with own appearance
what is derealization?
alteration in the perception of the environment
what is somatic symptom (somatization) disorder?
chronic syndrome of multiple somatic symptoms- cannot be explained medically AND are associated with psychosocial distress
An air traffic controller suddenly develops blindness. All physical findings are negative. The client's history reveals increased anxiety about job performance and fear about job security. What type of disorder is this?
conversion disorder
what is depersonalization?
disturbance in the perception of oneself
what is localized amnesia?
inability to recall ALL incidents associated with the traumatic event for a specific period following the event (someone in a car accident may not be able to remember anything about the accidents or the days leading up to it)
what is generalized amnesia?
inability to recall anything that has happened during the individual's entire lifetime, including personal identity (patient cannot remember who they are); related to stress unless there is brain damage
what is selective amnesia?
inability to recall only certain incidents related to a stressful event (if someone's dog dies in a fire, they may not be able to remember anything about the dog or may even forget they had a dog)
what is illness anxiety?
past experience with serious or life-threatening physical illness, either personal or that of close relatives, can predispose to hypochondriasis
what is binge-eating disorder?
pattern of binging without purging
An air traffic controller suddenly develops blindness. All physical findings are negative. The client's history reveals increased anxiety about job performance and fear about job security. What purpose is the blindness serving?
to help them manage their anxiety and to give an expression of their anxiety (unconsciously)
Symptoms of depersonalization disorder are often accompanied by:
•Anxiety and depression •Fear of going insane •Disturbance in the subjective sense of time
what is anorexia nervosa?
•Characterized by a morbid fear of obesity •Anorexia means not having an appetite (HCP in mental health field think they have an appetite, but do not respond to it) •Symptoms include -Gross distortion of body image -Preoccupation with food -Refusal to eat
What is factitious disorder?
•Conscious falsification •AKA Munchausen syndrome •Factitious Disorder Imposed on Another (By proxy) •Usually occurs in children (child's symptoms are fabricated by the parents- the mental health issue is with the parent)
what are the treatment modalities for sexual assault?
•Crisis intervention: making major decisions discouraged in period immediately following event and help with identifying and using resources •Safe house or shelter: overcoming guilt/self blame •Family therapy: parenting skills, coping
what are the behavioral indicators of emotional abuse in children?
•Extreme behaviors •Delayed emotional development •Suicidal ideation •Lack of attachment to parent
what are the etiological implications of somatic disorders?
•Family dynamics: in dysfunctional families, when a child becomes ill, focus shifts from the open conflict to the child's illness •Somatization brings some stability to the family and positive reinforcement to the child
what is the psychoanalytic theory for somatic disorders?
•Focuses on unconscious conflicts •Conversion disorder may represent emotions associated with a traumatic event that are too unacceptable to express and so are "converted" into physical symptoms
what are the etiological implications for dissociative disorders?
•Genetics: possible hereditary factors are associated with DID •Neurobiological: dissociative amnesia and dissociative fugue may be related to neurophysiological dysfunction; EEG abnormalities have been observed in some clients with DID (EEG is different in each state of dissociative disorder) •Psychoanalytic theory: dissociative behaviors are a defense against unresolved painful issues •Psychological trauma
what is the physiologic issues of eating disorders?
•Hypothalamus- contains the appetite regulation center •Regulates body's ability to recognize when it is hungry
what are the treatment modalities for dissociative disorders?
•Individual psychotherapy •Hypnosis: allowing someone to relax so much that they are more aware of unconscious thoughts and feelings •Supportive care •Integration therapy (DID)
what do you need to know about the survivors of abuse and violence?
•More injuries are attributed to intimate partner violence than to all stranger rapes, muggings, and automobile accidents combined •An increase in the incidence of child abuse and related fatalities has been documented (we are more aware of abuse, not that it is more prevalent) •Rape is thought to be vastly underreported
what are the biological theories thought to cause someone to be abusive?
•Neurophysiological influences-aggression •Biochemical influences- neurotransmitters (serotonin is related to aggression and violence) •Brain damage
what is the planning/implementation for dissociative disorders?
•Nursing care is aimed at restoring normal thought processes •Help efforts to determine strategies for coping with stress by means other than dissociation
what is the planning/implementation for somatic disorder?
•Nursing care of the individual with a somatic disorder is aimed at relief of discomfort from the physical symptoms and to help reduce anxiety •Assistance to determine strategies for coping with stress and expressing feelings by means other than preoccupation with physical symptoms •Teach relaxation techniques •Tricyclic antidepressants (TCAs)- may be prescribed •Non-judgmental attitude: the pain or discomfort is real to the patient even if there is no medical evidence for it
what are the nursing interventions for sexual assault?
•Nursing intervention for the victim of abuse or neglect is to provide shelter and promote reassurance of his or her safety •Immediately after assault- facilitate evidence collection before shower
what is an incestuous relationship?
•Often there is an impaired spousal relationship •Perpetrator is often domineering, impulsive, and physically abusive •Non-perpetrating parent is commonly passive and submissive; often aware of, or at least suspects, the incestuous relationship but uses denial or keeps quiet out of fear of being abused •Oldest child most at risk
what are the characteristics of a child abuser?
•Parents who abuse their children were likely abused as children themselves •Other influences include: -Stressful life situation -Few, if any, support systems -Lack of understanding of child development -Lack of adaptive coping strategies
what are the epidemiological factors of eating disorders?
•Prevalence rate of anorexia nervosa among young women in the United States 1% •Anorexia nervosa occurs predominantly in females age 12 to 30 years (death rate 6 per 1000) •Bulimia nervosa is more prevalent than anorexia nervosa, up to 4% of young women (death rate 2 per 1000) •Onset of bulimia nervosa occurs in late adolescence or early adulthood •Occurs primarily in societies that emphasize thinness- as a symbol of control
Sexual assault victims:
•Rape can occur at any age •The highest-risk group 20 to 34 years of age •The attack often occurs near their own neighborhoods •When "stranger rape," victims often chosen for being in that place at that time
what is the learning theory for somatic disorders?
•Somatic complaints often reinforced when sick person: -Learns that he or she may avoid stressful obligations thereby decreasing stress level (primary gain) -Becomes prominent focus of attention because of the illness (secondary gain) -Relieves conflict within family as concern is shifted to the ill person and away from the real issue (tertiary gain) •illness anxiety: past experience with serious or life-threatening physical illness, either personal or that of close relatives, can predispose to hypochondriasis
what are some common behaviors associated with anorexia nervosa that should not be allowed?
•The desire to provide others with food and/or watch them eat is common •These behaviors are thought to reinforce the illness- perception of self-control through dysfunctional food behavior. •Do not allow these clients to plan, prepare, or distribute food for unit-based activities.
what are the signs of physical abuse?
•Unexplained wounds in different stages of healing •Reluctant to go home •Parent offers conflicting version of injury •Shrinks at the approach of adults