Week 6 (Exam 3 study material) Flashcards
(118 cards)
1
Q
Abuse
A
maltreatment of one person by another
2
Q
Neglect
A
the refusal or delay in seeking health care, abandonment, expulsion from the home, inadequate supervision; failure to provide hope, love, and support necessary to development of a sound, healthy personality
3
Q
Battery
A
when a person physically strikes or attempts to physically strike another person, or acting in a threatening manner to place fear of immediate harm in another
4
Q
Family violence
A
spousebattering;neglect and physical, emotional, or sexual abuse of children; elder abuse; marital rape
5
Q
Common characteristics of family violence
A
Social isolation
Abuse of power and control
Alcohol and other drug abuse
Intergenerational transmission process
6
Q
What are specific types of abuse and neglect?
A
a. child abuse/neglect
- mandatory reporting requirement
b. Elder abuse
- mandatory reporting requirement
c. Spouse abuse / intimate partner violence
7
Q
What are consequences of child abuse and neglect?
A
a. improper brain development
b. impaired cognitive/socio-emotional skills
c. anxiety, depression, suicidal behaviors
d. smoking, alcoholism and dugs
e. increase change of psych. disorders before or at 21
f. conduct disorder, learning and attention difficulties
g. increase criminal and violent behavior
h. negative effects on the ability to establish a healthy intimate relationship in adulthood
8
Q
Consequences of elder abuse
A
a. persistent physical pain, soreness, visual injuries
b. nutrition and hydration issues
c. sleep disturbances
d. exacerbation of preexisting health conditions
e. increased risk for premature death
f. depression, helplessness, fear and anxiety
9
Q
Consequences of intimate partner violence / spouse violence
A
a. PTSD, depression, anxiety, SI behaviors
b. low self-esteem, fear of intimacy, inability to trust others
c. emotional detachment, sleep disturbances, flashbacks
d. engaging in high-risk sexual behaviors, using harmful substances, unhealthy dieting, overuse of health services
10
Q
Intimate partner violence: profile of the victim
A
~82% women
a. battered women represent all demographics
b. low self esteem
c. accept blame of batterer’s actions
d. poor support systems
e. some grew up in abusive home during childhood
11
Q
Intimate partner violence: profile of the “victimizer”
A
a. low self-esteem
b. jealous
c. possessive and see partner as possession
d. limited ability to cope with stress
e. may threaten to take the children away as tactic of emotional abuse
f. isolates partner from others and tries to keep partner totally dependent on them
12
Q
Cycle of battering (abuse cycle): intimate partner violence
A
Phase I: tension builds
Phase II: acute battering incident
Phase III: Calm, loving, respite (honeymoon phase)
13
Q
Intimate partner violence: “why does she stay???”
A
Fear own life or lives of children Fear of retaliation by partner Fear of losing custody of child Lack of financial resources Lack of support network Religious reasons Hoping the partner will change, life will get better
14
Q
Interventions in intimate partner violence
A
a. Help victim recognize choices and regain control over life
b. Medical/Surgical care and nursing interventions
c. Private area to discuss the battering incident
d. Final decision is made by individual (autonomy)
e. Discuss available resources (e.g. shelters, counseling services)
15
Q
Sexual assault
A
is any type of sexual act in which an individual is threatened or coerced, or forced to submit against his/her will
16
Q
Rape
A
is a type of sexual assault. Rape is an act of aggression, not one of passion.
the expression of power and dominance by means of sexual violence, most commonly by men over women, although men may also be rape victims.
