TEST 3 Flashcards
Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student’s crisis?
a) The time of year in which the event occurred
b) The presence of support systems
c) A lack of adequate coping mechanisms
d) The individual’s family birth order
C
Adequate coping mechanisms can influence the development of a crisis.
If a person can draw on past successful coping strategies, a crisis may be diverted.
The second student had a lack of adequate coping mechanisms.
Phases of Crisis Intervention: The Role of the Nurse
Nurses may be called on to function as crisis helpers in virtually any setting committed to the practice of nursing.
Aguilera described four specific phases in the technique of crisis intervention that are clearly comparable to the steps of the nursing process.
Crisis Intervention
The basic methodology relies heavily on orderly problem-solving techniques and structured activities focused on change.
Through adaptive change, crises are resolved and growth occurs.
Individual must experience some degree of relief almost from the first interaction.
Crisis intervention:
Using a crisis situation to restore functioning and at most to enhance personal growth
Anger
Need not be a negative expression
Is a normal human emotion that, when handled appropriately and expressed assertively, can provide an individual with a positive force to solve problems and make decisions concerning life situations
Becomes a problem:
- When not expressed
- When expressed aggressively
A client has not received what was expected for lunch and directs an angry verbal outburst at the nurse. Which is an accurate description of this display of emotion?
a) Anger is a primary emotion that is automatically experienced.
b) Anger is a psychological arousal.
c) Expression of anger can come under personal control.
d) Expression of anger and aggression are closely related.
C
The expression of anger can come under personal control and is a learned behavior.
What’s the first question you ask during Crisis intervention ?
what happened? What is bringing you in today?
Medication classification most often used for treating OCD and talk about the specifics in dosing?
- SSRIs are the mainstay of pharmacological treatment
- These are typically used at higher doses and for longer periods than in depression.Doses in excess of what is effective for treating depression may be required for OCD
Name the SSRIs and doses used to treat OCD?
- 40 mg of escitalopram,
- 80 mg of fluoxetine,
- 100 mg of paroxetine
- 300 mg of fluvoxamine
Though SSRIs are the mainstay of treatment for OCD, What tricyclic drug was the first drug approved by the FDA in the treatment of OCD and why is it not the first line treatment of OCD ?
- Clomipramine : it is more selective for serotonin reuptake than any of the other tricyclics.
- Its efficacy in the treatment of OCD is well established, although the adverse effects, such as those associated with all the tricyclics, may make it less desirable than the SSRIs.
Setting appropriate timing/outcome for client to perform rituals at initial hospitalization
Identify situations that precipitate compulsive behavior; encourage the client to verbalize concerns and feelings. Do not interrupt compulsive behaviors unless they jeopardize the safety of the client to or others (provide for client safety related to the behavior). Allow time for the client to perform the compulsive behavior, but set limits on behaviors that may interfere with clients physical well-being to protect the client from physical harm. Implement a schedule for the client that distracts from the behaviors (structure simple activities, games or tasks for the client). Establish a written contract that assists the client to decrease the frequency of compulsive behaviors gradually.
What characteristics would a client portray when experiencing specific phobias?
A persistent, intensely felt, and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the feared stimulus. Responses typically include intense anxiety or panic attacks
- A diagnosis of specific phobia is made only when the irrational fear restricts the individual’s activities and interferes with his or her daily living.
Medication classifications useful in treatment of phobic disorders?
(1) Benzodiazepines
(2) Tricyclics
(3) Propranolol
(4) SSRIs
Controlled studies have shown the efficacy of ____________and __________ in reducing symptoms of social anxiety.
- alprazolam
- clonazepam (klonopin)
What TCA and MAOI have been effective in diminishing symptoms of agoraphobia and social anxiety disorder?
- Imipramine (Tricyclic)
- phenelzine (MAOI)
What hypertensive agents have been used to treat stage fright (performance anxiety), situational anxiety and PTSD?
Propranolol and Atenolol
What are some Nursing interventions for a Panic Attack?
:
- Do not leave client in panic anxiety alone, Stay with client and offer reassurance of safety and security.
- Maintain a calm, nonthreatening, matter-of-fact approach. Anxiety is contagious and can be transferred from staff to client or vice versa. The presence of a calm person provides a feeling of security to an anxious client.
- Use simple words and brief messages, spoken calmly and clearly, to explain hospital experiences
- If hyperventilation occurs assist client to breathe into a small paper bag held over the mouth and nose. Six to 12 natural breaths should be taken, alternating with short periods of diaphragmatic breathing
- Calmly ask “what’s the cause as the panic attack?”Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor)
- Administer tranquilizing medication, as ordered by physician. Assess for effectiveness and for side effects
- When level of anxiety has been reduced, explore possible reasons for occurrence,
- Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (relaxation techniques, such as deep-breathing exercises and meditation, or physical exercise, such as brisk walks and jogging).
What symptoms must be present to identify the presence of a panic attack?
- Palpitations, pounding heart, or accelerated heart rate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded, or faint
- Chills or heat sensations
- Paresthesias (numbness or tingling sensations)
- Derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself)
- Fear of losing control or going crazy
- Fear of dying
Generalized Anxiety Disorder (GAD): is characterized by persistent, unrealistic, and excessive anxiety and worry that have occurred more days than not for at least __ months and cannot be attributed to specific organic factors, such as caffeine intoxication or hyperthyroidism.
6
What class of drugs have been used with success in the acute treatment of generalized anxiety disorder.
Benzodiazepines
What are the first-line treatments for generalized anxiety disorder. Once these are proven to be effective how can you expect the doctor to adjust the prescription?
- SSRIs and SNRIs
- If an SSRI is effective, it is recommended to take the medication for another 6 to 12 months, and then gradually reduce the dose.
What specific SSRIs & SNRIs have been approved for the treatment of General Anxiety Disorder?
- paroxetine (Paxil)
- escitalopram (Lexapro)
- duloxetine (Cymbalta)
- extended-release venlafaxine (Effexor XR)
What antianxiety agent is effective in about 60 to 80 percent of clients with generalized anxiety disorder .
buspirone (buspar)
One disadvantage of buspirone is its 10- to 14-day delay in alleviating symptoms.
What are the First-line choice of treatment for panic disorders?
- SSRIs
- SNRIs
- Buspirone
What SSRIs/SNRIs are used in the treatment of Panic Disorders?
- SSRIs - Paroxetine, fluoxetine, and sertraline
- SNRIs - Venlafaxine
Buspirone (BuSpar)
Buspirone (BuSpar) is an antianxiety agent but not a benzodiazepine and does not depress the CNS. Although its action is unknown, the drug is believed to produce the desired effects through interactions with serotonin, dopamine, and other neurotransmitter receptors. Clients should be instructed that buspirone has a lag period of 7 to 10 days before full therapeutic benefits are achieved. It does not have the addiction potential of the other antianxiety agents and therefore may be a better option for clients with anxiety disorders who have also struggled with substance use disorders.