Exam 5 Flashcards
the concept of ___-___ response was known as shell shock, battle fatigue, accident neurosis, or posttraumatic neurosis.
post-trauma
the DSM-IV-TR described trauma that precedes ___ as an
event outside the range of usual human experience
Rape, war, physical attack, torture, or natural/manmade disaster
PTSD
Less than __% of trauma victims will develop PTSD
10
true or false: PTSD is more common in women than in men.
TRUE
Individuals who have difficulties with stress reactions to more “normal” events may be diagnosed with ____ disorder.
adjustment
adjustment disorders are more common in what demographics but can occur at any age
- women
- unmarried persons
- adolescents
Extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects
Trauma
A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or manmade disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes
PTSD
PTSD symptoms may begin within the first __ months after the trauma
May be a delay of several months or even years
3
The full symptom picture of PTSD must be present for more than __ month and cause significant interference with social, occupational, and other areas of functioning
1
similar to PTSD in terms of precipitating traumatic events and symptomatology.
Symptoms are time limited.
Up to 1 month following the trauma
If symptoms last longer than 1 month, the diagnosis is PTSD.
Acute stress disorder (ASD)
Seeks to explain why some individuals exposed to massive trauma develop PTSD while others do not
psychosocial theory
variable of the psychosocial theory include characteristics
1.
2.
3.
- traumatic experience
- the individual
- the recovery environment
specific characteristics have been identified as crucial in the determination of an individual’s long term response to stress
- stress and duration of stressor
- anticipatory grief
- exposure to death
- numbers affected by life threat
- amount of control over recurrence
- location where the trauma was experienced
the traumatic experience
variables that are considered important in determining an individual’s response to trauma include
- degree of ego-strength
- effectiveness of coping resources
- presence of preexisting psychopathology
- outcomes of previous experiences with stress and trauma
- temperament
- current psychosocial developmental stage
- demographics
the individual
the quality of the environment in which the individual attempts to work through the traumatic experience is correlated with the outcome
the recovery environment
Negative reinforcement leads to the reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior.
Avoidance behaviors
Psychic numbing
learning theory
these models consider the cognitive appraisal of an event and focus on world assumptions an individual makes about the world
cognitive theory
3 fundamental beliefs that people construct within a personal theory of reality (cognitive theory)
When there is some disequilibrium then we call on these fundamental beliefs to deal with the trauma
The world is benevolent and a source of joy.
The world is meaningful and controllable.
The self is worthy.
Dysfunctions in the ___-pituitary-adrenal axis have been linked to psychiatric illnesses including PTSD, depression, Alzheimer’s disease, and substance.
hypothalamic
studies have shown ___ administered shortly after exposure to a trauma reduced the incidence of PTSD
opioids
____, dopamine, and benzodiazepine receptors are other neurotransmitters believed to be dysregulated in individuals with PTSD.
norepinephrine
describes a philosophical approach that values awareness and understanding of trauma when assessing, planning, and implementing care
trauma-informed care
trauma informed care
___ the widespread impact of trauma and various paths for recovery
___ the signs and symptoms of trauma in clients, families, staff, and all those involved with the system
___ by fully integrating knowledge about trauma in policies, procedures, and practices
___ to actively resist traumatization
realizes
recognizes
responds
seeks
Nursing diagnoses for trauma-related disorders
- postrauma syndrome
- complicated grieving
Defined as “a sustained maladaptive response to a traumatic, overwhelming event”
post trauma syndrome
Defined as “a disorder that occurs after death of a significant other in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment”
complicated grieving
these are ___ __ goals for post-trauma syndrome
the client will begin a healthy grief resolution initiating the process of psychological healing
the client will demonstrate ability to deal with emotional reactions in an individually appropriate manner
short-term
short term goal for complicated grieving diagnosis
client will verbalize feelings (guilt, anger, self-blame, hopelessness) associated with the trauma
this a ___-term goal for complicated grieving diagnosis
client will demonstrate progress in dealing with stages of grief and will verbalize a sense of optimism and hope for the future
long
Characterized by a maladaptive reaction to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms
adjustment disorders
adjustment disorder symptoms occur within __ months of the stressor and last no longer than __ months
3
6
perceptions, emotions, anxieties, interpersonal, social, or economic events that are considered threatening to ones physical health, personal safety, or well being
stress
This category is the most commonly diagnosed adjustment disorder.
