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What influences Self Concept?
- Culture, society, life experience
- Parents, siblings, and other significant people
- Body image
- Self-esteem (judgment of own self worth)
- Self-ideal (personal standards as to how one should behave)
- Personal identity (awareness as one as an individual
- Role performances (socially acceptable behavior patterns)
What are people who healthy self concept able to do?
§Able to effectively perceive and function within their worlds
What kind of sense do people with a healthy self concept have within them?
There is a sense of peace within themselves to successfully cope with trauma, anxiety, crises
One with high self esteem and confidence in one’s own abilities§
How do people with a healthy self conccept feel in their roles?
Socially satisfied in their roles
When is self concept established?
When is self concept developed?
When is self concept refined?
When do infants learn to trust?
when their needs are consistently met
What does stability in reactions cause
a stable sense of self
What kind of effect does rejection from family/reletives have on kids
strong negative effect on their self-concept
What do toddlers work on learning?
“Right vs. Wrong”
What do school aged kids learn about
about norms, peer pressure, morals
What happens when kids have a clear mental picture of their self concept as they move into adolescence?
they move into adolescence fairly smoothly,
What happens when kids do not have a clear mental picture of their self concept as they move into adolescence?
anxiety and turmoil
What do teens start to do with their self concept
begin to challenge self-concept from childhood
What type of self concept do teens develope as they get older?
a more mature self-concept
What is self concept influence by in adolescence?
- Sexual identity and the adjustment of a new adult physical body
- Struggles b/t previous roles and new emotions
WHat helps adolescents develop a comfortable self concept?
§Love and support of adults
How do positive experiences help self-concept in adulthood?
§Positive experiences help enhance self-concept, help the adult to grow, and the cycle of learning is enhanced
What happens if adult has a negative self-concept ?
- – one is easily threatened
- that increases anxiety levels and forces one to become preoccupied with defending oneself
What does Ageism cause in older adults?
negative self concept
What is Ageism?
stereotyping one as feeble, non-dependant and non-productive
What do changes in lifestyle cause in older adults?
change in self concept
How can we help self concept in older adults?
by listening actively and demonstrating TRUE concern
What is dissociation an attempt of?
an attempt to cope with deep-seated emotional anxiety or distress.
WHat is dissociation?
complicated neuropsychological processes that range from normal living to disrupt living
What are examples of normal dissociation?
- becoming absorbed in an activity so that you looses track of time
What is dissociation used as?
- a coping mechanism to protect one from trauma-
- the victim of a violent crime or attack often states that they cannot recall specifics
WHat group dissociates the most
Children dissociate more often than adults-
WHat happens when dissociation is used as a defense mechanism in childhood?
higher risk of growing into a dissociative disorder
In what type of people can dissociation be found in?
May be seen in those with Low self-esteem
How is dissociation expressed?
through various levels of anxiety
What does dissociation involve?
feelings of weakness, inadequacy and helplessness
WHat is dissociation common in?
many mental health problems
WHat is Identity diffusion?
failure to bring various childhood identifications into an effective adult personality (Those who suffer from this- not sure who they really are)
How were many people with ID diffusion treated as kids?
what don't people with ID diffusion do?
don't take things/experienceses from childhood to adulthood
WHat is lacking in ID diffusion d/o?
What does this lead to?
Feelings of empathy are lacking,
to problems with intimacy
What do people with ID diffusion often do?
They often bind their self-concept to others out of desperation to define themselves
What can the behaviors of those with ID diffusion do?
Behaviors can interfere with the ability to function in every day life
What is Dissociative Disorder?
Disturbance in the normally interacting functions of consciousness- identity, memory and perception.
WHat do people with dissociative disorder do to aspects that produce anxiety?
Anxiety producing aspects of the self are cut off from the remainder of the personality in an attempt to cope with severe anxiety or emotional trauma
The mind actually walls off traumatic or high anxiety causing events
In what people is dissociative disorder more common?
More common in those who were abused or neglected in childhood
In what group is dissassociative disorder diagnosed most frequently
What is a type of dissociation other cultures experience?
Other cultures experience trance-they communicate with spirits
What might someone with dissociative id disorder do?
