NUR 180 Exam 1

Tension building phase

- Abuser has minor episodes of anger and may be verbally abusive - Responsible for some minor physical violence - Victim is tense during this stage and tends to accept the blame for what is happening.

Serious battering phase

-Abuser becomes unbearable; violence occurs -Victim may try to cover up the injury or may look for help

Signs of an abusive personality?

A push for quick involvement Jealously controlling Unrealistic expectations Isolates partner from family and friends Blames others for own problems and mistakes Makes others responsible for his/her feelings Hypersensitive, easily insulted Cruel to animals and children Playful use of force during sex Verbal abuse Enforces rigid sex roles Sudden mood swings History of past battering Threatens violence

Mutism

Able to speak but remains silent

Honeymoon phase

Abuser- may bring gifts, show kindness, apologize, and promise it won't happen again Victim- believes abuse is over, stays in the relationship

Suicidal gestures

Actions that result in little or no injury but communicate the message of suicidal intent

A patient is admitted to the hospital. They are extremely worried about their pets at home. What would you do?

Ask them if there is anyone at home or if there is anyone they can call that will help them take care of their responsilities

If someone states they are going to kill themselves, what should you do?

Ask them if they have a plan what that plan is Figure out how obtainable that plan is

How do you know a client can conversate with you?

Assess to see if they can communicate Can they talk? Can they hear?

What are medications used to manage aggression?

Atypical antipsychotics (Clozapine, Risperdone) Beta Blockers (Propanolol, metoprolol) Antianxiety agents (Buspirone, lorazepam, benzos) Anticonvulsants (Valproic acid.. monitor labs)

Circumstantiality

Describes in too much detail, cannot be selective

What are the principles of mental health care?

Do no harm Accept each client as a whole person Develop mutual trust Explore behaviors and emotions Encourage responsibility Encourage effective adaptation Provide consistency

Suicidal ideation

Expressed thoughts or fantasies with no definite intent—may express ideas directly or symbolically

What are some nontherapeutic communication techniques?

Failure to listen Failure to explore client's point of view Failure to probe Eliciting vague descriptions Giving inadequate answers Parroting Following standard forms too closely Being judgmental Giving advise Being defensive Challenging Giving reassurance Rejecting Using stereotyped responses

When it comes to communication what should you focus on?

Focus on the behavior not the client

Rape/Trauma victim interventions

Give referrals Get them counseling Encourage them to talk about their feelings Be non-judgmental Encourage them to report the incident

Characteristics of a person with machismo? SATA

Has an attitude of male pride Engages in thrill-seeking behaviors Employs competition as his guiding principle Is egocentric Is unable to express emotions except anger and rage Dislikes being gentle or vulnerable Values sexual virility Displays sexist attitude Treats women as objects or commodities Sees women as objects of conquest Insists on being dominant toward girls and women Holds to unwritten law that infidelity by a woman must be avenged Unable to cooperate with women Agrees to sexual use and abuse of women Glorifies war and violence, supports the use of military force Enjoys contact sports Uses aggression to physically solve problems

Assessing illusions or hallucinations?

How many voices (images) do you hear or see? What do the voices say? Images do? Do you recognize and of the voices/images? When did the voices/images start? What was happening in your life? How do you feel about the voices/images?

Hyperalertness

Increased state of alertness or watchfulness (hypervigilance)

Signs and Symptoms of stress

Irritability, difficulty sleeping, sleeping too much, anxiety, guilt, indecisiveness, loss of appetite, sexual relations, and interest in work, isolation, alcohol or drug abuse, inability to concentrate

Silence

Lack of verbal communication for therapeutic reason Therapeutic value: allows client time to think and gain insights

Malpractice

Negligence by a professional person Duty, Breach of duty, Causation, Injury

Victims of violent or abusive acts often suffer from what?

