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Mental
Exam 3
| Question | Answer |
|---|---|
| Normal Aging | -Normally, there is some physical decline, but important functions do not change -Intellect, capacity for change and productive engagement with life remain stable |
| Demographics of Aging | -Young Old - 65 - 74 years -Middle Old - 75 - 84 -Old old - 85 - 94 -Elite Old - 95 or older |
| Elderly: Complicated Mental Health Problems | -Co-morbid medical problems and treatment -Symptoms of somatic disorders mimic or mask psychiatric disorders -Elderly are more likely to report somatic symptoms rather than psychological ones |
| Barriers to seeking mental health treatment | -Patient: stigma of mental health - people don't approve -Provider: elderly don't go to geriatric physician; they go to pcp that doesn't know enough about geriatrics -System-economic barriers: not enough money, medicaid, medicare |
| Depression | -Prevalence varies among reported studies -People can mix up depression and dementia in elderly -Depression and anxiety are the biggest issues in the elderly |
| Predictors of Suicide in Elderly | -Over 65 -Male -Caucasian -Chronic/ uncontrolled pain -Bereavement -Unmarried (widowed/divorced) -Social Isolation -Retirement -Financial difficulty -Hoplessness/helplessness -Alcohol/drug abuse -Major depressive disorder -Hx of previous att |
| Anxiety: Psychological Manifestations | -Apprehension -Fearful -Feelings of dread -Irritable -Intolerant -Panicky/preoccupied -Tense/worried -Phobic -Paranoia |
| Anxiety: Physical Manifestations | -GI/GU:ab pain, anorexia, butterflies, D,V, urinary freq -CV: chest discomfort, diaphoresis, dyspnea, flushing, HTN, pallor -MS: backache, fatigue, musc tension -Neuro: tremolos, dizziness, paresthesia |
| Alcohol and Substance Abuse: Potential Alcohol-related problems | -Fluctuations in ADL and IDL -Self-neglect -Trauma -Wt loss -Dehydration -GI complaints -Incontinence -Confusion -Depression -Legal trouble |
| CAGE - AID Screening | -C - cut down -A - annoyed -G - Guilty -E - Eye-opener |
| Pain Management | -Acetaminophen-effective analgesic -Anticholinergics&pentazocine-I confusion -Opiates-greater analgesic effect -Demerol-can't metabolize well;Morphine is better -Paranoid thinking/Anxiety-confused w/ dementia&depression -Few cases of schizophrenia |
| Interventions | -Remotivation Therapy - resocialize, reawaken interest in the environment -Reminiscence Therapy - share memories, increase self esteem, uniqueness -Psychotherapy - alleviate psychiatric symptoms and participate in group |
| Delirium | -Disturbance in consciousness and a change in cognition -Develops over a short period of time -Usually reversible if underlying cause identified -Serious, should be treated as a medical emergency |
| Delirium: Diagnostic Criteria | -Impairment in consciousness*** -Elderly - most common in this group, often mistaken as dementia |
| Delirium: Etiology | -Complex and usually multidimensional -Most commonly identified causes: variety of brain alterations, infections, meds, fluid/electrolyte imbalance -Reduction in cerebral functioning -Damage of enzyme systems, bbb or cell membranes |
| Delirium: Etiology | -Reduced brain metabolism: instead of using gray matter use white -Imbalance of neurotransmitters -Raided plasma cortisol level -Involvement of white matter |
| Delirium: Priorities | -Pay attention to life threatening disorders -Rule out life threatening illness -Stop all suspected meds -Monitor vs |
| Delirium: Biological assessment | -Pay special attention to CBC, BUN, creatinine, electroylytes, liver function and O2 saturation |
| Delirium: Pharmacological | -Substance abuse Hx -Assessment of drug combinations -Polypharmacy (greater than 5) -OTC/Herbals - grapefruit |
| Delirium: Psychological Assessment | -Cognitive Changes with rapid onset: fluctuations in LOC, reduced awareness of environment; difficulty focusing, sustaining, or shifting attention; severely impaired memory -May be disoriented to time and place but RARELY person |
| Delirium: Psychological Assessment | -Environmental perceptions altered -Illogical thought content -Behavior change: Hyperkinectic - psychomotor, hyperactivity, excitability, hallucinations; Hypokinetic - lethargic, somnolent, apathetic |
| Dementia: Alzheimer's type | -Degenerative, progressive neuropsychiatric disorder that results in cognitive impairment, emotional, and behavioral changes physical and functional decline and ultimately death -Types:early onset-65 yrs&younger, rapid progression;late onset-over 65 yrs |