The clinical presentation is one of predominant mood disturbance, although less pronounced than that of major depressive disorder (MDD).
adjustment disorder with depressed mood
the symptoms of this adjustment disorder include those such as depressed mood, tearfulness, and feelings of hopelessness, exceed what is an expected or normative response to an identified stressor.
adjustment disorder with depressed mood
Predominant features of this category of adjustment disorders include
Disturbances in mood (depression, feelings of hopelessness and sadness)
Manifestations of anxiety (nervousness, worry, jitteriness) more intense than would be expected to be a normative response to an identified stressor
adjustment disorder with mixed anxiety and depressed mood
this adjustment disorder is Characterized by conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules
Examples include truancy, vandalism, reckless driving, fighting, and defaulting on legal responsibilities.
Differential diagnosis must be made from conduct disorder or antisocial personality disorder.
adjustment disorder with disturbance of conduct
Predominant features of this category of adjustment disorders include Emotional disturbances (e.g., anxiety or depression) Disturbances of conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules (e.g., truancy, vandalism, fighting)
adjustment disorder with mixed disturbance of emotions and conduct
This subtype of adjustment disorder diagnosis is used when the maladaptive reaction is not consistent with any of the other categories.
The individual may have physical complaints, withdraw from relationships, or exhibit impaired work or academic performance, but without significant disturbance in emotions or conduct.
adjustment disorder unspecified
with an adjustment disorder the individual shows ___ in social and occupational functioning or exhibits symptoms that are in excess of an expected reaction to the stressor
impairment
with adjustment disorders the ___ can be almost anything but an individual’s response to a particular stressor cannot be predicted
stressor
___ theory looks into how genetic factors influence individual risk for maladaptive response to stress and Vulnerability related to neurocognitive or intellectual developmental disorders
biological
this theory views adjustment disorder as a maladaptive response to stress caused by early childhood trauma, increased dependency, and retarded ego development. Other factors that influence adjustment disorder include
Vulnerability related to neurocognitive or intellectual developmental disorders
psychosocial theories
this theory takes into consideration the interaction between the individual and the environment, the type of stressor,
situational factors, and intrapersonal factors
transactional model of stress and adaptation
what are the nursing diagnoses for adjustment disorder
- complicated grieving
- risk-prone health behavior
- anxiety
these are nursing ___ to be done on a patient with adjustment disorder
Adaptive progression through the grief process
Helping the client achieve acceptance of a change in health status
Assisting with strategies to maintain anxiety at a manageable level
interventions
nursing diagnosis
“impaired ability to modify lifestyle/behaviors in a manner that improves health status”
risk-prone health behavior
treatment for trauma related disorders includes
cognitive theory
prolonged exposure therapy
group/family therapy
eye movement desensitization and reprocessing
____
psychopharmacology
this is a treatment for trauma-related disorders
strives to help the individual recognize and modify trauma-related thoughts and beliefs.
The individual learns to modify the relationships between thoughts and feelings, and to identify and challenge inaccurate or extreme automatic negative thoughts.
Goal is to replace these negative thoughts with more accurate and less distressing thoughts, and cope more effectively with feelings such as anger, guilt, and fear.
cognitive theory
behavioral therapy similar to implosion therapy or flooding.
Conducted in an imagined or real (in vivo) situation
In the imagined situation, the individual is exposed to repeated and prolonged mental recounting of the traumatic experience
serves to neutralize the memories so that they no longer result in anxious arousal or escape and avoidance behaviors
Prolonged exposure therapy (PE)
PE has ___ parts
- Education about the treatment
- Breathing retraining for relaxation
- Imagined exposure through repeated discussion about the trauma with a therapist
- Exposure to real-world situations related to the trauma
four
Strongly advocated for clients with PTSD and has proved especially effective with military veterans
Share their experiences with empathetic fellow veterans
Talk about problems in social adaptation
Discuss options for managing aggression toward others has been emphasized
group/family therapy
Integrative psychotherapy approach with a theoretical model that emphasizes brain’s information processing system and memories of disturbing experiences as the basis of pathology
the process involves rapid eye movements while processing painful emotions
while concentrating on a particular emotion or physical sensation surrounding the traumatic event, the client is asked to focus his or her eye movements on the therapists fingers as the therapist moves them from left to right and back again
eye movement desensitization and reprocessing (EMDR)
treatment for trauma related disorders
Although some individuals report rapid results with this therapy, research has indicated that between 5 and 12 sessions are required to achieve lasting treatment effects.