17
Q
Type of rape
A
Acquaintance rape/date rape
Marital rape
Statutory rape
18
Q
Sexual assault/rape: profile of victimizer
A
Majority of rapists are between ages of 25 and 34
80% of cases rapists was known to victim
75% of rapists have prior criminal history
19
Q
Sexual assault/rape: profile of victim
A
Highest risk age group: 16 to 34 years
Most victims are single, and attacked near their own neighborhoods
The presence of a weapon is the principal measure of the degree to which a woman resists her attacker
20
Q
“stranger rape”
A
victims are chosen because they happened to be in that place at that time
21
Q
Sexual assault/rape” manifestations
A
Severe physical/psychological trauma STD’s Pregnancy Fear, helplessness, shock, guilt, embarrassment Depression Sexual dysfunction Insomnia Suicide
22
Q
Nursing assessment with sexual assault/rape
A
Physical exam should occur prior to shower, changing clothes, douching, brushing teeth or drinking anything to preserve evidence
Asking questions gently
Specially trained nurse or physician will assist with collecting rape kit
23
Q
Interventions in rape - trauma syndrome
A
Allowing victim to have control
“Victim” to “survivor” mindset
Sense of empowerment and regaining control over life as a survivor
Empathy
Minimize number of professionals providing immediate care or collecting evidence
24
Q
What are the rights of the patient
A
Informed consent
Confidentiality
Attorney, mail, visitors, basic necessities, safety
Least restrictive environment
Rights of voluntary versus involuntary admissions
25
Involuntary hospitalization
HCP respect client's wishes to not be treated unless danger to self or others (committed to long longer danger)
- - all other client rights remain intact
- - person can be detained in psychiatric facility for 48-72 hours on emergency basis
26
Release from hospital: voluntary hospitalization
Right to request discharge at any time
| Release unless danger to self or others; if such danger is present, then commitment proceedings instituted
27
Release from hospital: committed client may take medication
Rapid improvement
• May become dangerous again if medication ceased after release
• Mental health clinicians can be held liable for criminal actions of client
28
Mandated outpatient treatment
Continued participation in treatment on involuntary basis after release
• Taking prescribed medications
• Keeping appointments with health care providers for follow-up
• Attending specific treatment programs or groups
(also called conditional release or outpatient commitment)
clients are given several opportunities for voluntary compliance
29
Conservatorship/Guardianship
Legal guardianship; separate from civil commitment for reasons such as...
• Grave disability
• Incompetency
• Inability to provide self with food, clothing, shelter • Inability to act in own best interests
* Loss of right to enter into contracts
* Consent to be obtained from legal guardian who speaks for client
* Conservator sometimes refers to person who manages client’s financial affairs
30
What is a least restrictive environment
Free of restraint or seclusion unless necessart
31
Restraint
direct application of physical force to person without permission
- human
- mechanical
32
Seclusion
Involuntary confinement in specially constructed, locked room equipped with security window or camera for direct visual monitoring
33
When are restraints or seclusion permitted
only when client is imminently aggressive/dangerous
34
What is the policy for a client who has a short-term use of a restraint and seclusion?
* Face-to-face evaluation within 1 hour, every 8 hours (every 4 hours for children)
* Physician’s order every 4 hours (every 2 hours for children)
* Documented assessment by nurse every 1 to 2 hours
* Close supervision of client, one-to-one monitoring for the first hour
* Debriefing session within 24 hours after release from seclusion or restraint
35
What is in place that protect patient's confidentiality
* Health Insurance Portability and Accountability Act (HIPAA) of 1996
* Civil (fines) and criminal (prison sentences) penalties for violation of client privacy
36
When might it be acceptable for a patients confidentiality to be broken?
Duty to warn
37
Ethical considerations: ANA Code of Ethics for Nurses
ANA Code is accepted by the profession for nurses to use in making ethical decisions
38
What is the Nurse Practice Act?
used to determine if nursing actions are legal
39
what is Ethical Theory?
a system of moral principles that can be used to assess what is morally right versus what is morally wrong
40
What are main theories used in ethical dilemmas?
Utilitarianism
| deontology
41
Ethical theories in review: Utilitarianism
* greatest good
| * greatest ratio of benefit to harm for all persons involved
42
Ethical theories in review: Deontology
* Greek word “deon” means that which is binding; duty
| * Moral law, there are no exceptions and no mitigating circumstances
43
Ethical Theories in Review: Christian Ethical Theory
* the “Golden Rule” of “Do unto others as you would have them do unto you”
* treating others as moral equals
44
What are ethical principles?
* Fundamental guidelines that influence ethical decision-making
* Provide an analytical framework by which moral problems can be evaluated
* Autonomy
* Beneficence
* Non-maleficence • Justice
* Veracity
45
What are ethical issues in mental health nursing?
* Confidentiality & HIPPA (exceptions)
* Right to refuse treatment and/or medication
* Right to the least restrictive treatment
* Legal competency
* Involuntary vs voluntary
46
Anger
Emotional state varying in intensity between mild irritation to intense fury and rage
47
Physiological and biological changes when someone is angry:
• Increase HR, BP, hormones epinephrine and norepinephrine
48
Aggression:
Behavior intended to threaten or injure the victim’s security or self esteem
• To go against, to assault, or to attack
49
Phases of aggression
* Triggering
* Escalation
* Crisis
* Recovery
* Post-crisis
Do you need to know an explanation of each stage?