| Stages of AD | -Stage 1 (mild) forgetfulness -Stage 2 (moderate) confusion -Stage 3 (moderate to severe) ambulatory dementia -Stage 4 (late) end stage |
| AD: Diagnostic Criteria | -Essential feature-multiple cog deficit -1or more:Aphasia(trouble forming words),Apraxia(cant perform purposeful movements),Agnosia(cant recognize familiar objects),Disturbance of exec func, |
| Later stages of Dementia | -Agraphia (can't rd/write) -Hyperorality(put everything in mouth) -Hypermetamorphosis(touch evrything) |
| AD: Etiology | -Neuritic Plaques (extracellular lesions) -Neurofibrillary tangles -CHolinergic hypothesis - ACh is reduced -Genetic factors - roles of chromosome 1, 14, 21 -Oxidative stress and free radicals -Inflammation |
| Dementia: Priority Care Issues | -Priorities will change throughout the course of the disorder -Initially, delay cognitive decline -Later, protect patient from hurting self -Later, physical needs become the focus of care (nutrition, hydration) |
| Family response to Dementia | -Family can be devastated -Caregiver's health and well-being are often compromised -Caregiver distress is a major risk factor -Caregiver burden often leads to nursing home placement -Caregiver support can delay nursing home placement |
| Dementia: Pharmacological Interventions | -Cognitive Enhancers - Acetylcholinesterase Inhibitors: work by increasing CNS ach concentrations by inhibiting AcheEl -Donepezil,Tacrine,Rivastigmine,Galantamine -Used to delay cognitive decline -Most common side effects: N,V -Not a cure but can help |
| Later stage medication | -Memantine |
| Dementia: Pharmacological Interventions | -Antipsychotics: Be careful -Antidepressants and mood stabilizers -Antianxiety medications: use with caution -Avoid medications with anticholinergic side effects |
| Dementia: Psychological Assessment | -Responses to mental health problems: personality changes -Cognitive status: MMSE and others (memory, visuospatioal, language, executive functioning -Psychotic symptoms: suspiciousness, delusions, illusions, hallucinations |
| Dementia: Domain Assessment | -Mood Changes: depression, anxiety, catastrophic reactions -Behavioral responses: apathy, withdrawal, restelessness, agitation, aggression, aberrant motor behavior, disinhibition, hypersexuality -Stress and coping skills |
| Dementia: Interventions for Mood | -Management of depression (don't force activities, but encourage them) -Management of anxiety by helping patient deal with stress -Remaining calm during catastrophic reactions, minimizing environmental distractions, speaking slowly, being reassuring |
| Dementia: Interventions for Behavior | -Keep close contact with family, help engage patient -Do not interrupt wandering behavior but identify pattern. Determine is they are confused and can't find way, walk with patient and then redirect |
| Sex | -Person's inherited biological sexual characteristics |
| Gender Identity | -Sense of maleness or femaleness |
| Sexuality | -Complex and subjective concept that changes over time |
| Sexual and gender Identity | -Sexual Identity-identification of oneself as being male/female -Ego-syntonic-indiv emotionally comfortable w/his or her sexuality -Ego-dystonic- indiv. emotionally distressed by same sex attraction |
| Sexual and Gender Identity | -Transsexualism-a person wishes to change his or her anatomical sexual characteristics to those of the opposite sex -Hermaphroditism (intersexuality) - person born with both ovarian and testicular reproductive tissue |
| Sexual Disorders | -3 Categories: sexual dysfunction, paraphilias, gender identity disorder |
| Sexual Response Cycle | -Desire -Excitement -Orgasm -Resolution |
| Sexual Dysfunction | -a disturbance in the sexual response cycle or pain on sexual intercourse -Nonmedical/ non physiological, it's all mental |
| Types of Sexual Dysfunction | -Sexual Desire:hypoactive sexual desire disorder(r/t body image,no desire to have sex,Sexual aversion (thinking about sex makes you "sick") -Sexual Arousal Disorders:female sexual arousal disorder,male erectile disorder(erectile dysfun,impotence) |
| Types of Sexual Dysfunction | -Orgasm Disorder:Female orgasmic disorder(inhibited female orgasm or anorgasmia);Male orgasmic disorder (inhibited orgasm, retarded ejaculation); Premature Ejaculation |
| Types of Sexual Dysfunction | -Sexual Pain Disorders (not due to med condition):Dyspareunia (pain in labia or vagina during intercourse), Vaginismus (contraction/spasm of vaginal during intercourse) -Sexual dysfunction due to a general medical condition |
| Types of Sexual Dysfunction | -Substance-Induced Sexual Dysfunction: alcohol and drugs, prescribed meds (antidepressants, antipsychotics) -Sexual Dysfunction NOS |
