vulnerable pop unit 6- ptsd, dissociative disorders, sexual violence

bereavement

the time of sadness after a significant loss through death; encompasses grief and loss time

benzodiazepines, sedative hypnotics

treatment for acute stress disorder: - medications are short term in conjunction with crisis intervention ** - _______ are used to treat daytime anxiety - ________ ______ are used for sleep

psychotherapy

treatment of choice for PTSD; includes cognitive behavioral therapy, prolonged exposure therapy, and eye movement desensitization and reprocessing (EDMR)

c

A client with a dissociative identity disorder is to be discharged after a 2-week hospitalization. What does the nurse, evaluating the effectiveness of the short-term therapy, expect the client to verbalize? a The ability to deal openly with feelings b That many of the personalities can be ignored c The need for long-term outpatient psychotherapy d That the personalities serve no protective purpose

trust

______ is a central issue in treating dissociative disorders, especially DID, due to the etiology of trauma/abuse - acute care focuses on safety, stabilization, and symptom reduction - long term care includes processing of traumatic experiences and integration of alters, correcting faulty perceptions, healing from emotional damage resulting from abuse

Catastrophic reaction

extreme agitation and aggression that occurs in patients with cognitive disorders; may cause pt to scream, strike out, or cry because of overwhelming fear or feeling that environment is out of control

women

DID is more common in ____ because of higher rates/more severe abuse in females

anticonvulsants

medication for chronic aggression including valproic acid, carbamazepine, lamictal - targets labile mood, poor impulse control, and organic illness (dementia)

selective amnesia

Melody's husband complained of severe chest pain. Melody called the ambulance and accompanied her husband to the hospital. He died of a massive myocardial infarction in the emergency department. With the help of family and friends, Melody made arrangements for the memorial service and the burial. Now that it is all over, Melody is able to remember only certain aspects about what has occurred since her husband first experienced the severe pain. She remembers the doctor telling her that her husband was dead, but she cannot remember attending the funeral service.

trauma informed approach

A person-centered and strengths-based service delivery approach that recognizes the prevalence of trauma among clients across settings and human services systems - addresses reducing trauma's consequences and facilitating healing by adhering to 6 principles instead of a prescribed set of procedures - Realizes the widespread impact of trauma and understands potential paths for recovery, recognizes signs/symptoms of trauma, responds by fully integrating knowledge about trauma into policies/procedures, seeks to actively resist re-traumatization - based on: safety, trustworthiness, transparency, peer support, collaboration and mutuality, empowerment, voice, choice, cultural, historical, gender issues

dissociative amnesia with dissociative fugue

A young man is brought into the emergency department by the police. He gives his identity and home address (which is several hundred miles away) to the admissions clerk. He tells the nurse he is very frightened, because he doesn't know when or how he came to be in this place.

acute stress disorder

An anxiety disorder in which intrusive, dissociative, avoidance, and arousal symptoms are experienced soon after a traumatic event and last less than a month - >1 month = PTSD diagnosis

dissociative identity disorder

Margaret explains to the nurse that during the last year, she has had periods of time for which she cannot account. She has been attending college, and she finds pages of notes in her notebook that she cannot recall writing. Her roommate recently recounted an incident that took place when they were supposedly out together, for which Margaret has no recall. Recently, she was hospitalized when her roommate found her unconscious in their room with an empty bottle of sleeping pills beside her. She tells the nurse she has no memory of taking the pills.

assaultive stage

If the patient progresses to the assaultive stage, the staff must respond quickly. Generally a team approach of at least five staff members is advisable to restrain a resistant patient. Interventions include: *Medication*: patient takes their prescribed medicaiton *Seclusion*: the involuntary confinement of a person alone in a room or an area where the person is physically prevented from leaving. *Restraint*: any manual method or mechanical device, or equipment attached or adjacent to the patient's body where they cannot move their arms, legs, body, or head freely. *A patient may not be held in restraints or seclusion without a physician's order*

benzodiazepines, second generation antipsychotics

medications of choice for acute aggression - _______ (ie lorazepam): first choice for acute aggressive episodes, especially in episodic dyscontrol and incipient rage episodes - _____ _____ _____ (Ziprasidone IM, Olanzapine IM/oral): used for emergencies

structured reintegration

moving from four-point to two point restraints; once out of seclusion, use planned time-out periods to leave the room and move slowly into the milieu of the unit. Time-outs are then gradually lengthened.

