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446 Cards in this Set

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What are Coping mechanisms
Conscious attempts to control anxiety, which, if effective, contribute to a person's sense of competence and self-esteem.
What are Defense Mechanisms?
Unconscious attempts to manage anxiety, attempts that may or may not be successful.
What are the single largest mental health problem in the United States.
Anxiety disorders.
What is GAD?
Generalized anxiety disorder (GAD) is a chronic disorder characterized by persistent anxiety without phobias or panic attacks. Symptoms include excessive worrying, fatigue, muscular tension, irritability, difficulty concentrating, and sleep disturbance.
What is the name for the highest level of anxiety, which are characterized by disorganized thinking, feelings of terror and helplessness, and nonpurposeful behavior.
Panic Attcks
This is is characterized by sudden and unexpected panic attacks, catastrophic thinking, phobic avoidance, anxiety, depression, and obsessions. It may or may not be accompanied by agoraphobia.
Panic disorder
Who suffers from persistent, unreasonable fears that result in avoidance behavior, which is often disabling. When confronted with the feared object or situation, the person panics.
People with phobic disorders
What is Agoraphobia?
A fear of being away from home and of being alone in public places when assistance might be needed.
What are themajor defense mechanisms present in phobias?
are repression, displacement, symbolization, and avoidance.
What are the characteristics of Obsessive-compulsive disorder (OCD)?
It is characterized by unwanted, repetitive thoughts and behaviors.

Behavior is often time consuming and bizarre.
What is Posttraumatic stress disorder(PTSD)and what are some of its characteristics?
It is characterized by a constant anticipation of danger and a phobic avoidance of triggers that remind the person of the original trauma. Other characteristics include irritability, aggression, flashbacks, and self-devaluation.
What is the difference between Acute Stress Disorder and PTSD?
Acute stress disorder is a short-term response to an extreme trauma. If it persists longer than one month, the client is given the diagnosis of PTSD.
What are Dissociative disorders?
Characterized by an alteration in conscious awareness of behavior, affect, thoughts, and memories, and an alteration in identity, particularly in the consistency of personality.
What are some of the charactgeristic thought processes of people with dissociative disorder?
People with a dissociative disorder block the thoughts and feelings associated with a severe trauma from conscious awareness. This may take the form of amnesia, fugue, depersonalization, or identity disorder (DID).
x
The somatoform disorders involve physical symptoms for which no organic basis exists. Denial is used to transform anxiety into physical symptoms. The disorders include somatization disorder, conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder.
What is Factitious disorder?
It is diagnosed when a person intentionally simulates or produces physical or psychological symptoms in order to assume the sick role. The most severe and chronic form is referred to as Munchausen's syndrome.
x
Seeking external incentives such as sick leave or financial compensation is the motivation behind malingering.
What are Secondary Gains?
Advantages from or rewards for being ill.
x
People with anxiety disorders may have a profound effect on their family systems. They may control their family through dependency and helplessness or though detachment and emotional distance. Secondary gains may perpetuate the disorder.
Is anxiety cultural?
The meaning of anxiety and the responses to it are strongly influenced by cultural beliefs and practices.
x
The anxiety disorders of childhood and adolescence are separation anxiety disorder, selective mutism, reactive attachment disorder, GAD, panic disorder, social phobia, OCD, and PTSD.
How is Mild Anxiety used?
Mild anxiety helps people deal constructively with stress.
What are some symptoms of Moderately Anxious People?
Moderately anxious people focus on immediate concerns and may experience mild gastric symptoms or trembling lips.
What are signs of severe anxiety:
They include increased heart rate and blood pressure, shortness of breath, sweating, trembling, restlessness, fatigue, tension headache, and stiff neck.
What are Signs of panic?
They include hypotension, agitation, poor motor coordination, nonpurposeful behavior, dizziness, chest pain, palpitations, a choking sensation, and a feeling of terror.
x
There is a high correlation between anxiety disorders and substance abuse, depression, and suicide. Anxious children often exhibit oppositional behavior.
x
Factors that contribute to the development of anxiety disorders include genetic predisposition, altered neurobiology, inefficient defense mechanisms, problems with interpersonal relationships, cognitive expectations, learned avoidance responses, and rigid gender-role expectations.
What are treatment options for anxiety?
A variety of antianxiety agents and antidepressants may be used for treatment, along with individual, family, and group psychotherapy.
Name some alternative therapies for depression.
Alternative therapies include herbs, essential oils, homeopathic remedies, massage, Therapeutic Touch, yoga, and meditation.
Where are the bulk of clients with anxiety disorders assessed?
In community settings, clinics, offices, emergency departments, and medical-surgical units.
x
Most of the nursing diagnoses in this chapter apply to many individuals regardless of the specific medical diagnostic category. It is through understanding the issues and problems most significant for each client that care plans are developed and implemented.
x
Techniques for reducing anxiety include muscle relaxation, deep breathing, physical exercise, and distraction techniques.
How should you deal with someone who is experiencing a panic state?
Stay with the person experiencing a panic state and speak slowly in short, simple sentences.
What might you recommend as an effective way for clients to keep track of their thoughts, feelings, and memories.
Journaling
x
Calming techniques include deep breathing, muscle relaxation, changing sensory experiences, doing activities, and positive affirmations.
x
Help clients identify secondary gains and find more adaptive ways to meet those needs.
x
Aid clients in the search for meaning in life, connecting with others, and developing a support system.
x
Cognitive interventions include guided self-dialogue, thought stopping, and changing irrational ways of thinking.
x
Many clients benefit from social skills training, assertiveness training, and communication skills training.
x
Relationship or family therapy is appropriate in many cases, as the entire family system suffers from the effects of anxiety disorders.
x
Nutritional interventions include teaching clients to increase their intake of niacin and vitamin B6, which are necessary for the production of 5-HT.
x
The nursing process is dynamic, and an evaluation of outcomes leads to further assessment and modification of the plan of care.
x
People with anorexia lose weight by dramatically decreasing their food intake and sharply increasing their amount of physical exercise.
x
People with bulimia remain at near-normal weight and develop a cycle of minimal food intake, followed by binge eating and then purging.
Are bulemia and anorexia nervosa related?
The two disorders have many features in common, and a person can revert from one disorder to the other.
x
Eating disorders are more common among competitive athletes than the general population.
x
Psychosocial factors contributing to the development of obesity include learned patterns of eating, overeating to manage negative feelings, and viewing food as a reward.
x
Obesity has a strong heritable component.
What role do psychotropic medications have on weight?