Treatment encompasses an eight-phase process.
eye movement desensitization and reprocessing (EMDR)
what is the first line of treatment of choice for PTSD because of their efficacy, tolerability, and safety ratings
SSRIs
what medication is used to treat trauma related disorders
antidepressants
anxiolytics
antihypertensive
other medications
treatment for adjustment disorders include Individual psychotherapy Family therapy Behavior therapy Self-help groups Crisis intervention
psychopharmacology
Paroxetine and Sertraline are ___ used as the first line of treatment for PTSD
SSRIs
Two months ago, Ms. T was sexually assaulted while jogging in an isolated park. She is hospitalized for suicidal ideation at this time. She awakens in the middle of the night screaming about having nightmares of the incident. Which of the following is the most appropriate initial nursing intervention?
A. Call the doctor to report the incident.
B. Stay with Ms. T until the anxiety has subsided.
C. Administer prn alprazolam.
D. Allow her some privacy to work through the emotions.
B
Which of the following medications is considered to be a first-line medication of choice in the treatment of PTSD? A. Alprazolam B. Propranolol C. Carbamazepine D. Paroxetine
D.
the ___ contains the appetite regulation center within the brain and It regulates the body’s ability to recognize when it is hungry, when it is not hungry, and when it has been sated.
hypothalamus
___ and ___ influence eating behaviors
society
culture
more prevalent than anorexia nervosa
Onset occurs in late adolescence or early adulthood
Occurs primarily in societies that place emphasis on thinness as a model of attractiveness for women
bulimia nervosa
recurrent episodes of eating significantly more than people would eat in a similar time period under similar circumstances.
binge-eating disorder (BED)
with binge-eating disorder the episodes occur at least once a week for at least ___ months
3
this is the most common eating disorder and affects women twice as often as men
weight gain leading to obesity is a major health risk associated with this disorder
binge-eating disorder
defined as a body mass index (BMI) of 30 or greater.
obesity
true or false: obesity is considered a mental health disorder
FALSE
the percentage of obese individuals in the U.S. is higher in what demographics
non-Hispanic black and Hispanic
prolonged loss of appetite
anorexia
a subjective concept of one’s physical appearance based on the personal perceptions of self and the reactions of others
body image
Characterized by morbid fear of obesity
anorexia nervosa
Symptoms include: Gross distortion of body image Preoccupation with food Refusal to eat Weight loss is excessive, with some individuals who present for health-care services weighing less than 85 percent of expected weight.
anorexia nervosa
other symptoms of anorexia include Hypothermia \_\_\_\_\_ Hypotension Edema Lanugo Metabolic changes Feelings of anxiety and depression are common.
bradycardia
true or false: anorexia nervosa patients do not experience hunger
FALSE
they suffer from pangs of hunger and it is only when their intake is less than 200 calories that they don’t feel hunger
how does a patient with anorexia nervosa have a distorted body image
they view themselves as fat when they are obviously underweight
Which is characteristic of the diagnosis of anorexia nervosa? A. Obsession with weight gain B. Body image disturbance C. Disregard for the feelings of others D. Healthy family relationships
B.
excessive insatiable appetite
bulimia
An episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (bingeing)
Episode is followed by inappropriate compensatory behaviors to rid the body of the excess calories (self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
bulimia nervosa
what kind of foods will patients with bulimia nervosa eat
high caloric content, sweet taste, and a soft or smooth texture that can be eaten rapidly
Most clients with ___ are within a normal weight range, some slightly underweight, and some slightly overweight.
Depression, anxiety, and substance abuse are not uncommon.
Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalances.
Fasting or excessive exercise may also occur.
bulimia
Which assessment finding would the nurse expect to find in clients diagnosed with bulimia?
A. They are below normal weight.
B. They binge when they experience hunger.
C. They will be highly motivated to seek help.
D. They are within their normal weight range.
D.
An eating disorder that can lead to obesity.
Individual binges on large amounts of food, as in bulimia nervosa.
