psych safety (suicide, aggression, abuse)

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any stressful situation can precipitate a ____

crisis

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____ decreases problem solving skills

anxiety

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anxiety can lead someone to be nonfunctional- what is our goal

getting the person back to the previous level of functioning

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crisis: there thoughts become what; pt behavior is aimed at the relief of what;

obsessional; anxiety;

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crisis: some ppl have good ___ to deescalate the crisis

coping skills

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crisis: this can effect ___ health as well; ppl are in crisis when they have lack of ____ to deal with the stressor;

physicial; resources;

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crisis: resolution of the crisis promotes what; how does it promote growth

growth; if one works through the stressor they will come out with a better way to handle stress in the future

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crisis: does it affect everyone; this is precipitated by a specific what; what causes the crisis; are they acute or chronic; can they be resolved positively; can they be resolved negatively; how fast is it resolved

yes; identifiable event; the specific identifiable event; acute; yes; yes; with in a few months

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crisis: does the event have potential for growth; does it have potential for decline; when person learns new methods of coping that can be utilized when similar ____ recurs;

yes; yes; stressor;

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crisis: when can this be a dangerous time

person is overwhelmed with out adequate preparation for changes leading to maladaptive coping dysfunctional behaviors- they handle one more thing

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phases of crisis development: how many phases are there; what is phase one; def phase 2;

4; exposed to a precipitating stressor; exposed to a precipitating stressor; previous problem solving techniques do not relieve the stressor

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phases of crisis development: def phase 3; def phase 4;

all internal and external resources are utilized; tension mounts or increases to breaking point

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phases of crisis development: phase 1: what increases in the phase; previous ___ techniques are utilized

anxiety; problem solving

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phases of crisis development: phase 2- what continues to increase; why is there feelings of helplessness;

anxiety; when previously effective coping skills are ineffective;

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phases of crisis development: phase 3- why are all internal and external resources utilized; at this phase new ____ are used; if new problem solving techniques are used with resolution returning to what level of functioning

to resolve the problem and relieve the discomfort; problem solving techniques; higher, lower or previous level of functioning

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phases of crisis development: phase 4- this happens when there is no resolution from what; what type of anxiety is this; what is disordered; what is labile; behaviors may reflect presence of psychotic thinking

the previous phase; panic level; cognitive functions; labile; lack of sleep

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crisis of equilibrium response: what are the 3 factors that influence a crisis response;

perception of the event, availability of situational supports, availability of adequate coping mechanisms;

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crisis of equilibrium response: perception of event- realistic perception of event promotes what; distorted perception of event lessens what skills;

adequate resources to regain equilibrium; problem solving and equilibrium is unresolved

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crisis of equilibrium response: availability of situational support- what type of type help solve problems; what people might have a hard time getting support

dependable; person overwhelmed and alone with out support

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crisis of equilibrium response: availability of adequate coping mechanisms- what can divert a crisis; if no success with previous coping mechanisms what feelings can increase

success with previous coping mechanisms;tension and anxiety

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6 classes of emotional crisis: class one dispositional crisis- def;

an acute response to an external situational stressor;

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6 classes of emotional crisis: class 2 crisis of anticipated life transitions- def;

normal life cycle transitions that may be anticipated but the person may feel lack of control;

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6 classes of emotional crisis: 3 crisis resulting from traumatic stress- what are ex of traumatic stress; def;

death, war vets; crisis precipitated by unexpected external stresses over which the person has little or no control, results in being emotionally overwhelmed and defeated;

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6 classes of emotional crisis: class 4 maturational/developmental crises- def; these crisis are of what origin; this crisis reflects underlying ___ issues;

crises that occur in resonse to situations that trigger emotions related to unresolved conflicts in a person's life; internal; developmental;

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6 classes of emotional crisis: class 5crisis reflecting psychopathology- def; ex of preexisting psychopathology

emotional crisis in which preexisting psychopathology precipitates the crisis or impairs or complicates adaptive resolution; borderline personality, severe neuroses, characterological disorders, schizophrenia

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6 classes of emotional crisis: class 6 psychiatric emergencies- def; ex

crisis situations with general functioning severely impaired and the person is incompetent or unable to assume personal responsibility; acutely suicidal person, drug overdose, reactions of hallucinogenic drugs, acute psychoses, uncontrollable anger,

