Mental Health - Exam 2

Acute stress disorder vs PTSD

Acute stress disorder = event occurred <3 months PTSD = event occurred >3 months -PTSD is *chronic in nature* with periods of exacerbation during increased stress. -*PTSD can lead to other psychiatric disorders* such as depression, anxiety, and substance abuse.

Drugs for affective & predatory aggression

Affective aggression (normal) 1. lithium 2. anticonvulsants 3. low-dose antipsychotics Predatory (hostility/cruelty) 1. antipsychotics 2. lithium

Agranulocytosis

Caused by clozapine -*failure of the bone marrow to produce adequate WBCs* -fever, malaise, ulcerative sore throat, leukopenia

Dissociative amnesia

Client *cannot remember important personal information* (usually of traumatic or stressful nature) -includes a *fugue experience* where the client suddenly moves to a new location with no memory of past events & assumes a new identity

Depersonalization/derealization disorder

Client has a persistent or recurrent feeling of being *detached from his or her mental processes or body* (depersonalization) or sensation of being in a *dream-like state where everything seems foggy* or unreal (derealization) -client is *not psychotic* or out of touch with reality

Abuse & violence 5 outcomes

Client will: 1. Be physically safe 2. Distinguish between self-harm ideas and taking action on those ideas 3. Learn healthy ways to deal with stress 4. Express emotions nondestructively 5. Establish social support network in community

Borderline personality 6 outcomes

Client will: 1. Be safe/free from significant injury 2. Will not harm others or destroy property 3. Demonstrate increased control of impulsive behavior 4. Take appropriate steps to meet needs 5. Demonstrate problem-solving skills 6. Verbalize greater satisfaction w/ relationships

Grief & loss 4 outcomes

Client will: 1. Identify effects/meaning of his or her loss 2. Seek adequate support/develop plan for coping/apply effective coping strategies 3. Recognize negative effects of loss on life 4. Seek or accept professional assistance if needed

Aggression outcomes

Client will: 1. Not harm self or threaten others 2. Refrain from intimidating/frightening behaviors 3. Describe feelings, concerns without aggression 4. Comply with treatment

Antisocial personality 3 outcomes

Client will: 1. Demonstrate non-destructive ways to express feelings and frustration 2. Identify ways to meet self needs that do not infringe on rights of others 3. Achieve/maintain satisfactory role performance

Don't's of working with victims of abuse

DONT: 1. Tell the victim what to do 2. Express disgust, disbelief, or anger 3. Disclose client communications without consent 4. Preach, moralize, or imply doubt 5. Minimize the impact of violence 6. Express outrage with the perp 7. Imply that the client is responsible for the abuse 8. Recommend couples counseling 9. Direct the client to leave the relationship 10. Take charge and do everything for the client

Grounding techniques (3)

Helpful with dissociation or flashback 1. Remind the person that he/she is present, is an adult, and is safe. -"I know this is scary, but you are safe now" 2. Increases contact with reality 3. *Diminishes the dissociative experience by focusing on current senses*: -Can you see me and the room we are in? -Can you feel the watch on your wrist?

Disenfranchised grief

Grief over loss that is *not or cannot be openly acknowledged, mourned publicly, or supported socially*: -A relationship has no legitimacy. -The loss itself is not recognized. -The griever is not recognized.

Personality

Ingrained enduring pattern of behaving and relating to self, others, environment -Perceptions, attitudes, emotions -Usually not consciously aware of own personality -Personality disorders: traits inflexible and maladaptive; significant interference with functioning or cause of emotional distress

Cycle of abuse & violence

Initial period of battering or violence → abuser expresses regret, apologizes, promises it will never happen again → professes love and engages in romantic behavior (honeymoon period) victim wants to believe perp → tension-building phase (arguments, stony silence, complaints from the perp) → another violent episode (and repeat)

Patients who are agitated & aggressive but not psychotic benefit most from:

Lorazepam, which can be given in 2 mg doses, every 45-60 min. atypical antipsychotics are more effective than conventional antipsychotics for aggressive psychotic pts

Abuse & violence evaluation

Outcomes possibly taking years to achieve 1. Protection of self 2. Ability to manage stress, emotions 3. Ability to function in daily life

Complicated grieving: physiologic & emotional reactions

Physiologic: 1. Impaired immune system 2. Increased adrenocortical activity 3. Increased levels of serum prolactin and growth hormone 4. Psychosomatic disorders 5. Increased mortality from heart disease Emotional: 1. Depression 2. Anxiety/panic disorders 3. delayed/inhibited grief 4. Chronic grief

The client has an order for Lorazepam (Ativan) when becoming anxious and resorting to violently acting out. Which of the following statements by the client would indicate that client education about this medication has been effective? The client states: a) "This medication will help me right now while I learn to focus on problem solving." b) "This medication presents no risk of addiction or dependence." c) "I will not fight if I take this medication as prescribed." d) I will probably always need to take this medication for my anxiety and violent outbursts."

a) "This medication will help me right now while I learn to focus on problem solving."

Aggression tx: lorazepam (ativan)

Uses: *decrease agitation or aggression and psychotic symptoms (calming)* -Can be used for seizures as well as anxiety & n/v Side Effects: CNS: dizziness, ataxia, drowsiness, blurred vision, confusion -Paradoxical CNS stimulation in Psych patients, elderly, and ADHD can be given IM or PO -IM acts fast but the priority reason for doing this is so pt can't spit it out -PO can be given if they ask voluntarily for meds *Haldol & ativan decreases aggression*

Other side effects of antipsychotics/client teaching

Weight gain (most significant with clozapine & olanzapine) teaching: -use of sunscreen bc of photosensitivity -monitor sleepiness & drowsiness -avoid driving & performing other potentially dangerous activities until their response times & reflexes seem normal -if the client forgets a dose of antipsychotic meds, he or she can take the missed dose if it is only 3 or 4 hours late. -*if the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose*

What is CIWA?

assessment tool used to assess withdrawal symptoms and titrate medication. 1. mild withdrawal: score less than 8 2. moderate withdrawal: scores from 8-15 3. severe withdrawal: scores greater than 15

The charge nurse knows no further education about grieving is needed when the new graduate nurse states the following: a) "The patient's father died over five years ago, they need to get over it". b) "Although the patient's father died over five years ago, this may be the reason the client complains of headaches so often". c) "My father died last year but I'm not still crying about it." d) "Just like birth, death is a part of life"

b) "Although the patient's father died over five years ago, this may be the reason the client complains of headaches so often".