| Medication-Induced Sexual Dysfunction | -Antidepressants and antipsychotics commonly affect 3 phases of normal sexual response cycle: sexual interest (libido), Physiological arousal (including lubrication in women and erection in men), orgasm (and ejaculation in men) |
| Medication-Induced Sexual Dysfunction | -CV drugs: low libido, impotence, anorgasmia -GI:low libido, impotence -Hormones:low libido, impotence -Sedative (alcohol): impotence/loss of inhibition -Antimanic: low libido/impotence -Anticonvulsant:low libido, impotence, priapism |
| Paraphilias | -Recurrent,intense sexually arousing fantasies,sexual urges,or behaviors that involve:preference for use of nonhuman object;sexual activity w/ suffering or humiliation of self or others;repetitive sexual activity w/children or other nonconsenting adults |
| Paraphilias: Types | -Exhibitionism: intentional display of the genitals in public place -Fetishism: use of nonliving objects -Frotteurism: touching or rubbing against a nonconsenting person |
| Paraphilias: Types | -Pedophilia:sexual activity with a prepubescent child (13 and younger), perp must be at least 16 and 5 y older than victim -Sexual Masochism (self): sexual satisfaction by being humiliated, beaten, bound or made to suffer |
| Paraphilias: Types | -Sexual Sadism (others): sexual satisfaction form the physical or psychological suffering or humiliation of victim -Neither masochism nor sadism is wrong if it's b/w 2 consenting adults |
| Paraphilias: Types | -Transvestic fetishism: sexual satisfaction is achieved by dressing in the clothing of the opposite sex - cross dressing -Voyeurism: viewing of other people in sexual situations |
| Gender Identity Disorder | -Strong and persistent cross gender identification -Persistent discomfort about one's own assigned sex -Gender dysphoria: feelings of unease about their maleness or femaleness -Transsexualism: wishes to change anatomical sexual characteristics |
| Categories of Gender Identity Disorder | -Gender Identity Disorder: in children or in adolescents or adults -Gender Identity Disorder NOS -Sexual Disorder NOS |
| Gender Identity Disorder: Interventions | -Psychotherapy -Hormone treatment -Sex reassignment surgery |
| Sexual Disorder: Interventions | -Meds (not used independently but with other interventions): to decrease libido which can lead to reduced exhibitionism, voyeurism,pedophilia -Progestin derivatives (MPA), SSRI (CPA), TCA, -Viagra,Cialis,Levitra |
| Advanced Practice Interventions | -Group,couple,family -Sensate focus:pt progress from general touching&cuddling to more intimate forms of expression -Systemic desensitization: relaxation w/sexually anxiety-producing stimuli -Masturbation training:help pt learn abt body&orgasm |
| Family | -Open&developing system of interacting personalities w/a structure and process enacted in relationships among the members,regulated by resources and stressors,existing w/in the larger community -A separate entity w/its own structure,function,needs |
| Definition of a Family | -Made up of people -In a social system -Held together by affection and loyalty |
| Central Concepts of Family | -Boundaries: diffuse or enmeshed, rigid or disengaged -Triangulation -Scapegoating -Differentiation |
| Functional Families Continuum | -No such thing as a normal/functional family - on a teeter totter -The degree to which a family is able to function falls on a continuum |
| Functions of a Healthy Family | -Management:adults agree how these functions are to be performed -Boundary:clear, help define roles&allow for differences -Communication:clear/direct messages abt wants/needs |
| Functions of a Healthy Family | -Emotional-supportive:feeling of affection dominate family pattern, members emotional needs are met -Socialization: members flexible in adapting to new roles within the family |
| Dysfunctional Family Patterns | -Management:inappropriate member makes decisions -Boundary:diffuse/enmeshed,thoughts merged together,rigid/disengaged -Comm:manipulate,distract, general,blaming,placating -Emotional-Support:conflict/anger -Socialization:role change difficult, I stress |
| Family Development | -Progressive, structural differentiation and transformation over a family's hx of transitions -Developmental tasks are responsibilities that are connected to emotional growth |
| Relevance to Nursing | -Health (especially mental health) problems represent a family crisis -Functional families respond better to crisis -Mental illness may be a symptom of family dysfunction |