Weight gain is among the most problematic side effects of psycothropic medications and is one of the most frequent reasons for individuals discontinuing their medication.
x
Obese people are no more prone to emotional problems than are people of normal weight. It is the internalization of the culture's hatred and rejection that contributes to the psychological problems of obese people.
x
Prader-Willi syndrome causes an unrelenting feeling of hunger that can never be satisfied. Access to food must be rigidly enforced if these individuals are not to become morbidly obese.
x
Behaviors associated with anorexia and bulimia are compulsions and rituals about food and exercise, phobic responses to food, eating binges, purging, and the abuse of laxatives and diuretics.
x
Affective characteristics include multiple fears, dependency, guilt, and a high need for acceptance and approval from others.
x
Cognitive characteristics include selective abstraction, over-generalization, magnification, personalization, super-stitious thinking, dichotomous thinking, distorted body image, self-depreciation, and perfectionistic standards of behavior.
x
People suffering from anorexia experience a severely distorted body image.
x
The entire family system often becomes preoccupied with food, eating, and rituals involving meals.
x
In American society, thinness for women and a muscular build for men are equated with attractiveness, success, and happiness. This is a contributing factor to eating disorders.
How does Western Culture view Eating Disorders?
Eating disorders are considered to be culture-reactive syndromes in the Western world.
x
Physiological characteristics include fluid and electrolyte imbalances, decreased blood volume, cardiac arrhythmias, elevated blood urea nitrogen (BUN), constipation, osteoporosis, esophagitis, potential rupture of the esophagus or stomach, tooth loss, swollen salivary glands, Russell's sign, menstrual problems, and weight loss.
x
Concomitant disorders include depression, social phobias, panic attacks, obsessive-compulsive symptoms, and substance abuse.
x
Neurobiological factors in the development of eating disorders include 5-HT dysregulation, low levels of endorphins, and a genetic predisposition.
x
Intrapersonal theorists consider low self-esteem, problems with identity formation, anxiety intolerance, and maturational problems to be factors in the development of eating disorders.
x
Cognitive theorists believe that cognitive distortions and dysfunctional thoughts contribute to disordered eating patterns.
How does the Family System affect clients with Eating Disorders?
The family system of a person with an eating disorder may be enmeshed. Family members may have difficulty with conflict resolution and have high ambitions for achievement and performance.
x
Feminist theorists consider that women's preoccupation with their bodies results from the cultural ideal of thinness, and that their identity and self-esteem depend on physical appearance.
Does antidepressant medication have a role in eating disorders?
Antidepressant medication is more helpful in treating bulimia than anorexia.
x
Eating disorders cause multiple physical complications. Accurate physical assessment may prevent death.
x
The client's level of malnourishment must be identified, as well as binge eating and/or purging patterns, fear, cognitive distortions, and relationships with family and friends.
x
Help clients discuss their fears related to weight gain and loss of control.
x
Clients contract for the amount of food to be eaten in a day; a target weight is established, usually at 90 percent of average weight for the client's age and height.
x
Contract for a reasonable intake, beginning with 1,000 to 1,500 kcal per day.
x
Help clients identify situations that precede a binge and explore alternative coping behaviors. Discussion also focuses on how purging is used to cope with feelings.
x
Clients may find it helpful to keep a food diary and a body image diary.
x
Secondary gains must be identified in order to design interventions that will help clients meet these needs in constructive and healthy ways.
x
The family needs to let the client take responsibility for her or his own eating behavior.
x
Nurses must be leaders in actively challenging idealized cultural values in an effort to help women accept and value themselves as they are, and to prevent a continued increase in eating disorders.
x
It appears that people with bulimia are more responsive to treatment than people with anorexia, who often remain intensely preoccupied with weight and dieting.
x
At present, there are no long-term successful treatment programs for weight loss in the obese population.
x
The mood disorders are major depression (unipolar disorder), dysthymic disorder, bipolar disorder, cyclothymic disorder, and schizoaffective disorder.
x
Affect is the verbal and nonverbal expression of one's internal feelings or mood. Descriptors are appropriate versus inappropriate, stable versus labile, elevated versus depressed, and overreactive versus blunted or flat.
x
Postpartum mood changes range along a continuum from postpartum blues to postpartum depression to postpartum psychosis.
x
People who are depressed withdraw from activities and other people; experience feelings of despair, guilt, loss of gratification, and loss of emotional attachments; and suffer from self-depreciation, negative expectations, cognitive distortions, and self-criticism. They also have difficulty making decisions and experience a retarded flow of thought.
x
People who are in a manic phase engage in any available activity, are effusive in interactions with others, and form intense emotional attachments quickly. They experience feelings of euphoria but may become suddenly irritable. Thoughts focus on grandiose expectations for themselves, exaggerated accomplishments, and a positively distorted body image. Distractibility and flight of ideas interfere with decision making.
x
Mood disorders may be accompanied by psychotic symptoms such as hallucinations and delusions.
x
Families may be oversolicitous or may become frustrated when a family member is unable to change affect, behavior, or cognition. If the person is hostile and destructive, police may be called upon to intervene.
x
The sex life of couples is often disrupted by mood disorders. People who are depressed have little interest in sex, and people who are manic are obsessed with sex.
x
Appropriate expressions of mood are largely culturally determined.
x
Throughout the world, most cases of depression are experienced and expressed in somatic terms.
x
Symptoms of depression in children and adolescents reflect developmental stages.
x
Bipolar disorder in young people is frequently misdiagnosed as ADHD, conduct disorder, or schizophrenia.
x
Although depression is common, it may not be recognized in older adults and may be confused with dementia.
x
Older adults with chronic medical problems may develop a secondary depression.
x
Physiologically, people who are depressed experience loss of appetite, insomnia, decreased mobility, and constipation, while people in the manic phase experience hyperinsomnia, hyperactivity, and may not take the time to eat.
x
Concomitant disorders include anxiety disorders and substance-related disorders.
x
The inheritability of major depression is 40 to 50 percent and is 70 percent for bipolar disorder. The mix of multiple genes determines differences such as age of onset, symptoms, severity, and course of the mood disorders.
x
In the mood disorders, there is a change in the amount of neurotransmitters or a change in the sensitivity of the receptors, thus altering the transmission of electrical impulses.
x
The mood disorders may involve a desynchronization of circadian rhythm in some people.
x
Seasonal affective disorder (SAD) is cyclic and related to the amount of available sunlight.
x
Depression may be secondary to prescribed medications, metabolic disorders, and neurological disruptions.
x
Repressed hostility, losses, unachieved goals, learned helplessness, and cognitive distortions contribute to mood disorders.
x
Racism, classism, sexism, ageism, and homophobia contribute to depression by increasing feelings of powerlessness, hopelessness, and low self-esteem.
x
People experiencing multiple significant life events along with minimal support networks and maladaptive coping patterns are at higher risk for developing a depressive disorder.
x
Rigid expectations about gender roles and being isolated within the home may contribute to higher rates of depression among women. Role changes and losses may contribute to higher rates of depression among older adults.
x
Antidepressants, mood stabilizers, antipsychotics, electroconvulsive therapy (ECT), sleep deprivation, and phototherapy may be used in the treatment of mood disorders.