An elderly client diagnosed with Alzheimer's disease lives with family and attends day care. After observing poor hygiene and a significant drop in weight, the nurse speaks with the caregiver. The caregiver becomes defensive and states, "It takes all my energy to care for my mother. She's awake all night. I never get any sleep." Which nursing intervention has priority? a) Teach the family how to give physical care more effectively and efficiently b) Secure additional resources for the mother's evening and night care. c) Teach the caregiver about the effects of sundowner's syndrome. d) Support the caregiver to grieve the loss of the mother's cognitive abilities.

b) Secure additional resources for the mother's evening and night care.

Lithium

bipolar and conduct disorders; mental retardation -Used with benzodiazepine (anti-anxiety, seizures) or an antipsychotic for acute mania phase -Used with an antidepressant for depressive phase Side Effects -CNS: h/a, drowsiness, dizziness, tremors, seizure -CV: hypotension, edema, dysrhythmias -GI: dry mouth, n/v/d s/s for toxicity for lithium -minor toxicity: diarrhea, vomiting, tremor, twitching -major toxicity: coarse tremors, severe thirst, tinnitus, diluted urine -serum lithium levels 2x/week initially, then every 2mos -*therapeutic level: 0.5-1.5* -*toxicity: > 1.5 mcg/L*

Thought stopping is a technique to:

alter the process of negative or self-critical thought patterns -when the thoughts begin, the client may actually say stop in a loud voice to stop the negative thoughts -later, more subtle means such as forming a visual image of a stop sign will be a *cue to interrupt the negative thoughts*

Aggression: triggering phase

an event/circumstance in the environment *initiates the client's response*, which is often anger or hostility s/s: restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, anger 1. Approach in nonthreatening, calm manner. use of clear, simple, short statements is helpful 2. Convey empathy; listening (important) 3. Encourage verbal expression of feelings, suggesting client is still in control & can maintain that control 4. Suggest patient go to a quieter area 5. Suggest/Offer PRN medications 6. Suggest physical activity such as walk

Aggression tx: valproate (depakote)

anticonvulsant, mood stabilizer Uses: dementia, psychosis, personality disorders

A client tells the nurse, "My husband lost his job. He's abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me." The nurse is aware that which of the following risk factor is most predictive for the husband to become abusive? a) Poverty b) Loss of employment c) History of family violence d) Drinks alcohol

c) History of family violence

Positive self-talk

client *reframes negative thoughts* into positive ones: "I made a mistake, but it's not the end of the world. Next time, I'll know what to do"

Aggression: crisis phase

during an emotional and physical crisis, the *client loses control* s/s: loss of emotional and physical control, *throwing objects, kicking, hitting, spitting, biting, scratching,* shrieking, screaming, inability to communicate clearly 1. Inform patient that behavior is out of control, and staff is taking control to provide safety and prevent injury 2. Use of restraint or seclusion only if necessary

Substance abuse evaluation

effectiveness of substance abuse treatment is based heavily on pt's abstinence from substances

Catharsis

engaging in aggressive but safe activities (hitting a punching bag)

Child abuse is defined as:

intentional injury of a child -Can include physical abuse/injuries, neglect or failure to prevent harm, failure to provide adequate supervision, abandonment, sexual assault, overt torture -Abusers of girls: fathers, stepfathers, uncles, older siblings, live in partners of the child's mother -Adults with a history of childhood sexual abuse are at greater risk of depression, suicide attempts, marital problems, marriage to an alcoholic, smoking/alcohol abuse, chronic pain, or medically unexplained symptoms.

Neuroleptic malignant syndrome (NMS)

serious & *frequently fatal condition* in those being treated with antipsychotic meds. -muscle rigidity, high fever, increased muscle enzymes, & leukocytosis (increased leukocytes) -0.1-1% affected -*tx: stop meds*

PTSD is a disturbing pattern of behavior demonstrated by:

someone who has experienced, witnessed, or been confronted with a traumatic event. -responded with intense fear, helplessness, or terror -Symptoms occurring *3 months or longer* -Onset can be delayed, chronic in nature and transient exacerbations -Depression, anxiety and drug abuse are correlating disorders -At Risk: anyone at any age, typically veterans, victims of violence and natural disasters -*Severity, Duration, Proximity of trauma* are most important factors affecting PTSD development -*Rape victims (around 70%) develop*

Aggression: post-crisis phase

the client *attempts reconciliation with others and returns to the level of functioning before the aggressive incident* and its antecedents s/s: remorse, apologies, *crying*, quiet, withdrawn behavior 1. Remove patient from any restraint or seclusion to rejoin milieu. 2. Calmly discuss behavior (no lecturing or chastising); allow patient to return to activities, groups, and so forth. 3. Focus on appropriate expression of feelings, resolution of problems or conflicts in nonaggressive manner.

Aggression: recovery phase

the client *regains physical and emotional control* s/s: lowering of voice, decreased muscle tension, clearer, more rational communication, physical relaxation 1. Talk about situation or trigger 2. Help patient relax or sleep 3. Explore alternatives to aggressive behavior 4. Provide documentation of any injuries 5. Debrief staff

Aggression: escalation phase

the client's responses represent escalating behaviors that indicate *movement toward a loss of control* s/s: pale or flushed face, yelling, *swearing,* agitation, *threatening*, demanding, *clenched fists, threatening gestures*, hostility, loss of ability to solve the problem or think clearly 1. Take control; provide directions in firm, calm voice 2. Direct patient to room or quiet area for time-out 3. Offer medication again 4. Let patient know aggression is unacceptable; nurse or staff will help maintain/regain control 5. If ineffective, obtain help from other staff (show of force)

No self harm contract

used with suicidal patients -*clients agree to keep themselves safe & to notify staff at the first impulse to harm themselves* -not a guarantee of safety & use has been criticized

Clinical picture of abuse & violence

•Abuse: wrongful use, maltreatment of another •Perpetrator typically someone the person knows •Victims across lifespan: spouses, partners, children, elders •Evidence of physical injuries requiring medical attention •Psychological injuries with broad range of responses

AA 12 step programs

-founded in 1930 by alcoholics -developed the model for recovery, which is based on the philosophy that *total abstinence is essential & that alcoholics need the help & support of others to maintain sobriety* -Regular attendance at meetings is emphasized—may be closed or open. 1. "Closed" meetings: only those pursuing recovery can attend 2. "Open" meetings: anyone can attend -Includes individual counseling and a wide variety of groups -Group experiences education about substances & their use, problem solving techniques, and cognitive techniques to identify and modify faulty ways of thinking. -Overall theme: coping with life, stress, and other people without the use of substances

