Chapter 9: Crisis Intervention - Exam 2

Question 1

what is a crisis?

Answer 1

a sudden event during which usual coping mechanisms cannot resolve the problem, the crisis disturbs homeostasis

Question 2

what are the phases in crisis development?

Answer 2

1. exposed to precipitating stressor
2. previous prob-solv tech dont work, anxiety increases
3. all possible resources are called on to resolve problem
4. if no resolution, tension mounts beyond threshold to a breaking point, leads to drastic results for individual

Question 3

what do we assess (in patients) during stressful or crisis events

Answer 3

1. individual perception of the event
2. availability of support
3. adequate coping mechanisms

Question 4

what is a dispositional crisis

Answer 4

acute response to external stressor

eg stressful day at work then yell at family

Question 5

what is traumatic stress

Answer 5

stress from a traumatic event e.g., sexual assault, house fire, etc

Question 6

what is crisis reflecting psychopathology?

Answer 6

seen in personality disorders, extreme responses to crisis e.g., patient threatens to kill themselves when they get broken up with.

Question 7

what is the minimum therapeutic goal of crisis intervention

Answer 7

psychological resolution of the individual’s immediate crisis and restoration to at least the level of functioning that existed before the crisis period

Question 8

Phases of intervention - how will a nurse approach the crisis

Answer 8

you guessed it…use the nursing process

assesss
plan therapeutic intervention
intervention
evaluate

Question 9

what is comorbidity?

Answer 9

the simultaneous presence of two or more medical conditions

Question 10

Individuals with psychiatric disorders are five times more _____ than those without

Answer 10

violent

Question 11

it is thought that anger is a _______ emotion

Answer 11

secondary; typically masks grief, pain, saddness

Question 12

a major difference between anger and aggression is ________

Answer 12

intent

Question 13

anger is an ________ while aggression is an _________

Answer 13

emotion; action

Question 14

What is the best predictor of a patient being violent

Answer 14

having a history of violence

Question 15

Robert’s Seven Stage Crisis Intervention Model
(sounds like we need to memorize it)
Page 179 Table 9.2

Answer 15

1. psychosocial and lethality assessment
2. rapidly establish rapport
3. identify the major problem or precipitating factors
4. deal with feelings/emotions
5. generate and explore alternatives
6. implement action plan
7. follow up

Question 16

Important to remember for your own (the nurse’s safety)

Answer 16

don’t ever position yourself in a room you can’t get out of

always trust your instincts - if you don’t feel safe. Get help.

Question 17

Steps to handle aggressive or escalating behavior

Answer 17

• calmness
• encourage patient to express feelings
• personal space
• avoid accusatory statements
• offer client choices
• reassure their safety

Question 18

what is a B52

Answer 18

• Pharmacological intervention
• IM or PO
• benadryl, 5mg haladol, 2 mg ativan
• used in acute crisis (not something given around the clock)

Question 19

This type of therapy is seen to be especially helpful for male psychiatric patients who are experiencing violence/anger

Answer 19

dialectal behavioral therapy

Question 20

what does dialectal mean?

Answer 20

adjective
1.
relating to the logical discussion of ideas and opinions.

2.concerned with or acting through opposing forces.

‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it’s possible for you to achieve both of these goals together.

Question 21

what is disaster nursing

Answer 21

disasters such as 9/11, hurricane Katrina, Nashville floods in 2010

disasters leave victims with damaged safety, limited resources, emotional trauma

Question 22

dispositional crisis

Answer 22

an acute response to an external situational stressor

example - patient is an abusive relationship and flees their abuser

Question 23

crises to anticipated life transitions

Answer 23

normal life cycle transitions that may be anticipated but over which the individual may feel a lack of control

example - Tommy and Jane have just had a baby, money is tight and tommy has to work extra hours to support his family

Question 24

Crises resulting from traumatic stress

Answer 24

crisis precipitated by an unexpected external stressor over with the individual has little or no control and as a result of which he or she feels emotionally overwhelmed and defeated

example - ava left work one night and was sexally assaulted by 2 men, her physical wounds have healed but ava in unable to eat, sleep, or funtion.

Question 25

Crises maturational and developmental crisis

Answer 25

crises that occur in response to failed attempts to master developmental tasks associated with transitions in life

jane is under a lot of stress due to her mothers illness, jane has a young child and is increasingly disorganized and anxious, she believes she is a bad mother and should give up her child for adoption

Question 26

crises reflecting psychopathology

Answer 26

a crisis that is influenced or triggered by pre-existing psychopathology.

karen was diagnoised with borderline personality disorder and she fears abadonment. her doctor tells her that she will be moving out of state and karen freaks out. karen says everyone leaves her and that she should just disappear

Question 27

prodromal syndrome

Answer 27

not a diagnosis, a technical term.
indicates escalating behavior characterized by anxiety, tension, verbal abuse, profanity, hyperactivity, clenched fists, arguing, demanding, pacing, agitation

This is the warning stage. The event hasn’t happened yet and you may have not even recognized that it could happen. This is the time to assess the impact an actual crisis could have on your company, employees, customers, suppliers, operations and bottom line

Question 28

most assaultive behavior is preceded by a period of increasing _________________

Answer 28

hyperactivity

Question 29

true or false; NANDA does not include a seperate nursing diagnosis for anger because anger is not an unhealthy response

Answer 29

true

anger is one of a broad range of normal emotional responses but becomes unhealthy only when behavior is unsafe

a nursing diagnosis might be:
ineffective coping related to anger and feelings of blah blah blah

rick for self-directed or other-directed violence related to inadequate anger management

Question 30

the best intervention for a crisis (related to a patient’s anger/aggresion) is ____________

Answer 30

prevention

nurse must assess patient history of violence and violence potential, current behavior

Question 31

anger is often described as a _________ emotion

Answer 31

secondary

Question 32

what are some therapeutic nursing interventions when a patient is experiencing a crisis

Answer 32

reality-oriented approach,
remain with individual
show acceptance, active listening
set firm limits on aggresive behavior
acknowledge patient’s feelings

Question 34

Brittney and Ethan have been married for 3 years and have a 1 year old daughter. Ethan has been having difficulties at work and takes his anger out on Brittney to the point of physical abuse. One day Ethan slaps Britney. When Ethan leaves for work Britney takes the baby to an ER not know what to do.

This is an example of what type of crisis?

Answer 34

Dispositional crisis. An acute response to an external situational stressor.