| Assessment Tools | -Genogram: efficient format summarizing demographic data and functional information about a family -Focused interview -Family assessment |
| Ecomap | -tool used to diagram relationship qualities of a family system; addresses boundaries and interactions |
| Intervention Communication Guidelines | -Good listening skills -View fam members in pos, nonjudgmental way -Use nonblaming manner to keep communication open and flexible -Impart info in a clear and understandable manner -Listen to each family member's perspective of a situation |
| Family Therapy | -The goal of family therapy is to provide the opportunity for change based on perceptions of available options -The basic differences among models is how to achieve this goal |
| Contraindications: Family Therapy | -If there is physical harm being done (family secret by being brought out will do more harm than good) -If members of family aren't honest -Family members can't keep confidentiality |
| Structural Dynamics-Minuchin | -Internal structure: family composition (nuclear, skip generation-kids don't know about grandparents, multi generation-all generations included) -subsystems, boundaries, hierarchy |
| Subsystems | -Gender -Parents-make decisions together -Children -Common interests -Functions -Can belong to many different subgroups -Defined by boundaries |
| Healthy Boundaries | -Clear = balance -Know where self starts and stops -Maintains separateness -Emphasizes belonging to family system |
| Rigid Boundaries | -Rigid rules, shoulds, little tolerance and understanding -Unable to see another's perspective -Can't connect -Isolated -Disengaged |
| Diffuse Boundaries | -Parent intrusive, overprotective-can't exist without supervision/approval, can't set limits -Easily distracted -Can't separate (try to live through kids) -Enmeshed |
| Hierarchy | -Amount of power and status in each generation -In a functional system the power is clear and consistent (should be both parents) -In a dysfunctional system the power is diluted and unclear |
| Family Dynamics | -Presumes that the family system is fluid and every changing -A change in part of the system results in a change in other parts of the system -Much like the concept of a mobile |
| Case Management | -Based on family systems theory; family is the primary focus when planning management for an individual client -Family is the most powerful group to which an individual belongs |
| Psychopharmacological Issues | -Nurses role to explain to the family: purpose of a prescribed med, desired effects, possible side effects, adverse reactions -The more info they have the less anxiety there will be |
| Potential Causative Factors of childhood behavioral disorders | -Genetic influences-hereditary, 5% inborn errors of metabolism (tay sachs), chormosomal disorders (downs) -Biochemical-early alterations in embryonic development, maternal illness/infections, complication of pregnancy |
| Potential Causative Factors | -Temperament-observable differences in the strength and duration of a child's tendency to respond to circumstances/degree of emotionalism -Social and Environmental-parental physical/emotional neglect -Cultural and Ethnic factors -Resiliency |
| Resiliency | -Relationship b/w a child's constitutional endowment and environmental factors -Temperament that adapt to change -Ability to form nurturing relations -Distance self from chaos -Social intelligence -Problem solving skills |
| Pervasive Developmental Disorders:Autism | -impairment in social interaction, impairment in communication, restricted repetitive sterotyped patterns of behavior, delay abnormal social interaction, language and imaginative play |
| Pervasive Developmental Disorders: Asperger's Disorder | -Self-injurious/aggressive behavior -Impairment in social interaction -Restricted repetitive pattern -No sign delays in language,development, self help skills, curiosity |
| Pervasive Developmental Disorders: Retts | -Normal until about 5 month -Lack of purposeful hand movement -Severe social disengagement |
| Pervasive Developmental Disorders: Child Disintegrative | -Poorest prognosis -From few months -Personality disinegratives before its even formed -Die at very young age |
| Treatment Options | -Early intervention -Highly structured, specialized programs -Dietary-no conclusive results -Have parents keep detailed notebooks -The earlier diagnosed, the better the outcome |
| Marked Behavior Disorders: Oppositional Defiant Disorder | -Negativistic hostile and defiant -No violent of other's rights -Pull the cat's tail |
