exam 2- mental health abuse Flashcards
Anger
is what
can be
emotional response to frustration/ threat to ones needs
can be positive if expressed in healthy ways
aggression
what is it
can be
reaction/behavior that results in verbal/physcial attack
can be used with violence or self defense
Suicide and homicide
very common in anger and aggression
aggression
Assault and violence
causes potential injury to person when aggression acts out
who has anger and aggression
p
s a
m c i
ptsd,
substance abuse disorders,
multiple chronic illnesses
anger and hostility causes what in patients
h
c d
I
disruption
cant
hypertension,
cardiovascular disease,
inflammation,
disruption in feeling pain
cant sleep
Genetics
nueroboiologica-changes
risk factors
genetics- have high moa
neurobiological- changes in personality like Alzheimers, tumors
predictors of violence
h
a
v a
voice
intense
I
recent
Assessment for anger/violence
hyperactivty
anxiety
verbal abuse
loud voice
intese eyecontant
intoxication
recent acts of violence
Assessment of anger/aggresion
see what when angry
important to
important to
when pt is experience anger- see it behaviorally
important to identify pts history of violence
important to identify triggers
Assessment questions for anger and abuse
does
have
mean
what
does patient have wish to intend harm
have a plan
means to carry out plan
what demographic they are in
what is primary outcome you want with pt with aggression
want them
trying
want
want them to express feelings and deescalate
trying to promote calm response
want to build rapport
De-escalation
invest
maintain
identify
be
avoid
give
be
Anger and Aggression Nursing Process – Intervention: Pre- Assaultive Stage
invest time
maintain calmness
identify what pt needs
be honest
avoid invading personal space
give clear options
be genuine
teamwork with aggressive patients
avoid
ensure
dont
provide
know/have
avoid wearing anything dangling
ensure enough staff
dont stand in front of patient
provide feedback-you seem upset
know layout/ have an escape
Restraints and seclusion
Assessments
level
level
s
h
t
n
c
Anger and Aggression Nursing Process – Intervention: Assaultive Stage
level of awareness
level of activty
safety
hydration
toileting
nutrition
comfort
seclusion-
What is the purpose of seclusion?
Anger and Aggression Nursing Process – Intervention: Assaultive Stage
safety of others while allowing pt to come back to reality
seclusion/ restrsints
What do we need to do when a patient is in seclusion?
Anger and Aggression Nursing Process – Intervention: Assaultive Stage
assess for ability to get them off asap
seclusion-
Can they be used together?
Anger and Aggression Nursing Process – Intervention: Assaultive Stage
no
debriefing-
Anger and Aggression Nursing Process – Intervention: Post Assaultive
allows staff to analyze what could have been better with the patient
if there’s nay education that may need to take place
documentation- restraints/seclusion
pts
least
int
pts
plan
ongoing
Anger and Aggression Nursing Process – Intervention: Post Assaultive
pts behavior leading up to restraint use
least restrictive methods used
interventions used
pts response
plan of care for restriant
ongoing evaluations
when pt is reintegrated into unit
discuss
behaviors
what
alterative
discuss what pt can learn
behaviors that occurred
what stressors they have
alternative ways to respond
overwhelmed pt in hospital
pt may
find ways
search
pt may respond in unusal ways when overwhelmed
find ways to reestablish means of dealing with hospitalization
search for solutions to patient distress
use of
these people
Anger and Aggression in Hospital Settings: Patient with marginal coping skills
These people use of anger and intimidation very quickly
These people externalize blame.