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crisis intervention: this is designed to provide rapid assistance for what individuals; focus on supporting the person to restore them to what level of functioning; what is therapist role;

individuals with urgent need; precrisis level or higher; to mobilize resources needed to resolve crisis

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crisis intervention:are lengthy psychological inerpretations appropriate for crisis intervention; does it take place in inpatient of outpatient; what type of support system does a person need in order to be able to go home;

no; both; stable;

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crisis intervention: adaptive changes leads to what; the person should experience some degree of relief by how many interactions

resolution and growth; from the 1st interaction

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phases of interaction: role of the nurse in phase 1; phase 2; phase 3; phase 4

assessment; planning of therapeutic interventions; intervention; evaluation of crisis resolution and anticipatory planning

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crisis interventions phase 1 assessment: crisis can occur where in the hospital; gather information regarding what; client describe what event; assess ___ and ___ status

every unit; the precipitating stressor and resulting crisis; event leading to the crisis; physical and mental

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crisis interventions phase 1 assessment: why assess physical; assess what for safety; assess what about support; determine precrisis level of ____

look for weapons, skin issues, underwite; suicide attempts; if they have any; functioning

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crisis interventions phase 1 assessment: assess perception o fwhat; assess use of what; what dx is identified in this step

personal strengths and weakness; substances; nursing Dx

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crisis intervention nursing dx: this should reflect what; ex of nursing dx

the immediacy of the crisis situation; ineffective coping, anxiety, disturbed thought processes, risk for self-or other directed violence, rape-trauma syndrome, post trauma syndrome, fear

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crisis interventions phase 2 planning: select appropriate nursing actions for what; what are established: what is the goal for resolving the crisis; what is taken into consideration when planning

the nursing dx; goals; to return pt to precrisis level of functioning; the type of crisis, the individual's strengths and available resources

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crisis interventions phase 3 interventions: planning in phase 2 is what; interventions are the focus of what; use ____ oriented approach; focus on what problem;

implemented; the nursing crisis intervention; reality; the current one

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crisis interventions phase 3 interventions: why do we remain with the person experiencing a panic attach; promate an atmosphere to verbalize what; discourage what;

they are at risk for physical s/s - increased hr etc; true feelings; lengthy explanations or rationalizations

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crisis interventions phase 3 interventions: establish firm limits on what behavior; help client determine what stressor ___ the crisis;

aggressive, destrucptive behavior; precipitated

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crisis interventions phase 3 interventions: guide the client through what; client needs the confront the source ofwhat; coping mechanisms are ultimately whose choice

problem solving process; the problem; the clients

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phase 4 evaluation- eval what; what is done to determine if the stated obhective what achieved;

the crisis resolution; reassessment;

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phase 4 evaluation: can the client describe a plan of action for dealing with what; review what; anticipate what

stressors such as the current problem; what has been learned; how the client will respond in the futre

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suicide: is it a behavior; __% of ppl who attempt have mental disorder; it is the 3rd leading cause of what

yes; 95%; cause of death

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suicide: do ppl give clues and warnings of suicide; do most want to be saved; most suicidesoccur within how many months after improvement; is it inherited; does a close family member doing it increase the risk; what is the leading cause of death;

yes; yes; 3 months; no; yes: gunshots;

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suicide: risk factors- single/divorced or married twice as likely to commit suicide;

single;

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suicide: risk factors- who is most likely to attempt suicide women or men; women commit suicide how most often; who succeeds most often women or men; what do men use to commit suicide;

women; by overdose; men; gen

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suicide: risk factors- who is least likely to seek help men or women;

mne;

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suicide: risk factors- what age most common; what age are women most at risk; who is at greatest risk of all age/gender/race

40-50 yrs and 65 yo; throughout life and declines after 65 yo; white males >80yo

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suicide: risk factors- what are the factors that put adolescenes at risk

impulsive and high risk seekers, access to lethal weapons substance abuse, untreated mood disorders

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suicide: risk factors- do religious ppl have increased or decreased risk; what ethnic group have highest risk for suicide; who is at highest risk very rich, poor or mod; what careers have high risk

decreased risk; whites; richest and lowest class; physicians, artists, dentists, law enforcement, lawyers, insurance agents

