Flashcards in TEST 3 Deck (64):
Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student’s crisis?
a)The time of year in which the event occurred
b)The presence of support systems
c)A lack of adequate coping mechanisms
d)The individual’s family birth order
Adequate coping mechanisms can influence the development of a crisis.
If a person can draw on past successful coping strategies, a crisis may be diverted.
The second student had a lack of adequate coping mechanisms.
Phases of Crisis Intervention: The Role of the Nurse
Nurses may be called on to function as crisis helpers in virtually any setting committed to the practice of nursing.
Aguilera described four specific phases in the technique of crisis intervention that are clearly comparable to the steps of the nursing process.
The basic methodology relies heavily on orderly problem-solving techniques and structured activities focused on change.
Through adaptive change, crises are resolved and growth occurs.
Individual must experience some degree of relief almost from the first interaction.
Using a crisis situation to restore functioning and at most to enhance personal growth
Need not be a negative expression
Is a normal human emotion that, when handled appropriately and expressed assertively, can provide an individual with a positive force to solve problems and make decisions concerning life situations
Becomes a problem:
-When not expressed
-When expressed aggressively
A client has not received what was expected for lunch and directs an angry verbal outburst at the nurse. Which is an accurate description of this display of emotion?
a)Anger is a primary emotion that is automatically experienced.
b)Anger is a psychological arousal.
c)Expression of anger can come under personal control.
d)Expression of anger and aggression are closely related.
The expression of anger can come under personal control and is a learned behavior.
What's the first question you ask during Crisis intervention ?
what happened? What is bringing you in today?
Medication classification most often used for treating OCD and talk about the specifics in dosing?
- SSRIs are the mainstay of pharmacological treatment
- These are typically used at higher doses and for longer periods than in depression.Doses in excess of what is effective for treating depression may be required for OCD
Name the SSRIs and doses used to treat OCD?
- 40 mg of escitalopram,
- 80 mg of fluoxetine,
- 100 mg of paroxetine
- 300 mg of fluvoxamine
Though SSRIs are the mainstay of treatment for OCD, What tricyclic drug was the first drug approved by the FDA in the treatment of OCD and why is it not the first line treatment of OCD ?
- Clomipramine : it is more selective for serotonin reuptake than any of the other tricyclics.
- Its efficacy in the treatment of OCD is well established, although the adverse effects, such as those associated with all the tricyclics, may make it less desirable than the SSRIs.
Setting appropriate timing/outcome for client to perform rituals at initial hospitalization
Identify situations that precipitate compulsive behavior; encourage the client to verbalize concerns and feelings. Do not interrupt compulsive behaviors unless they jeopardize the safety of the client to or others (provide for client safety related to the behavior). Allow time for the client to perform the compulsive behavior, but set limits on behaviors that may interfere with clients physical well-being to protect the client from physical harm. Implement a schedule for the client that distracts from the behaviors (structure simple activities, games or tasks for the client). Establish a written contract that assists the client to decrease the frequency of compulsive behaviors gradually.
What characteristics would a client portray when experiencing specific phobias?
A persistent, intensely felt, and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the feared stimulus. Responses typically include intense anxiety or panic attacks
- A diagnosis of specific phobia is made only when the irrational fear restricts the individual’s activities and interferes with his or her daily living.
Medication classifications useful in treatment of phobic disorders?
Controlled studies have shown the efficacy of ____________and __________ in reducing symptoms of social anxiety.
- clonazepam (klonopin)
What TCA and MAOI have been effective in diminishing symptoms of agoraphobia and social anxiety disorder?
- Imipramine (Tricyclic)
- phenelzine (MAOI)
What hypertensive agents have been used to treat stage fright (performance anxiety), situational anxiety and PTSD?
Propranolol and Atenolol
What are some Nursing interventions for a Panic Attack?
- Do not leave client in panic anxiety alone, Stay with client and offer reassurance of safety and security.
