Psych Exam 2 Flashcards
WARNING: topics include suicide, mood disorders, intimate partner violence and abuse, and more
1
Q
What type of anti-psychotics target positive symptoms?
A
Conventional (first-generation)
2
Q
What type of anti-psychotics target positive and negative symptoms?
A
Atypical (second-generation)
3
Q
How do anti-psychotic medications work against schizophrenia?
A
Alleviate the symptoms but do not cure the underlying psychotic processes
Can return with medication noncompliance
4
Q
What are some reactions of anti-psychotic medications?
A
Anti-cholinergic effects
Orthostasis
Lowered seizure threshold
5
Q
What is schizophrenia and what does it affect?
A
Brain disorders affecting thinking, language, emotions, social behavior ability to perceive reality accurately
6
Q
Psychosis
A
Symptom; refers to a total inability to recognize reality
not a diagnosis
7
Q
Ongoing psychosis
A
Never fully recovering
8
Q
Episodes of psychotic symptoms
A
Alternating episodes of relatively complete recover
9
Q
Long-term course of psychosis
A
Intensity diminishes with age and the disease becomes less disruptive
10
Q
What are the co-morbidities of schizophrenia?
A
Substance abuse disorders
Anxiety
Depression
Suicide
Physical health illness
Polydipsia
11
Q
What factors may play a role in the etiology of schizophrenia?
A
Genetic
Brain structure abnormalities (less brain tissue and CSF)
Neurobiological theories (elevated dopamine, serotonin, and glutamate)
Immunovirologic factors
12
Q
What are the psychological and environmental factors which play a role in the etiology of schizophrenia?
A
Prenatal stress
Psychological stressors
Environmental stressors
13
Q
What can be seen in imaging results of patients with schizophrenia?
A
Enlarged ventricles
Smaller brains
Less grey matter
Less brain mass
Higher density of dopamine receptors
14
Q
What five items are included in the DSM for schizophrenia?
A
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
15
Q
What are examples of positive (hard) symptoms found in schizophrenia?
A
Delusions, hallucinations, hyper-vigilance
16
Q
What are the examples of negative (soft) symptoms of schizophrenia?
A
Flat effect, lack of volition, inattention
17
Q
What are alterations in thinking in schizophrenia?
A
Impaired reality testing
Delusions
Concrete thinking
18
Q
What are alterations in speech in schizophrenia?
A
Associative looseness
Neologisms
Clang association
Word salad
Echolalia
Echopraxia
19
Q
What are alterations in perception in schizophrenia?
A
Depersonalization
Hallucinations
Illusions
Command hallucinations
Derealization
20
Q
What are alterations in behavior in schizophrenia?
A
Bizarre behavior
Extreme motor agitation
Stereotyped behaviors
Waxy flexibility
Stupor
Negativism
Automatic obedience
Impulse control resulting in agitated behaviors
21
Q
What are therapeutic strategies for communicating with patients with schizophrenia?
A
Lower anxiety
Decrease defensive patterns
Encourage participation in therapy and social events
Raise feelings of self-worth
Increase medication compliance
22
Q
Tardive dyskinesia
A
irreversble
Seen more in long-term usage of conventional anti-psychotics
Involuntary rhythmic stereotyped movements of trunk and extremities
Symptoms increase with anxiety and tension
23
Q
Extrapyramidial syndrome
A
Reversible and can be treated with anti-cholinergics
Characterized by: pseudoparkinsonism,acute dystonia, and akathesia
Treatment: anti-parkinsonian drugs and lowered doses
24
Q
What falls under pseudoparkinsonism?
A
Stiffness/rigidity, tremors, drooling, pill rolling, mask-like experience, thick tongue, cog wheeling
25
What falls under acute dystonia?
Irregular, involuntary abnormal positioning of the neck, head, arms, legs, and trunk
Oculogyrc crisis
26
Akathesia
Motor restlessness
27
What is the purpose of antipsychotic medications?
Alleviate symptoms of schizophrenia (not a cure)
*symptoms will return if discontinued*
28
What are common reactions with antipsychotic medications?
Anticholinergic effects
Orthostasis
Lowered seizure threshold
29
What do conventional (first-generation) antipsychotics target?
Positive symptoms
30
What do atypical (second-generation) antipsychotics target?