50
Risk factors to aggression / anger?
* Learned behavior
* Past history of violence • Schizophrenia
* Dementia/delirium
* Head injuries
* Substance abuse
51
Etiology of aggression
* Unsure of exact cause
* Low serotonin levels may have an impact
* Increased levels of norepinephrine and dopamine
52
Assessment: anger vs aggression
```
Anger:
• Frowning facial
• Clenched fists
• Yelling and shouting
• Easily offended
• Passive-aggressive
• Defensive responses
• Intense or avoidance in eye contact
• Intense discomfort
```
```
Aggression:
• Pacing, restlessness
• Tense facial expression
• Loud voice, shouting, argumentative
• Homicidal or suicidal threats
• Overreaction to environmental stimuli
• Angry mood
• Suspiciousness
```
53
Nursing interventions for angry and aggressive patients
• Intervene while in early stage of cycle of aggression
• Be aware of factors that increase likelihood of violent
behavior/agitation
• Use verbal communication
• PRN medications before behavior becomes crisis and restraint is necessary
• If pt tells you verbally/non-verbally they feel hostile, attempt to help them express their feelings in a non-destructive way (therapeutic communication/exercise)
• Scheduling 1:1 time with pts on unit
• During triggering phase approach pt in non- threatening, calm manner, convey empathy, encourage pt to express feelings appropriately using clear, short, simple “I” statements
54
Nursing interventions for aggressive patients if they are in escalation phase
* Nurse must take control
* Provide directions in calm, firm voice
* Pt should be directed to quiet area
* Nurse needs to express aggressive behavior is not acceptable
* Offer PRN medications
* If interventions do not work RN must ask for assistance
55
Nursing interventions for aggressive patients if they are in crisis phase
* Staff must take charge for safety
* Only trained staff should engage with pt • Restraint or seclusion may be necessary
* Need proper order
* Adequate staff to safely restrain
56
Nursing interventions for aggressive client if they are in recovery phase
* Encourage pt to talk about triggers
* Help pt relax
* Explore alternatives to aggressive behavior
57
Treatment for anger/aggression: lithium can be used for?
• Bipolar, conduct disorder, intellectual disability
58
Treatment: Carbamazepine (Tegretol), Valproate (Depakote) can be used for
Dementia, psychosis, personality disorders
59
Treatment: atypical antipsychotics can be used for?
Dementia, TBI, Personality disorders
60
Treatment: ativan and haldol can be used for?
Agitation, aggression, psychotic symptoms
61
Oppositional defiant behavior: prevalence
Usually begins by 8 and no later than adolescents
| Common comorbid disorders (ADHD, anxiety, major depressive disorder, conduct disorder)
62
Oppositional defiant disorder (ODD): predisposing factors
Related to family influences
| Power and control issues of parents
63
Oppositional defiant disorder (ODD): assessment
* Negativistic, hostile behavior, defiance
* Easily loses temper, annoyed, resentful
* “Mouthy”, rude, argumentative with authority figures
* Blame placing; spiteful and vindictive
* School avoidance, underachievement
* Temper tantrums
64
Oppositional defiant disorder (ODD): interventions
* Convey acceptance of individual separate from behaviors
* Structured plan of activities
* Behavioral modification (BMOD)
* Positive reinforcement for good behavior
* Peer pressure or peer groups
* Set realistic goals & limit manipulative behavior
* Decrease attention to the manipulative behavior
* Address passive-aggressive and retaliation behavior
65
Oppositional defiant disorder (ODD): Treatment
* Parent teaching
* Individual therapy
* Very little evidence that medications helps
66
Conduct disorder: prevalence
Childhood to adolescence
| More common in males than females
67
Conduct disorder: predisposing factors
Biological (Temperament)
Psychosocial
Family
68
Conduct behavior assessment:
Behaviors that violate the basic rights of others
Aggression to people or animals
Property destruction
Deceitfulness, theft, lying
Serious violations of rules
Truancy, poor school performance
Poor anger control; bullies, initiates fights
69
Conduct disorder: nursing interventions
* Safe environment
* Protect others from the patient’s physical aggression
* Sufficient staff
* Educate how to express anger appropriately
* Hold patient accountable for behavior
* Improve social interaction and self esteem with groups
* Identification of stressor and triggers to behavior
* Set realistic goals
70
Conduct disorder treatment
* Treatment may not always be effective
* Early intervention is most effective and should be adjusted for age of pt
* School age children
* Adolescents
* Medications
71
Intermittent explosive disorder: what?