| Marked Behavior Disorders: Conduct Disorder | -Basic rights and societal norms are violated -Psychogenic not biological -Pour gasoline on the cat and set on fire |
| Outcomes/Interventions | -Family therapy - have a plan(decide what can be ignored), when reacting to behaviors - no emotions, last resort-atypical antipsychotic -Play therapy -Art therapy -Behavior therapy -Family counseling -Therapeutic games |
| Symptoms of anxiety in children (physical) | -Sweaty palms -Trembling -Muscle aches and tension -Upset stomach -Headaches -Difficulty sleeping -Change in eating habits |
| Symptoms in anxiety in children (mental) | -persistent worry -irrational fears -irritability -lack of social activity -fits of crying |
| Attention-Deficit Hyperactivity Disorder | -Inattention -Hyperactivity -Impulsivity (interrupting people, acts without thinking) |
| ADHD Symptoms | -are in constant motion -squirm and fidget -don't seem to listen -are easily distracted -don't finish tasks |
| Pharmacological management | -Stimulant drugs:adderall, ritalin -physical tolerance can occur -insomnia,anorexia, wt loss, tachycardia, temporary decrease in rate of growth and development |
| Nursing Considerations | -Assess mental status -to reduce anorexia, administer after meals -prevent insomnia, administer 6h before bedtime -drug holiday-titrate med during summer when not in school -avoid OTC -gradual withdrawal |
| Non-Stimulant Therapy | -Atomoxetine -Antidepressants: nortriptyline, bupropion, fluoxetine -Alpha-adrenergic agonists: clonidine -Antihypertensives |
| Other Disorders | -Tic Disorders: tourette's syndrome, involuntary movements and utterances especially in head and neck -Eating disorders |
| Elimination and Intake Disorders | -Pica: eating substances that shouldn't be eaten (clay,dirt,chalk) -Rumination: chewing excessively -Enuresis: after 5, inappropriate wetting -Encopresis: defecating inappropriately after the age of 4 |
| Mood disorders-depression | -Presentation in kids: irritability, boredom, poor motivation; HA, stomaches; poor concentration; not listless, will play with peers -Teens: hypersomnia, delusions, substance abuse, promiscuity, running away |
| Factors Associated with Adolescent Suicide | -Depression or mania -Antisocial or aggressive behavior -Hx of suicidal behavior in family -Availability of firearms -Incarcerated youths -Shameful event |
| Schizophrenia | -Very rare in kids -Beginning symptoms in adolescence: acute hypochondria,strange fears, school phobia, insomnia, concrete paranoid thinking -Intelligence and Orientation are okay |
| Substance Abuse | -Parents who use -Kids who use -Kids who deal -Kids who don't use but peers do |
| DSM-IV Criteria Anorexia | -Refusal to maintain body wt at or above a minimally normal wt for age and ht (15% wt loss) -Intense fear of gaining wt or becoming fat even though underwt -Body image disturbance, denial of the seriousness of current low wt -Amenorrhea |
| DSM-IV Criteria Bulimia Nervosa | -Recurrent episodes of binge eating (large amounts of food in a discrete period of time, sense of lack of control over eating) |
| DSM-IV Criteria Bulimia Nervosa | -Recurrent inappropriate compensatory behaviors in order to prevent wt gain -Occur on avg at least 2x a wk for 3 mo -Self evaluation in unduly influenced by body shape and wt -Does not occur during episodes of anorexia nervosa |
| Purging Type: Bulimia | -During the current episode the person engages in vomiting or the misuse of laxatives, diuretics, or enemas |
| Non-Purging Type: Bulimia | -During the current episode the person uses other inappropriate compensatory behaviors such as fasting and excessive exercise |
| Anorexia | -Diet out of control -Wt loss -Avoid food to cope -Deny -Rigid and controlled -Avoid sexual issues |
| Bulimia | -Eating out of control -Wt maintenance -Use food to cope -Aware of abnormality -Impulsive, extrovert -Struggle with sexual issues |
| Binge Eating Disorder | -Recurrent episodes of binge eating at least twice per week for 3 months -No use of extreme measures to lose weight -Awareness that eating pattern is abnormal -Fear of not being able to stop eating |
| Binge Eating Disorder | -Depressed mood&self-deprecating thoughts following binges -No evidence of body image disturbance other than body size dissatisfaction -Episodes not related to AN,BN or physical disorder -Consumption of high calorie, easily ingested food during binge |
| Binge Eating Disorder | -Secretive eating during binge -Repeated efforts to diet in an effort to lose weight -Negative affect, which often starts the binge eating -Frequent wt flucuations of greater than 10 lbs caused by alternating binges and dieting |