Positive and negative symptoms
31
Why are atypicals often preferred compared to conventional antipsychotics?
Fewer side effects and target more symptoms
32
What are some examples of conventional antipsychotic medication?
Thiothixene [Navane]
Fluphenazine [Prolixin]
Haloperidol [Haldol]
Pirozide [Orap]
Loxaine [Loxitane]
Molidone [Moban]
Perphenazine [Trilafon]
Chlorpromazine [Thorazine]
Thioriadizine [Mellaril]
33
What are some examples of atypical antipsychotic medications?
Aripiprazole [Abilify]
Clozapine [Clozaril]
Olanzapine [Zyprexa]
Paliperidone [Invega]
Quetiapine [Seroquel]
Risperidone [Risperdal]
Ziprasidone [Geodon]
34
What six antipsychotic medications are available in the form of depot injections?
Fluphenazine
Haloperidol
Risperidone
Paliperidone
Olanzapine
Aripiprazole
35
What is metabolic syndrome characterized by?
Hyperglycemia, dyslipidemia, and abdominal obesity
36
What labs should you look at in metabolic syndrome? Interventions?
CBC, serum glucose level, lipid panel, liver function, vision tests
Need baseline bloodwork and regular monitoring; check family history of metabolic disorders
37
What drugs seem to have the highest risk with metabolic syndrome?
Clozaril and Zyprexia
38
What are the side effects and adverse reactions of antipsychotics seen more in first-generation medications?
Extrapyramidal symptoms (EPS) and tardive dyskinesia (TD)
39
What are the side effects and adverse reactions of antipsychotics seen more in second-generation medications?
Metabolic syndrome
40
What is neuroleptic malignant syndrome?
**fatal**
Usually occurs suddenly and symptoms can be mistaken for an illness of other side effects
Altered consciousness (confusion and irritability)
Muscle rigidity and abnormal blood work
41
Should medication continue to be administered, or should it be held in a patient experiencing neuroleptic malignant syndrome?
Hold medication
42
What is a fairly common adverse reaction to Clozapine [Clozaril] in patients?
Agranulocytosis
43
What is agranulocytosis?
Bone marrow is unable to produce sufficient amounts of WBCs which leads to **fever, malaise, sore throat, and leukopenia**
*Interventions: regular bloodwork (WBCs over 3500)*
44
_____ are administered for severe depression.
Antidepressants
45
_____ and other _____ _____ reduce aggressive behaviors.
*Hint: medications*
Lithium
Mood stabilizers
46
_____ _____ improves positive and negative symptoms.
Benzodiazepine augmentation
OR atypical second gen anti-psychotics
47
_____ decreases anxiety, agitation, and possibly psychosis.
Clonazepam
48
According to evidence-based psychosocial therapies, family needs to be included in:
Psychologic strategies aimed at reducing psychotic symptoms
Teaching patient and family about illness
Recognizing effect of stress
Identifying support sources
Medication groups for patients and family
49
Schizoaffective disorder
Diagnosed when a client is severely ill and has a mixture of psychotic and mood symptoms
These symptoms can occur simultaneously or alternating
50
Schizophreniform disorder
The client exhibits an acute, reactive psychosis for less than 6 months necessary to meet the diagnostic criteria for schizophrenia
51
Catatonia
Characterized by marked psychomotor disturbance, either excessive motor activity or virtual immobility and motionlessness
52
Delusional disorder
The client has one or more non-bizarre delusions (believable)
Delusions may be persecutory, erotomanic, grandiose, jealous, or somatic in content
53
Brief psychotic disorder
The client experiences the sudden onset of at least one psychotic symptom which last from one day to one month
Symptoms include delusions, hallucinations, or disorganized speech or behavior
54
Shared psychotic disorder (folie à deux)
Two people share the same delusion after one begins to mimic the delusions of the other
55
Schizotypal personality disorder
This involves odd, eccentric behaviors - includes transient psychotic symptoms
56
Dysthymic disorder
A chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness
57
Disruptive mood regulation disorder
A persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not keeping with the provocation or situation
Begins before the age of 10
58
Cyclothymic disorder
Characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning
59
Substance-induced depressive or bipolar disorder
Characterized by a significant disturbance in mood that is a direct physiological consequence of ingested substances such as alcohol, other drugs, or toxins
60
Seasonal affective disorder (SAD) - winter depression or fall onset
Increased sleep, appetite, and carbohydrate cravings
Weight gain, interpersonal conflict, irritability, and heaviness in the extremities beginning in late autumn and abating in spring and summer
61
Seasonal affective disorder (SAD) - spring onset
*Less common*
Symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until the fall
62
Postpartum or "maternity" blues
Mild, predictable mood disturbance occurring in the first several days after delivery of a baby
Symptoms include labile mood and affect, crying spells, sadness, insomnia, and anxiety
63
Postpartum depression
Symptoms are consistent with those of depression with onset within 4 weeks of delivery
64
Postpartum psychosis
A severe and debilitating psychiatric illness, with acute onset in the days following childbirth
Symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion
Progresses to delusions, hallucinations, poor insights and judgment, and loss of contact with reality
65
Premenstrual dysphoric disorder
A severe form of premenstrual syndrome
Defined as a recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolving with menstruation
66
Non-suicidal self-injury
Involves deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing
Some report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility
67
What populations are more likely to experience depression?
