Exam #1 Flashcards
what is general adaptation syndrome?
the physiological changes the body undergoes in response to stress
what are the three stages of adaptation syndrome?
alarm reaction, resistance, and exhuastion
what occurs in the alarm reaction?
this is when the fight or flight is activated
what occurs physiologically during fight or flight?
brain signals adrenal glands, pupils dilate, heart rate increases, respiration rete increases, muscles become tense, digestion is slowed, glucose becomes available, bladder relaxes, and shaky hands
what happens during the resistance stage?
the body tries to defend itself against the stressor
what happens if adaptation occurs in the resistance stage?
the body relaxes
what happens during the exhaustion phase?
the person breaks down and gives up
what happens if the person fails to adapt in the resistance phase?
the person moves to the exhaustion phase
what are some complications of being in the exhaustion stage?
CAD, stomach ulcers, and UC
what does a patient do that is experiencing mild anxiety?
they are crying, cursing, nail bitting, drinking, eating, fidgeting, and are displaying defense mechanisms
what does a patient do that is experiencing moderate anxiety?
defense mechanisms, fight or flight is activated, if not relieved it will cause CAD, elevated cortisol, tachycardia, and hyperglycemia in diabetics
what does a patient do that is experiencing severe anxiety?
neurosis, phyisc and emotional symptoms worsen, if not relieved it will cause CAD, elevated cortisol, tachycardia, and hyperglycemia in diabetics, perception is impaired
what does impaired perception mean in relation to severe anxiety?
cant concentrate, limited attention, and must be given one small task at a time
what is neurosis?
psychiatric disturbance caused by excessive anxiety…..common disorders that cause?????….panic, phobia, somatic, dissociative
what does a patient do that is experiencing severe anxiety?
cant focus on anything, overwhelmed with terror, disorganized thought, exhausted, elevated fight or flight, hallucinations, delusions, feelings of insanity
what do you asses in a patient experiencing severe anxiety?
AAO, hygiene, and??
what is the defense mechanism rationalization mean?
attempt to make excuses for justifying bad behavior
what is an example of the defense mechanism rationalization?
I drink every day to cope with my job
what is the defense mechanism denial mean?
refusing to acknowledge the problem
what is an example of the defense mechanism denial?
I drink every day but im not addicted
what is the defense mechanism repression mean?
involuntary blocking of traumatic events
what is an example of the defense mechanism repression?
forgetting that my family was murdered
what is the defense mechanism suppression mean?
voluntarily blocking unpleasant experience
what is an example of the defense mechanism suppression?
I dont want to think about Camp Taco yesterday
what is the defense mechanism isolation mean?
separating thought or memory from the feeling or emotion associated with it
what is an example of the defense mechanism isolation?
the woman states that she was raped but says it with no emotion
what is Maslow hierarchy of needs?
a pyramid that shows what people need in order to reach self-actualization/be the best version of themselves
what are the parts of the Maslow’s hierarchy of needs?
physiological needs, safety needs, love/belonging, esteem, and self actualization
what does physiological needs mean on Maslow’s hierarchy of needs?
air, water, food, reproduction
what does safety needs mean on Maslow’s hierarchy of needs?
personal security, employment, resources health
what does love/belonging needs mean on Maslow’s hierarchy of needs?
friendship, intimacy, sense of connection
what does esteem needs mean on Maslow’s hierarchy of needs?
respect, self esteem, status, recognition
what does self-actualization mean on Maslow’s hierarchy of needs?
desire to become the best one can be
what happens to the immune system from prolonged fight or flight?
risk of infection
what is an immediate response to anxiety?
fight or flight
what is a sustained response to anxiety?
body respods, tachycardia, respiration rate increase
what are the stages of grief?
denial, anger, bargaining, depression, and acceptance
what does denial in relation to grief mean?
not believing what is being said is true
what does anger in relation to grief mean?
a response to grief when the person cant do anything to help or feels like the person does not deserve it
what does bargaining in relation to grief mean?
asking to have more time or to make it to a certain point
what is depression in relation to grief mean?
being overwhelmed by sadness
what does acceptance in relation to grief mean?
understanding what is going to happen will happen
what are some examples of adaptive grief?
sadness, anger, guilt, helplessness, hopelessness, and despair
what does autonomy mean for a patient?
able to make decision for themselves
what does beneficence mean?
doing things for good and not wanting something in return
what does nonmaleficence mean?
to not harm the patient
what does justice mean?
the right of the individual to be treated fairly
what does veracity mean?
telling them the truth
what does advocacy mean?
standing up for the patient
at what point can a patient not refuse medications?
if their is a court order placed
who decides if a patient has to take medications?
the fed and state
client has the right to refuse medications unless??? page 45
harm to self or others…. court order..not competent…reasonable chance to help the client
what does duty to warn mean?
nurses have the obligation to report threats made towards someone
what does mandated reporter mean?
nurses are required to report any suspicion of abuse
what happens in relation to consent when someone is deemed incompetent
next of kin will sign
when should restraints and seclusion never be used?
as punishment or as a way to control
in an emergency, how quickly must you get an order for restraints?
within 15-30 minutes
how long does an order last for restraints?