| Current Hypothesis | -Social and cultural issues involving women in our society -Dysfunctional family relationships with family members -Traumatic experiences including sexual abuse - mostly bulimia -Difficulty with identity formation -Biological and genetic dispositions |
| Personality traits of ED patients | -Perfectionism -Social insecurity -Instability -Interoceptive deficits(inability to correctly respond to bodily sensations) -Alexithymia(difficultly naming/expressing emotions) -Immaturity -Compliance -Sense of ineffectiveness in dealing w/the |
| Physiological Symptoms | -Dental concerns -Ulcers/Colitis -Esophageal bleeding/trauma/tears/hair/skin/lanugo hair/rashes/menses -Osteoporosis -Hypothermia -Constipation/Diarrhea |
| Electrolyte Disturbances | -Hypokalemia (most frequently in pts who abuse diuretics and laxatives) -Fatigue,lassitude -Paresthesias -Metabolic alkalosis -Cardiac arrthmias -Hypokalemic nephropathy |
| Complications of Laxative Abuse | -Nonspecific gastrointestinal complaints -Cathartic colon (a pathologic state of colon structure and function) the colon is dilated and distended, inflammation of the mucosa and muscular layers, multiple superficial ulcers, limited reversibility |
| Diuretic Abuse | -Electrolyte disturbances -Excessive loss of fluid: dehydration, thirst, dry mucus membranes, tachycardia, poor skin turgor, postural hypotension -Severe cases: delirium, acute tubular necrosis |
| Most Common Patient Complaints | -Inability to concentrate -Fatigue -Chest pain -Fainting spells -Orthostatic hypotension -Feeling of bloat after eating/drinking anything -Depression -Cold |
| Family Dynamics | -Conflict avoidance -Over protection -Rigid to others values, views and perceptions -Enmeshment-we all feel and think alike -Trouble with marriage |
| Outcomes | -Don't just use weight as a criteria for return to health |
| Outcomes | -Inpatient:priority given to achieving a state of nutritional balance that is adequate to sustain life&prevent physiological sequelae -Long term:concerned w/asserting cntl over one's life,incorporate a realistic view of body,develop trust |
| Medications | -SSRIs - prozac,paxil,zoloft,celexa,lexapro, luvox -Any medication that is indicated for depression and anxiety can be useful. Now beginning to use polypharmacy for this treatment |
| Palliative Care | -Dr.Kubler-Ross -Goal is quality,compassionate, care for indiv with a life limiting illness or injury -Team-oriented approach to expert med care, pain management and emotional and spiritual support -Terminally ill indiv choices regarding care are foll |
| Hospice | -Available to everyone regardless of age,dx, or the ability to pay -Requires a physicians best clinical judgment that the pt is terminally ill w/a life expectancy of 6 mo or less -Pt chooses this rather than curative tx -Ensuring pt dignity and respec |
| Nursing Goals | -Practice the art of presence (be open and available for pt) -Assess for spiritual issues -Provide palliative symptom management -Help keep pt free of pain -Become an effective communicator |
| Two pronged approach | -Focus on the here and now because life is today -Describe what the nurse is seeing and finding during physical examinations, paint a pic, from which family members can draw their own conclusions |
| Styles of Confronting the Prospect of Dying | -Struggle:living&dying are a struggle -Dissonance:dying isnt living -Endurance:triumph of inner strength -Incorporation:beliefs accommodates death -Coping:working to find a new balance -Quest:seeking meaning in dying -Volatile:unresolved,unresigne |
| Fears of Dying Person | -Loss of control -Pain -Having death prolonged artificially -Submitting to the suffering of death -Palliative nursing returns a sense of control to a dying person as well as hope that uncomfortable symptoms can be alleviated |
| Effective Communication | -People need at least 6 reiterations of new information when they are under stress -Convey info slow -Give information repeatedly -Have caregivers write down information -Review information frequently with caregivers |
| Four gifts of resolving relationships | -important role of hospice care is to encourage families to consent to the inevitability of death -Four gifts: forgiveness,love, gratitude, farewell |
| Forgiveness | -Admit the wrongs and hurts experienced from actions of the other person -Intention is to forgive and release the hurt -One-sided act -Does not mean that a truly injurious or abusive action has been condoned or accepted |
| Forgiveness | -Signals a desire to let go of blame and anger -Gift to the one offering forgiveness -Accompanied by the question "Is there anything I have done or not done for which I need to say I am sorry?" |