Living below the poverty level
Co-occurring chronic medical problems
Frequently accompanies other psychiatric disorders
68
What are the four etiological theories of mood disorders?
Genetic theory
Biochemical theory
Psychosocial theories
Cognitive theory
69
What two neurotransmitters involved in depression?
Serotonin and norepinephrine
70
What three things are involved in Beck's cognitive triad?
1. negative, self-depreciating view of self
2. pessimistic view of the world
3. belief that negative reinforcement will continue
71
List risk factors for mood disorders?
Prior episodes of depression
Family history of depressive disorders
Prior suicide attempts
Female
Age of onset prior to age 40
Post partum
Medical comorbidity
Lack of social support
Stressful life events
Substance abuse
Certain medications
Co-morbid psychiatric conditions
72
How long can an untreated depressive episode last for major depressive disorder?
Weeks, months, or years
Most clear in about 6 months
73
What are some key symptoms of major depressive disorder?
Depressed mood, anhedonia, changes in appetite, changes in sleep, psychomotor agitation, fatigue, feelings of worthlessness or excessive guilt, decreased cognitive ability, morbid thinking or suicidal ideation
74
What assessment are noted for major depressive disorder? What are the expected findings?
History
General appearance and motor behavior (psychomotor agitation, latency of response)
Mood and affect (anhedonia)
Thought process and content (rumination, thoughts of suicide)
Sensorium and intellectual processes (impaired memory)
Judgment and insight (impaired judgment)
Self-concept (feelings of worthlessness)
Roles and relationships (severity directly proportional to difficulty)
Physiological and self-care considerations
Depression rating scales
75
What are examples of rating scales used for major depressive disorder?
Hamilton rating scale
Zung self-rating scale
Beck depression inventory
76
What are nursing priorities and interventions common for major depressive disorder?
Free from self-injury
Independently carry out activities of daily living
Balance of rest, sleep, and activity
Evaluate self-attributes realistically
Socializing
Return to occupation or school activities
Medication compliance
Verbalize symptoms of recurrence
77
What types of medications are available for depression?
SSRI
Atypicals
Tricyclic
MAOI
78
Selective serotonin reuptake inhibitors (SSRIs)
Block the neuronal uptake of serotonin by inhibiting the uptake of serotonin in the nerve terminal
Therapeutic response: 2-8 weeks
**must monitor for suicidality in the first few weeks**
79
What are common side effects of SSRIs?
Dizziness, drowsiness, headache, GI
80
List SSRIs.
Fluoxetine [Prozac]
Sertraline [Zoloft]
Paroxetine [Paxil]
Citalopram [Celexa]
Escitalopram [Lexapro]
Vortioxetine [Trintellix]
81
What side effect should be reported to a physician when using SSRIs?
Sexual dysfunction
82
Serotonin and noradrenaline reuptake inhibitors (SNRIs)
Increases serotonin and norepinephrine
Side effects include fewer anticholinergic effects that tricyclic agents and nausea/vomiting
83
What are examples of atypical SNRIs?
Venlafaxine [Effexor]
Duloxetine [Cymbalta]
Desvenlaxafine [Pristiq]
84
Serotonin and noradrenaline disinhibitors (SNDIs)
Increase serotonin and norepinephrine
Has anti-anxiety, antidepressant, and anti-emetic effects
Side effects include sedation and weight gain
85
What are examples of atypical SNDIs?
