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Ch 13

Mr. D's Crisis Intervention

A crisis is a sudden event in one's life that disturbs homeostasis during which usual coping mechanisms cannot resolve the problem.
A crisis is preceded by an identifiable stressful life event.
Is a crisis objective or subjective? Subjective to the person experiencing it.
A crisis can be a time of ____ or _____. growth or regression
Whether or not an individual experiences a crisis in response to a stressful situation depends on 3 factors: (PAC) 1 Perception of event. 2 Availability of supports. 3 adequate Coping mechanisms
6 classes of emotional crises: 1 Dispositional. 2 Transitions. 3 Trauma. 4 Developmental. 5 Pathology. 6 Psychiatric.
Principles of Crisis Intervention (Same as quickie) Aid ASAP, Take Control, Time Limited, Sx reduction, Social Support, Express Feelings
7 stage model (Same as dating)(ARIDMAF) 1 assessment. 2 rapport(trust). 3 identify problem. 4 deal with feelings. 5 make alternatives. 6 action plan. 7 follow up.
Dispositional Crises An acute response to an external situational stressor.
Crises of Anticipated Life Transitions Anticipation of normal life-cycle transitions in which the person feels a lack of control.
Crises Resulting from Traumatic Stress Unexpected external stress in which a person feels a lack of control and FEELS EMOTIONALLY OVERWHELMED AND DEFEATED.
Maturational / Developmental Crises Emotionally triggered by unresolved conflicts in life. Internal and developmental in origin that involve dependency, value conflicts, sexual identity, control, and capacity for emotional intimacy.
Crises reflecting Psychopathology Emotional crises in which preexisting psychopathology impairs adaptive resolution. Psychopathology may include crises caused by borderline personality disorder, severe neuroses, characterological disorders, or schizophrenia.
Psychiatric Emergencies Impaired functioning caused by acutely suicidal individuals, drug overdoses, reactions to hallucinogenic drugs, acute psychosis, uncontrollable anger, and alcohol intoxication.
Loss is always _____ personal
The _____ of loss is just as powerful as the actual loss. perception
The anticipation of death can create a crises while the actual death is experienced less so.
Counseling for death of loved one (outline): 1 Help survivor. 2 Educate survivor. 3 Provide continuing support and encourage participation in support groups.
The most important factor in determining the potential of a suicide threat is the individual's ______. plan
Risk of suicide is greater when plans are specific and the means are lethal
A dual relationship is when a practitioner has more than one kind of relationship with the client.
Always keep it confidential
Confidentiality can be broken in cases of ______ and _____. criminal activity and danger to self or others.
Tarasoff Decision The duty to warn an individual of potential danger.
A client admits to thinking about suicide and having a plan. What is the nurses intervention priority? Confine the client to a seclusion room; provide for the client's safety.
The nurse is preparing a client for discharge. He was hospitalized for 10 days, having attempted to kill himself by overdosing on medications. What statement indicates that he is ready for discharge? "I do not feel like harming myself."
A client who has been highly suicidal tells the psych tech, "You don't have to worry anymore about me. Today has been my turning point, so you can stop the one to one." The psych tech feels that there is a "hollow ring" to the clients words. The PT should Report the client's statements and the tech's feelings about this situation to staff and suggest increased vigilance.
A psych tech working with adolescents would be wary of a client who reported: Today is the anniversary of the individual's mother's suicide.
Lowest lethality suicide method: Cutting wrists
While Frank and his family were out of town on vacation, their house burned down to the ground. Frank is devastated and stares into space, barely eating and rarely speaking. What kind of crises is this? Traumatic stress crises. (Leaves overwhelmed and depressed.)
George has OCD about germs, and would wash his hands excessively. Last night he had sex. Today he is anxious and keeps repeating that he has AIDS. His roommate cannot talk him out of the shower. Psychopathology Crises.
Bonnie got engaged. She has never had an intimate relationship and is now experiencing panic attacks at the thought of her wedding night. Maturational/Developmental Crises
Linda's husband verbally and physically abuses her. She married him knowing that he has a drinking problem. Her husband beat her in a drunken rage. Linda left to the hospital. Dispositional Crises
Crises occur when an individual: experiences a stressor and perceives coping strategies to be ineffective.
Client with long term chronic history of depression and recent suicide precautions starts to show improved mood and increased energy when STARTED on Paxil. The client is at a higher risk for committing suicide.
Which factor helps to make the event a crisis? The individual's perception of the event.
Characteristics of a crises: Crises occurs in most all individuals at one time or another. Some crises are precipitated by specific identifiable events. Crises are personal in nature. A crisis situation contains the potential for psychological growth or deterioration(regression)
With successful crisis intervention, what is the very best outcome that can be achieved after a crisis? A higher level of functioning and personal growth will be attained.
When providing assistance to a person in crisis: It is important that you stay with the person. Attend to the person's immediate needs. Establish a therapeutic working relationship and acknowledge their feelings. Clarify the problem with the person.
A psych tech is assigned to care for a suicidal patient. Initially, which is the psych tech's highest care priority? The client will not harm himself.
What is a correct assumption regarding the concept of crisis? A crisis situation contains the potential for psychological growth or deterioration.
Crises occur when an individual: Experiences a stressor and perceives coping strategies to be ineffective.
Amanda's home was destroyed by a tornado. Amanda is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called: Crises resulting from Traumatic Stress
The most appropriate crisis intervention with Amanda would be to: Discuss stages of grief and feelings associated with each.
Jenny told the school nurse that her mom drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. This type of crisis is called: Dispositional crisis.
The most appropriate nursing intervention with Jenny would be to: Make arrangements for her to start attending Alateen meetings.
Ginger, age 19, left 3 months ago to attend college > 500mi away from parents. Ginger's 1st time away from home. She has difficulty making decisions for herself, still needs mom opinion. Ginger has recently started to get anxiety attacks. What typ crises? Maturational/Developmental crisis.
The most appropriate nursing intervention for Ginger would be: Work with Ginger on unresolved dependency issues.
Marie, 56yr, mom of 5. Her youngest child graduated and got a job out of state. Marie devoted her life to her children. Marie has become despondent since last child left. What type of crisis is she experiencing? Crisis of anticipated Life Transitions
The most appropriate nursing intervention for Marie would be: Begin grief work and assist her to recognize areas of self-worth separate and apart from her children.
The desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety is: The individual will maintain an anxiety at a manageable level.
Andrew, NYFD, and his unit responded to WTC at 9/11/2001. His best friend was killed when the building collapsed. Andrew was injured, but survived. Since then, Andrew has nightmares and anxiety attax. He say, "Why he die and I didn't?" He is experiencing: Survivor's Guilt
Intervention with Andrew would include: Encourage expressions of feelings. Anxiety medications. Participation in a support group.
Created by: Sanctus Verus