exam 2- mental health abuse Flashcards by Logan Kaiser

Anger

is what

can be

emotional response to frustration/ threat to ones needs

can be positive if expressed in healthy ways

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aggression

what is it
can be

reaction/behavior that results in verbal/physcial attack

can be used with violence or self defense

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Suicide and homicide

very common in anger and aggression

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aggression

Assault and violence

causes potential injury to person when aggression acts out

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who has anger and aggression

p
s a
m c i

ptsd,

substance abuse disorders,

multiple chronic illnesses

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anger and hostility causes what in patients

h
c d
I
disruption
cant

hypertension,

cardiovascular disease,

inflammation,

disruption in feeling pain

cant sleep

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Genetics

nueroboiologica-changes

risk factors

genetics- have high moa

neurobiological- changes in personality like Alzheimers, tumors

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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

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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

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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

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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

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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

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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

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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

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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

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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

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seclusion-
Can they be used together?

Anger and Aggression Nursing Process – Intervention: Assaultive Stage

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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

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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

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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

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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

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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.

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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

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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

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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