X3 - Quizlet - Twiga88 - 75 Cards Flashcards
early identification and treatment
Secondary Prevention
Actually preventing the thing
Primary prevention
Avoiding complications
Tertiary prevention
The right patterns of behavior for a society
Norms
a time limited response lasting 4 to 6 weeks
A crisis
A crisis is initiated by internal or external demands that are perceived as a threat to a persons physical or emotional functioning.
Precipitating event is stressful and unusual or rare.
What initiates a crisis
Describes unfavorable person-environmental relationships that relate to maturational events such as leaving home for the first time, completing school or accepting the responsibility of adulthood.
maturational crisis
Goal for people experiencing crisis
To return to pre-crisis level of functioning.
Occurs whenever a specific stressful event threatens a person’s
biopsychosocial integrity and results in some degree of psychological disequilibrium
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situa- cri-
Situational Crisis
Initiated by an unexpected unusual events that can affect an individual or
a multitude of people. National and natural disasters.
During an __________ crisis (e.g., flood, hurricane, forest fire) that affects the
well-being of many people, the interventions of the PMH-APRN will be a part of
the community’s efforts to respond to the event.
adv-
Adventitious Crisis
Role of APRN in Crisis
The role of the PMH-APRN is to provide a framework of support systems that guide the
client through the crisis and facilitate the development and use of positive coping skills.
Assess risk of homicide/suicide/self-injury
Assess coping skills
Assess perception of problem and support mechanisms
Assess biologic items - sleep, eating, hygiene, etc
Assess psychological - emotions and coping
Asses social - individual, family, community. Social support
This is a sudden ecological or man-made phenomenon that is of sufficient magnitude to require external help to address the psychosocial needs as well as the physical needs of the victims.
dis-
Disaster
Injuries are extensive and chances of survival are unlikely
even with definitive care. Separate and provide comfort
Unresponsive patients with penetrating head wounds, high
spinal cord injuries, wounds involving multiple anatomical sites
and organs, 2nd/3rd degree burns in excess of 60% of body surface area, seizures or vomiting within 24hr after radiation
exposure, profound shock with multiple injuries, agonal
respirations; no pulse, no BP, pupils fixed and dilated
-
MCI triage category: Expec-
MCI triage category: Expectant
Injuries are life-threatening but survivable with minimal
intervention. Individuals in this group can progress rapidly to expectant
if treatment is delayed.
Sucking chest wound, airway obstruction secondary to
mechanical cause, shock, hemothorax, tension pneumothorax,
asphyxia, unstable chest and abdominal wounds, incomplete
amputations, open fractures of long bones, and 2nd/3rd degree
burns of 15%-40% total body surface area
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MCI Category: Imme-
MCI Category: Immediate
Injuries are significant and require medical care but can wait
hours without threat to life or limb. Individuals in this group receive
treatment only after immediate casualties are treated.
Stable abdominal wounds without evidence of significant
hemorrhage; soft tissue injuries; maxillofacial wounds without
airway compromise; vascular injuries with adequate collateral
circulation; genitourinary tract disruption; fractures requiring
open reduction, débridement, and external fixation; most eye
and CNS injuries
-
MCI Category: Dela-
MCI Category: Delayed
Injuries are minor and treatment can be delayed hours to days.
Individuals in this group should be moved away from the main triage
area.
o
Upper extremity fractures, minor burns, sprains, small
lacerations without significant bleeding, behavioral disorders or
psychological disturbances
-
MCI Category: Mini-
MCI Category: Minimal
Assess the victim for behaviors that indicate a
depressed state, presence of confusion, uncontrolled weeping or screaming,
disorientation, or aggressive behavior. Ideally, the PMH-APRN should assess the
coping strategies the victim uses to normally manage stressful situations.
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psyc- asse-
Psychological Assessment
The ABCs of psychological first aid
include focusing on A (arousal), B
(behavior), and C (cognition). When arousal is present, the intervention goal is to decrease excitement by providing safety, comfort, and consolation. When abnormal or irrational behavior is present, survivors should be assisted to function more effectively in the disaster and when cognitive disorientation occurs, reality testing and clear information should be provided.