One might assume separate personalities and a “dissociative identity disorder is diagnosed (or multiple personalities)
How is PTSD differant from dissociative disorder?
PTSD is an anxiety disorder, but one can recall the past trauma and this can alternate with dissociation or detachment
What are the 4 types of DISSOCIATIVE DISORDER classified in the DSM IV:
- 2)Dissociative Amnesia
- 3) Dissociative Fugue
- 4) Dissociative Trance
what is DEPERSONALIZATION a response to?
the response to severe anxiety associated with the blocking of awareness and a fading of reality
WHat happens to self concept in depersonalization ?
Self-concept becomes disorganized- one cannot tell the difference b/t internal and external stimuli
WHat happens to the world of someone that has depersonalization?
§The world becomes a “dream” and a defense mechanism
What do people with depersonalization disorder try to do?
§One tries to escape distress and anxiety by losing their own true identity
What is depersonalization associated with?
with other mental disorders such as- Acute stress disorder, OCD, Schizophrenia
What is Dissociative Amnesia?
Loss of memory characterized by an ability to remember personal info that cannot be explained by ordinary forgetfulness
What do people with Dissociative Amnesia try to do?
An attempt to avoid extreme stress by blocking
What usually happens with dissociative amnesia?
There are usually gaps in recallable info during childhood
What can sights, sounds, & images do in dissociative amnemia?
can trigger emotional distress a long time after the event occurred
WHat do pt's with dissociative amneia need?
high levels of emotional support
What is priority for dissociative amnemia?
Client safety is a priority- suicide is a very high risk
What is Dissociative Fugue?
SUDDEN, unexpected travel with an inability to recall the past!
What causes dissociative fugue?
an overwhelmingly traumatic event
What are behaviors of someone with dissociative fugue like?
Behavior may seem close to normal during travel, but they are confused about personal identity
What do people with dissociative fugue do?
- Extreme fight or flight to protect themselves
- May travel a few miles away or many, many miles away
What happens during the "fugue" in dissociative fugue?
During the “fugue”- there are hardly noticeable personality changes
What happens to the ID of some with dissociative fugue?
§Some assume totally different identities- new occupation, new S.O.’s
What is the mental status of many with dissociative fugue when they return to pre-fugue state?
they are often depressed, guilty, may have aggression and suicidal wishes
§There may be memory loss about events during the fugue state
What is a must for people with dissociative fugue?
Psychosocial and emotional support
What is Dissociative Trance?
State that resembles sleep, but consciousness remains but voluntary movement is lost!
What is Dissociative Trance considered in some cultures?
§In some cultures- this is an expression of spiritual/religious beliefs
Is there loss of ID in Dissociative Trance?
There is no loss of identity here
What is common in Dissociative Trance?
Amnesia is common
What do many need to get into a Dissociative Trance?
Many need psychotherapuetic interventions
WHat is Dissociative Identity Diorder (DID) the result of?
The result of sever physical, sexual and/or emotional abuse
What is Dissociative Identity Diorder (DID) ?
the presence of two or more identities or personalities that repeatedly take control of the individual’s behavior
What do abused kids use to cope with their situation?
Abused children use dissociation to escape, distance and defend themselves from the anxiety, trauma, and helplessness of reality
WHat was Dissociative Identity Diorder (DID) formerly known as?
This was formerly known as “multiple personality disorder”
In what country does Dissociative Identity Diorder (DID) occur the most in
US than in other countries
possibly b/c more able to Dx
What does each personality of someone with Dissociative Identity Diorder (DID) have?
- §Each personality has its own identity
- it’s own way of relating to the world that often represents the individual at different developmental stages
What are the emotions of someone with Dissociative Identity Diorder (DID) like?
Emotions are deeply buried- so a hx. of abuse or trauma is not always identified.
what are ther personality transformations of pt's w/ Dissociative Identity Diorder (DID) like?
The transformation from one personality to the other is sudden and r/t stress
what is ther relation of the primary personality of a pt w/ Dissociative Identity Diorder (DID) relate to the other personalities?
The PRIMARY PERSONALITY = HOST- may or may not be aware of the presence of the others “ALTERS”
How do the identities of someone with Dissociative Identity Diorder (DID) interact?