depersonalization derealization disorder

Sam is a salesman for a leading manufacturing company. His job requires that he make presentations for large corporations that are considering Sam's company product. Sam is up for promotion and realizes that the outcomes of these presentations will weigh heavily on whether or not he gets the promotion. Lately, he has been worried that he is going insane. Each time he is about to make a presentation, his thinking becomes "foggy," his body feels lifeless, and he describes the feeling as being somewhat "anesthetized." These episodes sometimes last for hours and are beginning to interfere with his performance

localized amnesia

Sandra is a clerk in an all-night convenience store. Three nights ago, the store was robbed at gunpoint, and Sandra was locked in a storage compartment for several hours until the manager was contacted by passersby who reported the robbery. She has been unable to recall the incident until just today, when details began to emerge. She is now able to report the entire event to the authorities.

1 15

Seclusion or restraint is used in the following circumstances: - Patient presents clear and present danger to self or others - Patient is legally detained for involuntary treatment and is thought to pose an escape risk - Patient requests to be secluded or restrained - THE PATIENT CANNOT BE HELD IN SECLUSION without PHYSICIANS ORDER - should be evaluated every __ hour by physician - pt should be monitored every __ minutes-- face to face through locked door window

loss

normal part of the human experience; can be commonplace, relationship oriented, or intangible and circumstantial - we respond to this with grief and mourning

dissociative fugue

The sudden loss of memory for one's personal history, accompanied by an abrupt departure from home and the assumption of a new identity - Person becomes bewildered/anxious/frightened because he doesn't know when or how he arrived at the new place - May be selective for the traumatic event or a particular time period, or for one's entire life history - May be sudden, causing inability to recall some or all of one's past

gaba, glutamate

the neurotransmitters ____ and _____ play a role in encoding fear memories, and disturbances are implicated in PTSD

perception, situational, coping

Whether individuals experience a crisis in response to a stressful situation depends on: 1. Their ______ of the event 2. The availability of _______ supports 3. The availability of adequate ______ mechanisms

male

____ rape victims are more likely to commit suicide and become infected with HIV

ptsd

_____ is the long-term consequence of sexual assault; it is important to teach survivors what to expect during this phase so they know they aren't "going crazy" symptoms include: - reexperiencing the trauma: recurrent nightmares, flashbacks, uninvited and intrusive thoughts during the day/at night - social withdrawal or "psychic numbing"-- not experiencing feelings of any kind - avoidance behaviors/actions: avoidance of all places and activities, and thoughts/feelings, that could recall events about rape - Increased psychological arousal characteristics: exaggerated startle response, hypervigilance, sleep disorders, difficulty concentrating - Fears and phobias: fear of being alone, sexual encounters, outdoors or indoors, etc - Nightmares and sleep disturbances

antisocial personality disorder

______ _____ ______ , in which people are viewed as objects, is prevalent among rapists/perpetrators of SA. The act of rape involves a need for control, power, degradation, and dominance, and it is thought that some sex offenders have difficulty finding willing sexual partners and resort to coercion and rape

self limiting; 4-6

a crisis is _____-limiting and usually resolves in __-__ weeks - goal of crisis intervention-- reutrn individual to precrisis level of functioning - max goal: improvement above pre crisis level - person in crisis is assumed to be mentally healthy and to have functioned well in the past, but is presently in disequilibrium - crisis intervention deals with their present problem and resolution of the immediate crisis only (here and now); addressing issues/needs not directly involved w the crisis can occur later

depersonalization/derealization disorder

a dissociative disorder characterized by recurrent periods of feeling unreal, numb, dreamlike, or detached/outside of the body (depersonalization), or experiencing a distorted sense of time or visual perception (derealization) - patients often worry they are going insane. thinking may be "foggy", body feels lifeless, describes feeling somewhat "anesthesized" - episodes last for hours

date rape

a form of acquaintance rape where the victim agreed to spend time with the attacker, but has not given consent for sexual contact

anxiety

a goal of crisis intervention is to reduce _____ to the level where the patient can hear/absorb potential ideas so they can actively solve problems

ambiguous loss

a loss that is not clearly defined, has no resolution and no predictable ending or closure - ex1: when the physical body is absent but the person is still psychologically present to family and others (missing in military) -ex2: when the body is physically present but the person is physiologically changed/absent from how they once were (i.e. dementia)