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ABC’s of Psychological First Aid
ABC’s of Psychological First Aid
support the
development of resilience, coping, and recovery while providing
technical assistance, training, and consultation
After initial assessment the PMH- APRN should
include helping the victims prioritize and match available
resources with their needs, and preventing further complications,
monitoring the environment, disseminating information, and
implementing disease control strategies
Goals of care
May be helpful but is no longer considered essential
Debriefing
helps the patient gain control and improve coping
Explanation of anticipated behaviors and reactions
The PMH-APRN should maintain a calm demeanor, obtain
and distribute information about the disaster and the victims, and reunite
victims and their families. In addition, there is a need to monitor the news
media’s impact on the mental health of the victims of the crisis
Assess for economic distress, access to shelter, food, etc
Social Assessment:
Providing a safe environment is the priority for any client who is a victim of a serious
crime/assault
ASD/PTSD support
ASD duration
2 days to 1 month
ASD: Focus on
Meet immediate needs
o
Build therapeutic alliance
o
If distressed, limit to immediate care
o
Complete psych assessment
Focus on reexperiencing, avoidance or numbing, hyperarousal, dissacociation
o
Goals of treatment: Reduce the severity of symptoms, Prevent or treat trauma-related
comorbid conditions, Improve adaptive functioning by promoting resilience, Prevent
relapse, Integrate the trauma into the patient’s life experience, Prevent the development
of PTSD
Psychological First Aid in ASD
The key features of PFA are empathy, compassion, stabilizing the patient by
reducing distress, and connecting the individual with resources
o
The frontline treatment for patients with ASD is multiple session, trauma-focused
cognitive behavioral therapy
o
Do something, instead of nothing (Pleasure promoting activities)
Factors that increase risk of PTSD:
Factors that appear to increase the risk for developing PTSD among individuals with ASD
include female gender, prior exposure to traumatic events, low levels of social support,
stressful life events in year prior to trauma, a personal or family history of
psychopathology, and experiencing new stressors after the original trauma
factors and interventions to prevent the development of PTSD focus on
preventing or
treating new stressors, reducing distress, modulating arousal, managing pain, and
treating depression.
Propranolol, opioid, psychotherapy
Primary Feature of PTSD:
disturbance of memory, in which memories of the
traumatic event are not processed and integrated with other information, so they are
reexperienced
Overall treatment goal for PTSD
is to enable patients to regain control of their
emotional responses and to place the trauma in the larger perspective of their lives as
an event that happened at a certain time and that is unlikely to recur.
One of the first steps in PTSD treatment
is to help the patient to develop a sense of trust,
safety, and separation from the traumatic event
Psychotherapy for PTSD
psychotherapy: Exposure, CBT, EMDR, Trauma management therapy, structured writing,
VRE/tech based, interpersonal therapy, psychodynamic
Pharmacological choice for PTSD
SSRI
Odd or eccentric PD
Which cluster?
Cluster A
Which PD?
Suspicious of others; fear others will exploit, harm, or deceive them; fear of confiding in others
(fear personal information will be used against them); misread compliments as manipulation;
hypervigilant; prone to counterattack; hostile; and aloof.
Psychotic episodes may occur in times of stress.
Nurses should give straightforward explanations of tests, history taking, and procedures, side
effects of drugs, changes in treatment plan, and possible further procedures, to counteract client
fear.
Traits of a person with Paranoid Personality Disorder.
o
They do not trust others easily and it’s best to use a respectful neutral approach.
o
They are critical of others because they project blame for their own shortcomings onto
others
Paranoid PD
Which PD?
Avoids close relationships, is socially isolated, has poor occupational functioning, and appears
cold, aloof, and detached.
Social awareness is lacking and relationships generate fear and confusion in the client.
Nurses should strive for simplification and clarity to help decrease client anxiety.
Therapy: Individual psychotherapy is the appropriate modality to use with Schizoid personality
disorder
Schizoid PD
Which PD?
ideas of reference; magical thinking or odd beliefs; perceptual distortions; vague, stereotyped
speech; frightened, suspicious, blunted affect; distant and strained social relationships.
These clients tend to be frightened and suspicious in social situations.
o
Explanations can ease their anxiety.