Mirtazapine [Remeron]
86
What are examples of other atypical antidepressants?
Bupropion [Wellbutrin, Zyban]
Nefazodone [Serzone]
Vilazodone [Viibryd]
87
Tricyclic antidepressants (TCAs)
Neurotransmitter effects
Contraindications - MI, hepatic history
88
What are examples of TCAs?
Amitriptyline [Elavil]
Amoxapine [Asendin]
Doxepin [Sinequan]
Imipramine [Tofranil]
Desipramine [Norpramin]
Nortriptyline [Pamelor]
89
Monoamine oxidase inhibitors (MAOIs)
Responsible for breaking down the different types of neurotransmitters
Adverse and toxic effects - inhibits breakdown of excess tyramine in liver leading to **hypertensive crisis, CVA, and death**
Interactions: avoid OTC medications and foods containing tyramines
**Contraindications: must be off of these for at least two weeks before starting another antidepressant**
90
What are examples of MAOIs?
Isocarboxazid [Marplan]
Phenelzine [Nardil]
Tranylcypromine [Parnate]
91
Serotonin syndrome
Due to central and peripheral serotonin hyper stimulation
Symptoms: confusion, delirium, agitation, irritability, incoordination tremor, seizures, fever, diaphoresis, nausea and vomiting, diarrhea, abdominal pain, hypo or hypertension, tachycardia, severe respiratory depression, coma
Treatment: discontinue the medication and/or treat the symptoms
92
Electroconvulsive therapy (ECT)
Electrodes are applied to a patient's head through which electrical impulses are sent to the brain
It is believed that these impulses alter and correct the brain's chemistry to fix imbalances
93
Interpersonal therapy
Relationship difficulties
94
Behavior therapy
Positive reinforcement of interactions
95
Cognitive therapy
Focus on cognitive distortions
96
Absolute, dichotomous thinking
Tendency to view everything in polar categories
97
Arbitrary inference
Drawing a specific conclusion without sufficient evidence
98
Specific abstraction
Focusing on a single detail while ignoring other, more significant aspects of the experience
99
Overgeneralization
Forming conclusions based on too little or too narrow experience
100
Magnification and minimization
Overvaluing or undervaluing the significance of a particular event
101
Personalization
Tendency to self-reference external events without basis
102
What symptoms are common in children with depression?
Persistent sadness
Withdrawal
Irritable, anhedonia
Low self-esteem
Excessive guilt
Sleep disturbances
Running away behaviors
Appetite changes
Somatic/physical complaints
Change or difficulty in school performance
Preoccupation with death
103
What are depressive symptoms common in adolescence?
Fluctuations between apathy and talkativeness
**Anger/rage, sarcasm, verbally attacking**
**Overreaction to criticism**
**Guilt**
Feels unable to satisfy ideals
Low self-esteem
Loss of confidence
Feelings of hopelessness and helplessness
Intense ambivalence between dependence and independence
Feelings of emptiness in life
**Restlessness/agitation**
Pessimism about the future
Death wishes
Rebellious
Sleep disturbances
Appetite changes and weight changes
104
Fact: depression in older adults is often underdiagnosed and misdiagnosed.
Check on them and make them feel as if they have a purpose. Please.
105
Bipolar mixed
Cycles alternate between periods of mania, normal mood, depression, normal mood, mania, and so forth
106
Bipolar type I
Manic episodes with at least one depressive episode
107
Bipolar type II
Recurrent depressive episodes with at least one hypomanic episode
108
What is the diagnostic criteria for Bipolar I?
Current or recent major depressive episode
Previous manic episode or mixed
Mood episodes not to to schizoaffective disorder or similar
109
What is the diagnostic criteria for Bipolar II?