x
Alternative therapies include transcranial magnetic stimulation, vagus nerve stimulation, exercise, St. John's Wort, SAMe, vitamin B12, tyrosine, melatonin, DHEA, Omega-3 fatty acids, and aromatherapy.
x
Nursing assessment must often be conducted in segments of 15 to 20 minutes for clients who have little energy or for those who are hyperactive.
x
Some clients are a danger to themselves or others; therefore, High risk for violence is a priority nursing diagnosis. Other diagnoses include Impaired verbal communication, Decisional conflict, Deficit in diversional activity, Fatigue, Constipation, Altered thought processes, Self-esteem disturbance, Spiritual distress, Caregiver role strain, Altered sexuality patterns, Knowledge deficit, and Sleep pattern disturbance.
x
The first priority of care is client safety. Safety concerns include monitoring for suicide potential and management of hallucinations.
x
Behavioral interventions include prevention of physical exhaustion, decreasing environmental stimuli, simple explanations, limit setting with intrusive behavior, and protection from impulsive sexual behavior.
x
Cognitive interventions include helping clients identify negative self-statements and distorted thought processes.
x
There are four phases for clients working toward self-management: realization of a need, seeking information, energy and will to move on the information; and the selection of useful self-management strategies.
x
Assisting clients through the process of active listening means that you listen for unexpressed messages and feelings and validate your understanding with the client.
x
When interacting with people who are depressed, introduce only one topic at a time, allow plenty of time for response, and provide other interactions if they are unable to converse.
x
Decreasing environmental stimuli, Identifying themes, and focusing on one topic at a time are helpful for clients who are experiencing flight of ideas.
x
Help clients and families identify the benefits of social interaction.
x
Peer counseling may enhance clients' socialization levels.
x
Problem solving is a key nursing intervention. The mere process of working on the problem, analyzing the options, and actively selecting a course of action provides clients with a sense of control which counteracts their feelings of helplessness and powerlessness.
x
Nursing activities should be designed to help clients advocate for themselves as a way of improving self-esteem and providing hope.
x
Advanced directive, initiated by clients, helps families and caregivers make decision for clients when they are unable to make them for themselves.
x
Use reality testing to help clients identify irrational beliefs regarding their sense of guilt.
x
Impulse control training includes stop and think, identifying other options, discussing the potential benefits of options, and decision making process.
x
Clients and families need to recognize the early warning signs of relapse so they can take preplanned action to alleviate the symptoms.
x
Help clients choose recreational activities that are consistent with their capabilities. In the acute phase, keep activities short and simple.
x
Set limits on the amount of time clients talk about their failures or their grandiose beliefs. Teach positive affirmations as a way to counteract negative self-talk.
x
Help clients identify purpose in life, value to friends, short-term goals, and availability of supportive people. Use spiritual resources to decrease distress.
x
For clients to become self-managers, it is essential they learn everything they can about their diagnosis and treatment strategies. Families must be included in this educational process.
x
Provide information to the family about the client's condition in accordance with client preferences, remembering the issue of confidentiality.
x
Discuss with the family how their strengths and resources can be used to enhance the health status of the client and the family's ability to cope.
x
One goal of family intervention is to help family members identify and change behaviors that maintain depression and dependency within the family system.
x
Exercise is a natural way to increase neurotransmitters and endorphins, thus decreasing feelings of sadness and tension.
x
Clients with mood disorders often find six small meals a day are easier to tolerate than three large meals a day.
x
Implementing natural sedative measures such as increased physical actiivity, decreased daytime napping, relaxation techniques, avoidance of caffeine may improve sleeping patterns.
x
Evaluation is accomplished by determining the client's progress toward achieving the outcome criteria. Mod-ification of the plan of care is based on evaluation data.
x
Chemical dependence is a chronic and progressive disease that can be fatal if untreated.
x
Most people who are chemically dependent are poly-drug abusers.
x
Substance abuse contributes to other illnesses, fetal syndromes, accidents, suicides, and homicides.
x
Substance abuse among nurses is not much higher or lower than that of the general population. There are statewide programs that help nurses seek treatment and save their licenses.
x
The pattern of alcohol abuse varies from person to person. Some abuse daily, some abuse on weekends, and others abuse on periodic binges.
x
Blackouts are a form of amnesia for events that occur during the drinking period.
x
Wernicke's encephalopathy results from thiamine deficiency and is characterized by ataxia, abnormal eye movements, and confusion.
x
Korsakoff's syndrome is an inability to retain new information and a disruption in long-term memory. People may use confabulation when confronted with memory loss.
x
Alcoholic dementia is characterized by impaired thinking, judgment, and memory as well as personality changes.
x
Alcohol withdrawal syndrome usually begins about six to eight hours after the last drink and is characterized by irritability, anxiety, insomnia, and tremors.
x
In alcohol withdrawal, the person may experience seizures, hallucinations, disorientation, confusion, tachycardia, hypertension or hypotension, diaphoresis, and fever.
x
Overdose of alcohol may result in unconsciousness, coma, respiratory depression, and death.
x
Sedatives, hypnotics, and anxiolytics provide a sense of well-being and relaxation. There is a great risk for addiction and overdose.
x
Rohypnol and GHB, the "date rape" drugs, are used to render rape victims unconscious.
x
Overdose of sedative-hypnotics and/or when combined with alcohol can lead to respiratory depression and death.
x
Opioids create a feeling of euphoria, pleasure and relaxation. Withdrawal symptoms may last as long as a week.
x
Overdose on opioids can lead to death from respiratory depression. Narcan (naloxone) may be given IV to reverse respiratory depress and coma. The client is likely to need repeated doses.
x
Cannabis, the drug category that includes marijuana and hashish, is the most widely used illegal drug in the United States.
x
Overdose of cannabis may result in a psychotic episode but is not lethal.
x
The primary reason people use cocaine is to stimulate the CNS reward center. Positive reinforcement includes euphoria, increased energy, and increased sexual arousal. Negative reinforcement occurs when the person takes more cocaine to overcome the rebound dysphoria.
x
Use of cocaine can result in cardiac and cerebral infarct and perforation of the nasal septum.
x
Signs of cocaine withdrawal include severe craving, depression, fatigue, and irritability.
x
Cocaine intoxication can result in rapid death.
x
Amphetamines stimulate the CNS by increasing DA in the reward system. Ice, the smokable form of methamphetamine, may substitute for cocaine as a stimulant because it is more easily available, is less expensive, and produces a much longer high.
x
Chronic abuse of amphetamine may lead to paranoid and often violent psychotic states.
x
MDMA can cause death when combined with high levels of physical activity, such as at a rave dance.
x
Hallucinogens can lead to accidents, out-of-control behavior, and a psychotic state. Cause of death may be due to accidents of suicide.
x
Inhalants produce euphoria, perceptual changes, impaired judgment, sense of well-being, sense of power, and a loss of contact with reality.