4 hours
how often do you lay eyes on your patient in restraints?
every 15-30 minutes
what is a voluntary admission?
when a patient admits themselves into the unit
how long can voluntary patients stay at the hospital?
as long as they need to
can voluntary patients leave when they want to?
yes
at what point can voluntary patients not leave?
if the physician and court system says they are not ready to go
what criteria must be met for a physician to hold a patient?
the patient must be harmful to themselves or others
what is an involuntary hold?
when the patient is forced to come because they are a harm to themselves or others or they cant take care of their personal needs
how long do involuntary holds last?
72 hours
what happens after the 72-hour hold?
the patient is D/c, voluntarily admitted, involuntarily admitted
how long does the court have to decide on what to do after an involuntary admission?
7-21 days
what does grave disabled / mentally ill mean?
??
what is malpractice?
an that does not meet the standard of care put forth by the professional organization
what does negligence mean?
failure to exercise the care towards others that reasonable people would or would not do
what is battery?
treatment done against the will of the patient….actually touching them
what is assault?
act that results in fear that he or she will be touched
what is a crisis?
an acute event where coping mechanisms do not work
what happens during phase 1 of crisis development?
exposure to stressors which starts anxiety
what happens during phase 2 of crisis development?
previous problem-solving does not work…anxiety increases…confusion, disorganization, and helplessness
what happens during phase 3 of crisis development?
all possible resources are called upon to relieve discomfort…fight, flight, freeze started…a new coping mechanism may develop
what happens during phase 4 of crisis development?
panic occurs…breaking point is reached…anxiety is unmanageable…major disorganization…emotions running wild… psychotic-like behavior..psychosis
how do you speak to someone in phase 4 of a crisis?
what is a dispositional crisis?
acute response to an external situation
what is an example of a dispositional crisis?
dads employer is being mean to him….wife buys child clothes that are too expensive and the dad beats the child
what anticipated life transition?
normal life cycle transitions
what is an example of an anticipated life transition
parents are sad that they are sending their child to college
what is crises resulting from traumatic stress?
unexpected stressor
what is an example of a crisis resulting from traumatic stress?
a person is abducted and raped….the person now has dreams and doesn’t feel safe alone
what is a maturational and developmental crisis?
occurs at failed attempts to master tasks associated with ageing
what is an example of maturational and developmental crisis?
a lady has a child but her mother was just diagnosed with cancer and now the mother can no long take care of the child because she is with her mother
what is crisis reflecting psychopathology?
the crisis triggered by bipolar, schizo, depression etc
what is a crisis from a psychiatric emergency?
general function is impaired and is incompetent due to suicide, OD, alcohol, LSD, shrooms, acut psychosis, and uncontrollable anger
what does assess mean in relation to crisis intervention?
gather information about what happened…..get a description of the event…have they been in this scenario before….suicide risk
what does plan mean in relation to crisis intervention?
nurse selects appropriate response and goals are established
what does intervention mean in relation to crisis intervention?
rapid relationship established..reorient the clien…remain with them….active listening…clarify the problem
what does evaluate and anticipatory planning mean in relation to crisis intervention?
evaluate and reassess outcomes….can they handle the situation in the future
what is anger?
a secondary emotion that helps recognize true feelings
what is aggression?
can be mild to severe….intent to hurt someone….intent is required for aggression
what are key parts to a therapeutic relationship?
rapport, trust, respect, genuineness, and empathy
what does rapport mean in relation to a therapeutic relationship?
acceptance…takes time to build…built with casual conversation
what does trust mean in relation to a therapeutic relationship?
reliability and keeping your word
what does respect mean in relation to a therapeutic relationship?
not judging them on their past
what does genuine mean in relation to a therapeutic relationship?
open, honest, and real
what does empathy mean in relation to a therapeutic relationship?
understanding that your client is feeling a certain way without showing emotion
what is the difference between empathy and sympathy?
sadness or anger for them`
what is included in pre interaction stage?
obtain chart information….examine your own feelings, fears and anxieties….personal history
what is included in the orientation stage?
establish trust and rapport….gather assessment information… identify clients strengths and weaknesses…set goals…develop plan for goals…
what is included in the working stage?
maintain trust and support….promote insight/perception of reality…problem solving…overcoming resistance behavior…..continue to evaluate progress….notice signs of transference/countertransference
what is transference?
from client to care giver…..feeling or emotion based on preconceived notions that put you off
what is countertransference?
caregiver to client
what is included in the termination stage?
progress has been made…..establish plan for continuing care…feelings about termination are explored
what is the therapeutic communication technique “using silence” mean?
giving them moments to think before responding
what is the therapeutic communication technique “offering general leads” mean?
let the client go on about the topic and conversation
what is an example of offering general leads?
