Mental Health- Test 2 Chapter 23

Front 1

-outcome of a crisis depends on:

Back 1

1)realistic perception of the event (THIS IS KEY!!!!)
2)adequate situational supports
3)adequate coping mechanisms ((internal resources (ability to problem solve, asking for help, reframing)
vs external resources (support, money, access to health care) so the amount of internal and
external resources someone has plays into how they cope with illness and crisis)

Front 2

Crises
-(acute or chronic) and time-limited, lasting how long?

Back 2

acute

lasting 4-6 weeks

Front 3

Crises are -associated with events that are experienced with

Back 3

overwhelming emotions of increased tension, helplessness, and disorganization

Front 4

-crisis is all about ________ and you become so overwhelmed that you are not functioning and you need help

Back 4

anxiety


-overwhelming anxiety (struggling for emotional balance)

Front 5

3 basic types of crisis situations:

Back 5

1)developmental / maturational crisis
2)situational crisis
3)disasters / adventitious crisis

Front 6

3 types of crises

moving from 1 life stage to the next (life cycle changes)

Back 6

maturational

Front 7

3 types of crises

ex: birth of a baby

Back 7

maturational

Front 8

3 types of crises

ex: marriage

Back 8

maturational

Front 9

3 types of crises

-based on Erikson
-we experience disequilibrium until we adjust

Back 9

maturational

Front 10

3 types of crises

something that happens to us that is unanticipated

Back 10

situational:

Front 11

3 types of crises

-common cause is the breakup of a relationship (hard on people that lost love)

Back 11

situational

Front 12

3 types of crises

-can be caused by nature or man made

Back 12

adventitious

Front 13

3 types of crises

-unplanned

Back 13

adventitious

Front 14

3 types of crises

-ex: 9-11 or earthquake

Back 14

adventitious

Front 15

crises

-person is overwhelmed with anxiety, one of the nurses first interventions is to

Back 15

lower anxiety (because
they can’t think, they need you to be directive)

Front 16

3 types of crises

-a critical period of increased vulnerability and heightened potential, a turning point

Back 16

Maturational crisis 530

Front 17

3 types of crises

-when a person arrives at new stage, previously used coping styles are not effective and new coping styles have yet to be developed
-the person is left without effective defenses
-which can then cause increase tension/anxiety

Back 17

Maturational crisis 530

Front 18

3 types of crises

-ex: leaving home during late adolescence

Back 18

Maturational crisis 530

Front 19

3 types of crises

-ex: retirement

Back 19

Maturational crisis 530

Front 20

3 types of crises

-ex: death of a parent

Back 20

Maturational crisis 530

Front 21

3 types of crises

-ex: midlife crisis

Back 21

maturational crisis

Front 22

3 types of crises

-Erikson thought that if a person lacks support systems and adequate role models, successful resolution may be difficult or may not occur

Back 22

maturational crisis

Front 23

3 types of crises

-Erikson thought unresolved problems in the past and inadequate coping mechanisms then adversely affect what’s learned in each developmental stage

Back 23

maturational crisis

Front 24

3 types of crises

-arises from events that are extraordinary(not internal) and are often not anticipated

Back 24

Situational crisis 531

Front 25

3 types of crises

-ex: loss/change of job

Back 25

Situational crisis 531

Front 26

3 types of crises

-ex: death of a loved one

Back 26

Situational crisis 531

Front 27

3 types of crises

-ex: abortion

Back 27

Situational crisis 531

Front 28

3 types of crises

-ex: change in financial status

Back 28

Situational crisis 531

Front 29

3 types of crises

-ex: divorce

Back 29

Situational crisis 531

Front 30

3 types of crises

-physical/mental illness, wife’s husband dies of cancer

Back 30

Situational crisis 531

Front 31

3 types of crises

-not part of everyday life

Back 31

Adventitious Crisis 532

Front 32

3 types of crises

-results from events that are unplanned and may be accidental, caused by nature, or human-made

Back 32

Adventitious Crisis 532

Front 33

3 types of crises

-results from:
1) natural disaster (Flood, fire, earthquake)
2) national disaster(acts of terrorism, war, riots, airplane crashes)
3) crime of violence (rape, assault, murder in the workplace or school, bombing in crowded areas, spousal or child abuse)

Back 33

Adventitious Crisis 532

Front 34

3 types of crises

-post-trauma phenomena commonly develop in those who experienced an adventitious crisis are:

Back 34

acute stress disorder, posttraumatic stress disorder, and depression


Adventitious Crisis 532

Front 35

4 phases of crisis

-phase 1:
-a person is confronted by:

-what does the increase in anxiety do?

Back 35

-a person confronted by a conflict or problem that threatens the self-concept responds with feelings of anxiety

-the increase in anxiety stimulates the use of problem solving techniques and defense mechanisms

Front 36

4 phases of crisis

-phase 2:
-what happens to the defense response?

-what happens to individual functioning?

-how do the pts attempt to solve the problem?

Back 36

-the defense response fails and the threat persists (anxiety rises & produces feelings of discomfort)

-individuals functioning becomes disorganized

-trial and error attempts at solving the problem and restoring a normal balance begin

Front 37

4 phases of crisis

-phase 3:
-if trial and error attemps fail, what can happen?

-what will the person do?

-what can the pt do/make in this stage?

Back 37

anxiety can escalate to severe/panic levels

-the person mobilizes automatic relief behaviors (withdrawal and flight)

-some form of resolution (compromising needs or redefining the situation to reach an acceptable solution may be made in this stage)

Front 38

4 phases of crisis

-phase 4:
-if the problem is not solved and new coping skills are ineffective, what can happen?