Current or history of major depressive episodes
Current or history hypomanic episodes
Symptoms cause significant distress as well as impairment in social, occupational, or other important areas of functioning
Current episode meets appropriate criteria for hypomania or depression
No history of manic episode or mixed episode
Mood symptoms not due to schizoaffective disorder or similar
110
Hypomania
Mood falling between normal euphoria and mania
Characterized by optimism, pressure of speech and activity and a decreased need for sleep; increased creativity; poor judgment and irritability
Able to function socially, academically, and occupationally although their behavior is different from their baseline
111
Manic episode
Mood persistently and abnormally elevated, expansive or irritable for at least 1 week
Inflated self-esteem or grandiosity
Decrease need for sleep
Increased talking or increased pressure to keep talking
Flight of ideas or subjective feelings of "racing thoughts"
Easily distractible
Increased goal directed activity or psychomotor agitation
Excessive over involvement in pleasurable activities usually associated with a high potential for painful consequences
May be preoccupied with religious, sexual, financial, political or persecutory thoughts that can develop into a delusional system-psychotic symptoms
Mood occurring with at least three other symptoms
Symptoms not related to a medical condition or substance use
112
What are some appropriate strategies for manic patients?
Display a firm, calm approach
Express short, concise explanations or statements
Remain neutral
Maintain consistency
Conduct frequent staff meetings to agree on approach and limit setting
Hear and act upon legitimate complaints
Firmly redirect energy
113
What are key components of milieu therapy with patients in acute phase of mania?
Teamwork and collaboration
114
What are assessment findings for someone experiencing bipolar disorders?
History
General appearance and motor behavior
Communication
Mood and affect (euphoria, grandiosity)
Thought process and content (circumstantiality, tangentiality)
Sensorium and intellectual processes (disoriented to time)
Judgment and insight
Self-concept (exaggerated self-esteem)
Roles and relationships
115
What expected outcomes are our biggest concerns when working with a patient experiencing bipolar disorders?
No injury to self or others
Balance of rest, sleep, and activity
Socially appropriate behavior
116
What interventions are important for patients experiencing bipolar disorders?
Providing for safety
Meeting physiological needs
Providing therapeutic communication
Promoting appropriate behaviors
Managing medications
Providing client and family teaching
117
What type of medications are available for bipolar disorders?
Lithium (0.5-1.5)
Anticonvulsants
Antipsychotics
118
Lithium [Eskalith, Lithobid]
Stabilizes depression and mania
Narrows the therapeutic index
Has a potential for toxicity
Absorbed in the GI tract; 80% excreted by kidneys
119
What are toxic symptoms of lithium?
**Nausea and vomiting, diarrhea, drowsiness, slurred speech**, agitation, coarse tremors, muscle spasms, blurred vision, stupor, coma, convulsions, death
**no antidote - may try dialysis**
120
Valproate [Depakote/Depakene]
Very effective in managing impulsive aggression
121
What are examples of anticonvulsants?
Carbamazepine [Tegretol]
Divalproex [Depakote]
Gabapentin [Neurontin]
Lamotrigine [Lamictal]
Topiramate [Topamax]
Oxcarbazepine [Trileptal]
122
What should you monitor for when a patient is taking lamotrogine [Lamictal]?
Rash - may indicate Stevens-Johnson syndrome
123
Suicide or completed suicide
Intentional ending of one's own life
124
Suicide attempts
Willful, self-inflicted, life-threatening attempts that have not led to death
125
Suicidal ideation
A person thinking of self-harm
*ask them directly if they are thinking of killing themselves*
126
Physician-assisted suicide (PAS)
For terminally ill patients
Operated under strict guidelines
127
What types of cues will a person provide when they are thinking of or planning to attempt suicide?
Verbal cues
Behavioral cues
Situational cues
128
What medications may contribute to suicidal ideation?
Antihypertensives, benzodiazepines, calcium-channel blockers, corticosteroids, hormonal medications, pain medications
129
Traumatic brain injury (TBI)
Refers to trauma to the head that affects brain functioning
130
What groups are at high risk for suicide?
People with a previous suicide attempt
Family member who has committed suicide
People with psychiatric disorders
People with substance abuse
Divorced, separated, widowed, unemployed, socially isolated
People with gambling problems
People who have command hallucinations
People experience grandiose thinking
People with poor impulse control
131
What are assessment markers for suicide in children?
Children or teenagers who lost a parent to suicide are three times more likely to commit suicide
Childhood maltreatment
Problematic family relations
History of bullying or victimization
Family history of suicide
Socioeconomic problems
Parental psychopathologic problems
Peer problems
Legal and/or discipline problems
132
What are the risk factors for suicide in adolescents and young adults?