| Love | -Express love to each other -The message is that all people are loved for being just who they are, and they are loved just for being |
| Gratitude | -Take the time to thank each other for what each has been in the other's life -Acknowledge the things that were taken for granted |
| Farewell | -When the final separation of death is near, the act of saying goodbye is deeply appropriate and meaningful |
| Loss | -Something of value is actually or potentially: changed or gone |
| Types of Loss | -Actual: identified by others, lost mom or lost pet -Perceived: can't necessarily be verified by others - loss of self esteem -Anticipatory: before a loss happens |
| Time Period of Loss | -Temporary: comes back - missing child, pet -Permanent: irreversible - death paralysis |
| Circumstances of Loss | -Maturational: results from normal life transitions (empty nest syndrome, retirement) -Situational: specific live event (losing someone, job, house fire) |
| Bereavement | -Mourning: public rituals, external displays -Grief: emotional, physical, spiritual |
| Bereavement | -The social experience of dealing with the loss of a loved one through death -Encompasses grief experience and mourning -Period of time after a loss during which grief is experienced and mourning occurs |
| Mourning | -The culturally patterned behavioral response to loss -What people see -People will show this differently -Process by which people adapt to a loss |
| Grief | -Individual process -Due to a loss of a loved one or cherished object |
| Manifestations of Grief | -Physical -Emotional/Psychological -Cognitive -Behavioral -Spiritual |
| Physical Responses to Grief | -Fatigue -Exhaustion -Insomnia -HA -Tension -Digestive -Medical flare ups -Crying -Tightness in chest, throat -Heartache -Noise sensitivity |
| Emotional/Psychological Responses to Grief | -Shock -Numbness -Sadness -Depression -Hopelessness -Overwhelmed -Powerlessness -Confusion -Anxiety -Abandoned -Anger -Fear -Guilt -Restlessness -Irritability -Loneliness -Freedom -Relief |
| Cognitive Responses to Grief | -Difficulty concentrating -Memory impairment -Absentmindedness -Disbelief -Day dreams,nightmares -Preoccupied with thoughts of deceased -Hearing,seeing,sensing presence of dead |
| Behavioral Responses to Grief | -Withdrawal socially -Silence -Talkitaveness -Anhedonia -Over interest in things that distract -Never wanting to be alone -Isolation -Carrying treasured objects of deceased -Avoiding reminders of deceased -Not talking about death |
| Spiritual Responses to Grief | -Questioning belief values -Asking "why" questions -Not finding meaning in things at this time -Reevaluation of life -Change in church habits -Changes in relationships with family friends and coworkers -Change in relationship to oneself |
| Anticipatory Grief | -Anxiety or sorrow experienced prior to an expected loss or death -Often unrecognized -Nurses should be able to recognize |
| Delayed Grief | -Postponed response in which the bereaved person may have a reaction at the time of the loss but it is not sufficient to the loss -A later loss may trigger a reaction that is out a proportion to the meaning of the current loss |
| Disenfranchised Grief | -A response to a loss or death in which an individual is given the opportunity to grieve or is unable to acknowledge the loss to others -Can't publicly grieve the loss -A mistress, gay partner, healthcare workers, neighbor |
| Dysfunctional Grief | -People fear experiencing the pain of loss therefore grief work is unresolved -Unresolved: prolonged or extended in length and severity of response -Inhibited: suppressed response that may be expressed in other ways, such as somatic complaints |
| Grief engendered in public tragedy | -Impact of loss is felt across the community of general population -Responses include two processes: coping with loss, grief and trauma; adapting to a changing world -Terrorist attacks, natural disasters, school shootings, assassinations |
| Grief vs Depression:Grief | -Relates directly to loss -Sx disappear after the loss if resolved -Sad,angry,hopeless,despair,agitation -Physical symptoms cover wide spectrum -Spiritual beliefs may provide comfort |
| Grief vs Depression: Depression | -Not specifically r/t loss -Must be > 2 mo -Guilt abt things other than death -Cyclic or static -Symptoms get more intense than grief -Anger less seldom expressed -SI much more common -Spiritual beliefs seldom provide context or meaning |