Sometimes the identities cooperate with each other, but most often one will take control
Hostility can occur among the more powerful personalities
What might all pt's with any Dissociative Disorder might have?
may have s/s of post-traumatic stress syndrome- nightmares, flashback
What is the goal of treatment for pt's with Dissociative d/o?
Help the client to combine the personalitites into one functional individual capable of coping with stressors in a healthy manner!
WHen should pt's with dissociative d/o be hospitalized?
When anger, depression or violence toward self or others
When one is unable to function due to memory loss, rapid changing from one identity to another, flashbacks, or overwhelming emotions
When meds need to be evaluated or adjusted
WHat are the stages of treatment for Dissociative d/o?
- Reworking past traumas
WHat is the stage Assessment of treatment for Dissociative d/o?
Assessment- s/s and history
WHat is the stage Stabilization of treatment for Dissociative d/o?
- plan is jointly developed- individual/group therapy, family therapy- expressive therapy: poetry, art, dance, music
Contracts for safety (no-suicide, etc.)
Trust development b/t client and staff
WHat is the stage Reworking past traumas of treatment for Dissociative d/o?
- revisiting the trauma
Each identity is treated equally with respect and is encouraged to communicate with the others
What gets the best results in treatment for dissociative d/o?
WORKING with well-established multidisciplinary teams
What do you assess for when treating dissociative d/o?
- medical status,
What kind of dissorders do you assess for in dissociative d/o?
- substance abuse
- eating/sleeping disorders
What kind of history do you want info on when treating dissociative d/o?
Family history as well as current family situation
What is a form of treatment and therapy that can be used for dissociative d/o?
Videotaping the alters
are there any specific meds for dissociative behaviors?
No specific meds for amnesia, fugues, or other dissociative behaviors!
what is treatment of dissociative behavior based on?
- High anxiety- anti-anxiety meds
- Depression- anti-depressants
- §Hallucinations/Delusions – antipsychotics
What is the duration of meds prescribed for dissociative d/o's
All meds prescribed for short periods to encourage use of inner coping skills!
What do you interview pt's with dissociative d/o's for?
- for thoughts,
- coping skills
how should nursing assessments of pt's with dissociative d/o's be?
thorough and all compassing with holistic approach
What kind of care might pt's with dissociative d/o's need
one on one care
what should nurses do when treating pt's with dissociative d/o's?
- Foster autonomy WHEN SAFE
- Accept the client
What is a substance/chemical?
any mind changing chemical, alcohol, drugs (both prescription and street drugs)
basically any chemical that can cause the mind to be altered.-
What does the term substance or chemical also pertain to?
to glues, paint and paint thinners, household chemicals such as cleaning products, aerosol hairspray
these tend to be readily available and more inexpensive
how many factors contribute to the development of substance abuse and dependency?
Many factors contribute
What is the DSM-IV?
The Diagnostic and Statistical Manual, 4th edition
What does the DSM – IV provide?
provides criteria for diagnosis of substance dependency vs. substance abuse (a less severe disorder)
If left untreated, what can substance abuse develop into?
dependency unless treated
What is Tolerance?
the need for more drugs and/or alcohol to provide the same desired effect
What is a biologic theories of substance related disorders?
A faulty physiologic process contributes to substance dependence
How much more likely are kids of alcoholic biological parents to become alcoholic
- 4X more likely to become alcoholic
- even when the child is raised away from the parent!-
In the biologic theory, what gene may transmit pedisposition of substance related d/o?
Human chromosome gene 11 may also transmit predisposition
WHat types of theories are there about substance
- BIOLOGIC THEORY
- SOCIOCULTURAL THEORY
- INTRAPERSONAL (psychological) THEORY
What does the medical community consider dependency ?
a physical illness
What are some factors in the SOCIOCULTURAL THEORY of substance related d/o's?
Those who are raised in or live in a poverty stricken area use drugs and alcohol to relieve stress-
Religious values that prohibit excessive use of alcohol or drugs have a lower incidence of addiction-
Drugs may be a right of passage for young gang members-
Stereotyping certain cultural groups- the Irish are considered heavy drinkers, country music lovers and beer, etc…
in the BEHAVIORAL THEORY of substance related d/o what are some questions that are asked?