x
Chronic use of inhalants can cause significant damage to the cardiovascular, pulmonary, and renal systems.
x
Sudden death with inhalants is associated with arrhythmias, ventricular fibrillation, or respiratory depression.
x
Some athletes and bodybuilders use anabolic steroids to build body mass and strength. A side effect may be "roid rage" with dramatic mood swings, manic-like episodes, and a tendency toward violence.
x
Caffeine is the most widely used drug in the world. Side effects include nervousness, anxiety, and gastroesophogeal reflux.
x
Nicotine acts as a CNS stimulant by releasing DA in the reward center. It is still the leading cause of preventable, premature death in the world.
x
Lack of control in using chemicals is the central behavioral characteristic of people who are chemically dependent. They may become loud, hostile, argumentative, and even violent. They may experience work or school problems and may become involved in a drug subculture.
x
The overall intention of substance dependence is to decrease negative feelings and increase positive feelings. People who are chemically dependent are emotionally labile and experience guilt and shame.
x
Alcoholic denial includes denial of facts, denial of implications, denial of change, and denial of feelings. Other defense mechanisms include projection, minimization, and rationalization.
x
Substance abuse is a family problem, and the most devastating impact occurs when the abuser is a parent. To avoid embarrassment, family members often deny the severity of the problem.
x
Co-dependency may occur in non-substance-abusing partners when they become overresponsible and the substance-abusing partner becomes underresponsible.
x
Co-dependents engage in enabling behavior, which is any action that facilitates substance dependence.
x
Children growing up in a substance-abusing home learn not to talk about the problem, not to talk about their own needs and wants, and not to feel. They become objects whose reason for existence is to please the abusing parent. They are expected to be perfect and always in control. They learn very early not to trust other people.
x
Children of alcoholics suffer the consequences of a dysfunctional family. They expect all relationships to be based on power, violence, deceit, and misinformation. Some grow up to repeat the family patterns by either becoming addicted themselves or marrying an addicted person.
x
Most Americans view substance dependence as a sin or the result of a weak will. Women are more stigmatized than men are, and lesbians suffer the double stigma of being lesbian and being alcoholic.
x
Illicit drug activity is a growing problem among high-tech workers.
x
Men abuse substances at a higher rate than women do. Among women, twice as many European American women drink heavily compared to African American, Hispanic American, Asian American, and Native American women.
x
Substance-related disorders progress more rapidly in adolescents than in adults. They often experience developmental delays and shift to a peer group of other drug users.
x
Alcohol abuse often goes undiagnosed in old age since the symptoms can be subtle or mimic symptoms of other geriatric illnesses.
x
Abuse of prescription drugs among the elderly is two to three times higher than the general population.
x
Sexually transmitted infections and AIDS are on the rise among people who abuse substances.
x
Sexual consequences of substance-related disorders include decreased desire, erection problems, and orgasmic difficulties. Cocaine is linked to sexual acting-out behaviors.
x
Tobacco is the most abused substance by pregnant women and is a risk factor for miscarriage, ectopic pregnancy, preeclampsia, and placental problems.
x
Fetal alcohol syndrome (FAS) is the third leading cause of birth defects in the United States. Effects include heart defects, malformed facial features, mental retardation, a slow growth rate, hyperactivity, and learning disabilities.
x
Cocaine use during pregnancy may result in learning and behavioral problems.
x
Children who have been exposed to opioids prior to birth are very sensitive to noise, are irritable and tremulous, and may have feeding problems.
x
Dual diagnosis indicates that there is a substance abuse problem as well as another coexisting mental disorder. The risk for a substance use disorder is twice as high for those suffering from major psychiatric disorders as compared to the general population.
x
Neurobiological theorists believe that an underlying predisposition to substance abuse is the result of genetic defects. Genetic defects lead to deficiencies and imbalance in neurotransmitters, neuropeptides, and receptors. An abnormal mechanism involving the reward center of the brain creates compulsive behaviors involving alcohol and drugs. The primary neurotransmitter involved is DA.
x
Behavioral theory considers reinforcement principles that maintain substance dependence. Learning theory states that it is a result of learned maladaptive ways of coping.
x
Sociocultural theory considers cultural and family values regarding the use of chemicals, peer group pressure, the impact of racism, and the stress of acculturation in the development of chemical dependence.
x
Feminist theory believes that addiction may be a response to an inadequate self-concept. There is often a history of abuse, dysfunctional relationships, or both.
x
Antabuse, naltrexone, acamprosate, ondansetron, and baclofen may be used by some individuals to help avoid craving.
x
Clonidine may ease opiate withdrawal symptoms and methadone, levomethadyl, and buprenorphine are used for heroin withdrawal.
x
Drug rehabilitation is the recovery of optimal health through medical, psychological, social, and peer group support. The recovery model is a lifelong, day-to-day process, typically includes 12-step programs, and places the responsibility for recovery on the client.
x
Nutritional supplements and herbs useful for substance abusing clients are SAMe, chamomile, evening primrose oil, ginseng, milk thistle, kudzu kudzu, heantos, and fish oil.
x
Acupuncture eases the symptoms of withdrawal and decreases the intensity of craving.
x
The nursing assessment begins with a substance abuse followed by a focused nursing assessment designed to elicit understanding of the impact of substance abuse on the client and family.
x
Abnormal physical findings in individuals who have chronic use of alcohol include liver disease; effects of trauma; easy bruising; spider angiomas on the face; facial edema; teeth and gum problems; congestive heart failure; ascites; esophageal varices; gastrointestinal bleeding; and impaired consciousness, cognitive function, and motor function.
x
Abnormal physical findings in individuals who have chronic use of alcohol include liver disease; effects of trauma; easy bruising; spider angiomas on the face; facial edema; teeth and gum problems; congestive heart failure; ascites; esophageal varices; gastrointestinal bleeding; and impaired consciousness, cognitive function, and motor function.
x
Nursing diagnoses include Ineffective individual coping, Social isolation, Ineffective family coping, Powerlessness, Disturbance in self-esteem, Ineffective denial, High risk for violence, and Spiritual distress.
x
Client goals include acknowledging the disorder and its negative consequences, sobriety, rehabilitation, and improved family coping.
x
Emergency management of acute alcohol intoxication or drug overdose is vitally important to save the client's life. Common problems include respiratory depression, seizures, and cardiovascular disorders. Clients may need ventilatory support, cardiac monitoring, seizure precautions, medications to support blood pressure, and treatment for hyperthermia.
x
Nursing interventions include helping clients overcome denial and recognize the significance of their problem. This must occur before clients can make a commitment to abstinence and recovery.
x
Most substance-abusing clients need to learn how to solve problems rather than avoid problems through the use of drugs.
x
Clients may need vocational guidance such as educational programs and job training.
x
A regular exercise problem in an important component of rehabilitation.
x
Relapse prevention includes self-control training. Clients are taught to identify and manage feelings, high-risk situations, and active coping strategies.