Schizotypical PD
Dramatic, Emotional, Erratic
Which cluster?
Cluster B
Unstable, intense relationships; identity disturbances; impulsivity; self-mutilation; rapid mood
shifts; chronic emptiness; intense fear of abandonment; splitting; and anger
Inability to tolerate perceived rejection
Borderline Personality symptoms
BPD Major defense
A major defense is splitting (alternating between idealizing and devaluing).
Self Mutilation in BPD
Self-mutilation and suicide-prone behavior are often-used impulsive self-destructive behaviors.
Self mutilation occurs:
because a client may feel that pain is better than not feeling
anything, it also results from feelings of abandonment, it can be a manipulative gesture,
and it is also happens when a safety plan has been put in place.
Self mutilation is mainly due to:
fear of abandonment or the increase of independence
Regarding BPD:
If a client with BPD who was making progress but recently had an anxiety producing
situation arise and now cut herself is that even though this behavior is dysfunctional, it is
mostly the patient’s best effort to cope
Best response from PMH-APRN in BPD
The best response by the PMHNP when speaking with a client with BPD who has been in
counseling for management of self-harm behaviors who now wants to cut themselves is
to assist the client to identify an appropriate coping strategy
Anger in BPD
Anger is intense and pervasive and help with anger management is an important intervention
Other focuses of BPD Management
Relationship building, safety, and limit setting are other foci.
Clients with BPD have not successfully
achieved the developmental stage of separation-
individuation during which a child normally develops a sense of self, a permanent sense of
significant others (object constancy), and integration of seeing both bad and good components
of self
falsely attribute to others their own unacceptable feelings, impulses, or
thoughts
Projective Identification:
Boundaries and BPD
Respecting a client’s boundaries is important in establishing a therapeutic relationship with a
patient with BPD.
Risk Factors for BPD
sexual abuse, parental separation, biological component (A decrease in serotonin
activity and an increase in α2-noradrenergic receptor sites may be related to the irritability and
impulsiveness; an increase in dopamine may be responsible for transient psychotic states)
DBT/ Mindfulness
DBT is a psychosocial treatment developed by Marsha M. Linehan specifically to treat
individuals with borderline personality disorder.
DBT includes:
o
Individual component in which the therapist and client discuss issues that come up
during the week, recorded on diary cards and follow a treatment target hierarchy.
During the individual therapy, the therapist and client work towards improving skill
use. Often, skills group is discussed and obstacles to acting skillfully are addressed.
DBT targets behaviors in a descending hierarchy:
Decreasing high-risk suicidal behaviors
Decreasing responses or behaviors (by either therapist or client) that
interfere with therapy
Decreasing behaviors that interfere with/reduce quality of life
Decreasing and dealing with post-traumatic stress responses
Enhancing respect for self
Acquisition of the behavioral skills taught in group
Additional goals set by client
o
Group therapy, which ordinarily meets once weekly for about 2 - 2.5 hours, in which
clients learn to use specific skills that are broken down into 4 modules: core
mindfulness skills, emotion regulation skills, interpersonal effectiveness skills, and
distress tolerance skills.
Understand that DBT helps to replace irrational thoughts.
Which PD?
o
Grandiosity, fantasies of power or brilliance, need to be admired, sense of entitlement,
arrogant, patronizing, rude, overestimates self and underestimates others.
o
Behavior covers a fragile ego.
o
In health care setting, they demand the best of everything.
o
When client is corrected, when boundaries are defined, or when limits are set on client’s
behavior, client feels humiliated, degraded, and empty.
To lower anxiety the client may launch a counterattack.
o
The nurse should gently help the client identify attempts to seek and become perfect,
exhibit grandiose behavior, and sense of entitlement
Narcissistic PD
Which PD?
Center of attention; flamboyant; seductive or provocative behaviors; shallow, rapidly shifting
emotions; dramatic expression of emotions; overly concerned with impressing others;
exaggerates degree of intimacy with others; self-aggrandizing; preoccupied with own
appearance.
Experience depression when admiration of others is not given.
Suicide gestures may result in client entry into the health care system.
o
A thorough assessment of suicide potential must be undertaken, and support offered in
the form of clear parameters of psychotherapy.