Anticholinergic side effects of antipsychotics include:

-orthostatic hypotension -dry mouth -constipation -urinary hesitance or retention -blurred near vision -dry eyes -photophobia -nasal congestion -decreased memory these side effects usually decrease within 3-4 weeks but do not entirely remit. *Using caloric free beverage or hard candy may alleviate dry mouth; stool softeners, adequate fluid intake, & inclusion of grains & fruit in the diet may prevent constipation*

Second generation: atypical antipsychotics (dopamine, serotonin antagonists)

*Diminish/lessen positive AND negative symptoms* -negative symptoms including: *Lack of volition/motivation, social withdrawal, and anhedonia (inability to feel pleasure)* -Several weeks of oral therapy for these to to reach a stable dosing level before transition to depot injections -*Not suitable for treating acute episodes* 1. Clozapine (Clozaril) 2. Risperidone (Risperdal) 3. Olanzapine (Zyprexa) 4. Quetiapine (Seroquel)

Aggression tx: haloperidol (haldol)

*EPS* 1. acute dystonia 2. akathisia 3. antipsychotic induced parkinsonism 4. tardive dyskinesia Use benadryl to counteract side effects - causes sedation

Decatastrophizing is a technique that involves learning to:

*assess situations realistically* rather than always assuming a catastrophe will happen

Antisocial personality disorder is characterized by a pervasive pattern of:

*disregard for & violation of the rights of others* & by the central characteristics of *deceit & manipulation* -pattern referred to as psychopathy, sociopathy, or dissocial personality disorder -70% of inmates in correctional facilities -VERY important to *be CONSISTENT with rules* with these average/above intelligent patients

Tardive dyskinesia

*irreversible*, late-appearing side effects of antipsychotics abnormal involuntary movements include: -tongue thrusting & protruding -lip smacking -blinking -grimacing -embarrassing for client & can cause further social isolation *Clozapine (clozaril) atypical antipsychotic drug has not been shown to cause this, so clients are often switched to this med after symptoms appear*

Extrapyramidal symptoms (EPS) (3)

*major side effect of antipsychotic drugs, more prominent in first generation* 1. acute dystonia- occur early in course of treatment; *spasms in discrete muscle groups* such as the neck or eye muscles. *Protrusion of tongue, dysphagia, & laryngeal & pharyngeal spams* may also occur -tx: benadryl IM/IV or congentin IM 2. pseudoparkinsonism- shuffling gait, masklike faces, muscle stiffness or cogwheeling rigidity (ratchet-like movements), drooling, & akinesia (slowness & difficulty initiating movement) 3. akathisia: *restless movement*, pacing, inability to remain still, & the client's report of inner restlessness -occurs when drugs are started or increased -adherence is an issue bc clients are uncomfortable with sedation side effects -tx: beta blockers & benzodiazepines for side effects

First generation antipsychotics

-Dopamine antagonists -Target *positive symptoms ONLY*: *Delusions, hallucinations, disturbed thinking, and other psychotic symptoms* -Injection effects last 2-4 weeks 1. Chloropromazine (Thorazine) 2. Perphenazine (Trilafon) 3. Fluphenazine (Prolixin) 4. Haloperidol (Haldol) 5. Trifluoperazine (Stelazine) 6. Thiothixene (Navane)

Complicated grieving

-Person devoid of emotion; *grieving for prolonged periods; expressions of grief seem disproportionate to event* -Sudden & violent losses (disasters, military losses, terrorist attack, or killing sprees) by an individual are more likely to lead to prolonged grief

Aggression assessment (8)

1. Be aware of factors that influence aggression 2. Strong staff leadership, clear staff roles, planned events, and activities decrease aggressive behavior on psych units 3. Lack of psychological space, having no privacy, being unable to have sufficient rest may be more important in triggering aggression than a lack of physical space 4. *History of aggressive behavior is best predictor of future aggression* 5. Pts who are angry and feel like no one is listening are more prone to behave aggressively 6. Pts who believe their hallucinated voices are all power-full are more likely to be aggressive 7. Watch for clues that predict aggressive behavior such as changes in client voice- volume, speed, pitch... changes in behavior and facial expressions 8. Maintain safe distance from client

Drugs used to treat EPS & nursing interventions

1. Benzotropine (Cogentin) -increase fluid & fiber to avoid constipation; use ice chips & hard candy for dry mouth; *assess for memory impairment* 2. Diphenhydramine (Benadryl) -use ice chips or hard candy for dry mouth; observe for sedation 3. Lorazepam (Ativan) -observe for sedation; *potential for misuse or abuse* 4. Trihexphenidyl (Artane) 5. Amantadine (Symmetrel) -use ice chips/hard candy for dry mouth; *assess for worsening psychosis (an occasional side effect)*

Child abuse assessment

1. Burns may have an identifiable shape such as cigarette marks 2. Parent of an infant with a severe skull fracture may claim he or she "rolled off the couch" even though the child is too young to do so or the injury is much too severe for a fall of 20 inches 3. Bruises may have familiar, recognizable shapes such as belt buckles or teeth marks 4. High incidence of UTIs, bruised, red/swollen genitalia in sexually abused children *Report suspected child abuse*

Substance abuse: alcohol

1. CNS *depressant*, absorbed rapidly. 2. intoxication: Initially relaxation & loss of inhibition. -Slurred speech, unsteady gaits, lack of coordination, impaired attention & concentration, memory & judgement. 3. overdose: potential in a short period. -Vomiting, unconsciousness & respiratory depression. -Can cause aspiration pneumonia or pulmonary obstruction. Potential for hypotension leading to CV shock & death. 4. withdrawal: requires medical treatment. -Symptoms begin 4-12 hours after cessation. -coarse hand tremors, sweating, elevated pulse & BP, insomnia, anxiety & N/V. -*Severe withdrawal may progress to Delirium tremens* which include hallucinations, seizures or delirium. -Withdrawal may take 1-2 weeks. Can be fatal. 5. detox: Can be accomplished by tapering benzodiazepines (lorazepam, diazepam Librium).