x
Self-help groups for clients and families are an important part of the recovery process.
x
A client's history of violent behavior is one of the best predictors of current potential for violence. Clients must be assessed frequently and provided with outlets for anxiety and energy. Other interventions include a quiet environment, PRN medication, and, if absolutely necessary, seclusion or restraints.
x
Spiritual support and hope installation promote recovery from substance abuse.
x
Family members need help in identifying and changing co-dependent and enabling behaviors. They must learn new ways to respond to the client and how to respect and care for themselves.
x
Recovery is total abstinence from all drugs. The recovering person can never return to controlled use without rekindling the addiction
x
Personality disorders are inflexible and maladaptive behavior patterns by which certain people cope with their feelings, the way they see themselves and others, how they respond to their surroundings, and how they find meaning in relationships.
x
Usually the personality problems are ego-syntonic and clients perceive their difficulties in dealing with other people to be external to them.
x
There is a high degree of overlap among the personality disorders, and many people exhibit traits of several disorders. The most commonly diagnosed is borderline personality disorder.
x
The common characteristics of Cluster A disorders are odd, eccentric behavior and social isolation.
x
Paranoid personality disorder refers to clients who are suspicious, secretive, and pathologically jealous.
x
Schizoid personality disorder refers to clients who have a restricted range of emotions, are loners, and are not influenced by praise or criticism.
x
Schizotypal personality disorder may be related to chronic schizophrenia. People with this disorder have an odd style of speech and their affect is often inappropriate. They may be suspicious and experience ideas of reference and magical thinking.
x
The common characteristics of Cluster B disorders are dramatic, emotional, or erratic behavior, and behavior that exploits others.
x
Antisocial personality disorder (ASPD) refers to clients who consistently violate the rights of others as well as the values of society. They are unable to experience guilt for their inappropriate behavior. They are more often found in prisons than in hospitals.
x
Borderline personality disorder (BPD) sufferers often have other mental disorders such as mood disorders, eating disorders, and substance abuse. Symptoms vary in any given person at any given time. Their behavior is impulsive and manipulative, and they are at high risk for suicide and self-mutilation. Their moods are intense and unstable.
x
Histrionic personality disorder (HPD) refers to clients who are overly dramatic and self-centered, and who need people to admire them constantly.
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Narcissistic personality disorder (NPD) refers to clients who strive for power and success, mask their feelings with aloofness, and are extremely grandiose. They exploit others to achieve personal goals.
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The common characteristics of Cluster C personality disorders are anxiety, fear, and overtly compliant behavior.
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Avoidant personality disorder (APD) refers to clients who are shy, introverted, lacking in self-confidence, and extremely sensitive to rejection.
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Dependent personality disorder (DPD) refers to clients who are unable to do things by themselves, fear abandonment, and force others into making their decisions.
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Obsessive-compulsive personality disorder (OCPD) refers to clients who have a high need for routines, are unable to express feelings, fear making mistakes and therefore have difficulty making decisions, and attempt to control all interpersonal relationships.
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Depressive personality disorder and passive-aggressive personality disorder are coded under personality disorder not otherwise specified.
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Forms of passive-aggressive behavior include procrastination, forgetfulness, intentional inefficiency, chronic lateness, and no carryover of learning.
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Since personality, and therefore personality disorder, is relatively stable over time, they begin at a young age and continue on throughout life.
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Concomitant disorders include substance abuse, chronic anxiety, panic attacks, depression, and suicide.
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There is no single cause of personality disorders. They likely arise from an interaction between biological factors and the environment. Neurobiological factors include limbic system dysregulation, low levels of 5-HT, high levels of NE, and abnormal levels of DA.
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Intrapersonal factors include projection of hostility, perfectionistic standards, underdeveloped superego, and fear of abandonment.
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Social oppression and changing value systems may contribute to the development of personality disorders.
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Family factors include an inability to manage conflict, lack of individuation from the parents, and a chaotic and abusive environment.
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Feminist theorists consider rigid sex-role stereotyping to be a factor in personality disorders.
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Medications used for clients with personality disorders include SSRIs and antipsychotic agents.
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Clients typically do not see that a problem exists within themselves. It is often helpful to interview family and friends, if possible.
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You must maintain a sensitivity in the interview process so that the client does not become guarded or defensive.
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Based on the typical characteristics, nursing diagnoses can be made for each cluster and individualized for each client.
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Outcomes include fear control, social support, spiritual well-being, impulse control, social interaction skills, and anxiety control.
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Goals include a decrease in self-destructive behavior, verbalization of less anxiety, utilization of the problem-solving process, and the development of healthy peer relationships.
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You should approach people with Cluster A disorders in a gentle, interested, and nonintrusive manner that is respectful of the client's need for distance and privacy.
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Clients with Cluster B disorders require much more patience and structure on your part. The milieu must be consistent to avoid manipulation and power struggles.
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In clients with Cluster C disorders, it is helpful to point out their avoidance behaviors and secondary gains. Problem solving and assertiveness training help them become more independent.
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The three fundamental beliefs guiding nursing practice are self-determination, role functioning, and maintaining hope.
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The first priority of care is safety from suicide and self-mutilation. Clients must be protected until they can protect themselves. Antiharm contracts may help maintain safety.
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The problem solving process is used to determine positive coping alternatives in response to thoughts of self-harm.
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Manipulative clients need a highly structured approach. Nurses may need frequent staff reports and supervision to counteract the client's ability to play one staff member against the other.
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Helpless and dependent clients need interventions to increase their coping skills and develop a more independent style of functioning. Problem solving, social skills training, and assertiveness training are effective interventions.
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Group therapy helps clients focus on interpersonal issues as they get feedback from more than one person and have the opportunity to be therapeutic with other group members.
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Clients need to learn how to make their own decision to reinforce an internal locus of control. Using the problem solving process helps them see the variety of choices that can be made, tested, and evaluated.
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Promote clients' realistic self-appraisal through discussion of abilities and limitations.
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Help clients acknowledge that an anxiety-free life is impossible, which may help them give up striving for perfection.
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Avoid power struggles and help clients' accept responsibility for their own behavior.
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Discuss how fear of rejection may interfere with seeking help from others when appropriate.
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Provide enough distance and privacy to prevent escalation of anxiety.
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In evaluating the care of clients with personality disorders, it is important to remember that these disorders are often lifelong and are not likely to yield readily to intervention strategies.
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For every completed suicide, there are 10 to 20 unsuccessful attempts.
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Over 90 percent of suicide victims have a psychiatric disorder at the time of death.
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Nurses have higher rates of completed suicide than the general population, which is partly attributed to access to and knowledge about lethal medications.
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Suicide can be precipitated by hopelessness, delusions, hallucinations, intractable pain, multiple crises, and/or unexpressed anger.
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Previous attempts and a sense of hopelessness are the most powerful indicators of future completed suicide.