| Factors Influencing Grief | -Age -Significance of loss -Culture/Spiritual beliefs -Gender -Support system -Cause of loss/death |
| Factors Influencing Grief: Childhood | -Preschool-fear separation and do not understand finality -5-6y - death is reversible,magical -6-9y-accept finality, see death as destructive -10y-death is inevitable -Teen-intellectualize, but repress feelings |
| Factors Influencing Grief: Early Middle Adult | -Loss and death as normal developmental task |
| Factors Influencing Grief: Older Adult | -Loss of health, function and or independence -Loss of longtime mate -Multiple losses-control,competence, material possessions, important people |
| Factors Influencing Grief: Significance of Loss | -Value placed on person, object or function -Degree of change resulting from loss |
| Factors Influencing Grief: Culture | -Describes nature of life after death -Explains meaning of death -Defines relationships between dead and living -Designates the process of bereavement/ mourning -Delineates appropriate expression of grief/ mourning |
| Factors Influencing Grief: Male | -Toned down expressions of grief -Thinking often precedes feelings -Focus on problem solving -Experience intense feelings privately or immediately following the loss during death rituals |
| Factors Influencing Grief: Female | -Expression is more overt -May express verbally for longer period of time -More communicative about loss -More likely to seek and accept support |
| Factors Influencing Grief: Support System | -People closest often support the survivors -Some people may withdraw from grieving individual -Support is plentiful in immediate periods after loss - later needs are often unmet |
| Factors Influencing Grief: Cause of Loss or Death | -Views society places on loss or death -Loss from murder, suicide or other tragedy bay be more difficult to accept -Losses that are beyond one's control (cancer) are often more acceptable than one that is preventable (drunk driving accident) |
| Framework for Grieving | -Shock and Disbelief -Sensation of somatic distress -Preoccupation with the image of the deceased -Guilt -Anger -Change in behavior -Reorganization or behavior directed toward a new object or activity |
| Five stages of Grief: Kubler Ross Model | 1)Denial 2)Anger 3)Bargaining 4)Depression 5)Acceptance |
| Bereavement Process | -Acute stage (4-8wks) -Shock and disbelief (denial) -Development of awareness (somatic symptoms, anger, guilt, crying) -Restitution |
| Bereavement Process | -Long-term stage (1-2y) -Most people resolve with support -Broken-heart syndrome (during 1st year of significant other passing, person passes) -Suicide rates higher -Dysfunctional/Unresolved grief |
| Successful Bereavement | -Accept reality of loss -Share in the process -Adjust to an environment without the deceased -Restructure the family's relationship |
| Psychological Factors Affecting Medical Conditions | -Factors that: interfere with medical treatment, pose health risks, cause stress-related pathophysiology changes |
| Common Illnesses Known to be Affected by Stress | -CHD-MI after sudden loss -Cancer-prolonged stress -HA-anxiety,tension -HTN-stress,type A -Diabetes Mellitus -Peptic Ulcer |
| Psychological responses to serious medical conditions | -Depression-risk for med nonadherence, low motivation/energy -Anxiety-common,accompanies almost any illness, feeling of helplessness -Substance Abuse-people may turn to this, help to not deal w/stress -Grief&Loss-may grieve loss of function or body par |
| Psychological responses to serious medical conditions | -Denial-this isn't happening to me, noncompliance -Fear of dependency-fear will lose their independence, function |
| Mind-Body Connection | -Interaction between the sympathetic nervous system, pituitary adrenal cortical axis and the immune system -General adaptive syndrome: flight vs fight, consequences of prolonged stress |
| Factors Influencing response to medical illness | -Developmental stage at time of medical illness -Personality traits -Coping behavior -Precipitating stressors -Support systems -Coexisting conditions |
| Effective Coping Skills | -Optimistic attitude -Confronts the issues -Seeks information -Shares concerns -Has capacity for healthy denial -Redefine the situation -Constructive use of distractions |
| Ineffective Coping Skills | -Sees glass as half empty instead of half full -Forgets it happened, minimizes critical health status -Shows tendency to escape or withdraw -Prolonged denial -Feels hopeless -Withdraws, brood overwhelmed |
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prettyinpink7
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