• Repeated episodes of impulsive, aggressive, violent behavior; angry verbal outbursts
• May physically injure others and self
• May feel guilty after outbursts; this does not prevent future
outbursts
• Most common in adolescence and young adulthood
72
Intermittent explosive disorder etiology
* Comorbid psychiatric disorders
| * Neurotransmitter imbalance (serotonin) • Frontal lobe dysfunction
73
Intermittent Explosive Disorder: treatment
* Cognitive–behavioral therapy
* Anger management
* Relaxation techniques
* Avoidance of alcohol and other substances
* psychopharmacology
74
Intermittent Explosive Disorder: psychopharmacology
* Fluoxetine
* Lithium
* Anticonvulsant mood stabilizers
* SSRI antidepressants
75
Personality
lasting pattern of how we behave and how we relate to ourselves
76
DSM 5 Description of Essential Features: cluster of personality types (cluster a, b and c)
Cluster A: odd or eccentric behaviors
Cluster B: dramatic, emotional or erratic behaviors
Cluster C: anxious or fearful behaviors
77
Cluster A: Paranoid personality disorder -- key features
Pervasive, persistent and inappropriate mistrust of others
- - test the honesty of others
- - recurrent suspicions
78
Paranoid personality disorder nursing interventions
a. approach in formal manner
b. be on time and keep commitments
c. involve patient in creating care plan
d. helping patients validate ideas
79
Cluster A: Schizoid personality disorder -- key features
Inability to form close, personal relationships
- social isolation
- appears cold, aloof, flat/bland affect
- little to not pleasure in activities
80
Schizoid personality disorder nursing interventions
Focus on improving functioning in society
Allow for alone time
Need to have a working relationship with at least on trusted person
81
Cluster A: Schizotypical personality disorder -- key features
o “Latent schizophrenia”- doesn’t
deteriorate to that level
o Magical thinking, ideas of reference, social isolations
o Superstitiousness, telepathy, “sixth sense”
o Inappropriate, constricted, bland affect
o Psychotic symptoms- hallucinations, delusions, bizarre behavior
82
Schizotypical nursing interventions
* Focus on self-care and social skills to improve function in the community
* Establish daily routine for hygiene
* Create list of people in community that is necessary to have contact with
* Role play
* Using written requests or telephone for business
* Social skills training
83
Cluster B: anti-social personality disorder -- key features
Socially irresponsible, guiltless behavior
Exploit and manipulate others for personal gain
Hx conduct disorder
Inability to sustain employment, or conforming to the law
84
Anti-social nursing interventions
setting boundaries, limit setting, confrontation, teach problem solving skills and practice, managing emotions, decrease or eliminate drugs/alcohol
85
Cluster B: borderline personality disorder -- key features
Instability in interpersonal relationships
Distorted or lack of self-image and sense of ID
Hover between neurosis and psychosis
Manipulative when necessary
86
BPD nursing interventions
* Ensuring safety
* Psychotherapy long term
* Provide structure and set limits
* Setting boundaries
* Teaching communication skills
* Assisting with emotional control
* Cognitive restructuring
* Structure with schedule
87
Cluster B: Histrionic personality disorder -- key features
Excessive emotional and attention-seeking behavior
exaggerated expression of emotions
Overreaction to minor events, constantly seeking approval
Egocentric, vain, demanding
88
Histrionic nursing interventions
* Nurse gives feedback
* Teaching social skills and practice
* Explore patients strengths
89
Cluster B: narcissistic personality disorder
Grandiose sense of self-importance
Preoccupation with fantasies of success, power, brilliance
Constant need for admiration and attention
Lack empathy
90
Narcissistic nursing interventions
```
Nurse must be self-aware
Nurse must not internalize criticism
Gain the cooperation of the patient
Use matter of fact manner of communication
Set limits on rude or abusive behavior
```
91
Cluster C: avoidance personality disorder -- key features
Extremely sensitive to rejection
Socially withdrawn
Unwilling to start relationships
Low self esteem
92
Avoidance personality disorder treatment / nursing interventions
* Psychotherapy
* Nurse to support and reassure
* Practicing self-affirmations or positive self-talk
* Reframing and decatastrophizing
* Teach social skills and practice