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Behavioral cues to potential suicide are verbal comments, obtaining a weapon, social isolation, giving away belongings, and substance abuse.
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Lethality is measured by the degree of effort it takes to plan the suicide, the specificity of the plan, the accessibility of the method, and the ease by which one may be rescued.
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In the United States, more people kill themselves with guns than by all other methods combined. Of gun-related deaths in the home, 83 percent are suicides.
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Affective cues to potential suicide are ambivalence, desolation, guilt, failure, shame, hopelessness, and helplessness.
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Cognitive cues to potential suicide are a rigid cognitive style, fantasies about death, interpersonal problems, command hallucinations, and delusions.
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Stressors related to suicide include unemployment, family disruption, rejection by significant other, abrupt changes in career responsibilities, and recent catastrophic events.
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Gay, lesbian, bisexual, or transgendered teens are ostracized from the dominant culture and are six times more likely to commit suicide than heterosexual youth.
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Copycat suicide seems to be an adolescent phenomenon, with girls more susceptible than boys are.
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Homicide-suicide often occurs within a family, and the perpetrator is usually a male.
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In addition to grief, survivors of suicide must cope with the stigma and cultural taboos associated with the death. They may experience shock, bewilderment, guilt, shame, anger, or relief.
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Euro-Americans have the highest rates of suicide in the United States.
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People over 65 have the highest suicide rate of all age groups followed by teens and young adults.
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At issue in assisted suicide is whether the dying should have the right to request and receive aid-in-dying from physicians.
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Oregon has a Death with Dignity Act, and the Netherlands is the first country to fully legalize euthanasia.
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People with mood disorders, schizophrenia, substance use disorders, and personality disorders are at risk for suicide.
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Suicide may be caused by many factors, including serotonin dysfunction, genetics, rapid social change, interpersonal or intrapersonal losses, a learned method of problem solving, and developmental crises.
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Health care professionals must initiate suicide assessments. If the topic is not discussed, the person will have been abandoned while in a dangerously vulnerable position.
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You cannot give the idea of suicide to anyone.
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Use specific language such as kill yourself or commit suicide when assessing clients.
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Assess for protective factors against suicidal acts.
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Accurate assessment will not prevent all suicides.
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The most appropriate nursing diagnosis is high risk for violence, self-directed, related to acute suicidal state.
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The main goal is that the client remains safe from self-harm.
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Other goals include a decrease in suicidal thoughts, ability to problem solve, willingness to sign a no-suicide contract, and the development of a sense of hopefulness.
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The first priority of care is to keep the client safe. Clients may need to be on suicide precautions or under constant observation.
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Encourage clients to implement the problem-solving process for alternative solutions to the difficulties fostering their suicidal intentions.
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It is appropriate to discuss the meaning of death with clients who are thinking about killing themselves.
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Clients may be asked to write and sign a no-suicide contract.
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Help clients develop a crisis card for community resources.
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If the suicide is successful, families will need active and supportive intervention.
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The most successful outcomes of the plan of care are that clients remain safe from self-harm, and that they improve their problem-solving skills.
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Although the image of the ideal American family is one of happiness and harmony, in reality there is a great deal of domestic abuse and violence.
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Abuse refers to a pattern of behavior that dominates, controls, lowers self-esteem, or takes away freedom of choice.
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Nurses are required by law to report suspected incidents of child abuse in all states and most states also have mandatory reporting for elder abuse.
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The most common and unrecognized form of domestic violence occurs between siblings.
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Each year, 2.8 million American children experience at least one act of physical violence. Shaken baby syndrome causes permanent brain damage or death to many children.
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In the United States, homicide is one of the five leading causes of death before the age of 18. Sixty percent of children who are killed by their parents are under the age of four.
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In most cases of adolescents killing their parents, the teens have been severely abused.
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In Munchausen syndrome by proxy the parent persistently fabricates or induces illness in a child with the intent of keeping in contact with health care providers and hospitals.
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Violence is the single, largest cause of injury to women in the United States.
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The first acts of partner violence usually occur in dating relationships.
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Domestic violence occurs in some gay and lesbian relationships, for the same reasons as in heterosexual relationships.
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Elder abuse includes neglecting basic needs, psychological abuse, violation of rights, financial abuse, sexual, and physical abuse.
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Pregnancy is a time of increased risk for abuse, and a past history of abuse is one of the strongest predictors of the likelihood that pregnant women will be abused.
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Stalking is the act of following, viewing, communicating with, or moving threateningly toward another person.
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Domestic violence is the deliberate and systematic pattern of abuse used to gain control over the victim. The behavior is always intentional.
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Domestic violence can happen without warning and without a buildup of tension. A pattern or cycle develops consisting of begging for forgiveness, hope on the part of the victim, and a return to violence.
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Abused children often try to please the parent in order to stop the violence.
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The abuser has total control over the victim, who lives in a constant state of fear.
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Some 50 percent of the women who are murdered, are killed by a past or present husband or lover. The risk of death increases as the victims resist or try to take control over their lives by leaving the abuser.
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Violent people are extremely jealous and possessive and view others in terms of property and ownership.
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Victims may be immobilized by anxiety, helplessness, depression, self-blame, and guilt.
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The abuser is often most dangerous when threatened with or faced with separation.
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Anger may turn to violence when children are unable to fulfill the unrealistic expectations of parents.
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Severe and ongoing domestic violence has been documented in almost every country.
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Risk factors for violence related to ethnicity in the United States include financial strain, unemployment/underemployment, and undereducation.
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There appears to be a genetic-environmental link to violence involving low levels of serotonin (5-HT).
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Domestic violence is frequently transgenerational; as many as 80 percent of male abusers have grown up in violent homes.
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If the use of violence is rewarded by a gain in power, the behavior is reinforced.
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The cultural values and economic system help entrap women, who are often forced to choose between poverty and abuse.
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Clients in all clinical settings should be routinely assessed for evidence of violence.
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Assessment questions should be adapted to the client's age, gender, and family situation.
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The most important outcome of nursing assessment is identifying the existence of domestic violence. Priority must be given to critical and serious physical injuries.
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The severity and potential fatality of the situation must be considered, as well as the needs of dependent children and legal issues surrounding the case.
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The most important outcome for victims of domestic violence is remaining safe and free from harm.
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The treatment of families experiencing domestic violence requires a multidisciplinary approach.
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The priority for care is assuring the victim's physical safety.
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Victims need to develop an escape plan to use when their safety is threatened.
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Families must learn to use effective communication.
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Family members must identify methods to manage anger appropriately.
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Parents need help in developing and improving their parenting skills.
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Feminist-sensitive therapy is a survivor-centered approach. Adult victims are supported and empowered to take charge of their own lives.
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Most abusers do not seek treatment unless it is court ordered or there are custody issues involved. Group therapy is more helpful than individual therapy for abusers.