- Maintain a calm, nonthreatening, matter-of-fact approach. Anxiety is contagious and can be transferred from staff to client or vice versa. The presence of a calm person provides a feeling of security to an anxious client.
- Use simple words and brief messages, spoken calmly and clearly, to explain hospital experiences
- If hyperventilation occurs assist client to breathe into a small paper bag held over the mouth and nose. Six to 12 natural breaths should be taken, alternating with short periods of diaphragmatic breathing
- Calmly ask “what's the cause as the panic attack?”Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor)
- Administer tranquilizing medication, as ordered by physician. Assess for effectiveness and for side effects
-When level of anxiety has been reduced, explore possible reasons for occurrence,
-Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (relaxation techniques, such as deep-breathing exercises and meditation, or physical exercise, such as brisk walks and jogging).
What symptoms must be present to identify the presence of a panic attack?
- Palpitations, pounding heart, or accelerated heart rate
-Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
-Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
Generalized Anxiety Disorder (GAD): is characterized by persistent, unrealistic, and excessive anxiety and worry that have occurred more days than not for at least __ months and cannot be attributed to specific organic factors, such as caffeine intoxication or hyperthyroidism.
What class of drugs have been used with success in the acute treatment of generalized anxiety disorder.
What are the first-line treatments for generalized anxiety disorder. Once these are proven to be effective how can you expect the doctor to adjust the prescription?
- SSRIs and SNRIs
- If an SSRI is effective, it is recommended to take the medication for another 6 to 12 months, and then gradually reduce the dose.
What specific SSRIs & SNRIs have been approved for the treatment of General Anxiety Disorder?
- paroxetine (Paxil)
- escitalopram (Lexapro)
- duloxetine (Cymbalta)
- extended-release venlafaxine (Effexor XR)
What antianxiety agent is effective in about 60 to 80 percent of clients with generalized anxiety disorder .
One disadvantage of buspirone is its 10- to 14-day delay in alleviating symptoms.
What are the First-line choice of treatment for panic disorders?
What SSRIs/SNRIs are used in the treatment of Panic Disorders?
- SSRIs - Paroxetine, fluoxetine, and sertraline
- SNRIs - Venlafaxine
Buspirone (BuSpar) is an antianxiety agent but not a benzodiazepine and does not depress the CNS. Although its action is unknown, the drug is believed to produce the desired effects through interactions with serotonin, dopamine, and other neurotransmitter receptors. Clients should be instructed that buspirone has a lag period of 7 to 10 days before full therapeutic benefits are achieved. It does not have the addiction potential of the other antianxiety agents and therefore may be a better option for clients with anxiety disorders who have also struggled with substance use disorders.
What Benzo's have been particularly effective in the treatment of panic disorder?
Indications for Doxepin
- Chronic pain syndromes
- topically for short -term control of pruritus
What is Conversion disorder? What are typical symptoms?
- loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism
- symptoms affect voluntary motor or sensory functioning suggestive of neurological disease. Examples include paralysis, aphonia (inability to produce voice), seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, anosmia (inability to perceive smell), loss of pain sensation, and hallucinations. Abnormal limb shaking with impaired or loss of consciousness that resembles epileptic seizures is another type of conversion disorder symptom, referred to as psychogenic or nonepileptic seizures. Pseudocyesis (false pregnancy) is a conversion symptom and may represent a strong desire to be pregnant. **** Most symptoms of conversion disorder resolve within a few weeks.
Nursing care for Conversion disorder?
- Monitor physician’s ongoing assessments, laboratory reports, and other data to ensure that possibility of organic pathology is clearly ruled out.
- Identify primary or secondary gains that the physical symptom may be providing for the client (e.g., increased dependency, attention, protection from experiencing a stressful event).
- Do not focus on the disability, and encourage client to be as independent as possible. Intervene only when client requires assistance.
- Maintain nonjudgmental attitude when providing assistance to the client. The physical symptom is not within the client’s conscious control and is very real to him or her.