**substance abuse, aggression, disruptive behaviors, depression, and social isolation**
Frequent episodes of running away
Frequent expressions of rage and problems with parents
Family loss, instability, and withdrawal
Perception of failure
Expression of suicidal thoughts when sad or bored
Difficulty dealing with sexual orientation
Unplanned pregnancy
133
What are risk factors for suicide in older adults?
Social isolation, solitary living arrangements, widowhood, lack of financial resources, poor health, and hopelessness
134
What are behavioral cues of suicide in people considering it?
Giving away prized possessions
Writing farewell notes
Making out a will
Putting personal affairs in order
Global insomnia
Exhibiting sudden or unexpected improvement in mood after being depressed and withdrawn
Neglecting personal hygiene
135
What questions are asked (or should be) to patients presenting with suicidal thoughts or plans?
Passive death wish
Suicidal ideation
Suicidal intent
Suicidal threat
Suicidal gesture
Suicidal attempt
136
What should be assessed if a history of suicide attempts exists?
Intent
Lethality
Injury
137
What interventions are important for patients experiencing suicide?
Provide a safe environment
Document the patient's activity (every 15 minutes)
Maintain accurate records of nurse and physician actions
Place the patient on either suicide precaution or suicide observation
Construct a verbal or written no-suicide contract
Encourage the patient to talk about their feelings and alternatives
138
What are protective factors that can be implemented for patients experiencing suicide?
Family and community support
Effective and appropriate clinical care for mental, physical, and substance abuse disorders
Restricted access to highly lethal methods of suicide
Cultural and religious beliefs that discourage suicide
Acquisition of problem-solving skills, conflict resolution, and nonviolent management of disputes
Cognitive-behavioral therapy
139
Intimate partner violence
Defined as a pattern of assault and course of behaviors that may include physical injury, psychologic abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats between current or former partners of an intimate relationship **OF ANY KIND**
140
Abuse
A repetitive pattern of behaviors to maintain power and control over an intimate partner
141
What are warning signs (red flags) of intimate partner violence?
Telling partner they never do anything right
Showing jealousy of partner's friends and time spent away
Keeping partner or discouraging them from seeing friends or family
Embarrassing or shaming partner with put downs
Controlling every penny spent in the household
Taking partner's money or refusing to give them money for expenses
Preventing partner from making your own decisions
Telling partner they are a bad parent or threatening to harm or take away their children
Preventing partner from working or attending school
Destroying partner's property or threatening to hurt or kill their pets
Intimidating with weapons
Pressuring partner to be intimate when they don't want to
142
What does the cycle of violence look like?
Tension building phase
Acting out
Honeymoon
143
What are the characteristics of intimate partner violence?
Denial and blame
Emotional abuse
Control through isolation
Control through intimidation
Control through economic abuse
Control through power
144
What can be found in people experiencing battered woman syndrome? This can be seen in anybody who is a victim, not just women.
PTSD symptoms
Learned helplessness
Self-destructive coping responses to violence
145
What can be done to help someone leave an abusive relationship?
Come up with a plan
Keep location and plan a secret
**never tell the abuser that the person is leaving**
146
What questions should be asked to someone who you suspect may be experiencing intimate partner violence?
Within the last year, have you been hit, slapped, kicked or otherwise physically hurt by someone?
If pregnant, since the pregnancy began, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
Within the last year, has anyone forced you to have sexual activities?
Are you afraid of your partner or anyone else?
Is there a partner from a previous relationship who is making you feel unsafe now?
147
What interventions can be done for someone experiencing intimate partner violence?
Let them know help is available
Give them specific information about resources
Document the battering with accurate medical records
Acknowledge them experiences in a supportive manner
Respect them right to make their own decisions
148
What is included in a rape assessment?
Determine if life threatening and/or acute issues
History of incident (may need to review several times) Documentation is crucial
Chain of evidence (who handles-how obtained)
Hopefully victim hasn’t bathed
Assess skin, look for signs of physical force
Rape kit in all ER’s
Items in paper bag
Referrals
149
What is included in the nurse's role when it comes to intimate partner violence?
Screen for intimate partner violence
Conduct initial assessment in private
Screen using direct questions – need to ask won’t usually volunteer
If violence is identified – make sure person knows they are not alone and that they do not deserve to be treated in this way
Stress confidentiality
Assess immediate safety
Ask to consult an advocate
Report situation to physician
If necessary, let security know
150
What does the word violence encompass?