Substance abuse: Sedatives, Hypnotics and Anxiolytics

1. CNS *depressants* include Barbituates, nonbarbituate hypnotics & anxiolytics & benzodiazapines. 2. intoxication: similar to other CNS depressants -Slurred speech, lack of coordination, unsteady gait, labile mood impaired attention or memory, stupor & coma 3. overdose: *benzodiazepines are rarely fatal*. Symptoms improve as the drug is excreted. -*Barbiturates can be lethal*. Can cause coma, respiratory arrest, cardiac failure & death 4. withdrawal: onset depends on half-life. Lorazepam produces withdrawal symptoms in 6-8 hours. -Diazepam produces withdrawal symptoms for 1 week. -Symptoms are (autonomic hyperactivity) elevated pulse, BP, respirations & temp, insomnia, anxiety & nausea. 5. detox: *managed medically by tapering* the medication over a period of time.

10 Drugs used for substance abuse treatment

1. Disulfiram (antabuse): maintians *abstinence from alcohol* 2. Acamprosate (campral): *suppress alcohol cravings* 3. Lorazepam (ativan): *alcohol withdrawal* 4. Chlordiazepoxide (Librium): *alcohol withdrawal* 5. Methadone (dolophine): maintains *abstinence from heroin* 6. Naltrexone (revia, trexan): *blocks the effects of opiates; reduces alcohol cravings* 7. Thiamine (Vitamin B1): *prevents or treats Wernicke-Korsakoff syndrome in alcoholism* 8.Cyanocobalamin (Vitamin B12): *treats nutritional deficiencies* 9. folic acid: *treats nutritional deficiencies* 10. Naloxone (Suboxone): *maintains abstinence from opiates & decreases opiate cravings*

Substance abuse: stimulants

1. Excite and Stimulate the CNS -Limited clinical use (except for treatment of attention deficit) -High potential for abuse -Highly addictive 2. intoxication: cause *psychosis & brain damage* -develops rapidly & includes high euphoric feeling, hyperactivity, hypervigilance, talkativeness, anxiety, grandiosity hallucinations. -Tachycardia, elevated BP, dilated pupils 3. overdose: Seizures & coma; death rare 4. withdrawal: Withdrawal or crashing occur within a few hours to a few days. -Marked dysphoria & fatigue, vivid dreams insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation. 5. detox: *not treated pharmacologically*

Grief & loss nursing 4 diagnoses

1. Grieving 2. Complicated grieving 3. Risk for complicated grieving 4. Anticipatory grieving

Trauma & stress related assessment (9)

1. History of trauma/stress or abuse 2. When it occurred 3. Observation of the patient's appearance and motor behavior -hyperalertness, anxiety, restlessness, or fetal positioning -may be uncomfortable if nurse is too close; may require greater distance 4. Mood and affect -Can range from passive to angry, frightened, agitated, hostile -when dissociating, may talk in a different tone or appear numb with a vacant stare 5. Thought process/content -Experience nightmares, flashbacks, intrusive thoughts, hallucinations, self-destructive thoughts, fantasies -suicidal ideation common 6. Sensorium and intellectual processes -Memory gaps: no clear memories -ability to make decisions or solve problems may be impaired 7. low self-esteem -may believe they're bad people who deserve or provoked abuse -may feel they are going crazy & are out of control -may see themselves as helpless, worthless, & hopeless 8. Roles and relationships -Problems with relationships, work, social, or authority -ability to trust is severely compromised -intrusive thoughts keep them from participating in social or family events 9. Physiologic concerns -Disturbed sleep -Change in appetite -Alcohol and drug use

Rape treatment & interventions

1. Immediate support: nurse is essential in providing emotional support to the victim 2. Education: warning signs of relationship violence, characteristics of men who are more likely to commit dating violence 3. Prophylactic treatment of STIs, pregnancy 4. Therapy to restore victim's sense of control

Antisocial personality 3 nursing diagnoses

1. Ineffective Coping 2. Ineffective Role Performance 3. Risk for Other-Directed Violence

Drugs for severe anxiety

1. MAOIs 2. low-dose antipsychotics

Clinical picture of parents who abuse children (3)

1. Minimal parenting knowledge/skills 2. Emotionally immature, needy & incapable of meeting their own needs 3. Views children as property—does not value the children as people with rights & feelings

Etiologies of hostility & aggression (2)

1. Neurobiological Theories •Possible role of neurotransmitters: decreased serotonin; increased dopamine, norepinephrine •Structural damage to limbic system; damage to frontal or temporal lobes 2. Psychosocial Theories •Failure to develop impulse control •Inability to delay gratification

Rape assessment

1. Physical examination; preservation of evidence (rape kit/rape protocol) -Should occur before woman has showered, brushed her teeth, changed her clothes, or had anything to drink -If no report of oral sex, brushing teeth and drinking fluids can be permitted immediately. 2. Description of what happened

Cycle of intimate partner abuse (violence)

1. Physical: shoving, pushing, battering, choking 2. Sexual: assaults during sexual relations, rape 3. Combination (common) 4. Victims: primarily women (increased rates during pregnancy)

Substance abuse: opioids

1. Popular and abused -Desensitize the user to pain -Induce a sense of euphoria and well-being. -Users go to great length and illegal activities to obtain the drugs. 2. intoxication: develops after initial consumption. -Symptoms are apathy, euphoria, lethargy, listlessness, impaired judgement, impaired attention, psychomotor retardation, drowsiness and agitation. 3. overdose: Death can occur. Coma, resp depression, pupillary constriction and unconsciousness. -*NARCAN (naloxone) to reverse* 4. withdrawal: significant distress. N/V, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia. 5. detox: Doesn't require pharm interventions -*Methadone can be used as a replacement for opioids & can reduce symptoms.* -Withdrawal symptoms & drug craving may persist for weeks or months.

Male rapists can be divided into 4 categories:

1. Power Assertive Rapist (30%) -Desires to dominate and control the victim, may repeat with the same victim, acts macho -May cruise bars or the internet to obtain victims -*44% of all rapes are in this category.* 2. Anger Retaliation Rapist (24%) -Wants to punish victims, hates women, often causes substantial injury -Sees himself as masculine & action oriented -Spends time in chatrooms on internet voicing general hatred for women due to some perceived "injustice" 3. Power Reassurance or Opportunity Rapist (30%) -Commits rape when opportunity presents itself, is lonely, has low self-esteem, keeps souvenirs -Thinks victims "liked" it 4. Anger Excitement or Sadistic Rapist (16%) -Wants to hurt the victim, often the victim is killed, acts out fantasies -Compulsive in personal appearance, carries a rape kit, learns better ways to stalk -Finds victims on the internet

Abuse & violence 4 interventions

1. Promoting patient's safety 2. Helping patient cope with stress, emotions using grounding techniques 3. Helping promote patient's self-esteem 4. Establishing social support

