Nursing 526 Exam 3 Study Guide Module 9 - Chapter 11, Study Guides, Projects, Research of Nursing

Download Nursing 526 Exam 3 Study Guide Module 9 - Chapter 11 and more Study Guides, Projects, Research Nursing in PDF only on Docsity! Nursing 526 Exam 3 Study Guide Module 9 - Chapter 11 Crisis Intervention/phases (9 questions) • Levels of prevention: o Primary – actually preventing the thing o Secondary – early identification and treatment o Tertiary – avoidance of complications • Norms are considered the "right" patterns of behavior for a society. • Crisis: o A crisis is generally regarded as time limited, lasting no more than 4 to 6 weeks o Internal or external demands that are perceived as threats to a person’s physical or emotional functioning can initiate a crisis. The precipitating event is not only stressful, but unusual or rare. o Maturational – Describes unfavorable person-environment relationships that relate to maturational events, such as leaving home for the first time, completing school, or accepting the responsibility of adulthood. o Situational - Occurs whenever a specific stressful event threatens a person’s biopsychosocial integrity and results in some degree of psychological disequilibrium. o Adventitious - Initiated by an unexpected unusual events that can affect an individual or a multitude of people. National and natural disasters. ▪ During an adventitious crisis (e.g., flood, hurricane, forest fire) that affects the well-being of many people, the interventions of the PMH-APRN will be a part of the community’s efforts to respond to the event. o The goal for people experiencing a crisis is to return to the pre-crisis level of functioning. o The role of the PMH-APRN is to provide a framework of support systems that guide the client through the crisis and facilitate the development and use of positive coping skills. ▪ Assess risk of homicide/suicide/self-injury ▪ Assess coping skills ▪ Assess perception of problem and support mechanisms ▪ Assess biologic items – sleep, eating, hygiene, etc ▪ Assess psychological – emotions and coping ▪ Asses social – individual, family, community. Social support o Disaster: ▪ A disaster is a sudden ecological or man-made phenomenon that is of sufficient magnitude to require external help to address the psychosocial needs as well as the physical needs of the victims. ▪ Mass Casualty Incident Triage categories: • Expectant: Injuries are extensive and chances of survival are unlikely even with definitive care. Separate and provide comfort o Unresponsive patients with penetrating head disaster and when cognitive disorientation occurs, reality testing and clear information should be provided. • After the initial interventions, the PMH-APRN should support the development of resilience, coping, and recovery while providing technical assistance, training, and consultation. • Goals of care include helping the victims prioritize and match available resources with their needs, and preventing further complications, monitoring the environment, disseminating information, and implementing disease control strategies • Debriefing may be helpful but is no longer considered essential • When the PMH-APRN explains anticipated reactions and behaviors, this helps the victims gain control and improve coping. ▪ Social assessment: The PMH-APRN should maintain a calm demeanor, obtain and distribute information about the disaster and the victims, and reunite victims and their families. In addition, there is a need to monitor the news media’s impact on the mental health of the victims of the crisis • Assess for economic distress, access to shelter, food, etc. Acute Stress/PTSD support (2 questions) • Providing a safe environment is the priority for any client who is a victim of a serious crime/assault. • ASD: 2 days to 1 month o Meet immediate needs o Build therapeutic alliance o If distressed, limit to immediate care o Complete psych assessment ▪ Focus on reexperiencing, avoidance or numbing, hyperarousal, dissacociation o Goals of treatment: Reduce the severity of symptoms, Prevent or treat trauma-related comorbid conditions, Improve adaptive functioning by promoting resilience, Prevent relapse, Integrate the trauma into the patient’s life experience, Prevent the development of PTSD o Psychological First Aid ▪ The key features of PFA are empathy, compassion, stabilizing the patient by reducing distress, and connecting the individual with resources o The frontline treatment for patients with ASD is multiple session, trauma-focused cognitive behavioral therapy o Do something, instead of nothing (Pleasure promoting activites) • PTSD: longer than a month o Factors that appear to increase the risk for developing PTSD among individuals with ASD include female gender, prior exposure to traumatic events, low levels of social support, stressful life events in year prior to trauma, a personal or family history of psychopathology, and experiencing new stressors after the original trauma o factors, interventions to prevent the development of PTSD focus on preventing or treating new stressors, reducing distress, modulating arousal, managing pain, and treating depression. ▪ Propranolol, opioid, psychotherapy o The primary feature of PTSD is disturbance of memory, in which memories of the traumatic event are not processed and integrated with other information, so they are reexperienced. o The overall goal of treatment for PTSD is to enable patients to regain control of their emotional responses and to place the trauma in the larger perspective of their lives as an event that happened at a certain time and that is unlikely to recur. o One of the first steps in treatment is to help the patient to develop a sense of trust, safety, and separation from the traumatic event o Psychotherapy: Exposure, CBT, EMDR, Trauma management therapy, structured writing, VRE/tech based, interpersonal therapy, psychodynamic o SSRIs Module 10 - Perese (pp. 207-208) & Chapter 18; Kaplan, Sadock and Ruiz– Chapter 22 & 28.5 BPD who has been in counseling for management of self-harm behaviors who now wants to cut themselves is to assist the client to identify an appropriate coping strategy. • Anger is intense and pervasive and help with anger management is an important intervention. • Relationship building, safety, and limit setting are other foci. • Clients with BPD have not successfully achieved the