Binge-eating disorder
how does binge-eating disorder differ from bulimia nervosa
the individual doesn’t engage in behaviors to rid the body of the excess calories
___% of individuals with BED have a history of depression
50
some individuals with bulimia nervosa develop Russell’s sign which is what
calluses on the dorsal surface of their hands and knuckles from long-term self-induced vomiting
anorexia nervosa is more common among sisters and ___ of those with the disorder than it is among the general population
mothers
Neuroendocrine abnormalities
There has been some speculation about a primary ____ dysfunction in anorexia nervosa.
hypothalamic
Bulimia nervosa may be associated with the neurotransmitters, serotonin and ______
norepinephrine
Anorexia nervosa may be associated with high levels of endogenous ___
opioids
Suggests that eating disorders result from very early and profound disturbances in mother-infant interactions
Delayed ego development
Unfulfilled sense of separation-individuation
psychodynamic influences
true or false: family influences are seen as the primary cause of eating disorders
FALSE
what is the formula used to determine an individuals BMI
weight in kg divided by height in meters squared
what is a normal BMI
20-24.9
BMI for being overweight
25-29.9
BMI for obese
30
anorexia nervosa is characterized by BMI less than __ or lower
17
A client is 5′8″ tall and weighs 105 pounds. The client has been taking laxatives daily and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client?
A. Ineffective denial
B. Disturbed body image
C. Low self-esteem
D. Imbalanced nutrition, less than body requirements
D.
this a nursing diagnosis defined as less than body requirements, or “intake of nutrients insufficient to meet metabolic needs.”
imbalanced nutrition: less than body requirements
these are ___-term goals for a patient with an imbalanced nutrition diagnosis
the client will gain a certain amount of pounds per week to be established by the dietician
the client will drink 125 mL of fluid each hour during waking hours
short-term
the client is an imbalanced nutrition diagnosis should be observed for ___ hour following meals as they can use this time to discard food or vomit
1
nursing diagnosis
“conscious or unconscious attempt to disavow the knowledge or meaning of an event to reduce anxiety and/or fear, leading to the detriment of health”
denial
nursing diagnosis defined as confusion in mental picture of one’s physical self”
disturbed body image
nursing diagnosis
defined as “negative self-evaluating/feelings about self or self-capabilities.”
efforts to change the maladaptive eating behaviors of clients with anorexia nervosa and bulimia nervosa have become the accepted treatment
Issues of control are central to the etiology of these disorders.
For the program to be successful, the client must perceive that they are in control of the treatment.
behavior modification
this therapy is Helpful when underlying psychological problems are contributing to the maladaptive behaviors
the goal is to establish more adaptive coping strategies for dealing with stressful situations
individual therapy
Maudsley approach
Involves educating the family about the disorder
Assesses the family’s impact on maintaining the disorder
Assists in methods to promote adaptive functioning by the client
family therapy
the experience of separation from something of personal importance.
loss
deep mental and emotional anguish that is a response to the subjective experience of loss of something significant.
grief
In this stage of grief there are feelings of sadness, guilt, shame, helplessness, and hopelessness
anger
John Bowlby proposed four stages of grief which are what
- numbness or protest
- disequilibrium
- disorganizations and despair
- reorganization
this stage of Bowlby’s grief process is characterized by feelings of shock and disbelief that the loss has occurred
numbness or protest
during this stage of Bowlby’s grief process the individual has a profound urge to recovery what has been lost; they have feelings of loss, intense weeping and anger towards self and others, and guilt.
disequilibrium
during this stage of Bowlby’s grief process activities of daily living become increasingly disorganized and behavior is characterized by restlessness and aimlessness
disorganization and despair
during this stage of Bowlby’s grief process the individual accepts or becomes resigned to the loss
reorganization
these are the stages of the grief process proposed by \_\_\_ \_\_\_ Stage I: Shock and disbelief Stage II: Developing awareness Stage III: Restitution Stage IV: Resolution of the loss Stage V: Recovery
George Engel
this person views the bereaved person as active and self-determining
Proposes bereavement includes a set of tasks that must be reconciled in order to complete the grief process
Worden
These are Worden’s __ tasks of mourning
Task I: Accepting the reality of the loss
Task II: Processing the pain of grief
Task III: Adjusting to a world without the lost entity
Task IV: Finding an enduring connection with the lost entity in the midst of embarking on a new life
4
Worden’s tasks of mourning
when something of value is lost the individual refuses to believe that loss and misidentifies individuals in the environment for their lost loved one or hold on to their possessions
Accepting the reality of the loss
A client’s husband died 1 year ago. She has recently started dating a gentleman from her grief support group. This behavior is indicative of which of the grief tasks described by Worden?
A. Task I: Accepting the reality of the loss
B. Task II: Processing the pain of grief
C. Task III: Adjusting to a world without lost entity
D. Task IV: Finding an enduring connection with the lost entity in the midst of embarking on a new life
D.
acute grief lasts about ___to__ weeks or longer in older adults
6-8
the grief response is more ___ if:
The grief response is more difficult
The bereaved person was strongly dependent.