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Short-term evaluation focuses on the identification of domestic violence, the family's ability to recognize that a problem exists, the willingness of the family to follow through with referrals, and the removal of the victim from a volatile situation.
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Long-term evaluation focuses on the victim's recognition of blamelessness, ending denial of the problem, awareness of competence, sense of power over his or her own life, recognition of personal rights, and decreased isolation and secrecy.
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Evaluation of nursing practice focuses on actions taken to combat violence both within families and in society, preventive teaching strategies, and advocating for increased bilingual/bicultural professionals to intervene with families.
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Sexual violence is an act of violence, hatred and aggression with physical and/or psychological injury to the victims.
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Sexual harassment is unwanted and unwelcome sexual behavior that interferes with everyday life. It can be either quid pro quo or a hostile environment.
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Sexual harassment can lead to severe stress in the victims.
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Rape is a crime of violence perpetrated against innocent victims of all ages.
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Ninety-three percent of rape victims are female and 90 percent of the perpetrators are male.
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Date rape and marital rape are often unreported because victims may feel responsible or fear the disbelief of others.
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Male victims, as a group, are more likely to have been beaten and are more reluctant to reveal the sexual component of their assaults.
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Sexual abuse is defined as inappropriate sexual behavior, instigated by a perpetrator, for purposes of the perpetrator's sexual pleasure or for economic gain through child prostitution or pornography.
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Sexual abuse occurs in all ethnic, religious, economic, and cultural subgroups in the United States. The vast majority of victims know their abusers.
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Fifty to sixty percent of juvenile offenders were sexually abused as children; the other 40 to 50 percent usually have conduct disorder.
Name the five types of incestuous fathers:
Sexually preoccupied abusers, adolescent regressors, self-gratifiers, emotional dependents, and angry retaliators.
There are four major types of female sex offenders...name them.
Teacher-lovers, experimenter-exploiters, predisposers, and women coerced by males.
What is Rape-trauma syndrome?
It is characterized by symptoms of, or specific responses to, the experience of being raped.
Name some behavioral characteristics of rape victims.
They include agitation, outward calmness, crying, nightmares, sleep problems, phobias, and relationship difficulties.
What are some affective characteristics of rape victims
They include shock, anxiety, fear, depression, and a sense of helplessness and vulnerability.
What are some cognitive characteristics of rape victims
They include depersonalization, dissociation, denial, difficulty making decisions, self-blame, obsessions, and concerns for future safety.
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Families of rape victims experience many of the same thoughts and emotions as the victims themselves. They must be educated about rape and the immediate and potential long-term reactions of the victims.
Does Rape occur cross-culturally?
Yes, and is one of the most underreported crimes worldwide.
Some countries have customs that westerns might find offensive regarding rape victims. What are they?
In some countries women are forced to marry their rapist or go into prostitution so they may survive, or they may even be put to death by their families to cleanse the family name.
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Physiological characteristics include trauma and injuries, pregnancy, sexually transmitted infections (STIs), and difficulties with sexual functioning.
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As a direct result of the rape, survivors may experience PTSD, substance abuse, depression, anxiety disorders, eating disorders, and suicidal behavior.
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Most theorists agree that rape is a crime of violence generated by issues of power and anger. Theories relating to rape include revenge, dominance, eroticized assault, gang rituals, inadequate relationships, acceptance of violence within a culture, and sexist cultural values.
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Clients must be immediately assessed for any serious or critical injuries. Prior to any further assessment, clients must be informed of their rights including the right to have a rape crisis advocate, family, or friends with them during the assessment process.
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The client must be given as much control as possible through every step of the assessment and treatment process.
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A SANE is a registered nurse who has advanced education and clinical preparation in forensic examination of sexual assault victims.
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The nursing diagnosis is Rape-trauma syndrome, which may be further classified as compound or silent reaction.
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The most common outcomes include abuse recovery: emotional; abuse recovery: sexual; coping; and fear control.
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It is important to support defense mechanisms until clients are able to cope with the reality of the abuse.
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Many clients have a compulsive need to recount the abuse as a way to gradually desensitize the trauma.
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Stress that survival is the most important outcome and the act of violence was not their fault.
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Help clients identify immediate concerns and prioritize them.
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Help them identify who to tell about the rape through the process of anticipatory guidance.
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Discuss beliefs about postcoital contraception and abortion if appropriate.
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Provide a written list of community resources.
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Support groups provide an opportunity for victims to have their feelings validated as normal reactions to the assault, to speak openly, to network with other survivors, and to take charge of their own recovery.
What is a core nursing intervention for girls and women faced with sexual violence?
Girls and women must be empowered to deal with sexual harassment.
When are nursing interventions for the sexual violence client deemed effective?
Nursing interventions are evaluated as effective when clients return to their precrisis level, or achieve a higher level, of functioning.
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The effects of sex abuse are most severe when the incidents are frequent and occur over a long period of time, the activities are extensive, there is more than one perpetrator, the relationship to the perpetrator is close, and when sex abuse is combined with physical and emotional abuse.
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Adult perpetrators initiate sexual behavior in a manipulative or coercive manner. They often feel weak, afraid, and inadequate. They use secrecy and silence to escape accountability. If confronted by others, they will often deny the abuse.
When children are sexually abused, how might they interact with other adults and children?
Child victims are at the mercy of adult perpetrators. Some become extremely affectionate, while others have problems with impulse control and aggression toward others. They may act out sexually with other children or adults.
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Child victims are filled with fears of not being believed, being blamed, and/or being rejected by the family. Secrecy and guilt often keep them isolated from their peers.
How do child victims survive trauma of sexual abuse?
Child victims may use denial, minimization, or dissociation.
How might Adolescent victims deal with sexual abuse?
They may run away from home and may turn to prostitution for a variety of reasons.
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Some adult survivors engage in self-mutilation for a number of reasons: to prove their existence, as a plea for nurturance, as a way to self-nurture, to stop dissociation, to punish the self, and/or to reduce emotional pain through physical pain.
What are some of the affects on adults of childhood sexual violence?
Many adult survivors have sexual problems such as aversion, inhibition, and compulsive sexual behavior. Others suffer from confusion about their sexual orientation.
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Many adult survivors continue to believe that they were to blame for the abuse. They suffer from low self-esteem, depression, anxiety, and rage.
Do adults always remember the sexual abuse they experienced as children?
Some adult survivors have total amnesia about the abuse, which is a response to the trauma.
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Intimate relationships are often difficult for adult survivors. Survivors of childhood sexual abuse remain vulnerable and may be revictimized as adults.
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Physiological characteristics of sexual abuse include STIs, trauma to the genitals, chronic vaginal or urinary tract infections, and pregnancy.
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Having suffered sexual abuse in childhood is often a hidden feature of adult mental disorders. Adult psychiatric clients with a history of abuse have a bewildering combination of symptoms, including anger, depression, anxiety, insomnia, suspicion, eating disorders, substance abuse, and self-mutilation.