1 year

a minimum of __ ___ is needed before you can learn to live with loss; includes birthdays, anniversaries, other important dates w/o loved one

schizophrenia

a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression - affects thought process, language, socialization, and ability to interpret reality

critical incident stress debriefing

a tertiary intervention directed toward a group that has experienced a crisis such as a school shooting or natural diaster - offers individuals the opportunity to share their thoughts and feelings in a safe and controlled environment - addresses precrisis through post crisis interventions - allows staff to get "back to normal" after working through turmoil and emotional impact of the incident and prevent PTSD

rape-trauma syndrome

a two-stage set of symptoms that follow the trauma of being raped, consisting of physical, emotional, and behavioral stress reactions. includes acute phase of disorganization and long-term recovery/organization phase

generalized amnesia

a young man is brought into the ER by police, and he does not know who he is or anything about his life

adventitious crisis (crisis of disaster)

accidental, uncommon, unanticipated, catastrophic crisis that results in multiple losses; generally much larger than situational, impacting a community, not just an individual - may result from natural disasters, national crises (war, terrorism), crimes of violence → victims are permanently changed and left to mourn, recover from effects of severe trauma, and rebuild their lives and communities

flashback

acting or feeling as though the traumatic event is happening again; common in PTSD

6-8

acute grief usually lasts __-__ weeks, longer in older adults (individual and could last longer)

covert

aggression that may not be obvious to others and can come in the form of belittling comments, placing blame where it doesn't belong, or shaming others

adaptive

aggression with a goal of regaining control over a stressor (ie parents fighting to protect their children)

mourning

all outward expression and management of grief; this process gradually releases us from the pain of loss - ex: culturally determined practices (wakes, funerals, shiva, decorating grave), sharing grief with others, attending support groups

comfort room

alternative to seclusion/restraint that uses a room where people can manage sensory input, decrease stimuli like lights/sounds, and self-manage anxiety and distress; allows for voluntary isolation

sexual assault

an act of violence, power, and hate, and most often results in devastating severe and long-term trauma; often committed in the context of unequal power in order to demonstrate dominance and control - an UMBRELLA term encompassing rape, date rape, acquaintance rape, gang rape, marital/partner rape, sexual molestation, incest, statutory rape, and sexual assault of older adults - Occurs when a perpetrator commits sexual acts without the victim's consent or when a victim is unable to consent (due to age, illness, or while under the influence of drugs/alcohol) or refuse (due to physical violence or stress)

crisis

an acute, time-limited occurrence experienced as overwhelming reactions to a stressful event or change; event disturbs homeostasis and usual coping mechanisms are ineffective in resolving the problem - Any stressful situation can precipitate a crisis - Can be situational, developmental, or existential

dissociative amnesia

an inability to recall important personal info that is too extensive to be explained by ordinary forgetfulness, and which is not due to the direct effects of substance abuse or a neurological/medical condition - Onset usually follows severe psychosocial stress - includes localized amnesia, selective amnesia, generalized amnesia, and dissociative fugue

repression

an individual unconsciously excluding the distressing emotions, thoughts, or experiences from awareness, causing it to be "forgotten" and unable to be deliberately brought to awareness

dissociation

an unconscious defense mechanism to protect the individual against overwhelming anxiety, usually related to past or current trauma - common with BPD, overlapping features with PTSD - INTACT reality testing, no displays of delusional thinking or hallucinations

restraint

any manual method or physical or mechanical device, material, or equipment that immobilizes or reduces freedom of movement; also includes medication to manage one's behavior/restraict freedom of movement

aggression

behavior aimed at harming others physically or psychologically; anger's motor counterpart - a goal directed action/behavior that results in a verbal/physical attack - may be appropriate or protective for self, family, others

