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TOPIC 8 - crisis nursing Flashcards

1
Q

what is a crisis

A

acute, time limited occurrences experienced as overwhelming emotional reactions to a stressful situational event, developmental event, or the persons perception of an event

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2
Q

crisis will result in which two responses from the person experiencing crisis

A

fall apart and decompensate or problem solve and grow through the process

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3
Q

what impacts the outcomes of crises

A

individual, family, and community perception of the response
coping abilities and resiliency
availability and outside supports

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4
Q

factors that limit coping and problem solving abilities

A

mental illness, substance abuse, history of poor coping, diminished cognitive ability, preexisting physical health problems, limited social supports, developmental and or physical changes

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5
Q

clients with the best outcomes …

A

feel safe, connected, calm and hopeful

have access to social, physical, and emotional supports

find ways to help themselves

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6
Q

developmental crisis

A

have to do with the predictable transitions that individuals experience as they move from one stage to another

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7
Q

examples of developmental crises

A

getting married, starting college, retirement, becoming a parent

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8
Q

situational crisis

A

arise suddenly and unexpectedly from an external source and are events or circumstances that threaten the physical, social, and psychological integrity of individuals , frequently involving grief or loss

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9
Q

examples of situational crises

A

being forced to retire, financial distress, illness, death of a loved ones, going through divorce

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10
Q

adventitious or social crisis

A

rare, unexpected events that affect a group or community
not part of everyday life

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11
Q

examples of adventitious crises

A

natural disaster, terrorism, pandemics, flood, earthquake, active shooter

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12
Q

existential crisis

A

inner conflicts, often centered around life’s purpose and spirituality

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13
Q

examples of existential crises

A

what is my calling in life? midlife crisis, am i making a difference? does god really exist?

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14
Q

phase 1 of psychological crisis

A

Person confronted by conflict; responds with increased anxiety.

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15
Q

phase 2 of psychological crisis

A

If usual defensive responses fail and threat persists, anxiety escalates. Trial-and-error begins.

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16
Q

phase 3 of psychological crisis

A

If trial-and-error attempts fail, anxiety can escalate to severe & panic levels.

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17
Q

phase 4 of psychological crisis

A

If the problem is not solved and new coping skills are ineffective, anxiety can overwhelm the person & lead to serious illness; assess for suicidal thoughts.

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18
Q

crisis interventions need to be …

A

bold, creative, flexible

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19
Q

strategies of primary level of care

A

Promote mental health before crisis strikesProvide education, information & resource listings