Back 38

anxiety can overwhelm the person and lead to disorganization, depression, confusion, violence, or suicidal behavior

Front 39

4 phases of crisis

which phase?
-potential for suicidal and homicidal
-lacking adequate social support, inadequate coping skills

Back 39

4

Front 40

Nurses tasks: in crisis

first task is to promote a sense of safety
(how do you do that?)

Back 40

(establishing that the pt is no danger to self or other, the nurse will assess)

Front 41

Nurses tasks: in crisis

2) pts perception of the precipitating event
-how do you do that?

Back 41

(assess the individual or family and the problem)

-getting a clear definition of the problem (what leads you to seek help now, or what do you think needs to happen for you to get through this)

p. 533 ex

Front 42

crisis intervention
-goal for nurse:
-always consider the pt as _____ and ____

Back 42

-goal for nurse: get pt to function a pre-crisis level
-consider the pt as confident and able to problem solve (even tho they need our help)

Front 43

Nurses tasks: in crisis

situational supports (determines available resourced by assessing the pts support system)

how do you do that?

Back 43

set up it for them if they need it (shelter if their house burnt down) who is available to help, who do you lean on when your in trouble, has anything happened like this before, how did you handle it?

Front 44

Nurses tasks: in crisis

patients personal coping skills (assess the pts personal coping skills by??)

Back 44

evaluating the pts anxiety level and identifying the pts established patterns of coping.

assess the level of anxiety first (if anxiety is too high they wont be able to take anything in) then ask what do they usually do to cope? in a crisis, the coping can turn to extreme behavior “what’d you do to handle difficult times in the past”

common coping mechanisms are: overeating, drinking, smoking, withdrawing, talking to someone, yelling, fighting, engaging in physical activity

Front 45

-crisis intervention deals only with

Back 45

the pts presenting problem and resolution of the immediate crisis (The here and now)

Front 46

Diagnosis / Crisis

-when a person is in a crisis, the nursing diagnosis of

Back 46

“ineffective coping” is useful

Front 47

diagnosis

example

Back 47

-powerlessness (overwhelmed with anxiety and they don’t know what to do, they feel vulnerable)

Front 48

outcomes

-short term
-long term

Back 48

-outcome: short term: identify 1 problem solving strategy to deal with crisis (that empowers them)
long term: return to pre level crisis

Front 49

Implementation

-crisis intervention has 2 goals:

Back 49

1) patient safety (external controls for protection if they are suicidal or homicidal)
2)anxiety reduction (used so inner sources can be mobilized)

Front 50

-what comes after natural disasters when people are traumatized with an adventitious crisis

Back 50

CISD:

Front 51

Foundations for crisis intervention

-a crisis is ________ and usually resolves within 4-6 weeks

Back 51

self limiting

Front 52

Foundations for crisis intervention

-goal of crisis intervention:

Back 52

return pt to pre crisis level of functioning

Front 53

Foundations for crisis intervention


during a crisis, people are more open to

Back 53

outside intervention

Front 54

Foundations for crisis intervention

-the nurse must take what kind of role?

Back 54

an active, directive role in intervention

Front 55

Critical Incident Stress Debriefing (CISD)

-what is it directed towards?
-what does it offer people to do?

Back 55

-directed towards a group that has experienced a crisis (pt suicide or incidence of violence, terrorist attack)

-7 phase group meeting that
offers people to share their thoughts/feelings in a safe and controlled envt

Front 56

planning

what’s the effect of the crisis on the persons life?

WHAT CAN YOU ASK

Back 56

-ask pts “how is this affecting you in your life”
-how is this crisis affecting significant people in the pts life? “

Front 57

evaluation
-perform when?

-goal:

Back 57

evaluation
-perform 4-6 weeks after crisis occurred
-anxiety and functioning should be at pre-crisis level

Front 58

self-assessment 534

Back 58

table 23-1

Front 59

self-assessment

-the nurse needs to be needed

Back 59

-over helping / overdoing pt becomes dependent and encourage goal setting and problem solving
-consult your supervision to work through it (for all 4 interventions)

Front 60

self-assessment

-setting unrealistic goals

Back 60

-examine realistic expectations of slef
-reevaluates pts level of functioning and works with patient on his level

-consult and then reassess

Front 61

self-assessment

-difficulty terminating after crisis resolved

Back 61

-nurse brings up more problems for the pt to work on


-explore nurses efeligns about serparation/termination
-nurses own feelings are reocognzied

-look at the nurses own issues assessment guidelines:

Front 62

primary prevention

-prevention like:

Back 62

(teaching coping skills, lowering anxiety)
-teaching triggers of relapse (going off meds)
-teach family about symptoms that indicate that the pt is relapsing
-teach the pt and family what to do about it (coping skills)
-prevent the next crisis of relapse

Front 63

what are 4 NOC outcomes for patients in crisis

Back 63

coping (personal actions to manage stressors)

decision making (Choose b/w 2 or more alternatives)

role performance (congruence of an indivudals role behavior with role expectations)

stress level


p. 537

Front 64

the nurse needs to feel needed
"allows phone cells b/w sessions"

what intervention should the nurse do

Back 64

evaluate personal needs vs pts needs with supervisior

encourage goal setting and problem solving by the patient

Front 65

nurse sets unrealistic foals for patients...

"expects physically abused woman to leave her battering partner"

2 interventions the nurse can d o

Back 65

examine realistic expectations of self

reevaluations pts level of functioning and works with pt on his level

Front 66

nurse has difficulty terminating after crisis has resolved

"tempted to work in pts life to prolong contact"

Back 66

explore own feelings