PTSD

Myths about suicide

People who talk about it will not commit suicide One does not need to take a suicide threat seriously A failed suicide attempt is a manipulative behavior People who are really serious about suicide give no clues It is harmful to discuss the subject of suicide Only psychotic or depressed people commit suicide Suicide occurs only in the poor Young children never commit suicide When people show signs of an improved mood, the threat of suicide is over

Suggesting

Presenting alternative ideas for client's consideration relative to problem solving Therapeutic value: increases client's perceived options or choices

Focusing

Questions or statements that help client expand topic Therapeutic value: allows client to discuss central issues keeps communication process goal directed

Chronic stress

Represents a sustained or perpetual demand, threat, or pressure, that is harmful to health because it wears on individuals continuously. Can stem from long-term stressors such as chronic occupation stress, relationship, or financial stress Often associated with a loss of hope that the situation can improve

Suicidal attempts

Serious self-directed actions with the intent to end one's life

Flight of ideas

Shifts rapidly between unrelated topics

Primary prevention of stress

Stress management and reduction techniques, Counseling, Health education, Family enhancement, Social support enhancement and network building, Wellness programs

What's included in a suicide assessment?

Suicide ideation (thoughts) History of suicide attempts Present suicide plan Availability of items to carry out plan Substance use or abuse Level of despair Ability to control own behavior

What are the cycles of domestic violence

Tension building Serious battering incident Honeymoon

Completed suicide

The successful ending of one's life

Tertiary prevention of stress

Treatment and recovery from stress related illnesses, Counseling services, Employee assistance programs. Help them live a therapeutic lifestyle

What is the first thing you should do when you meet a mental health patient?

Try to get them to trust you

Theme identification

Underlying client issues or problems that emerge repeatedly during caregiver-client relationship Therapeutic value: allows caregiver to promote client's exploration and understanding of important problems

Comatose/unconscious

Unresponsive to any verbal or painful stimuli

Parasuicidal behavior

Unsuccessful attempts with a low likelihood of success

Secondary prevention of stress

Using screening tools to determine stress levels.

Therapeutic communication

Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship.

Is light stress good for cognition?

Yes

Domestic violence

abuse and battering within a family

Common unpleasurable emotional responses

aggression, agitation, ambivalence, anxiety, depression, fear

Coping

alleviating stress using emotional, cognitive, or behavioral methods being action oriented toward a goal of changing a situation abstract thoughts based on past experiences to reduce stress

Broad openings

allowing the client to take the initiative in introducing the topic Therapeutic value: indicates acceptance by caregiver and value of client's initiative

PTSD

an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience

Stress

an internal or external even or demand of life experienced by the individual that is perceived and appraised for scope and meaning on a continuum to determine whether resources and abilities for management are available, exceeded, or exhausted

What are the interrelated concepts for stress?

anxiety coping functional ability family dynamics cognition mood and affect perfusion sexuality sleep Immunity

What are some problems with communication?

aphasia dyslexia speech clustering

What are some things you need to do if your patient has alzheimers?

approach from the front use normal tone of voice face them maintain distance of 1-1.5 ft minimize hand movement don't frighten avoid high sensory levels/places maintain eye contact/smile use simple words/statements allow time for response repeat important info ask one question at a time conflict = distract/remove

Sharing perceptions

asking client to verify caregiver's understanding of client's message Therapeutic value: conveys understanding to client and can clear up confusing communication

Alert

awake and responsive, oriented to time, place, and person

Somatic symptoms of child abuse?

bad grades unexplained injury UTI's malnutrition

Examples of psychological/emotional stressors

birth of child caregiving change in health status death of close family member or friend diagnosis of terminal illness divorce failing an exam loss of job marriage parenting physical disability relationship problems

Disorders of thinking

blocking flight of ideas loose associations perseveration delusions obsession phobias preoccupations amnesia confabulation

Lethargic

can be verbally aroused, shows decreased wakefulness, may have periods of excitability alternating with periods of drowsiness