Histrionic PD
Which PD?
Center of attention; flamboyant; seductive or provocative behaviors; shallow, rapidly shifting
emotions; dramatic expression of emotions; overly concerned with impressing others;
exaggerates degree of intimacy with others; self-aggrandizing; preoccupied with own
appearance.
Experience depression when admiration of others is not given.
Suicide gestures may result in client entry into the health care system.
o
A thorough assessment of suicide potential must be undertaken, and support offered in
the form of clear parameters of psychotherapy.
Antisocial PD
Anxious & Fearful
Which cluster?
Cluster C
Which PD?
Inability to make daily decisions without advice and reassurance, need of others to be
responsible for important areas of life, anxious and helpless when alone, and submissive.
Solicit care taking by clinging.
Fear abandonment if they are too competent.
Experience anxiety and may have co-existing depression.
Know the cluster! (C)
Dependent PD
Which PD?
Social inhibition, feelings of inadequacy, hypersensitivity to criticism, preoccupation with fear of
rejection and criticism, and self-perceived to be socially inept.
Low self-esteem and hypersensitivity grow as support networks decrease.
Demands of workplace often overwhelming.
Project that caregivers will harm them through disapproval and perceive rejection where none
exists.
Nurses can teach socialization skills, provide positive feedback, and build self-esteem.
Avoidant PD
Preoccupied with rules, perfectionist, too busy to have friends, rigid control, and superficial
relationships.
Complains about others’ inefficiencies and gives others directions.
OCD
Assessment of a Child (8 Questions)
Behaviors that are possible indicators of a mental illness in a 3-year-old child:
o
Most psychiatric disorders in children are multifactorial.
Understand that children from different cultures develop at different rates.
Most children will adopt the same world view as their parents (ex. If a child was brought up by
parents who thought the world was hostile, they would most likely adopt this view as they grow
older.
The psych NP needs to foster a child’s healthy characteristics and existing environmental
supports no matter how negative (ex a child lives in a homeless shelter).
Therapeutic drawing is a helpful technique if a child feels self-blame regarding their parent’s
divorce.
Establishing a therapeutic alliance is important because acceptance and trust convey a feeling of
security in an adolescent.
Objective observations help the most in evaluating outcomes of child therapy.
Important because it allows the child to play out their fears and frustrations.
Play therapy is child-centered and typically builds on the foundation of the psychodynamic,
object-relations, and attachment theories.
Used for children 3 years or older
Nondirective play is normally viewed as the best way to begin play therapy.
Structured play is rarely used until nondirective play has enabled a full assessment of relevant
themes and issues, and the child’s trust around anxiety-laden issues has been developed.
Useful for catharsis, abreaction (assimilate previous experiences that have been traumatic or
painful), role-play
Interventions include reflection (commenting) and interpretation (after rapport developed)
Play Therapy
Which therapy?
Understand schemas
o
Individuals with BPD develop dysfunctional beliefs and maladaptive schemas leading
them to misinterpret environmental stimuli continuously, which in turn leads to rigid and
inflexible behavior patterns in response to new situations and people
Cognitive therapy is the modality that prioritizes a client’s schema.
7 and older
Cognitive therapy
Uses books and a librarian as resources.
When children listen to or read a story, they unconsciously identify with the characters and
experience a catharsis of feelings.
Bibliotherapy
This therapy can promote the greatest change in an adolescent’s behavior.
Know different family styles such as “closed Family”.
The Developmental Theoretical approach describes a family’s progression through the lifecycle.
Family Therapy
Flooding
Know an example of flooding in a child.
(Per the Quizlet card)
When conducting a counseling session for a group of at-risk adolescents on drug use
it is
important to have their peers involved in teaching some of the problem-solving skills
Nursing Theorists
Freud - Psychodynamic
Erikson - Developmental
Piaget - Cognitive
Fairbairn, Winnicott, Klein, Mahler, Stem - Object-relations
Bowlby and Ainsworth - Attachment
Skinner - Behavioral/learning
Bower - Family
General Info
Play Therapy (1 question)
Play therapy is important because it allows the child to play out their fears and frustrations.
Play therapy is child-centered and typically builds on the foundation of the psychodynamic,
object-relations, and attachment theories.