Domestic violence
Family violence
Intimate partner violence
151
What are indicators for family violence?
Recurrent emergency department (ED) visits for injuries attributed to being “accident prone”
Presenting problems reflecting signs of high anxiety and chronic stress
Stress-related conditions
152
How does the social learning theory apply to domestic violence?
Relies on role modeling, identification, and human interaction
153
What are the societal and cultural factors of domestic violence?
Poverty or unemployment
Communities with inadequate resources
Overcrowding
Social isolation of families
154
Patriarchal theory
Male dominance in our political and economic structure enforces the differential status of men and women
155
What are psychologic factors in domestic violence?
Personality traits
Substance abuse
"loss of control" according to some abusers
Low self-esteem
Poor problem-solving skills
History of impulsive behavior
Hypersensitivity
Narcissism
156
What are the types of child abuse?
Neglect
Physical
Sexual
Emotional
157
What are common signs of abuse?
Verbal complaints of beatings and/or parent’s significant other doing things when parent not home
Arrives early and leaves late, doesn’t want to go home
Compliant, shy, withdrawn, passive, and uncommunicative
Nervous, hyperactive, aggressive, disruptive, and destructive
Unexplained injury, hair missing, burns or bruises
Injury not adequately explained
Goes to bathroom with difficulty
Inadequately dressed for inclement weather
Clothing is soiled, tattered, too small
Dirty, odorous, poor dental, hair falling out, lice
Thin, emaciated, tired
Unusually fearful of other children and adults
Has been given inappropriate food, drink or drugs
158
What are signs of abusive parents?
Shows little concern for child’s problems
Takes an unusual amount of time to seek health care for child
Does not adequately explain an injury
Gives different explanations for the same injury
Complains about irrelevant problems unrelated to the injury
Blames a third party
Reluctant to share information about the child
Uses alcohol or drugs
Has no friends or relatives to turn to in crises
Very strict disciplinarians
Were abused as children
Goes to different doctors and clinics
Antagonistic and hostile
159
Infant whiplash syndrome
Shaken baby syndrome
Potentially life threatening
Serious injury
Often due to adults becoming frustrated and angry
160
Shaken baby syndrome
It is: abusive head trauma, closed head injury, blunt force trauma to the head, non-accidental head injury
Happens when: someone forcefully shakes a baby, uncontrolled head rotation, brain violently moves back and forth in the skull, ruptured blood vessels, nerves, and tearing of brain tissue, bruising and bleeding in the brain
161
What are the signs of shaken baby syndrome?
Bruising from being grabbed firmly
Major head injury (cerebral edema, subdural hematoma)
Blindness due to retinal hemorrhage
Cerebral palsy
Cognitive impairment
Death
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Kimberlin West Act 2002 Florida Law
Requires hospitals, birthing centers or home birth providers to give new parents informational brochures about the danger of shaken babies
Department of health must prepare and provide these brochures
Training sessions to teach nurses to talk to new parents about Shaken Baby Syndrome
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What are actions the nurse does when assessing a child who has been a victim of family violence?
Reassure children that they did not do anything wrong.
Experience should be nonthreatening and supportive. Interview should not resemble trial or inquisition.
Children may express experiences through playing out the incident with dolls or drawings.
Do not suggest answers.
Do not promise that everything is confidential (abuse must be reported).
Do not react with shock to anything; do not force a child to undress or be examined.
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What are interventions the nurse can perform for a child experiencing family violence?
Gently confirm abuse and treat the problem
May not come right out and confess the abuse
Provide very safe atmosphere
Assure they will be protected
Reframe that parents need guidance and help
Educate about how many children go through this
Play therapy
Family therapy
Group therapy for all
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What are the types of abuse against elders?
Physical
Emotional
Financial
Neglect
Sexual abuse
Self-neglect
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What are warning signs common in elder abuse?
Bruises, pressure marks, broken bones, abrasions and burns
Unexplained withdrawal from normal activities, sudden change in alertness, unusual depression
Bruises around the breasts or genital area
Sudden changes in financial status
Decubitus ulcers, poor hygiene unusual weight loss
Belittling, threats by caregivers
Strained and tense relationships with caregivers
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Who is more at risk for elder abuse?
People with dementia or cognitive impairment
Long term domestic violence
Personal problems of abusers/caregivers
Social isolation