Antisocial personality interventions (11)

1. Promoting responsible behavior 2. *Limit setting* (state limit, ID consequences, ID acceptable/expected behavior) 3. Consistent adherence to rules & tx plan 4. Confrontation (*point out problem behavior, keep client focused on self, help client solve problems & control emotion*) 5. Effective problem-solving 6. Decreased impulsivity 7. Expressing negative emotions such as anger or frustration 8. Taking a time-out from stressful situations 9. Enhancing role performance 10. ID barriers to role fulfillment 11. Decreasing or eliminating the use of drugs or alcohol

Borderline personality evaluation

1. Promoting safety (no self-harm contract; safe expression of feelings & emotion) 2. Helping the client to cope & control emotions 3. Cognitive restructuring (thought stopping, decatastrophizing) 4. Structuring time 5. Teaching social skills 6. Teaching effective communication skills 7. Entering therapeutic relationship

Trauma/stress 8 treatment options

1. Psychotherapy (individual or group) 2. Medications (antidepressants, anxiolytics, sleep aids) 3. Self-help groups 4. Exposure therapy 5. Relaxation techniques 6. Adaptive disclosure 7. Cognitive processing therapy 8. Mental health promotion

Common myths & misunderstandings about rape

1. Rape is about having sex 2. When a woman submits, she really wants it to happen 3. Women dressed provocatively are asking for it 4. Some women like rough sex but later call it rape 5. Once a man is aroused he cannot stop his actions 6. Walking alone at night is an invitation for rape 7. Rape cannot happen when you're married to each other 8. Rape is exciting for some women 9. Rape only occurs between heterosexual couples 10. If a woman has an orgasm it can't be rape 11. Rape usually happens between strangers 12. Rape is a crime of passion 13. Rape happens spontaneously

Substance abuse: cannabis

1. Research has shown it to decrease intraoccular pressure, relieve n/v in chemo, anorexia & weight loss of AIDS. 2. intoxication: Active 1 minute after inhalation, peak effect 20-30 minutes & last 2-3 hours. -Users report high feelings similar to alcohol, lowered inhibitions, relaxation euphoria & increased appetite. -Intoxication includes impaired motor coordination, inappropriate laughter, impaired judgement & short-term memory loss. 3. no withdrawal

Grief and loss evaluation (3)

1. Review of tasks, phases of grieving 2. Demonstration of continuing denial or outcry 3. Evidence of reorganization, recovery, healing

Abuse & violence 5 nursing diagnoses

1. Risk for Self-Mutilation 2. Ineffective Coping 3. Posttrauma Coping 4. Chronic Low Self-Esteem 5. Powerlessness

Borderline personality nursing diagnoses

1. Risk for Suicide, Self-Mutilation, Other-Directed Violence 2. Ineffective Coping 3. Social Isolation

Trauma & stress nursing diagnoses (6)

1. Risk for suicide/self-mutilation 2. Ineffective coping 3. Posttrauma syndrome 4. Powerlessness 5. Chronic low self-esteem 6. Risk for self- or other-directed violence Other: anxiety, fear, disturbed sensory perception, sleep deprivation, sexual dysfunction, spiritual distress, social isolation

Borderline personality 7 interventions

1. Safety (no self-harm contract) 2. Therapeutic relationship (structured, with limit setting) 3. Strict adherence to boundaries 4. Communication skills 5. Coping, emotion control 6. *Reshape thinking patterns (cognitive restructuring, thought stopping, positive self-talk, decatastrophizing)* 7. Structuring of daily activities

Community violence

1. School violence (homicides, suicides, theft, violent crimes) 2. Bullying (correlated with an increase in suicides) 3. Hazing 4. Effects on children, young adults 5. Violence on larger scale (i.e., terrorism) 6. Early intervention, treatment for victims

Antisocial personality assessment (7)

1. Skillful deceit/manipulation -nurse: *validate/check all info from client* 2. False emotions; *no empathy* 3. Narrowed view of world -cold & hostile "dog eat dog world" mentality 4. appearance usually normal; clients may be engaging & even charming 5. Poor judgment; no insight -pay no attention to legality of actions & don't consider morals when making decisions 6. Egocentric, but actually self-shallow and empty -appear confident & usually believe they can't be caught in lies 7. Relationships as *serving own needs* -believe no one else will care/help them -everyone else's fault and not their own

Restraint & seclusion use

1. Talk to the pt, offer meds (pt can still make their own decisions) 2. Offer quiet time 3. Seclusion 4. *Restraints (the last resort)* -*the nurse should obtain a physician's order ASAP after deciding to use restraint or seclusion* -4-6 trained staff members are needed to restrain an aggressive client safely -4 staff members take each limb, 1 member protects the pt's head, & 1 controls the torso if needed -client is transported by gurney or carried to seclusion -restraints are applied to each limb & fastened to bed frame -nurse may obtain order for IM meds in emergency situation -nurse performs close assessment & documents actions

Borderline personality assessment (8)

1. Unstable interpersonal relationships, self-image, and affect; marked impulsivity 2. Wide range of behavior, appearance -when severe, appear disheveled & may be unable to sit still, or display labile emotions 3. Dysphoric mood -unhappiness, restlessness, & malaise -often report: intense loneliness, boredom, frustration, feeling "empty" -*rarely experience satisfaction or "well-being"* 4. Polarized extreme thinking (splitting); dissociation 5. Impaired judgment; *safety not a concern* -make decisions impulsively -have difficulty accepting responsibility for meeting needs outside a relationship -see life's problems & failures as a result of shortcomings -limited insight 6. Threats of self-harm 7. *Social isolation* -clients hate being alone but erratic, labile, & dangerous behaviors isolate them from others -usually have a history of poor school & work performance bc of constantly changing career goals & shifts in identity & aspirations 8. in addition to suicidal & self harm behavior, clients may also engage in binging, substance abuse, unprotected sex, or reckless behavior -usually have difficulty sleeping

Aggression tx: carbamazepine (tegretol)

1. Uses: aggression associated with dementia, psychosis, & personality disoders 2. Side Effects: •n/v, dizziness, drowsiness, dry mouth, unsteadiness 3. Dietary Restrictions •Avoid consumption of grapefruit and grapefruit juice—can cause levels of the drug to increase. Avoid/limit the use of alcohol—can increase

Aggression evaluation

1. Was patient's anger defused in an early stage? 2. Did angry, hostile, and potentially aggressive patient learn to express feelings verbally and safely without threats or harm to others or destruction of property?