Oh I see what your saying and then what
what is the therapeutic communication technique “placing events in sequence” mean?
a talking technique where you let the patient tell you everything lead up to the point they are at now
what is the therapeutic communication technique “making observations” mean?
help the client be aware of there emotions
what is an example of making observations?
you look anxious
what is the therapeutic communication technique “restating? mean?
confirming what the patient said by rewording their statement
what is the therapeutic communication technique “reflecting” mean?
bouncing a question back at them when they ask you
what is the therapeutic communication technique “focusing” mean?
specific discusion about a word they said they are feeling
what is an example of focusing?
the patient states that they are anxious and you ask them to tell you more
what is the therapeutic communication technique “exploring” mean?
asking more about
what is the therapeutic communication technique “seeking clarification and validation” mean?
let them know that you understand or don’t understand their statements
what are some non therapeutic forms of communication?
approving/disapproving…false reassurance…giving advice…probing…requesting explanations…. belittling…stereotype comments
what are some characteristics of active listening?
sitting squarely…open posture…lean forward…eye contact..relaxed
what are some health care disparities?
lack of insurance, access to healthcare, cultural bias, language barrier
what are some predisposing factors that may lead to someone being a victimizer
neurophysical, biochemical, genetic, brain disorders, psychodynamic, low tolerance for frustration, learning theory, sociocultural
what is intimate partner violence?
aka domestic violence….trying to control their spouse..can be emotional, sexual, physical, or spiritual
what is assault?
the threat of doing harm to someone
what is battery?
the act of actually touching/doing harm
what are some characteristics of a victimizer?
low self-esteem, jealousy, dual personality, threatened by partner independence, degrading, humiliating, intimidation, ensuring the victim is dependent on them
what are some characteristics of a victim?
low self esteem, nondiscriminatory, helplessness, guilt, anger, fear, shame, isolated from friends/family, looks at the relationship as male-dominant
what happens during phase 1 of abuse
tension is building….victimizer becomes angry…lashing out…victimizer apologizes…victim is nurturing…the battery that occurs is minor ex pushing
what happens during phase 2 of abuse?
acute battering incident…..most violent stage…..shortest…cant last for 24 hours….victimizer tries justify behavior and minimize severity….victim tries to find the safest place for themselves and children
what happens between phase 1 and phase 2?
trigger event
what happens during phase 3 of abuse?
honeymoon phase…victimizer becomes loving….promises that it wont happen again…victimizer becomes afraid the victim will leave….plays on the victim senses of guilt
what are some reasons that someone who is being abused stays in the relationship?
fear of life or children’s life….fear of retaliation….fear of losing custody…financial dependence…lack of support….cutlural/religious….hope…lack of confidence
what should a nurse do whe caring for a patient who has experienced intimate partner violence?
treat injuries first…take photos for documentation…provide privacy….encourage discussion…avoid rescue….provide resources…stress safety…..can report unless the patient wants you too
what are some signs of physical abuse in children?
burns, bites, bruises, broken bones….unexplained absence from school…shrinks at adults…abuses animals…scared of parents…crying when leaving school…
what is physical abuse in children?
nonaccidental injury to a child from a parent or caregiver
what is emotional abuse in children?
impairment of social and intellectual function
what are some examples of emotional abuse?
belittling, rejection, ignoring, blaming,
what are some behaviors associated with emotional abuse?
inappropriately infantile, adult-like, delayed physical/emotional development, has attempted suicide
what are some examples of neglect?
inadequate supervision, love, support, physical, or emotional abuse
how might a child experiencing neglect act?
absence from school, begging for food, stealing food, doesn’t have medical/dental care, dirty, not dressed correctly, drug abuse, states no one is providing care
what should you focus on when you suspect child abuse?
perform assessment, treat wounds, note injuries, make sure injuries align with parents’ story, act out incident, determine if the injuries
signs of sexual abuse in children?
nightmares/bedwetting, change in appetite, advanced sexual knowledge, participating in sexual activity early, pregnancy/UTI before 14, runs away, reports, bleeing/trauma from genitalia, difficulty walking/sitting
what are some symptoms of incest?
difficulty navigating affection, low self esteem, feeling trapped, avoiding/ participating in sex early, libido issues, pain during intercourse, ED, depression, anxiety, substance abuse, eating disorder, SI, unstable relationships
what is acquaintance rape?
when the victim knows their victimizer
what is marital rape?
when the victim is in a relationship with their victimizer
what is statutory rape?
rape between someone who can consent with someone who cant
what is expressed response pattern in relation to rape?
within a few hours and symptoms are fear, anxiety, crying, restless
what is a controlled response in relation to rape?
within hours….masked feelings
what is a silent reaction in relation to rape?
dont say anything about it
what is compound rape response?
other issues arris from the rape
what are some risk factors for child abuse?
young children, use of substances, stressful life situations, lack of coping, expecting child to be perfect, chronic child illness, ill-equipped parents
what happens during the pre-interaction phase?
obtain information about the client and examine your own beliefs
what happens during the orientation stage?
Establish trust and rapport
Gather assessment information
identify clients’ strengths and weakness
Set mutually agreeable goals
Develop a plan of action to meet goals
Explore the feelings of clients and nurses
what happens during the working stage?
Maintain trust and rapport
Promote insight/perception of reality
Saying that they may see something and you don’t
Problem-solving
Overcoming resistance behaviors
Push back against therapy
Continue to evaluate progress
what happens during the termination stage?
Progress has been made
Establish a plan for continuing care
Feelings about termination are explored
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