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20
Q

goals of primary level of care

A

Improve clients’ coping ability &Decrease incidence of crises

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21
Q

strategies of secondary level of care

A

Prevent prolonged anxiety during acute crisis

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22
Q

goals of secondary level of care

A

Ensure client safety & Shorten duration of client distress

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23
Q

strategies of tertiary level of care

A

Provide support during recovery from crisis

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24
Q

goals of tertiary level of care

A

Facilitate optimal client functioning & prevent further emotional disruption

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25
example of tertiary care
critical incident stress debriefing
26
objectives of CISD
-lessen the impact of the traumatic event -facilitate recovery process and restore adaptive functioning in psychologically healthy people in distress by the crisis event -screen for and identify community members who might benefit from additional support services/provide referrals for those who need it
27
best effects of CISD happen when
there is enhanced group cohesion and unity performance CISD should be part of a broader crisis support system
28
who benefits from CISD
staff members and clients after an incident of violence or trauma crisis hotline volunteers rescue and health care workers who respond to traumatic situations
29
phase 1 - introduction
the team members introduce themselves and describe the process. They present guidelines for the conduct of the CISD and they motivate the participants to engage actively in the process. set the tone of the session
30
phase 2 - facts
Only extremely brief overviews of the facts are requested. Excessive detail is discouraged. This phase helps the participants to begin talking. It is easier to speak of what happened before they describe how the event impacted them. overall view point of what happened
31
phase 3 - thoughts
The thought phase is a transition from the cognitive domain toward the affective domain. It is easier to speak of what one’s thoughts than to focus immediately on the most painful aspects of the event. The typical question addressed in this phase is “What was your first thought or your most prominent thought once you realized you were thinking?
32
phase 4 - reactions
The reaction phase is the heart of a Critical Incident Stress Debriefing. It focuses on the impact on the participants. Anger, frustration, sadness, loss, confusion, and other emotions may emerge. The trigger question is “What is the very worst thing about this event for you personally?”
33
phase 5 - symptoms
Team members ask, “How has this tragic experience shown up in your life?” or “What cognitive, physical, emotional, or behavioral symptoms have you been dealing with since this event?” The team members listen carefully for common symptoms associated with exposure to traumatic events. The CISM team will use the signs and symptoms of distress presented by the participants as a kicking off point for the teaching phase.
34
phase 6 - teaching
provide explanations of the participants’ reactions and provide stress management information. Other pertinent topics may be addressed during the teaching phase as required.
35
phase 7 - re entry
The participants may ask questions or make final statements. The CISD team summarizes what has been discussed in the CISD. Final explanations, information, action directives, guidance, and thoughts are presented to the group. Handouts maybe distributed.
36
4 primary categories of abuse and neglect
emotional physical sexual neglect
37
among who is abuse and neglect prevalent
all social divisions : ethnic, religious, age, social, and socioeconomic groups
38
what does the intergenerational theory of family violence believe ?
It is most likely the interaction of societal, cultural, psychologic, and neurobiological factors. Child learns violence as a behavioral norm through Role modeling, Identification and human interaction within the family unit. However, not all abused children become abusers.
39
what societal or cultural factors play a role in family violence
* Poverty or unemployment * Communities with inadequate resources * Overcrowding * Social isolation of families
40
what is the classic frustration aggression hypothesis
frustration is high in response to societal situations and aggression follows
41
what is the patriarchal theory
AKA feminist theory male dominence enforces the differential status of men and women - women are kept relatively powerless
42
signs that may indicative abuse or neglect
recurrent ED visits hyperventilation anxiety depression GI disturbance hypertension physical injuries insomnia extreme fatigue cachexia loss of hair
43
what happens in the tension phase in the cycle of violence?
small offenses start to accumulate, avoidance of trouble, hindered communication
44
what happens in the confrontation phase in the cycle of violence?
acting out, abuse, intimidation, threats
45
what happens in the reconciliation phase in the cycle of violence?
apologies, denial, rationalization, "it wasn't that bad"
46
what happens in the honeymoon phase in the cycle of violence?
past offenses have been forgotten
47
what is child abuse ?
Any recent act or failure to act on the part of a parent or caregiver that results in death, serious physical harm, sexual abuse, or exploitation, or any act or failure to act that presents an immediate risk of serious harm
48
which act provides states with federal funding, guidance, and support for abuse prevention
CAPTA act of 1974
49
overindulgence abuse
in developed countries is considered a type of neglect (appease a child or keep a child “happy” / “busy” by providing whatever the child wants: unhealthy snacks, unlimited screen time. This leads to serious adjustment issues and social impairments, as well as obesity and medical conditions as a result of obesity
50