localized amnesia

being unable to recall a specific event or specific period of time, usually related to trauma or stress; localized memory loss with a specific window of time Ex: forgetting months/years of being abused as a child, or days spent in intense combat Ex: survivor of car wreck having no memory of the experience until 2 days later

psychotherapy

brief and time limited _____ may be used for those at risk for complicated grief: - teaches what to expect and normalizes confusing feelings - encouragement of full expression of emotions and affect (letter writing to deceased, looking at pics) - attempt to help the bereaved come to peace with a new relationship to the deceased (integrating loss of the deceased into current reality)

situational crisis

crisis that arises from an exeternal situational stressor vs an internal source; often unanticipated - involves a change/loss that threatens one's self concept/self esteem (ex: unwanted pregnancy, change in financial situation, divorce, illness, death of loved one) - successful resolution depends on resolving the grief surrounding the loss - depends on support available, previous resiliency, overall physical/emotional ehalth

developmental crisis

crisis that occurs in response to developmental changes (like marriage, birth, retirement, mid-career- passed over for promotion for the 4th time) - occurs bc new stages mean previous coping styles are inappropriate, and new coping mechanisms need to be developed = Transitionary period --> anxiety, which may manifest as variations in the person's normal behavior until they establish a new equilibrium - Alcohol and drug addiction will interrupt an individual's progression through maturational stages (escaping from stressors → not practicing communication and coping skills that build resilience). When the person gets sober they will discover that maturation has been halted at about the age the drugs/alcohol began to be used. - But, the developmental process can resume and progress through supportive treatment! (without treatment, coping skills will be compromised) - if a person lacks adequate parenting, support systems, and role models, successful resolution of developmental tasks/emotional learning may be difficult or delayed, and this can affect them throughout the lifespan

existential crisis

crisis that occurs when a person questions their life purpose or spirituality; can be brought on by experiencing a significant event, either positive or negative, such as marriage, death of a loved one, children becoming adults and leaving the home, or reaching an aged-related milestone - can lead to newfound motivation/higher goals for self actualization, or it can cause feelings of isolation, depression, or uncertainty

regression

curling into a tight ball and being swaddled show ______, which occurs when an individual reverts to an earlier stage of development involving less mature behavior and responsibility as a way of coping with a stressful situation; often results in more dependent behavior

national incident management system

disaster response that provides a systematic approach to guide agencies at all levels to work seamlessly during a disaster; effective response requires triage time and ability to distribute casualities to most appropriate facilities

dissociative disorders

disorders in which there is a disturbance in the normally well-integrated continuum of consciousness, memory, identity, and perception; a protective response to past/present trauma - dissociative symptoms are present in many mental disorders and are connected to a higher burden of illness and poorer treatment response

selective amnesia

dissociative amnesia that occurs when a person can recall only small parts/certain aspects of events that took place in a defined period of time

blanking out

dissociative symptom where you are unable to remember a period of time (aka localized amnesia)

pre-assaultive

during the ___-_____ stage of violence, de-escalation approaches, such as verbal communication, are appropriate - maintain paitent's self esteem and dignity-- they are doing the best they can, they want to be getter, their behavior makes sense in their eyes

support, anticipatory

effective grieving is facilitated when: - the individual has _______ from others - the grief was _______ and they had the opportunity to prepare for the loss

secondary intervention

establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization Ensure safety of patient, work with patient to assess problem, support systems, coping styles Explore goals and plan interventions Lessens the time a person is mentally disabled during a crisis

tertiary intervention

establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization Ensure safety of patient, work with patient to assess problem, support systems, coping styles Explore goals and plan interventions Lessens the time a person is mentally disabled during a crisis

post traumatic stress disorder

feelings of extraordinary helplessness or powerlessness in the face of overwhelming circumstances that usually occurs after exposure to a trauma severe enough to be outside the range of normal human experience; symptoms must last longer than 1 month - s/s may begin within first 3 months of trauma, or there may be a delay of several months/years s/s: - intrusive re-experiencing of initial trauma (flashbacks, nightmares, unwanted distressing memories, strong physical/emotional response when reminded of event) - avoidance (attempting to avoid anything that might cause recall of the event) - alteration in arousal (increased irritability, angry outbursts, self destructive behavior, exaggerated startle response, hypervigilence, sleep difficulties) - persistent negative alterations in cognition/mood (distorted cognitions about self/others --> excessive fear, guilt, and detachment) - may also include Dissociative Symptoms (blacking out, flashback, depersonalization, derealization)