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suicide: risk factors- 90% with successful suicide have a dx of what; suicide risk increases in the early tx with what meds

mental disorder; antidepressants;

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suicide: risk factors- what type of psychosis increases the risk; what age a gays is there a high rate;

command hallucinations; youth;

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suicide: risk factors- deficiency in what neurotransmitter increases the risk;

serotonin;

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suicidal assessment: what is assessed; what questions are asked to determine if it is a threat;

demographics, psychiatric dx, med dx; do you have a plan, any previous attempt;

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suicidal assessment: what life events can lead to it; what hx is relevant; what are some life stages issues

adverse life events, precipitating stressor, depression; what is their coping to situations- do they have dysfunctional responses due to numerous failures; decreased ability to tolerate losses and disappointments during developmental stages

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suicidal assessment: what type anxiety do they have; what depression do they have; what type of isolation; what is their daily function; do they have resources;

high or panic; severe; hopeless; not good at any activity, poor hygiene; no

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suicidal assessment: what are their coping strateges; do they have any sig others; what is their lifestyle;

predominantly destructive; only one or none; unstable;

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suicidal assessment: what is alcohol or drug use; are there previous suicide attempts; are they disorganized; are they hostile

continual abuse; yes; yes; yes

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suicidal assessment: what is an easy way to remember this

plaid pals

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plaid pals: P= ___; L=__; A=____; I=___; D=__;

is there a plan; lethality- could they die with this plan; availability- means to carry out the plan; illness- mental or physical;depression- chronic/situation

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plaid pals: P=___; A=___; L=____; S=___

previous attempts-lethality, recent; alone-do they have a support system, partner, are they alone; loss-death, job, relationship; substance abuse-

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suicide: ex of nursing dx ; what are some short term goals

risk for suicide related to feelings of hopelessness and desperation, hopelessness related to absence of support systems and perception of worthlessness; will experience no physical harm to self, will set realistic goals for self, express optomisn

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suicide: what are interventions neededto prevent client injury

1:1 observation, room cleared of potential weapons, remove all clothing and place a patient in gown, remove all personal belongings from persons reach, room close to nursing station, do not assign private room, accompany pt to BR

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nursing DX for suicide: Risk for suicide - what is goal; what is special care when administering meds; how often should rounds occur

client will not harm self; check for cheeking and under the tongue; q15m and in irregular intervals;

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evaling the suicidal client: is this ongoing; after immediate crisis is resolved extended ____ may be needed;

yes; psychotherapy;

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suicide: what are long term goals;

develop and maintain a more positive self concept, learn more effective ways to express feelings to others, achieve successful interpersonal relationships, feel accepted by others and achieve a sense of beloning

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outpatient/discharged suicidal client interventions: when may they not be hospitalized; what are 2 important guidelines when pt is not being hospitalized;

if they are a low risk for suicide; never leave pt alone must be at home with family, establish a written no-suicide contract with client

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outpatient/discharged suicidal client interventions: family/friends need to ensure what is safe; what appointments should be kept daily;

home; conseling;

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anger/aggression: is it a normal human emotion when handled appropriately;serves as what type of signal; how can it provide a positive force; triggers what SNS response

yes; a warning signal and alerts to potential threat or trauma; to solve problems and make decisions; fight or flight

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anger/aggression: when is it problematic;

when not expressed or expressed aggressively;

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key points of anger: is it a primary emotion; it is an automatic inner response to what; the physiological arousal instills what;what is learned; can anger come under personal control

no; hurt, frustration or fear; feelings of power and gnerates preparedness; how one expresses anger; yes

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def anger: what physical problems can it precipitate; what mental health problems can it precipitate if turned inward

migraines, ulcers, colitis, coronary artery disease; depression, low self esteem

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def anger: is it neg or pos when linked with aggression; what type of behavior occurs when suppressed anger becomes resentment;

neg; passive aggressive;

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def anger: arousal of the SNS- what happens to HR and BP; what happens to glucose; what happens f anger is not resolved over the years

increases; increases; can lead to illness over time

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aggression: def; ex; the behavior is meant to ___ ; they are often __

a behavior intended to threaten or injure the victim's security or self esteem; to assault or attack persons or objects can be words, physical force or weapons; punish; vengegul

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predisposing factors to anger/aggression: modeling- this is the strongest form of what; children model whom; physically abused children become physically abusive ____; what stimuli can lead to aggressive behavior

learning; behaviors of parents/caregivers; adults; television, video game violence

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predisposing factors to anger/aggression: operant conditioning- this occurs when a specific ___ is reinforced; what are the 2 types; def positive; ex

behavior; positive and negative; pleasurable or rewarded behavior; temper tantrum leads to getting what child wants

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predisposing factors to anger/aggression: operant conditioning- def neg; ex neg

strengthens a behavior bc negative condition is stopped or avoided as consequence of the behavior; driving in heavy traffic is neg, we leave home early to avoid it

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predisposing factors to anger/aggression: neurophysiological disorders- ex; what meds can decrease behaviors

epilepsy, tumors in brain, trauma to brain, encephalitis; anticonvulsant meds

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predisposing factors to anger/aggression: biochemical factors- what hormonal dysfunction; what neurotransmitters may facilitate or inhibit aggressive impulses;

cushing or hyperthyroidism; epi, norepi, dopamine, acetycholine, serotonin

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predisposing factors to anger/aggression: socioeconomic factors- there is an increased violence in what class; why increase in violence in this class;

poverty; lack of resources, separation of families, alientation, discrimination and frustration

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predisposing factors to anger/aggression: environmental factors- why might physical crowding cause this; does extreme heat increase or decrease aggression; what doe ETOH do;

due to increased contact and decreased defensible space; decrease it; increase violent behaviors;

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what behaviors are associated with anger

frowning, clenched fists, clenced teeth, low pitch verbal, yelling and shouting, easily offended, defensive response to criticism, passive-aggressive behaviors, intense discomfort, state of tension, emotional over control

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anger: this is a stage of the ___ process; if someone becomes fixed in this stage what does that lead to; why may one deny anger as a feeling; client needs to recongnize true feelings and know that anger is acceptable if expressed how

grieving; depression; bc of negative implications; appopriatey

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what behaviors are associated with aggression

pacing, restlessness, tense facial expression and body language, verbal and physical threat, loud voice, shouting, arguing, threats of homicide or suicide, increased agitation with overreaction to environmental stimuli, panic anxiety, disturbed thoughts,

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aggression: can arise from what; what are the 3 classes; ex of mild; ex of mod; ex of extreme;

anger, anxiety, guilt, frustration, or suspiciousness; mild, mod, extreme; sarcasm; slamming doors; physical acts of violence against others

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anger: assessment- what is the goal in management of aggressive/violent behaviors; safety of whom is nurse's priority; what are 3 factors to assess for potential violence

prevention; client and others; past hx of violence, client dx, current behavior

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anger: assessment- what dx are associated with violence; what dx have risk of violence;

schizophrenia, major depression, bipolar disorder, and substance use disorder; dementia, antisocial, borderline personality intermittent explosive personality;

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anger: assessment- a client's threatening behavior may be an overreaction to feeling what; does aggression rarely occur suddenly or unexpectedly;

impotence, helplessness, feelings humiliation; yes;

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anger: assessment: prodromal syndrome- def; these behaviors should be addressed how

characterized by anxiety and tension, verbal abuse and profanity and increasing hyperactivity; emeregent with immediate attention

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anger/aggression nursing dx: complicated grieving r/t; ineffective coping r/t; risk for self-directed violence r/t;

loss; negative role modeling and dysfunctional family system; having been nurtured in an atmosphere of violence;

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anger/aggression nursing dx: outcome- the client should recognize angry feelings and seek out whom to talk to; they can take responsibility for what; the control exert what kind of control over feelings; they will not cause harm to whom

staff/support person; own feelings; internal; themselves or others;

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anger/aggression planning: ineffective coping- client will be able to recognize what; they should be able to ___ before losing control; what are intervention

anger; take responsibility; remain calm, do not touch client. write feelings of anger in a diary, assist with finding the true source of the anger, assist with alternate ways of tension release,

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anger/aggression nursing dx: risk for selfdirecting or other directed violence- client will not harm whom; client will do what instead of hit; what are behaviors assocc. with prodromal syndrome

self or others; verbalize anger; attempt to defuse anger with least restrictive means, ensure sufficient staff isavailable to assist with potentially violent situation