Examples of physiological stressors

cancer copd dementia DM Organ failure MI Acute and chronic pain Traumatic injury

Neologism

coins new words and definitions

Machismo

compulsive masculinity evidenced by preoccupation with physical strength and athletic prowess, attempts to demonstrate daring, or violent and aggressive behaviors

Therapeutic listening skills

concentrate on the speaker and message keep distractions to a minimum Change the setting if needed Assess nonverbal communications Listen objectively without judgement Discover words that trigger emotional responses Use eye contact and body language that is culturally appropriate Do not interrupt Jot down notes if needed Do not assume that you understand anothers thoughts Clarify any message about which you are unsure

What are motivations for suicide

cry for help refusal to accept a diminished quality, style, or pace of life Need to affirm the soul To relieve distress Preoccupied with suicide To exercise control

child abuse

deliberate action that is harmful to a child's physical, emotional, or sexual well-being

Reflection

directing back the client's ideas, feelings, questions, and content Therapeutic value: Validates caregiver's understanding of what client is saying and signifies empathy, interest, and respect for client

Humor

discharge of energy through comic enjoyment Therapeutic value: can promote insight by making conscious repressed material, resolving paradoxes, tempering aggression, and revealing new options, is socially acceptable form of sublimation

When women get pregnant we see an increase in what?

domestic violence

Common pleasurable emotional responses

euphoria, exaltation

For any patients make sure you don't provide this?

false reassurance

Characteristics of victims

feels captive in the system (family, group, community) Blames self for problems leading to abuse Has low self-esteem, feels self as unworthy Feels helpless and powerless to change the situation Is financially, emotionally, or physically dependent on the abuser Unable to see a future without abuse Is depressed

Mental status exam

general description- appearance, speech, motor Emotional state- mood, affect Experiences- perceptions Thinking- thought content Sensorium- LOC, memory, concentration level

Common inappropriate emotional responses

labile, inconsistent, flat

Blocking

loses train of thought, stops speaking because of unconscious block

Abuse

physical or emotional harm to someone **Once confirmed you must report** Get patient alone so you can talk to them

Battering

repeated physical abuse of someone, usually a woman, child or elder

Restating

repeating the main idea expressed Therapeutic value: indicates that caregiver is listening and validates, reinforces, or calls attention to something important that has been said

Echolalia

repeats last word heard

Perseveration

repeats single activity, cannot shift from one topic to another

Verbigeration

repeats words, phrases, sentences several times over

Stuporous

responds only to strong physical stimuli; falls asleep if not stimulated

Somatic symptoms of being bullied?

self harm - cutting constant stomachache or headache

Episodic acute stress

self inflicted stress Most common in type A personalities They may always be in a hurry or irritable or constantly worry

Informing

skill of information giving Therapeutic value: helpful in client education about relevant aspects of well being and self care

Loose associations

speaks constantly, shifting between loosely related topics

Pressured speech

speech becomes fast, loud, rushed, and emphatic

Mania

state of extreme excitement, elation, activity, and agitation

Empathy

the ability to understand and share the feelings of another

Suicide

the act of intentionally taking one's own life

Clarification

the act of making clear or understandable Therapeutic value: helps to clarify feelings, ideas, and perceptions of client and provides explicit correlation between them and client's actions

Cognition

the mental activities associated with thinking, knowing, remembering, and communicating

Acute stress

the most common type of stress and typically occurs for a short period of time. Occurs in reaction to a real or perceived threat, demand, or pressure. Resolution of the stressor leads to elimination of the stress response

Elder abuse

the physical or psychological mistreatment or neglect of elderly individuals

Listening

the process of receiving, constructing meaning from, and responding to spoken and/or nonverbal messages Therapeutic value: nonverbally communicates caregiver's interest and acceptance

Signs and symptoms of elder abuse?

unexplained bruising malnourished will shy away lower hygiene levels

Suicidal threats

verbal or written expressions of intent without actual actions

Drowsy/Somnolent

wakens with strong verbal stimuli; falls asleep if left undisturbed