post assaultive

final stage of violence where patient no longer requires seclusion/restraints, and the staff reviews the incident with patient and themselves; allows patient to learn from behavior, identify stressors that precipitated the out of control behavior, and plan alternatives to reacting to the stressors in the future - also involves critical incident debriefing, documenting episode

ssri's; paroxetine, sertraline

first line pharm treatment for ptsd; name 2

sexual assault nurse examiners (SANEs)

forensic nurses who with with victims of SV Perform physical exam on the survivor Collect forensic evidence Provide expert testimony and forensic evidence Provide support and psychobiological needs of a survivor

gradual reintegration

geared to the patient's ability to handle increased stimulation

prevent PTSD

goal of critical incident stress debriefing after a disaster?

anticipatory grief

grief experienced prior to a loss, that may be just as intense as grief felt after the loss - during this time, teh ding/family may display primary emotions such as anger, sadness, hurt, fear, anxiety, and bridled grief (experience of bottle up bursts of grief)

uncomplicated grief

grief that goes through a normal progression of the grief process, as defined by societal values, and includes reactions such as depressed mood, insomnia, anxiety, poor appetite, loss of interest, guilt, dreams about the deceased, confusion, and poor concentration - psychological states-- shock, denial, anger, yearning/searching for the deceased - may experience isolation/disappointment as their friends/families fail to understand what they are facing

disenfranchised grief

grief that is not socially sanctioned, openly acknowledged, or publicly mourned; may not have opportunity to grieve publicly - once losses are recognized as this, it becomes easier to support them within and among individuals sharing the same experience - may be sanctioned due to relationship of the griever (divorced spouse, nurse), the nature of the loss (marriages, abortions, war heroes), the type of death (executions, homicides, suicides), or the grieving style related to gender differences/stage in life

sexual assault response teams (SARTs)

helps victims of SV cope with the present situation and aftermath of SV; work in collaboration with a variety of resources, including mental health agencies, rape crisis advocates, law enforcement personnel, detectives or investigators, emergency department, sexual assault nurse examiners, and attorneys

urine sample

if a date rape drug is suspected, a ____ sample should be collected in addition to preservation of body fluids/swabs for rapist DNA - emphasize they are not at fault for being assaulted if they were intoxicated

survivor

individual who has experienced a sexual assault and has worked through many of the issues and is going forward in their life

victim

individual who has experienced an SA and can become a survivor with time, intervention, or counseling

grief

individualized response to a loss that is perceived, real, or anticipated

seclusion

involuntary confinement of a person alone in a room or an area where the person is physically prevented from leaving. May be sued for the management of violent or self-destructive behavior

ssri

med for chronic aggression that targets "anger attacks" + anxiety, depressed mood, and agitation - sertraline, fluoxetine, citalopram, escitalopram

antipsychotics

med for chronic aggression that targets disorganized behavior, labile mood, and poor impulse control - second gen: risperidone (risperdol), olanzapine (zyprexa), ziprasidone (geogon), quetiapin (seroquel)

lithium

med for chronic aggression that targets labile mood, aggression, and suicidality

anti hypertensives

med for chronic aggression that targets poor impulse control, anxiety, and agitation - clonidine, guanfacine, propranolol

triage

medical screening of patients after disaster that separates those who need rapid medical care from those with more minor injuries - Process reduces the acute burden on medical facilities and finite resources, allowing responders to address the greatest number of casualties

anger

normal, not always logical human emotion; ranges in intensity from mild irritation to intense fury and rage; an emotional response to feelings of hurt, fear, or vulnerability, a frustration of desires, threat to one's needs (emotional or physical), or a challenge - usually a response to something that has/is happening - becomes unhealthy if it gets in the way of one's functioning/relationships, puts others at risk - escalated anger --> violence and aggression

generalized amnesia

patients forgetting identity and life history (who they are, where they are); sometimes occurs with dissociative fugue