who are typically perpetrators of physical abuse and deaths of children
parents and siblings
51
the most underreported type of abuse
neglect
52
sexual abuse includes what other type of abuse
emotional
53
interventions for child abuse
Remain nonjudgmental Play therapy, dolls Medical treatment as needed Report suspected abuse to proper authorities
54
short term goals for medical care
should be received within 1 hour for injuries
55
most immediate concern
ensure child's safety and well being
56
primary interventions for TIC
Child abuse prevention initiatives Recognize increased risk factors for abuse
57
secondary interventions for TIC
Provide appropriate, non-judgmental care to child survivors of abuse and abusers
58
tertiary interventions for TIC
Education and supports to prevent recurrence of abuse
59
reporting obligations
Nurses, other health care providers, teachers, spiritual leaders, coaches, counselors, child care providers all MUST legally report suspicion of abuse to the appropriate child protective agency the person reporting does not have to have proof (authorities will perform investigation)
60
what is intimate partner violence
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, regardless of gender or marital status
61
what is intimate partner violence all about ?
instilling fear and wanting to have power or control in the relationship
62
types of abuse in intimate partner violence relationships
denial and blame, emotional abuse, control through isolation, control through intimidation, control through economic abuse, control through power
63
IPV during pregnancy
IVP is the leading cause of injury-related female deaths Birth defects and infant deaths are frequent outcomes
64
questions to revel IPV
Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom? Do you feel safe in your current relationship? Is there a partner from a previous relationship who is making you feel unsafe now?
65
before taking pictures of evidence for abuse ...
ask for consent follow laws and facility policies
66
physical examination includes assessing :
Internal injuries—concussions, perforated eardrums, abdominal injuries, eye injuries, and strangulation marks on the neck Broken (fractured) bones—arms, pelvis, ribs, clavicle, legs, or jaw Examination might reveal burns from cigarettes, acids, scalding liquids, or appliances.
67
primary interventions incorporated into TIC
Abuse prevention education and programs
68
secondary interventions incorporated into TIC
Facilitate physical and emotional healing for survivors of IPV (physical and emotional) Facilitate treatment for abusers
69
tertiary interventions incorporated into TIC
Promote safety plans and healthy relationship choices to mitigate future occurrences of abuse
70
if the patient is interested in pressing charges :
give verbal or written information on: Local attorneys who handle spouse abuse cases Legal clinics and/or battered persons advocates
71
if the patient is not interested in pressing charges :
provide a list of community resources: Hotlines, shelters, battered women’s groups Battered persons advocates Aid to Families with Dependent Children (AFDC)
72
when are reporting obligations mandated for IPV
only if the victim meets criteria (minor or vulnerable adult or if in state mandates)
73
your role as a nurse in identifying if the patient want to press charges
do not attempt to convince the victim to pursue legal action remain nonjudgmental regardless of their decision
74
types of elder abuse
Physical Emotional Financial (exploitation) Sexual Neglect Self-neglect
75
who is at highest risk for elder abuse
those above the age of 80
76
indications that there may be elder abuse occurring
Fear of being alone with caregiver Obvious malnutrition Bedsores or skin lesions Begging for food Needs medical and/or dental care Left unattended for long periods Reports of abuse and neglect Passive, withdrawn, and emotionless Concern over finances and missing valuables
77
primary interventions that involve TIC
Provide education and support to those at high risk for elder abuse Respite care for family caregivers may be available/Senior Daycare Visiting Nurse Services Meals on Wheels
78
secondary interventions that involve TIC
Provide treatment and support for victims of elder abuse Facilitate treatment for perpetrators of elder abuse
79
tertiary interventions that involve TIC
Ongoing promotion of safe environment for previously victimized elder to reduce possibility of recurrence of abuse or neglect
80
how many states is elderly abuse reporting mandated in
44
81
what is sexual assault
an act of violence, power, and control
82
common date rape drugs
gamma-hydroxybutyric acid flunitrazepam ketamine
83
which date rape drugs cause anterograde amnesia
GHB and ketamine
84
how quickly does GHB clear from your system
within hours therefore, it is hard to detect by testing
85
GHB is therapeutically used for what
type 1 narcolepsy
86
what is dangerous to mix GHB with
alcohol or other CNS depressants likely to cause respiratory depression
87
what does GHB affect
the central nervous system
88
what is the most frequently used date rape drug
alcohol
89
what type of drug is flunitrazepam
a potent benzo the "forget" drug, roofies
90
FDA approval of flunitrazepam
NOT FDA approved for any use
91
flunitrazepam causes which type of amnesia
both retrograde and anterograde amnesia
92
what type of drug is ketamine
an anesthetic, hallucinogenic, psychedelic, dissociate drug (derived from PCP)
93
what is ketamine therapeutically used for
treatment resistant depression procedural sedation in medical settings or veterinary practice
94
acute phase goals
Typical reactions to a crisis often reflect cognitive, affective, and behavioral disruptions. The most common responses are shock, numbness, and disbelief.
95
long term phase goals
Teach the individual to know what to expect during this phase to enable her or him to be prepared and not feel like they are going crazy. Understanding that all assault survivors will deal with the event in their own manner is also important.

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