- Do not reinforce the client’s attempts to use the disability as a manipulative tool to avoid participation in therapeutic activities. Withdraw attention if client continues to focus on physical limitation.
- Encourage the client to verbalize fears and anxieties. Help identify physical symptoms as a coping mechanism that is used in times of extreme stress.
- Help client identify coping mechanisms that he or she could use when faced with stressful situations rather than retreating from reality with a physical disability.
- Give positive reinforcement for identification or demonstration of alternative, more adaptive coping strategies.
- Teaching family about length of time symptoms are present
related to a specific stressful event. For example, the individual with localized amnesia is unable to recall all incidents associated with a stressful period. It may be broader than just a single event, such as the inability to remember months or years of child abuse
the individual can recall only certain incidents associated with a stressful event for a specific period after the event
individual has amnesia for his or her identity and total life history.
inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness and is not due to the direct effects of substance use or a neurological or other medical condition . Many cases of dissociative amnesia resolve spontaneously when the individual is removed from the stressful situation.
characterized by a sudden, unexpected travel away from customary places or by bewildered wandering, with the inability to recall some or all of one’s past. An individual in a fugue state may not be able to recall personal identity and sometimes assumes a new identity
For more refractory Dissociative Amnesia conditions, intravenous administration of __________ is useful in the retrieval of lost memories. Most clinicians recommend supportive psychotherapy to reinforce adjustment to the psychological impact of the retrieved memories and associated emotions.
What are client appropriate client outcomes for a client with Somatic Symptom Disorder
-Effectively uses adaptive coping strategies during stressful situations without resorting to physical symptoms (somatic symptom disorder)
- Interprets bodily sensations rationally, verbalizes understanding of the significance of the irrational fear, and has decreased the number and frequency of physical complaints (illness anxiety disorder and somatic symptom disorder)
- Is free of physical disability and is able to verbalize understanding of the possible correlation between the loss of or alteration in function and extreme emotional stress (conversion disorder)
- Can recall events associated with a traumatic or stressful situation (dissociative amnesia)
Can verbalize the extreme anxiety that precipitated the dissociation (depersonalization-derealization disorder)
- Can demonstrate more adaptive coping strategies to avert dissociative behaviors in the face of severe anxiety (depersonalization-derealization disorder)
- Verbalizes understanding of the existence of multiple personality states and the purposes they serve (dissociative identity disorder)
- Is able to maintain a sense of reality during stressful situations (depersonalization-derealization disorder)
Characteristic of Somatic Symptom Disorder
physical symptoms suggesting medical disease but without demonstrable organic pathology.`
Med classifications used to treat generalized Anxiety?
- Beta blockers
- Anticonvulsants - (pregabalin (lyrica))
What is systematic desensitization?
- client is gradually exposed to the phobic stimulus in either a real or imagined situation.
Systematic desensitization with reciprocal inhibition involves two main elements:
1. Training in relaxation techniques
2. Progressive exposure to a hierarchy of fear stimuli
while in the relaxed state
The individual is instructed in the art of relaxation using techniques most effective for him or her (e.g., progressive relaxation, mental imagery, tense and relax, meditation). When the individual has mastered the relaxation technique, exposure to the phobic stimulus is initiated. He or she is asked to present a hierarchical arrangement of situations pertaining to the phobic stimulus in order from most disturbing to least disturbing. While in a state of maximum relaxation, the client may be asked to imagine the phobic stimulus. Initial exposure is focused on a concept of the phobic stimulus that produces the least amount of fear or anxiety. In subsequent sessions, the individual is gradually exposed to stimuli that are more fearful. Sessions may be executed in fantasy, in real-life (in vivo) situations, or sometimes in a combination of both. Following is a case study describing systematic desensitization.
What is Adjustment Disorder?
- adjustment disorder is characterized by a maladaptive reaction to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms.