depersonalization

persistent or recurrent experiences of feeling detached from or as one is an outside observer of one's mental processes or body or of time moving slow - experiences of unreality or detachment from one's surroundings

derealization

persistent or recurrent experiences of unreality of surroundings (world around seems unreal, dreamlike, distant, or distorted)

benzodiazepine, SSRI

pharm treatments for rape-trauma syndrome: - short term treatment with _____ can help reduce acute anxiety/agitation that follows trauma - _______/antidepressants may be helpful for PTSD symptoms

disorganized; automatic, compromise

phases of crisis: - Phase 1: person is confronted by conflict/problem that threatens their self-concept → increased anxiety → use of problem solving techniques and defense mechanisms in an effort to solve the problem and lower anxiety - Phase 2: if threat persists and the usual defensive response fails, anxiety and discomfort continue to rise; functioning becomes _________. Trial and error attempts at solving the problem and restoring a normal balance again -Phase 3: if trial and error attempts fail, anxiety can escalate to severe and panic levels, and the person mobilizes automatic relief behaviors (ie withdrawal, flight). Some form of _______, such as redefining the situation or reevaluating needs, may occur in order to find some sort of resolution - Phase 4: if the problem is not solved after considerable time and efforts, and coping skills have been ineffective and exhausted, anxiety can overwhelm the person → serious personality disorganization, depression, confusion, violence against others, or suicidal behavior can develop

primary intervention

promotes mental health and reduces mental illness to decrease the incidence of crisis - Nurse can work with individual to recognize problems and evaluate stressful life events - Teach individual-specific coping skills - Assist them in evaluating the timing/reduction of life changes to mitigate the effects of stress (working w patient to plan environmental changes, make important interpersonal decisions, rethink changes in occupational roles)

reality orientation

providing the correct information to the patient about time, place, date, and current life circumstances; this may not work with some patients and cause them to become frightened and agitated - Sedation only further clouds a patient's sensorium, which makes disorientation worse and increases the risk for falls and injuries

cognitive behavioral therapy

psychotherapy that focuses on evaluating and changing distressing thoughts experienced since the trauma

eye movement desenstization and reprocessing (EDMR)

psychotherapy that helps change how individuals react to memories of their trauma; While thinking of/talking about traumatic memories, the individual focuses on other stimuli, such as eye movements, hand taps, and sounds

prolonged exposure therapy

psychotherapy that teaches the patient to gradually approach trauma-related memories, feelings, and situations that have been avoided since the trauma. By confronting these challenges, PTSD symptoms decrease

women

ptsd is more common in (women/men)

acute/disorganization phase

rape-trauma phase characterized by shock, numbness, disbelief; person may appear self contained and calm, but may have impaired cognitive function and have difficulty making decisions, solving problems, or concentrating - also includes physical reactions such as generalized pain throughout the body, eating and sleeping disturbances, and emotional reactions such as anger, fear, anxiety, guilt, humiliation, embarrassment, self-blame, and mood swings

long term/delayed/organization phase

rape-trauma syndrome phase that may not occur for months or even years after event; characterized by flashbacks, nightmares, phobias, and somatic and gynecological symptoms - may cause depression, panic, suicidality, substance abuse (risk for self-destructive behavior, low self esteem, helplessness, acute confusion, labile moods)

therapeutic presence

remaining near the patient and family, or simply holding a hand, provides strength while facilitating the expression of emotions and grief; helps them feel seen, valued, and important - effective presence requires that the care provider accept the reality of suffering, helplessness, mourning, and mortality.

complicated

risk factors for ______ grief include: - loss of a child - sudden loss - surgery results in loss of visible body part that has significance - strongly dependent bereaved person - ambivalent relationship or unresolved conflict - experienced other recent losses - poor coping in past with losses - bereaved person's health is unstable - person perceives some responsibility for the loss

grief work

the process of grief recovery/how a person adjusts to the loss; frameworks for grieving help normalize the phenomena of loss common phenomena: - shock and disbelief, denial, guilt, anger, somatic distress - change in behavior: depression, disorganization, panic, restlessness - reorganization of behavior toward a new object/activity - acceptance - preoccupation with image of deceased