The 12 steps of AA

1. We admitted we were powerless over alcohol, that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our wills and lives over to the care of God as we understood him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people whenever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to alcoholics and to practice these principles in all of our affairs.

Tasks of grieving: Worden

1. accept reality of loss -common for people to deny that loss has occurred -sometimes traditional rituals (funerals, wakes) are helpful 2. work through pain & grief -pain must be experienced for person to move forward 3. adjust to changed environment -feelings of failure, inadequacy, helplessness are common to experience -must develop NEW coping skills, adapt, find meaning in new life, & regain control 4. emotionally relocate loss & move on -lost person or relationship is not forgotten/diminished in importance, but rather relocated in the mourners life as the person forms new relationships, friends, rituals, & moves ahead with life

Grief & loss assessment (3)

1. adequate perception regarding the loss 2. adequate support while grieving for the loss 3. adequate coping behaviors during the process

Negative (soft) symptoms of schizophrenia (9)

1. alogia- tendency to speak very little or to convey little substance of meaning 2. anhedonia- feeling no joy or pleasure from life or any activities or relationships 3. apathy- feelings of indifference 4. asociality- social withdrawal, lack of closeness 5. blunted affect- restricted range of emotional feeling, tone, or mood 6. catatonia- psychologically induced immobility occasionally marked by periods of agitation or excitement; client seems motionless, in a trance 7. flat affect- absence of facial expression 8. avolition or lack of volition- absence of will, ambition, or drive to accomplish tasks 9. inattention- inability to concentrate

Positive (hard) symptoms of schizophrenia (9)

1. ambivalence- holding contradictory beliefs about the same person, event, or situation 2. associative looseness- fragmented or poorly related thoughts/ideas 3. delusions- fixed false beliefs that have no basis in reality 4. echopraxia- imitations of the movements & gestures of another person whom the client is observing 5. flight of ideas- continuous flow of verbalization in which the person jumps rapidly from one topic to another 6. hallucinations- false sensory perceptions or perceptual experiences that do not exist in reality 7. ideas of reference- false impressions that external events have special meanings for the person 8. perseveration- persistent adherence to a single idea or topic 9. bizarre behavior

What is anger, hostility, & aggression?

1. anger is a normal human emotion -*becomes negative when the person denies it, suppresses it, or expresses it inappropriately* -often seen as negative but can help a person solve problems or cause physical or emotional problems/interfere with relationships -*leads to hostility and aggression* if not controlled 2. hostility (verbal aggression): emotion expressed through *verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior* -may express hostility when person feels powerless -used to intimidate or cause emotional harm -*can lead to aggression* 3. aggression: when a person *attacks or injures another person or destruction of property* -meant to harm, punish, or force someone into compliance

Abuse & violence assessment

1. bc most abused women do not seek help, nurses must help identify abused women in various settings 2. nurse can make referrals & offer caring and support throughout

Do's of working with victims of abuse

1. believe the victim 2. ensure & maintain confidentiality 3. listen, affirm, & say "I'm sorry you've been hurt" 4. express concern for safety 5. tell the victim, "you have a right to be safe & respected" 6. say, "the abuse is not your fault" 7. recommend a support group or individual counseling 8. identify community resources & encourage client to develop a safety plan 9. offer to help client contact a shelter, police 10. accept & respect victim's decision

5 Dimensions of Grieving

1. cognitive responses -*Questioning, trying to make sense of loss and attempting to keep lost one present* -Questioning may help the person accept the reality of why someone died. -attempting to keep one present helps soften the effects of the loss while assimilating its reality 2. emotional responses -anger, sadness, anxiety -*directed toward dead person and his/her health practices, family members, or HCPs* 3. spiritual responses -*disillusioned and angry with God, hopelessness, meaninglessness* -Providing opportunities for the client to share their suffering assists in the psychological and spiritual transformation that can evolve through grieving 4. behavioral responses -functioning "automatically" or routinely—indicates the person is numb/reality has not set in, coping techniques (good or bad) -sobbing, anger, drug alcohol abuse, suicide/homicide attempts 5. physiologic responses -insomnia, HA, impaired appetite, lack of energy -*sleep disturbances are among the most frequent symptoms*

5 Risk factors leading to vulnerability & complicated grieving

1. death of spouse or child 2. death of parent 3. sudden, unexpected, untimely death 4. multiple deaths 5. death by suicide or murder

Dual diagnosis, denial, & codependence

1. dual diagnosis- client with both substance abuse & another psychiatric mental illness 2. denial- defense mechanism; clients may deny having any problems or minimize the extent of problems 3. codependence- maladaptive coping pattern on the part of family members that results from a prolonged relationship with the person who uses substances

Grief & loss 6 interventions

1. exploring perception of loss 2. obtaining support 3. promoting coping behaviors 4. offer client food without pressure to eat 5. use effective communication 6. establish rapport & maintain interpersonal skills

Substance abuse nursing interventions (7)

1. health teaching 2. dispel myths surrounding substance abuse 3. decrease codependent behaviors among family members 4. make appropriate referrals for family members 5. promote coping skills 6. focus on the here & now with clients 7. set realistic goals: "stay sober today"

Substance abuse assessment (9)

1. history: pts with a parent or family members with substance abuse problems may report a chaotic family life -typically will describe some crisis that precipitated entry into treatment -rarely seek help without outside assistance 2. general appearance & motor behavior: normal 3. wide ranges of mood & affect are possible 4. thought process & content: pts likely to minimize their substance abuse 5. sensorium & intellectual: generally oriented & alert unless experiencing withdrawal -intellectual abilities intact unless clients have experienced deficits from long-term alcohol use or inhalant use 6. poor judgement & insight -difficulty acknowledging behavior 7. self concept: low self esteem; don't feel adequate to cope with life & stress without substance 8. roles & relationships: many difficulties with social roles; absenteeism & poor work performance common 9. physiologic considerations: hx of poor nutrition & sleep disturbances -liver damage -HIV infection or hepatitis from IV drug use -lung/neuro damage from inhalants

Role of the nurse in culture specific rituals

1. individualize care 2. encourage clients to discover and use what is effective/meaningful for them 3. the nurse can pray for the deceased, stay with the body while the client notifies relatives

Substance abuse 10 nursing diagnoses

1. ineffective denial 2. ineffective role performance 3. dysfunctional family processes: alcoholism 4. ineffective coping 5. imbalanced nutrition 6. risk for infection/injury 7. activity intolerance 8. self care deficits 9. excess fluid volume 10. diarrhea