Priority Intervention for Adjustment Disorder?
The primary focus of intervention is to maximize the potential for adaptation. Individual psychotherapy is the most common treatment for adjustment disorder.
What are the stages of grief?
What is Adjustment disorder with disturbance of conduct, prioritization of care ?
Adjustment disorder with disturbance of conduct occurs when the stressor leads to behavior problems, . If conduct disturbances are present before stressor(s) are experienced, then the diagnosis is a different disorder.
What are 4 things occuring with an individual who is diagnosed with adjustment disorder with disturbance of conduct ?
- Violates the rights of others to feel better.
- Expresses symptoms that reveal a high level of
- Exhibits severe social isolation and withdrawal.
- Is experiencing a complicated grieving process.
- Atypical Antipsychotic
- Increased effects of clozapine may occur with concomitant use of venlafaxine.
- Instruct the client receiving clozapine that regular monitoring of white blood cell and absolute neutrophil counts is essential.
- A baseline WBC count and absolute neutrophil count (ANC) must be taken before initiation of treatment with clozapine and weekly for the first 6 months of treatment. Supply of medication is given based off WBC labs. (only a weekly supply is given at first)
- Jewish people have a higher rate of side effects from the antipsychotic clozapine
Domestic violence profile of victim
-Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups
-Inadequate support systems
-Some grew up in abusive homes
Domestic violence profile of victimizer
- Low self-esteem
- Pathologically jealous
- “Dual personality”
- Limited coping ability
- Severe stress reactions
- Views spouse as a personal possession
Victims have been known to stay in an abusive relationship for many reasons, some of which include the following ?
-Fear of retaliation:
-Fear of losing custody of children:
-Physical or financial dependence:
-Lack of a support network:
-Lack of attention to the danger: victim’s numbness or --lack of awareness of the reality of the situation.
Unlabeled use for citalopram (SSRI)
Obsessive-compulsive disorder (OCD).
Generalized anxiety disorder (GAD).
Post-traumatic stress disorder (PTSD).
Social anxiety disorder
What drug is contraindicated in patients with a history of QT prolongation or cardiac arrhythmias, recent myocardial infarction (MI), un-compensated heart failure, and concurrent use with other drugs that prolong the QT interval
John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John?
Paroxetine and group therapy
What medications are now considered first-line treatment of choice for PTSD because of their efficacy, tolerability, and safety ratings
What drug has been prescribed for PTSD clients for its antidepressant and antipanic effects.
What meds have been reported to alleviate symptoms of intrusive recollections, flashbacks, nightmares, impulsivity, irritability, and violent behavior in PTSD clients
What is Ketamine,
an anesthetic agent believed to disrupt the fear associated with trauma. effects are short term and there is potential for addiction.
What med has demonstrated benefit in reducing nightmares and enhancing normal dreaming patterns in clients with PTSD
Prazosin (alpha1 antagonist)
Class 1 Dispositional Crisis:
An acute response to an external situational stressor.
Class 2 Crises of Anticipated Life Transitions:
Normal life-cycle transitions that are anticipated but over which the individual may feel a lack of control.
Class 3 Crises
Resulting From Traumatic Stress: Crisis precipitated by an unexpected external stressor over which the individual has little or no control and as a result of which he or she feels emotionally overwhelmed and defeated.
Class 4: Maturational/Developmental Crisis:
Crises that occur in response to failed attempts to master developmental tasks associated with transitions in the life cycle.
Class 5: Crises Reflecting Psychopathology:
A crisis that is influenced or triggered by preexisting psychopathology. Examples of psychopathology that may precipitate crises include personality disorders, anxiety disorders, bipolar disorder, and schizophrenia.
Class 6: Psychiatric Emergencies:
Crisis situations in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility for his or her behavior. Examples include acute suicide risk, drug overdose, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger, and alcohol intoxication.
Techniques for dealing with aggression
Call for assistance
Observation and documentation