93
Cluster C: Dependent personality disorder
Passively allow others to assume responsibility of life
lack self-confidence, unable to make own decisions
views themselves as helpless, stupid
fear of being alone and abandoned
94
Dependent personality disorder: treatment / nursing interventions
* May have treatment for anxiety/depression
* Nurse must help with expression of feelings
* Nurse must foster autonomy
* Help identify patients strengths
* Reframing/decatastrophizing
* Determining areas of true need
* Teach problem solving and practice
95
Cluster C: obsessive compulsive personality disorder
o Pervasive pattern of
perfectionism and inflexibility
o Difficulty expressing sensitive feelings
o Insist things be done a specific way
o Preoccupation with details, policies, following rules
o Rigidity and stubbornness
96
obsessive compulsive personality disorder: treatment / intervention
* Individual therapy is very effective
* Setting goals instead of striving for perfection
* Nurse can help patients accept less than perfect work
* Decatastrophizing
* Encouraging patients to take risks
97
Treatment of personality disorders: aggression
lithium, anticonvulsant mood stabilizers, benzos, low dose antipsychotics
98
Treatment of personality disorders: mood swings
lithium, carbamazepine, valproate, low dose Haldol
99
Treatment of Personality Disorders: emotional detachment
SSRIs and 2nd Gen antipsychotics
100
Treatment of Personality Disorders: Atypical depression
SSRIs, MAOIs, low dose antipsychotics
101
Grief
Subjective emotions and affect; normal response to loss
102
Grieving/Bereavement
process by which person experiences grief
- content
- process
103
Anticipatory grieving
persons facing in imminent loss begin to deal with possibility of loss or death in near future
104
Mourning
outward expression of grief, including rituals
105
What are different types of loss?
```
Physiological loss
safety loss
loss of security and sense of belonging
loss of self-esteem
loss related to self-actualization
```
106
Kubler-Ross's five stages of grieving
```
Denial
anger
bargaining
depression
acceptance
```
107
What are the dimensions of grieving?
Cognitive responses
-- questioning, trying to make sense of loss
-- attempting to keep lost one present
Emotional responses (anger, sadness, anxiety)
Spiritual responses
Behavioral responses
Physiological responses
108
Disenfranchised grief
```
Grief over loss that is not or cannot be openly acknowledged, mourned publicly, or supported socially:
• A relationship that has no legitimacy
• The loss itself is not recognized.
• The griever is not recognized.
• The loss involves social stigma.
```
109
Why is the disenfranchised grieving process more complex?
Due to the absence of usually support for grieving, healing
110
What relationships receive the most attention in the case of death in US culture?
kin-based relationships
111
What is complicated grieving
Person voids emotion, grieves for prolonged periods of time, or the expression of grief seem disproportionate to the evenT
112
What complicates complicated grief even more
preexisting psychiatric disorders
113
What characteristics put someone at increased risk for complicated grieving?
Low self esteem, low trust in others, previous psychiatric disorder, previous suicide threats or attempts, absent or unhelpful family members, ambivalent, dependent, insecure attachment to deceased person
114
Complicated grief: risk factors leading to vulnerability
* Death of spouse or a child
* Death of parent (particularly in early childhood or adolescence)
* Sudden, unexpected, untimely death
* Multiple deaths
* Death by suicide or murder
115
Complicated grief: unique, varied experience (physical, emotional, reactions)
Maladaptive thoughts
Dysfunctional behaviors
Inadequate emotional regulation
116
The nursing assessment: grief
All dimensions of human response
Three critical components
1. adequate perception regarding the loss
2. adequate support while grieving for the loss
3. adequate coping behaviors during process
117
The nursing process: data analysis and planning (possible nursing diagnoses)
Grieving
Complicated grieving
Risk for complicated grieving
Anticipatory grieving
118
The nursing process - outcomes (grief and loss)
The client will...
a. ID effects of their loss
b. seek adequate support
c. develop plan for coping with the loss
d. recognize negative effects of the loss on their life
e. seek or accept professional assistance if needed