Drugs for emotional lability

1. lithium 2. carbamazepine (tegretol) 3. antipsychotics

People who are vulnerable to complicated grieving include those with: (6)

1. low self-esteem 2. low trust 3. previous psychiatric disorder 4. previous suicide threats or attempts 5. absent/unhelpful family 6. ambivalent, dependent, or insecure attachment to the deceased person

Antipsychotics MOA

1. major action of all antipsychotics in the nervous system is to *block receptors for the neurotransmitter dopamine* 2. dopamine receptors D2, D3, & D4 have been associated with mental illness 3. first generation antipsychotic drugs are *potent antagonists* of D2, D3, & D4. this makes them effective in treating target symptoms but also *produces many extrapyramidal side effects.* 4. newer, atypical second generation antipsychotics are *relatively weak blockers of D2, which may account for the lower incidence of EPS* 5. second gen. antipsychotics *inhibit the reuptake of serotonin* (as do some antidepressants), *increasing their effectiveness in treating the depressive aspects of schizophrenia*

5 Types of losses

1. physiologic loss- amputations of a limb, mastectomy, hysterectomy, loss of mobility 2. safety loss- Loss of safe environment is evident in domestic violence, child abuse, or public violence -feeling of safety is shattered when public violence occurs on campus or holy place 3. Loss of security, sense of belonging -Loss of a loved one affects the need to love & the feeling of being loved -Changes in relationships; birth, marriage, divorce, illness, & death 4. Loss of self esteem- a change in how a person is valued at work or in relationships. Death of a loved one, broken relationship, loss of a job, retirement 5. loss r/t self actualization -External/internal crisis that blocks or inhibits striving toward fulfillment -May threaten personal goals & individual potential

Personality disorder treatment (2)

1. psychopharmacology: focuses on the client's symptoms rather than the particular subtype cognitive perceptual distortions including: -psychotic symptoms -affective symptoms -mood dysregulation -aggression & behavioral dysfunction -anxiety 2. individual & group psychotherapy -Goals: improve quality of life, improved functional abilities, and reduced symptoms -Anxiety and Depression medication utilized for symptoms -Cognitive-behavioral therapy (cognitive restructuring techniques): *change the way the client thinks about self & others* -Dialectical behavior therapy (borderline personality disorder): *focuses on distorted thinking & behavior*

Tasks of grieving: Rando's (6 R's)

1. recognize- experiencing the loss & *understanding that it is real* 2. react- emotional response to loss, *feeling the feelings* 3. recollect & re-experience- *memories are reviewed and relieved* 4. relinquish- *accepting that the world has changed* and there's no turning back 5. readjust- begin to return to daily life, *loss feels less overwhelming* 6. reinvest- *accepting changes & re-entering the world,* forming new relationships and commitments

Aggression patient teaching & community-based care (5)

1. regular follow-up appointments 2. compliance with prescribed meds 3. participation in community support programs 4. the forensic early warning signs of aggression 5. anger management groups to help pts express feelings, learn problem-solving, and conflict-resolution techniques

Aggression nursing diagnoses

1. risk for other directed violence 2. ineffective coping -if client is intoxicated, depressed, or psychotic, additional nursing diagnoses may be indicated

3 Types of child abuse

1. sexual abuse: sexual acts performed by an adult on a child <18 -ex. incest, rape, sodomy performed directly on the person or with an object, oral-genital contact, & acts of molestation such as rubbing, fondling, or exposing the adult's genitals -May be a single incident or multiple episodes 2. neglect: malicious or ignorant withholding of physical, emotional, or educational necessities for the child's well being -Ex. abandonment, inadequate supervision, reckless disregard for the child's safety, spousal abuse in the child's presence, failing to enroll the child in school 3. psychological abuse: emotional abuse -Ex. verbal assaults (blaming, screaming, name-calling, using sarcasm), fighting, yelling, chaos, withholding of nurturing & affection -Often accompanies other types of abuse (physical/sexual abuse)

Limit setting is an effective technique that involves 3 steps:

1. stating the behavioral limit (describing the unacceptable behavior) 2. identifying the consequences if the limit is exceeded 3. identifying the expected or desired behavior

5 phases of aggression

1. triggering 2. escalation 3. crisis 4. recovery 5. post-crisis

Grieving/bereavement

process by which person experiences grief; 1. Content- WHAT a person thinks, says, & feels 2. Process- HOW a person thinks, says, & feels -One of the most difficult & challenging processes of human existence

Adjustment disorder

reaction to a stressful event that causes problems for the individuals -*difficulty coping with or assimilating the event* into his or her life -*financial, relationship, & work-related stressors are most common* -symptoms develop within a month, lasting no more than 6 months -outpatient therapy is most common & successful treatment

Cognitive restructuring is a technique useful in changing patterns of thinking by helping clients to:

recognize negative thoughts & feelings & to *replace them with positive patterns of thinking.*

Acute stress disorder occurs after a traumatic event & is characterized by:

reexperiencing, avoidance, & hyperarousal that occur from *3 days to 4 weeks* following a trauma -can be a *precursor to PTSD* -cognitive behavioral therapy (CBT) involving exposure & anxiety management can help prevent progression to PTSD

Trauma/stress outcomes & interventions (4)

Focus is to *improve self-esteem and promote empowerment*: 1. Refer to patient as "survivor" rather than "victim" 2. Identification of flashback triggers 3. Encourage journaling of feelings 4. Utilize distractions and relaxation techniques

Adaptive disclosure is a specialized CBT approach developed by the military to:

offer an intense, specific, short-term therapy for active duty military personnel with PTSD -*incorporates exposure therapy & empty-chair technique, in which the pt says whatever he or she needs to say* to anyone alive or dead

Mourning

outward expression of grief, including rituals Ex: having a wake, sitting Shiva, holding religious ceremonies

Anticipatory grieving

persons facing an imminent loss *begin to deal with very real possibility of loss or death in near future.*

Aggression 5 nursing interventions

1. *Engaging the hostile person in dialogue is the most effective way to prevent the behavior from escalating to physical aggression* 2. Most effective, least restrictive when implemented early in cycle of aggression 3. Managing the Environment -Group & Planned Activities (playing cards, watching movies, informal discussions) give clients the opportunity to talk about events/issues when they are calm. -Engage clients in the therapeutic process & minimizes boredom 4. Scheduling one-on-one interactions with the clients indicates the nurse's genuine interest 5. Assistance with problem solving or conflict resolution to avoid expression of anger

Substance abuse 4 outcomes

1. Abstain from alcohol and drug use. 2. Accept responsibility for own behavior. 3. Practice non-chemical-coping alternatives. 4. Establish an effective aftercare plan.