Is there a single cause of childhood sexual abuse?
There is no single cause of childhood sexual abuse. Perpetrators may lack impulse control, or they may be rigid and overcontrolled. Many of them were sexually abused as children.
In incestuous families, how are hierarchical lines crossed?
The father moves down to the child's level, or the child moves up to replace the mother. These families are often enmeshed, and the family system is either chaotic or rigid.
Are nursing assessment questions easier for adult or child rape victims?
It is very difficult for both child victims and adult survivors to break the silence and respond to nursing assessment questions.
What is an appropriate action to take when one of many children is the victim of sexual abuse?
All other children in the family must also be assessed for abuse.
How should the enviroment be controlled when a child is being assessed for sexual abuse?
You must continually be aware of the client's comfort level with the physical environment during the assessment process.
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Nursing diagnoses are formulated for the child victim, the family members, and the adult survivor. The most common are: Ineffective individual coping, powerlessness, post-trauma syndrome, social isolation, ineffective family coping, disabling, altered parenting, altered family process, spiritual distress, chronic low self-esteem, social isolation, and sexual dysfunction.
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The most common outcomes include abuse recovery, sexual, coping, family integrity, self-esteem, social support, and spiritual well-being.
What is the priority of care with child rape victims?
To ensure the safety of the child.
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Nurses help families move toward a moderate position between the extremes of rigid and chaotic; they learn to increase their flexibility of roles or implement consistent rules.
How do child vicitms of Sexual abuse manage their feelings?
Child victims learn to manage their feelings through verbalization, play therapy, art therapy, and journal writing.
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Types of therapy useful with adult survivors include feminist-sensitive therapy, traumatic stress therapy, developmental therapy, and loss therapy.
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The most helpful approach with adult survivors is being ally, collaborator, and supporter as they struggle through the healing process.
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It is important to restore power and control to adult survivors.
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Spiritual recovery is part of the healing process.
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Both child victims and adult survivors must place responsibility for the abuse where it belongs--100 percent with the offender.
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Interventions are designed to help the adult survivor increase self-esteem and reduce anxiety.
How do Adult survivors heal from childhood sexual abuse?
Through the use of art therapy, music therapy, journal writing, group therapy, and self-help groups.
How does US Culture influence violence?
The U.S. culture is one that promotes, supports, and even encourages and romanticizes violence.
Who are the child perpertrators and victims of violent acts?
Males
What is Affective violence?
It is the verbal expression of intense anger and emotions. It is the bullying, ugly taunts, disrespect, and physical threats that many people experience every day.
What motivates hate crimes?
Hate crimes are motivated by bias and hatred of minority groups and may even end in murder.
What are the specifics of stalking?
Stalking ranges from delusional to nondelusional, and there may or may not be a relationship with the victim.
What are nonspecific homicides?
In nonspecific homicides, the motive is known only to the perpetrator, and there may be a massacre with little regard for life.
What are revenge killings?
Revenge killings retaliate for real or imagined offenses by the victim.
What might cause Matricide or Patricide?
May be in response to many years of physical and sexual abuse.
What is Authority Killing?
It may be targeted at individuals or at buildings or institutions that symbolize the authority.
How many people each year are victims of workplace violence?
Nearly 1 million people a year are victims of workplace violence.
What are the most common settings for violence in hospitals?
The emergency room and psychiatric inpatient units.
What percentage of violent deaths of children occur in or around school property?
Fewer than 1 percent.
Are teens or adults more likely to be victims of violence?
Teens are much more likely than adults to be victims of violence.
What does hitting or spanking children do?
It gives the message that violence is acceptable.
Describe the difference between children who see vs. experience violence.
Children who witness violence display more internalizing behavior, while those who are victims display more externalizing behavior.
How does living along in isolation without a support network affect violence?
When individuals live in isolation and have no supportive network, their internal world may be filled with bitterness, resentment, and rage, which can precipitate violent acting out.
What role do rationalization or projection have in violence?
Violent people may rationalize their behavior or project their anger onto the victim.
Describe the demographics of firearm deaths in Children in the US.
The rate of firearm deaths among children 14 years and younger is nearly 12 times higher in the United States than in 25 other industrialized countries combined.
What are two co-morbid disorders for Violent People?
ADHD and PTSD.
Is violence a caused by a single factor?
NO, there is no single cause of violence. It results from an interaction of neurobiological, personality, and societal factors.
What role does seratonin play in violence?
Violent people may have low levels of 5-HT, which is implicated in a lack of control, loss of temper, and explosive rage.
What has been shown to be a cause of antisocial behavior?
Low cortisol levels.
What is the Social Learning Theory?
Children learn about violence from observation, from being victims, and from behaving violently themselves.
What role do poverty and racism play in violence?
Extremes of poverty and racism contribute to the trauma of children and become breeding grounds for violence.
Do violent youth usually have violent parents?
Violent youths are more likely than other youths to have a biological parent who also engages in antisocial behavior, which is thought to reflect both the genetic transmission of temperament and modeling of aggression.
What can be said about the peer groups of violent and antisocial children?
Antisocial and violent children tend to make friends with peers similar to themselves through which antisocial behavior is reinforced.
What should be done at the first sign of violence in children?
Early warning signs are indicators for doing an in-depth assessment of children who may become violent.
What are Imminent warning signs and what do they indicate?
That a person is very close to behaving in a dangerous way and include: serious physical fighting, severe destruction of property, detailed threats of lethal violence, possession of weapons, and threats of suicide.
What are some Nursing diagnoses for violent people?
They include: risk for loneliness, self-esteem disturbance, ineffective individual coping, altered role performance, fear, post-trauma response, impaired social interaction, and risk for violence directed at others.
What are some EOC's for violent clients?
Outcomes include abusive behavior self-control, aggression control, role performance, self-esteem, social interaction skills, and social involvement.
How are nursing interventions directed with the violent child?
Nursing interventions are directed at helping violence prone children establish and maintain social relationships.
Are limits important when dealing with violent clients?
It is critical that you set appropriate limits.
When are Feedback and Concequences for behaviors delivered?
Feedback and consequences for behavior must be immediate to avoid reinforcing inappropriate behavior.
How are Time-outs are used?
As a cooling-off period as well as providing the necessary time for reflection.
How are excused handled when dealing with violent children?
Excuses are not accepted for bad choices, and children are held responsible for personal decisions regarding behavior.
If a child is being violent, what type of choices are offered?
Provide the child with limited choices to both deescalate the situation and provide the child with some sense of control.
When is a therapeutic hold used?
If the child is out of control, you may need to institute a therapeutic hold.
How is modeling used when dealing with violent children?
Model positive interactions by treating the child with warmth, friendliness, humor, and empathy.
What is a key component in halting the violence in schools, in the workplace, and on the street?
Cooperative community action is needed to halt the violence in schools, in the workplace, and on the street. Nurses can be leaders in this area.