complicated

risks for _______ grief include symptoms that are not characteristic of normal mourning! - acute grief can exacerbate medical/psych problems: depression, substance abuse, PTSD, unresolved grief work, prolonged depression - ALWAYS assess for suicide - guilt about things other than actions taken/not taken by survivor at time of death - thoughts of death other than the survivor feeling they would be better off dead without the deceased person: - morbid preoccupation with worthlessness - significant psychomotor retardation - prolonged functional impairment - hallucinations other than thinking they hear the voice/transiently sees images of the dead

anti-adrenergic drugs

second line of treatment for PTSD; drugs that act on NS to oppose the effects of SNS, inhibiting release of norepinephrine and decreasing SNS activity - includes: - Mirtazapine, Phenelzine (MAOI) - Tricyclic Antidepressants (Imipramine)

bpd, ptsd

significant overlap of symptoms of _____ and complex presentation of _______ can complicate a dissociative identity disorder diagnosis

critical incident debriefing

staff analysis of an episode of violence; ensures quality of care and provides opportunity for self-care for staff members documentation includes: Reason for seclusion/restraint Assessment of behaviors that occurred during pre assaultive stage (time) Nursing interventions and patient's responses (time) Evaluation of interventions used Detailed description of patient's behaviors during assaultive stage All interventions used to defuse the crisis, and patient's responses to the intervention Name of person called to assess patient and order meds/seclusion/restraint (time) Time patient put in restraints/seclusions Observations of/interventions performed while in restraints/seclusion — 15 to 30 minutes depending on the law Any injuries to patients or staff Way in which patient was reintegrated into the unit milieu (time + behavior)

compassion fatigue

state of exhaustion in which healthcare workers become indirectly traumatized when trying to help someone who has experienced primary traumatic stress; cumulative physical, emotional, and psychological effects - high risk in nurses with unrealistic self-expectations, those who are over involved with patients, are inexperienced, or are having a personal crisis - s/s: Feeling overwhelmed, physically/mentally exhausted Inability to function Intrusive thoughts/images of another's critical experience Difficulty separating work from personal life Becoming pessimistic, critical, irritable, prone to anger Dread of working with certain individuals Depression Ineffective and/or destructive self-soothing strategies Withdrawing socially and becoming emotionally disconnected from others Becoming easily frustrated Insomnia Lowered self-esteem in nonprofessional situations Loss of hope

dissociative

symptoms suggestive of ________ disorder: -History of abuse, particularly child abuse -Missing blocks of time -Reported feelings of unreality, being in a dream like state, or not feeling like self -Unrecognized handwriting on personal documents, finding clothes/items that there is no memory of purchasing -Friends report they act like a different person at times -Instances of suicidal gestures or self-harm behaviors with no recall of the event -Clinician-observed switching of alters or distinct personalities

true

t/f Most perpetrators of sexual abuse report being SA'd as children. - Other characteristics include: - Impulsive and antisocial tendencies - Association with sexually aggressive and delinquent peers - Preference for impersonal sex - Hostility toward women - Childhood history of sexual and physical abuse or witnessing family violence as a child - Membership in a gang - Belonging to a societal group that often refuses to acknowledge acts of sexual assault (military, prisons)

true

t/f Reporting crimes of sexual assault is not mandated unless it involves the abuse of a minor/older adult; it is up to the survivors of assault to make the decision to report the crime

false - each personality has the ability to deal openly with feelings, but the personalities need to be integrated - none of the personalities can be ignored, because their presence must be dealt with before integration can occur - personalities serve a protective purpose, and if they didn't, they would be abandoned

t/f in a patient with DID, personalities can be ignored because they serve no protective purpose. the goal of therapy is to also be able to openly deal with feelings