Grief & loss cultural considerations (10)

1. African Americans -deceased viewed in church before burial in cemetery; public prayers, black clothing, decreased social activities 2. Muslim -does not permit cremation -five steps of burial procedure including washing, dressing, and positioning of the body *First step: traditional washing of the body by a Muslim of the same gender* 3. Haitian -vodun (voodoo) or "root medicine" 4. Chinese -strict norms for announcing death, preparing body, arranging funeral and burial, mourning after burial; *Bowls of food on table for spirit for 1 year after death* 5. Japanese -*death as life passage;* bathing with warm water and dressing in white kimono after purification rites 6. Filipino -black clothing or armbands; *wreaths on casket; black cloth on home of deceased* 7. Vietnamese -bathing deceased and dressing in black clothing; *rice in mouth and place money with deceased so they can buy a drink as spirit moves on to afterlife*; display of body for viewing in home before burial 8. Hispanic -norvena (9 day prayers) and rosary; luto (mourning in black or black & white in subdued manner). respect for deceased by *absence of tv, movies, social events* 9. Native Americans -*tribal medicine man or priestly healer*; baptism ceremonies; end of mourning noted with ceremony at burial ground with *grave covered with blanket or cloth* later given to tribe member 10. Orthodox Jewish -relative staying with dying person; body covered with sheet; eyes closed; burial within 24 hours of death unless Sabbath; Shivah (7 day period that begins on funeral day for mourners to reflect on changes)

Aggression pharmacological interventions (4)

1. Carbamazepine (tegretol) 2. valproate (depakote) 3. haloperidol (haldol) 4. lorazepam *haloperidol & lorazepam are commonly used in combination* to decrease agitation/aggression

Passive aggressive behavior

1. Characterized by: Negative attitudes and a *pervasive pattern of passive resistance to demands* for adequate social and occupational performance -appear cooperative, even ingratiating, or sullen and withdrawn - depends on circumstance. *Mood fluctuates rapidly and erratically - easily upset or offended* 2. Clinical picture: negative attitude, passive resistance to demands for adequate social and occupational performance; blaming of others 3. Nursing interventions: identification and expression of feelings

Child abuse treatment & interventions (6)

1. Child safety, *well-being a priority* 2. Psychiatric evaluation/possible long-term therapy/play therapy (for very young child) 3. Therapeutic relationship between the therapist/child is crucial to help the child deal with the abuse. 4. Family therapy if reuniting feasible 5. Psychiatric or substance abuse for parents 6. Foster care (short or long term)

Addiction treatment settings & programs

1. Clients needing *medically supervised detoxification are often treated in medical units* in the hospital setting. -After stable: referred to an appropriate outpatient treatment setting. 2. HCPs provide extended or outpatient treatment in various settings. -Clinics, Halfway Houses, Residential Settings, Special Chemical Dependency Units 3. Generally, the type of treatment is based on..... -*The client's needs & his/her insurance coverage* •Ex. For someone who has limited insurance coverage, is working & has a supportive family, the outpatient setting may be chosen first because it is less expensive, the client can continue to work, and the family can provide support. -If the client CAN'T remain sober during outpatient treatment—inpatient treatment may be required for success. -May need the structure of a halfway house with a gradual transition into the community 4. Programs: •Alcoholics Anonymous •Al-Anon Family Group Headquarters •Women for Sobriety (exclusively for women) •Rainbow Recovery (for gay/lesbian individuals)

7 Dynamics of rape

1. Crime of violence, humiliation of victim expressed through sexual means 2. sexual intercourse with female against her will and without consent -Whether will is overcome by force, fear of force, drugs, or intoxicants 3. Also considered rape if woman incapable of exercising rational judgment because of mental deficiency or when younger than age of consent 4. Only slight penetration of vulva needed (full erection/ejaculation not necessary) 5. Most men that commit rape are between 25 & 44 years old 6. victims can be any age 7. most rapes are premeditated

Kubler-Ross's 5 Stages of Grieving

1. Denial- shock & disbelief regarding the loss 2. Anger- may be expressed toward God, relatives, friends, or health-care providers 3. Bargaining- when person asks God or fate for more time to delay inevitable loss 4. Depression- when awareness of the loss becomes acute 5. Acceptance- person shows evidence of coming to terms with death

3 major elements of PTSD

Experiencing the trauma leads to: 1. Dreams or intrusive, recurrent thoughts of the trauma 2. Emotional numbing (feeling detached from others) 3. Hyperarousal (being on guard, irritable)

Exposure therapy is a treatment approach designed to:

combat avoidance, help client face troubling thoughts & feelings, & regain control The client *confronts the fears & trauma rather than attempting to avoid them* Relaxation techniques are employed to help the client tolerate & manage the anxiety response -may confront the event in reality by returning to the place where one was assaulted -may use imagined confrontation, placing ones self mentally in the situation

Confrontation is designed to manage what kind of behavior?

manipulative or deceptive behavior the nurse *points out a client's problematic behavior while remaining neutral* & matter of fact; avoids accusing the client -can also use confrontation to keep clients focused on a topic & in the present

Characteristics of violent families (4)

spouse battering; neglect, and physical, emotional, or sexual abuse of children; elder abuse; marital rape 1. social isolation -Keep to themselves & usually do not invite others into the home or tell them what is happening -Abusers threaten victims with greater harm if they reveal the secret. 2. abuse of power & control -Exerts not only physical power but also economic/social control—he/she is often the only family member who makes decisions, spends money, or spends time outside of the home with other people. -The abuser belittles/blames the victim, often using threats and emotional manipulation. 3. alcohol or other drug use -Alcohol does not cause the person to be abusive; rather, an abusive person is also likely to use alcohol/drugs. -The majority of victims of intimate violence report alcohol was involved in the violent incident. -researchers believe alcohol may diminish inhibitions & make violent behaviors more frequent & intense 4. intergenerational transmission process -Patterns of violence are perpetrated from one generation to the next through role modeling & social learning. -Family Violence is a learned pattern of behavior. •Ex. Children who witness violence between their parents learn that violence is a way to resolve conflict and is an integral part of a close relationship. -1/3 of abusive men are likely to have come from abusive homes where they witnessed wife beating or were abused themselves. -Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships.