Ch10 Crises Intervention

Question 0

Phases in Crisis

Answer 0

Phase 1: stressor appears and anxiety increases. Previous problem solving techniques (PPST) are employed!
Phase 2: when PPST d/n relieve stressor anxiety increases further. Previous Coping techniques are attempted! Confused.
Phase 3: all possible resources are called on to resolve the problem. Individual tries to look at problem in different perspective.
Phase 4: with no resolution; tension mounts beyond threshold and may reach panic

Question 1

Crisis Assumptions

Answer 1

Crisis is ACUTE and personal by nature (what an individual perceives). Crisis is potential for psychological GROWTH want can be precipitated by specific IDENTIFIABLE events. Crisis occurs in ALL individuals at one time in life

Question 2

Class 1: dispositional crises

Answer 2

And acute response to an external situational stressor. Ex/ husband difficulty @work lets out anger on family- Jen afraid to invite friends over because mom is alcoholic REFER TO AGENCY ASSISTANCE/COUNSELOR

Question 3

Class 2: crises of anticipated life transitions

Answer 3

Is that expected to happen?!? Normal life-cycle transitions that may be anticipated but the individual feels lack of control of. Ex/ student complaining of numerous VAGUE PHYSICAL COMPLAINTS-has low grades. Works over time. Wife lost job. Cannot study as much. INTERVENTION: PHYSICAL EXAM. FIND PROBLEMS AND VENT. REFER TO SERVICES OF FINANCIAL/OTHER. REASSURE AND GRIEF WORK/ FIND SELFWORTH

Question 4

Class 3: crises resulting from traumatic stress

Answer 4

Crisis precipitated by unexpected external stresses over which the individual has LITTLE OR NO CONTROL. Ex/ Sally is kidnapped and raped. She is now constantly in fears. or home destroyed by tornado INTERVENTION: EXPLORE FEELINGS AND DISCUSS STAGES OF GRIEF, IDENTIFY SUPPORT SYSTEMS AND NEW METHODS OF COPING

Question 5

Class 4: maturational/ developmental crises

Answer 5

Crises that occur in response to situations that trigger emotions R/T UNRESOLVED CONFLICTS IN ONE’S LIFE. INTERVENTION: HELP PT IDENTIFY THE UNRESOLVED DEVELOPMENTAL ISSUE

Question 6

Class 5: crisis reflecting psychopathology

Answer 6

Emotional crises in which PRE-EXISTING PSYCHOPATHOLOGY has been instrumental in precipitating the crisis ex/ therapist tells client she’s moving and client with personality disorder wanders through traffic INTERVENTION: BRING ANXIETY LEVEL DOWN. VERBALIZE FEELINGS AND SOMEONE STAY W/PT TO REASSURE SECURITY AND SAFETY. POSITIVE REINFORCEMENT. POSSIBLY REFER TO LONG TERM CARE. THERAPIST SHOULD PURSUE ISSUE AT LENGTH

Question 7

Class 6: psychiatric emergencies

Answer 7

No previous history of psychiatric problem. Crisis situations in which general functioning has been severely impaired. Ex/acutely suicidal individuals, drug overdoses INTERVENTION: CHECK VITALS,MAINTENANCE OF ADEQUATE AIRWAY. VENTILATE FEELINGS IN FAMILY THERAPY AND WORK ON COPING METHODS.

Question 8

Crisis Intervention: Phase 1

Answer 8

Assessment: assess suicidal potential, assess support systems and coping methods:: nursing diagnoses are identified

Question 9

Crisis Intervention: Phase 2

Answer 9

Planning or therapeutic intervention: appropriate nursing actions are selected for the identified nursing diagnoses. Goals are established for crisis resolution.

Question 10

Crisis Intervention: Phase 3

Answer 10

Intervention: The actions that were identified in phase 2 are implemented. Use a reality-oriented approach. Identify what precipitated crisis. Show acceptance and set limits. Describe perception of the problem and compare. Explore feelings on things that cannot be changed. Find alternative coping strategies.

Question 11

Crisis Intervention: Phase 4

Answer 11

Evaluation of crisis resolution and anticipatory planning: reassessment is made to determine if the stated objective was achieved. Can the individual describe a plan of action for dealing with stressors?

Question 12

Anger Assessment

Answer 12

Frowning, clench fist, low-pitch through clench teeth, yelling, intense eye contact or avoidance of it, easily offended, defensive to criticism, passive-aggression, flushing face, intense discomfort-tension may lead to depression

Question 13

Aggression Assessment

Answer 13

In contrast to anger: aggression is almost always goal directed. Pacing, restless, verbal physical threats, loud voice, threats of suicide, overreaction to environmental stimuli

Question 14

Aggression (mild)

Answer 14

Sarcasm

Question 15

Aggression (moderate)

Answer 15

Slamming doors

Question 16

Aggression (severe)

Answer 16

Threats of physical violence against others

Question 17

Aggression (extreme)

Answer 17

Physical acts of violence against others

Question 18

The difference between anger and aggression

Answer 18

Aggression is almost always goal directed and has the aim of harm to a specific person or object

Question 19

Intent

Answer 19

It refers to behavior that is INTENDED to harm or destruction (not an accident)

Question 20

Risk factors

Answer 20

Past history of violence, client diagnosis, and current behaviors

Question 21

Crises occurs when

Answer 21

An individual experiences a stressor and perceives coping strategies to be ineffective

Question 22

Traumatic Event: Anxiety (panic) diagnosis OUTCOME:

Answer 22

Client will maintain anxiety at manageable level. ADMINISTER MEDS

Question 23

Nursing Diagnosis: risk for self-directed or other-directed violence: OUTCOME

Answer 23

The client will not harm self or others. The client will verbalize anger rather than hit others.

Question 24

Ineffective coping OUTCOME:

Answer 24

Client will be able to recognize anger in self and take responsibility before losing control.

Question 25

Spiritual Distress OUTCOME:

Answer 25

Client expresses belief and values about spiritual issues. Refer to AA MEETINGS

Question 26

Risk for post trauma syndrome OUTCOME:

Answer 26

Client demonstrates ability to deal with emotional reactions and individually appropriate manner. (Could have surviver’s guilt) ADMINISTER MEDS

Question 27

Ineffective community coping OUTCOME:

Answer 27

Client demonstrates increased activities to improve community functioning

Question 28

Dealing with aggressive pt

Answer 28

1. ensure that sufficient staff are available/ call assistance
2. Talk down patient
3. Punch pillows or “I’ll stay with you” PHYSICAL OUTLETS
4. Medicate
5. Call code
6. Restraint/seclusion

Question 29

Crisis intervention: problem solving process

Answer 29

Confront the problem, identify realistic changes, explore coping strategies, identify various alternatives, weigh the benefits and consequences, select the most appropriate alternative.

Question 30

Problem Solving Process

Answer 30

Confront the problem, identify realistic changes, explore coping strategies for what cannot be changed, identify various alternatives for coping w/the situation, weigh the benefits and consequences for each alternative, and select the most appropriate alternative