Interventions for the client with marginal coping skills
provide
reduce
offer
be
teach
Provide comfort items
Reduce ambiguity
offer Distraction
be Predictable
Teach alternative behaviors
leave
withdraw
have a
Alternative Interventions for the client with marginal coping skills – when teaching alternatives isn’t successful
Leave the room
Withdraw attention
have aPredictable routine
Predicators of violence
History
Impulsivity
Situational factors for violence
v/p
intrusive
unrealsitc
feelings
perception
Vulnerability and powerlessness
Intrusive procedures
Unrealistic expectations
Feelings of being ignored
Perception that they’re not unique
Interventions for patients with cognitive deficits
what meds
what aids
controlling
giving
what manner
offer
Sedating medications
Orientation aids
Controlling the environment
giving Routine
Calm and unhurried manner
offer Validation
Family Abuse and Violence comorbidity
a
d
s
p
anxiety
depression
suicidal ideation
PTSD
risk factors for abuse
perceived
reminds
dont
unwanted
interferences
perceived as different through different traits or abnomralites
reminds pt of ex spouse
dont live up to fantasy
unwanted pregancies
interference with bonding
The Perpetrator Characteristics
p/c
j
p
sa
Power and control
Jealousy
Possessiveness
Substance abuse
types of family abuse
p
s
e
n
e
Physical
Sexual
Emotional
Neglect
Economic
The Vulnerable Person characteristics
p
move
c
e
Pregnancy
Move toward independence
Children
Elderly
tension building stage
minor incidents- p/s/va
victim
abusers
minor incidents- pushing, shoving, verbal abuse
victim ignores or accepts behaviors due to fear of escalation
abusers rationalize behavior
honeymoon stage
abuser
feels
gives
abuser demonstrates kindness and loving behaviors
feels remorseful
gives presents
acute battering stage
tension
triggered
tension peaks
triggered by external event
older adults abuse
defined
risk factors
defined as anything that creates a risk for harm
risk factors- poor mental health and disruptive //highly dependent
general assessment abuse
screen
symptoms
all
screen everyone for abuse
symptoms may be vague
all assessments should include history of abuse and violence or drugs
interview guidelines DO
conduct
be
ask
be
assess
help
conduct interview in private
be direct
ask pt to clarify
be attentive
assess safety
help reduce danger
interview guidlines dont
try
display
place
allow
probe
try to prove it
display horror or shock
place blame
allow pt to Geel at fault
probe for questions pt is unwliining to give
anxiety-
living with
s/s that its difficult to talk about-h,lack,use
s/s-h. I, gi
Family Abuse and Violence Assessment
living with chronic stress
difficult- hesitation, lack of eye contact , use of vague statments
s/s-hypertension, irritability, gi distrubances
coping responses
may
may take
Family Abuse and Violence Assessment
may isolate
may take form of flawed beliefs or myths
suicide potential
sometimes
children
family abuse
sometimes feel like its the only way out of a terrible relationship
children who were abused are at risk for suicide as an adult
drug and alcohol abuse
may
family abuse
may self medicate to get away from the situation
family coping patterns
s/s
potentials
type
coping
use
any
Family Abuse and Violence Assessment
s/s of abuse
potentials for abuse
type of abuse
coping
use of drugs
any ideas of suicide
primary prevention
reducing s
reducing i
increasing s
increasing c
increasing s
Intervention
preventing it from happening
reducing stress
reducing influence of risk factors
increasing social support
increasing coping skills
increasing self esteem
secondary prevention
early
providing
early interventions to minimizing long term effects
providing support therapy and groups
counseling
people have right to live without
v
p
a
violence
physical harm
and assault
safely plan
plan
identify
plan for rapid escape when abuse recurs
identify signs of violence that tells them time to leave
shelters/sfe houses
open
if a
open 24 hours
if a partner chooses to leave due to violence
case management
what is involved
coordinate -c,m,s
family abuse
community centers are involved in serving victims
coordinate community, medical and social services to families
health teaching/promotion abuse
learning
recongize
explain
learning to recognize behaviors that trigger violence
recognize when children are at risk and make referrals
explain normal development and changes
Individual therapy
goals
addressing
helpful
Advance Practice Interventions
goals are for empowerment
addressing symptoms of depression anxiety and ptsd
helpful to understand pts feelings
Group therapy
working in
groups can
can create
advance practice interventions
working in a group can help diminish feelings of isolation
groups can help abuser see patterns that they can change
can create a feeling of community and healing
Family therapy
each
interventions
will
learn
refrain
Advance Practice Interventions
each part of family needs attention
interventions increase positive interactions in family members
will recognize destructive patterns of behavior
learn alternative responses
refrain from abusive behavior
evaluation
failure
nursing process
failure can be due to systems that we live in
What can a nurse do?
SCREEN ALL PATIENTS!
Do not act on stereotyped thoughts
What can a Nurse Do?
keep
keep
keep
rmcourage
referral
Keep asking,
keep listening,
keep bridging to services
Encourage a safety plan, a plan for a fast escape when violence recurs
Referral phone numbers may be kept for years before the decision to call is made
Sexual Assault is-
rape is-
SA-unwatnted sexual advances and harassment to rape
R- any activity that involves penetration
Sexual Assault stranger rape
when a stranger does the raping
Sexual Assault marital rape
when a spouse makes advances without consent
Sexual Assault date reape drugs
g
r
k
GHB
rohypnol
ketamine
will feel
want to
collect
what’s important
sexual assualt
will feel very low self esteem, depressed
want to provide a safe environment
collect evidence
social support is very important