The relationship was an ambivalent one.
The individual has experienced a number of recent losses.
The loss is that of a young person.
The bereaved person’s health is unstable.
The bereaved person perceives some responsibility for the loss.
difficult
the grief response may be facilitated if
the individual has support
the individual is able to prepare for the loss
Which statement would indicate to the nurse that a widow is nearing the end of the grief process?
A. “My husband left me so quickly. I’m furious that he is not here for me!”
B. “My husband was often grumpy, but I know he loved me unconditionally.”
C. “I feel so guilty that I was out with my friend when he had his heart attack.”
D. “My husband was the best husband in the world.”
B.
resolution of grief is thought to occur when the bereaved individual can comfortably and realistically remember both the pleasures and ___ about the lost loved one
disappointments
The experiencing of feelings and emotions associated with the normal grief response before the loss actually occurs
anticipatory grieving
there are ___ types of pathological grief reactions that are considered maladaptive responses to loss
Delayed or inhibited grief
Exaggerated or distorted grief response
Chronic or prolonged grief
3
The absence of grief when it ordinarily would be expected
Potentially pathological because the person is not dealing with the reality of the loss
Remains fixed in the denial stage of the grief process
Grief may be triggered much later in response to a subsequent loss
delayed or inhibited grief
what is an example of delayed grief
overreaction to another person’s loss
All of the symptoms associated with normal grieving are exaggerated.
The individual becomes incapable of managing activities of daily living.
The individual remains fixed in the anger stage of the grief process.
Depressed mood disorder is a type of distorted grief response.
distorted grief
A prolonged grief process may be considered maladaptive when certain behaviors are exhibited.
Behaviors aimed at keeping the lost loved one alive
Behaviors that prevent the bereaved from adaptively performing activities of daily living
chronic or prolonged grieving
normal vs. maladaptive grieving
One crucial difference between normal and maladaptive grieving: the loss of ___-___
Marked feelings of worthlessness are indicative of depression rather than uncomplicated bereavement.
self-esteem
Which would the nurse identify as a maladaptive grieving response?
A. An individual thought she saw her dead husband when she was out shopping.
B. A client is experiencing marked feelings of worthlessness and low self-esteem.
C. A woman has not cried since the death of her husband.
D. A year after his death, a wife maintains all of her husband’s belongings.
B.
children ages __to __ Have some understanding about death but have difficulty distinguishing between fantasy and reality; believe death is reversible
3-5
children ages ___to ___ Beginning to understand the finality of death; difficult to perceive their own death; normal grief reactions include regressive and aggressive behaviors
6-9
children ages ___ to ___ Understand that death is final and eventually affects everyone; feelings of anger, guilt, and depression are common; peer relations and school performance may be disrupted
10-12
this age group is usually able to view death on an adult level
May or may not cry; may withdraw; may act-out
adolescents
this age group is influenced by experiential, cultural, and religious background when processing loss
adults
Elderly individuals often experience a convergence of losses, the timing of which makes it impossible for the aging individual to complete the grief process in response to one loss before another occurs. What term is used to describe this situation? A. Prolonged grieving B. Distorted grief response C. Bereavement overload D. Delayed grief response
C.
tools are used to assess the risk for maladaptive grief responses and are framed to identify multiple risk factors which include
Financial problems
Lack of coping skills or lack of experience
Emotional or physical dependence
History of mental illness, substance abuse, or trauma
Multiple losses within a short time.
bereavement risk assessment
what are some nursing diagnoses for grieving
Risk for complicated grieving related to loss of a valued entity/concept; loss of a loved one
Risk of spiritual distress related to complicated grief process
hospice
A program that provides palliative and supportive care to meet the special needs of people who are dying and their families
Provides physical, psychological, spiritual, and social care for the person for whom aggressive treatment is no longer appropriate
hospice
hospice is based on ___ components which include
- interdisciplinary team
- pain and symptom management
- emotional support
- pastoral and spiritual care
- bereavement counseling
- 24-hour on call
- staff support
7
who is included in the interdisciplinary team of hospice
Nurses Attendants Physicians Social workers Trained volunteers Rehabilitation therapists Dietitian Counseling services
Reasons why advance directives are sometimes not honored
the time treatment decisions need to be made.
The advance directive is not clear.
The health-care proxy is unsure of the client’s wishes.