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de-escalation techiques: talk how; never positive self how; what physical outlet: what meds; call for what; what to use if talking down is not successful

down; w/o easy exit from room; punch pillow; voluntary if threat to self or others reassess situation; assistance to remove others from the immediate area; restraints

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restraints: follow who's policy; how many ppl; this is the last ___; an in-person eval by physician with/in ___ hours of initiation; new order for restraints required every __hours for adults and every ___ hours for kids; 1:1 for how many hours;

facilities; 5; resort; 1 hour; 4 hours and 1-2 hours; 1st;

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restraints: after 1:1 how is pt monitored; what is assessed q15m;

by audio and visual monitoring; circulaton, nutrition, hydration, elimination;t

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chemical restraints: this is rapid ___; what meds

tranquilization; Haldol, Ativan, thorazine, apsine, zyprexa, geodon

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eval anger/aggression: reassess to determine what;

success of nursing intervnetions in achieving care objectives;

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anger/aggression core documentation when in restraints:

admission screening, minutes of physical restrain, minutes of seclusion, justification for multiple antipsychotic meds, post discharge care plan, patient strengths, substance use

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abuse: who is the abuser; what is wastly underreported in US; many abusers are victims of ____

men and women; rape; abuse

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abuse predisposing factors: neurophysiological-what areas of the brain are associated with aggressive behaviors;

temporal lobe, limbic system, amygdaloid nucleus;

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abuse predisposing factors: biochemical- what neurotransmitters play a role;

norepi. dopamine, serotonin;

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abuse predisposing factors: how does psychodynamics play a role; how does learning theory play a role; socio cultural theories play are role

unmet needs for satisfaction and security lead to aggression and violence; imitate role models, usually parents; products of one's culture and social structure

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intimate partner violence: battering- def; leads to what feelings in the victim; more common in men or women; what age most common;

a pattern of power andcontrol through physical/sexual violence or threat of violence of an intimate partner; fear intimidation; women; 20-24;

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intimate partner violence: profile of the victim- they have low what; they grew up in what type of home; they are isolated from what; def learned helplessness phenomenon;

self esteem; abusive; family and support system; progressive inability to act on her own behalf;

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intimate partner violence: profile of victimizer- self esteem low or high; they are pathologically ___; how do they have a dual personality; they have high or low stress; they consider ___ as a possession; insults and humiliates whom; who becomes pawns

low; jealous; one to partner and one to rest of the world; high; spouse; spouse; children

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cycle of battering: phase 1 the tension building phase- woman senses the man's tolerance for ___ is declining; be becomes angry with little __; after anger he will quickly do what; woman caters to what to keep peace; does battering occur in this phase

frustration; provoking; apologize for lashing out; needs; minor

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cycle of battering: phase 1 the tension building phase- she denies what; she rationalizes what; as battering becomes more intense she does what; the withdrawal is seen as what to him; how long does this phase last

her anger; his behavior; withdraws; rejection and escalates his anger; weeks to months and years

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cycle of battering: phase 2 acute battering phase- this is the longest or shortest phase; most or least violent phase; how long does it last; abuser justifies what; after incident abuser cannot understand what

shortest; most; 24 hours; his behavior; what happened;

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cycle of battering: phase 2 acute battering phase- women feel their only option is to find what; is beating severe; help is sought when;

a safe place to hide; yes; only when severe injury or a woman fears for her childs life

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cycle of battering: phase 3 calm,loving, respite phase: aka __ phase; batterers behaviors change how; the baterer promises what

honeymoon; they become extremely loving, kind and contrite; it will never happen again;

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cycle of battering: phase 3 calm,loving, respite phase: he plays on her feelings of what; does the cycle start over

guilt and that she has learned her lesson; yes

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why do women stay in abusive relationships: fear of what; for the children fear of losing what; what other reasons;

retaliation- he will kill her and kids; custody; finances

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abuse: Nursing dx- powerlessness: r/t what; what is outcomes

cycle of battering evidenced by verbalization of theattack; immediate attention to physical injuries, verbalizes assurance of immediate safety, discusses life situation with nurse, can verbalize choices and receive assistance

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