Used for children 3 years or older
Nondirective play is normally viewed as the best way to begin play therapy.
Structured play is rarely used until nondirective play has enabled a full assessment of relevant
themes and issues, and the child’s trust around anxiety-laden issues has been developed.
Useful for catharsis, abreaction (assimilate previous experiences that have been traumatic or
painful), role-play
Interventions include reflection (commenting) and interpretation (after rapport developed)
Cognitive Therapy (1 question)
Understand schemas
o
Individuals with BPD develop dysfunctional beliefs and maladaptive schemas leading
them to misinterpret environmental stimuli continuously, which in turn leads to rigid and
inflexible behavior patterns in response to new situations and people
Cognitive therapy is the modality that prioritizes a client’s schema.
7 and older
Bibliotherapy (2 questions)
Bibliotherapy uses books and a librarian as resources.
When children listen to or read a story, they unconsciously identify with the characters and
experience a catharsis of feelings.
Family Therapy (Systems) (1 question)
Family therapy can promote the greatest change in an adolescent’s behavior.
Know different family styles such as “closed Family”.
The Developmental Theoretical approach describes a family’s progression through the lifecycle.
Flooding (1 question)
Know an example of flooding in a child.
Adolescent education on substances (1 question)
When conducting a counseling session for a group of at-risk adolescents on drug use, it is
important to have their peers involved in teaching some of the problem-solving skills.
Child Protective Services (1 question)
Reporting requirements for Child Protective Services and the Health Professional
Oppositional Defiant Disorder (1 question)
Event interpretation should be included for problem solving therapy for a child with conduct
disorder.
The primary treatment of oppositional defiant disorder is family intervention using both direct
training of the parents in child management skills and careful assessment of family interactions.
This therapy advocates that, rather than trying to bring the person with dementia back to
our reality, it is more positive to enter their reality.
Validation therapy
Remotivation/Reminiscence Therapy
Once the person has experienced severe short-term memory loss and can no longer
make sense of the present, they are likely to go back to the past to resolve unfinished
conflicts, relive past experiences or to retreat from the present.
o
Acknowledge and empathize with with the feelings behind the behavior.
Reminiscence therapy and life review are useful interventions for elders who are experiencing
self-esteem disturbance, grief, hopelessness, powerlessness, altered role performance, and
social isolation.
o
Reminiscence uses the recall of past events, feelings, and thoughts to facilitate pleasure,
quality of life, adaptation to present circumstances, or distraction.
o
Life review is a structured process involving the recall of past events in one’s life in an
effort to find meaning in those events. The process systematically reviews remote
memories and addresses the expression of related feelings and the recognition of
conflicts. A life review is a chance to reexamine one’s life, solve old problems, make
amends, and restore harmony.
Quite useful in the earlier stages of dementia.
Resocialization is used to facilitate the elder’s ability to interact with others and to renew
interest in his or her surroundings.
o
One form of resocialization group focuses on remotivation therapy, in which the
emphasis is on stimulating interest in the environment and relationships with others.
Group discussion focuses on topics chosen by members of the group and may include
world affairs, current local activities, and happy experiences
Limit Setting
Patients will respond better to limit setting if the PMHNP can reflect back to the client an
understanding and validation of their emotional distress
MIndfulness
Focuses on situations where the objective is to change
something (e.g., requesting that someone do something) or to resist changes someone else
is trying to make (e.g., saying no). The skills taught are intended to maximize the chances
that a person’s goals in a specific situation will be met, while at the same time not damaging
either the relationship or the person’s self-respect.
Identifying and labeling emotions; Identifying obstacles to changing
emotions; Reducing vulnerability to emotion mind; Increasing positive emotional events;
Increasing mindfulness to current emotions; Taking opposite action; Applying distress
tolerance techniques
Emotional Regulation
The ability to accept, in a non-evaluative and nonjudgmental fashion,
both oneself and the current situation. Although the stance advocated here is a
nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is
not approval of reality. Distress tolerance behaviors are concerned with tolerating and
surviving crises and with accepting life as it is in the moment. Four sets of crisis survival
strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros
and cons.
Distress Tolerance