TRUE

t/f seclusion and restraint have no therapeutic value, cause human suffering, and frequently result in severe emotional/physical harm, and even death. also linked withlonger inpatient care and higher rates of readmission. - new approaches: comfort room, trauma informed approach

false

t/f the long-term use of benzodiazepines is recommended for PTSD because it is not considered ineffective or potentially harmful

true

t/f to preserve rape evidence on the body, do not wash hands, face, bathe/shower, brush teeth, or change/straighten up where assault took place

compassion

the ability to be with someone who is suffering; a human capacity that is developed and sustained in relationship to others -action that connects us meaningfully to others

violence

the expression of hostility and rage with the intent to injure, or damage people or property through physical force → physical and psychological harm to others - Unjust, unwarranted, unlawful display of verbal threats, intimidation, or physical force

after

the least restrictive method of restraint is always tried ______, and seclusion/restraint are used only after alternatives have been attempted (medications, trauma informed approach, verbal interventions, observation)

dissociative identity disorder

the most severe of the dissociative disorders; disruption of identity by two or more distinct personality states or alternate personalities (alters), causing a loss of sense of self, alterations in affect, behavior, memory, and functioning; s/s: - patients "lose time"-- they do not have a memory of periods of time where an alter personality is in control of the host person. Signs include finding clothing/unfamiliar items in your possession, being recognized by unfamiliar people, different handwriting on documents, and losing periods of time - transition from one personality to another is often sudden, dramatic, and usually precipitated by stress - each alter has its own personality, perception, and memories - thought to originate in childhood traumatic experiences that overwhelm the individual's capacity to cope by any means other than dissociation; severe and repetitive childhood abuse/trauma, usually by trauma occurring at less than 9 years of age

complicated grief

unresolved grief that occurs when individuals have difficulty coming to terms with their loss, and experience c=phenomena outside the normal grief reaction, which impairs their ability to function in social/occupational situations or resume previous roles - may be chronic = lasts longer than a year after death - delayed = when normal grief reactions are suppressed or postponed - exaggerated: when the individual takes drastic measures that are self-destructive or masked

validation therapy

used to calm disoriented patients who misperceive their setting or life situation; i.e. some patients believe they are young and feel the need to return to important tasks that were a significant part of their earlier years - Rather than attempting to reorient, ask the patient to further describe the setting/situation references by the patient, and during the conversation the nurse can comment on what appears to be the underlying source of distress, thus validating it

perspective, strengths

whether an event is perceived as a crisis depends on the ______ and _____ of the patient crisis assessment guidelines: 1 identify wehther the patient's response to the crisis warrants psychiatric treatmetn/hospitalization (harm to self orothers) 2. determine if patietn can identify the precipitating event 3. identify their understanding of their present situational supports 4. identify patient's usual coping skills and support system and determine what coping mechanisms may help the present situation 5. determine if any spiritual/cultural beliefs should be considered in assessing/intervening in crisis 6. assess whether this situation is one in which the patient needs primary intervention (educational, enviro manipulation, new coping skills), secondary intervention (crisis intervention), or tertiary intervention (rehabilitation)

safety, security

which 2 needs are priority for a client who was sexually assaulted? - safety - security - love and belonging - belief and acceptance

document client statements

which action is a nurse's responsibility for a client who was sexually assaulted and decides to seek persecution of the rapist? - file the physical evidence - contact persecutor - testify against the rapist - document client statements

2 3 4 5 6

which assessment data would the nurse obtain from a woman who was sexually assaulted 2 hours ago? 1 details of sexual history and past partner relationships 2 verbatim statements regarding the assault 3 signs/symptoms of physical trauma 4 signs/symptoms of emotional trauma 5 availability of support systems 6 level of anxiety and coping mechanisms

statement by the client about the sexual assault and the rapist - eliminates the nurse's subjectivity from the report!

which information is the most important to document for a female sexual assault victim? - statements by the client about the sexual assault and the rapist - summary of the client's description of the assault and the rapist

obtaining info about her perception of the incident - notifying legal authorities or the husband is the CLIENT's decision - teaching about evidence collection is appropriate after the urgent physical and psychological needs are addressed

which intervention is the priority for a woman who was sexually assaulted by a stranger? - obtaining info about her perception of the incident - notifying legal authorities that a sexual assault has occurred - talking with the husband about his feelings concerning the assault - teaching the client about how sexual assault evidence will be collected

referring the child to a clinical psychologist

which nursing intervention is appropriate for an 8 year old victim of an earthquake who has trouble sleeping, startles easily, and experiences "flashbacks" of the disaster - restraining the child while sleeping - referring the child to a child psychologist - administering sedatives to the child at night - placing the child's favorite toys in the bed while sleeping

decompensation

worsening of symptoms