developmental stage of separation- individuation during which a child normally develops a sense of self, a permanent sense of significant others (object constancy), and integration of seeing both bad and good components of self • Often, these clients falsely attribute to others their own unacceptable feelings, impulses, or thoughts, termed projective identification. • Respecting a client’s boundaries is important in establishing a therapeutic relationship with a patient with BPD. • Risk factors: sexual abuse, parental separation, biological component (A decrease in serotonin activity and an increase in α2-noradrenergic receptor sites may be related to the irritability and impulsiveness; an increase in dopamine may be responsible for transient psychotic states) • DBT/Mindfulness (1 question) • DBT is a psychosocial treatment developed by Marsha M. Linehan specifically to treat individuals with borderline personality disorder. • DBT includes: o Individual component in which the therapist and client discuss issues that come up during the week, recorded on diary cards and follow a treatment target hierarchy. During the individual therapy, the therapist and client work towards improving skill use. Often, skills group is discussed and obstacles to acting skillfully are addressed. DBT targets behaviors in a descending hierarchy: ▪ Decreasing high-risk suicidal behaviors ▪ Decreasing responses or behaviors (by either therapist or client) that interfere with therapy ▪ Decreasing behaviors that interfere with/reduce quality of life ▪ Decreasing and dealing with post-traumatic stress responses ▪ Enhancing respect for self ▪ Acquisition of the behavioral skills taught in group ▪ Additional goals set by client o Group therapy, which ordinarily meets once weekly for about 2 – 2.5 hours, in which clients learn to use specific skills that are broken down into 4 modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills, and distress tolerance skills. • Understand that DBT helps to replace irrational thoughts. • Mindfulness: The capacity to pay attention, non-judgmentally to the present moment. All about living in the moment, experiencing your emotions and all your senses and being aware of them. • Interpersonal effectiveness: Focuses on situations where the objective is to change something (e.g., requesting that someone do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect. • Emotional regulation: Identifying and labeling emotions; Identifying obstacles to changing emotions; Reducing vulnerability to emotion mind; Increasing positive emotional events; Increasing mindfulness to current emotions; Taking opposite action; Applying distress tolerance techniques • Distress tolerance: The ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality. Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Narcissistic PD (1 question) • Traits of a client with Narcissistic Personality Disorder. o Grandiosity, fantasies of power or brilliance, need to be admired, sense of entitlement, arrogant, patronizing, rude, overestimates self and underestimates others. o Behavior covers a fragile ego. child: o • Most psychiatric disorders in children are multifactorial. • Understand that children from different cultures develop at different rates. • Most children will adopt the same world view as their parents (ex. If a child was brought up by parents who thought the world was hostile, they would most likely adopt this view as they grow older. • The psych NP needs to foster a child’s healthy characteristics and existing environmental supports no matter how negative (ex a child lives in a homeless shelter). • Therapeutic drawing is a helpful technique if a child feels self-blame regarding their parent’s divorce. • Establishing a therapeutic alliance is important because acceptance and trust convey a feeling of security in an adolescent. • Objective observations help the most in evaluating outcomes of child therapy. Play Therapy (1 question) • Play therapy is important because it allows the child to play out their fears and frustrations. • Play therapy is child-centered and typically builds on the foundation of the psychodynamic, object-relations, and attachment theories. • Used for children 3 years or older • Nondirective play is normally viewed as the best way to begin play therapy. • Structured play is rarely used until nondirective play has enabled a full assessment of relevant themes and issues, and the child’s trust around anxiety-laden issues has been developed. • Useful for catharsis, abreaction (assimilate previous experiences that have been traumatic or painful), role-play • Interventions include reflection (commenting) and interpretation (after rapport developed) Cognitive Therapy (1 question) • Understand schemas o Individuals with BPD develop dysfunctional beliefs and maladaptive schemas leading them to misinterpret environmental stimuli continuously, which in turn leads to rigid and inflexible behavior patterns in response to new situations and people • Cognitive therapy is the modality that prioritizes a client’s schema. • 7 and older Bibliotherapy (2 questions) • Bibliotherapy uses books and a librarian as resources. • When children listen to or read a story, they unconsciously identify with the characters and experience a catharsis of feelings. Family Therapy (Systems) (1 question) • Family therapy can promote the greatest change in an adolescent’s behavior. • Know different family styles such as "closed Family". • The Developmental Theoretical approach describes a family's progression through the lifecycle. Flooding (1 question) • Know an example of flooding in a child. Adolescent education on substances (1 question) • When conducting a counseling session for a group of at-risk adolescents on drug use, it is important to have their peers involved in teaching some of the problem-solving skills. Child Protective Services (1 question) • Reporting requirements for Child Protective Services and the Health Professional Oppositional Defiant Disorder (1 question) • Event interpretation should be included for problem solving therapy for a child with conduct disorder. • The primary treatment of oppositional defiant disorder is family intervention using both direct training of the parents in child management skills and careful assessment of family interactions. Nursing Theorists (1 question) • Freud – Psychodynamic