- What triggers are present?-
- How are the behaviors reinforced?-
- Is drug and alcohol use a learned maladaptive coping mechanism?-
- Example- the young, shy teen who feels he/she can join in the fun if they are drinking or drugging
- - they feel more at ease socializing and are acceoted more easily by a peer group.
What do kids who develop substance abuse often have in common
- some similar personality traits: Self-centeredness Attention seeking
- strong need to be in control of others
- Difficulty delaying gratification (“I want/need it NOW)!
WHen are kids more apt to turn to drugs Alcohol?
If the child is placed under increased stress, early failures, overprotection, etc
to cope with stress or numb anxieties and frustrations-
What is critical in development and affect us profoundly?
Intrapersonal relationships early in life
What can happen if the If the child is placed under increased stress, early failures, overprotection, etc
…. they may be more apt to turn to drugs/alcohol to cope with stress or numb anxieties and frustrations-
What is an interpersonal finding of those who abuse
Those who develop substance abuse often have some similar personality traits:
What are some common personality traits of those who develop substance abuse?
- Attention seeking
- A strong need to be in control of others
- Difficulty delaying gratification (“I want/need it NOW)!
Where should information of a pt with substance abuse be gathered from?
Taken from client, family, past medical record, etc…
Social assessment Has the abuser sustained any significant losses in life (property, self-esteem, loss of a loved one, jobs, homes…)
factors of those that abuse substances
REMEMBER: “significant” will be different for one versus others- do NOT judge!
Many face legal charges
- Many do NOT seek help until they reach “rock bottom”- (and that bottom will vary for each client!)
- that they realize that their lives have become completely unmanageable because of the drugs and alcohol
What should you be when questioning a Substance abuser
- should be specific- example: “I took a few pills last night”.- “What pills did you take and how many?” When was the last time the client used?-
- this will not only assist in the assessment of the client’s behavior, but also cue the nurse into withdrawal s/s..
how do substance abuse pt's tend to be
This client tends to be defensive about their situation
How should you be with substance abuse pt's
Unless you establish trust with the client- it will be difficult to get honest, straight answers.
What do you need to be sure of with nurses treating substance abuse pt's?
- the nurse is not overly supportive
- so the client will avoid the negative impact the abuse has had on his/her life
- be accepting and supportive of the client- not the behavior
What are many that work with the area of substance abuse?
Many of those who work in the area of substance abuse are recovering from addiction themselves
this tends to allow the client to feel more comfortable, less alone, and less defensive
What do substance abuse withdrawl s/s depend on
- How much the client uses,
- how often,
- the client’s baseline physical status
- the drugs used.
What are some s/s of substance abuse?
Erratic mood swings are common
What does the lifestyle of a pt that has a substance related d/o tend to
They describe a lifestyle revolving around the use of “drug of choice”
When do many with substance related d/o use their substance
- Many use alone
- Many use first thing in the morning and continue through the day
- Many have significant relationship problems and work-related problems
What kind of periods do many substance abusers describe
Many describe “blackouts” or periods of amnesia episodes (see the safety risks!)
Defense mechanisms: in substance related d/o
- Projection- excuses for his/her addiction, blame shifting
What is denial?
client does not see there is a problem due to his/her abuse of chemicals, deny they need help staying clean and sober
What is Rationalization?
minimizing the problem, uses defense mechanisms Projection- excuses for his/her addiction, blame shifting
Whatis the defense mechanism projection?
excuses for his/her addiction, blame shifting
What is the most commonly abused drug in the US?
Alcoholism is what kind of disease?
- Primary, chronic disease
- for many Progressive disease,
- often deadly
Why is alcohol considered a drug?
it’s addictive qualities
What are s/s of a "hangover"
- increased thirst,
- blurred vision-
What is a hangover thought to be caused by?
- dehydration and a build up of acetaldehyde and lactic acid in the blood
Chronic use- daily consumption, large quantities, regular HEAVY drinking on weekends, or binges of heavy drinking accompanied by long periods of abstinence
What is physical addiction of alcohol on the cellular level?
the cells become dependent on the alcohol to carry on a certain metabolic process in the body.
- If alcohol is not available OR is only available in smaller than usual amounts- the cell goes into “shock” ,
- thus alcohol withdrawal syndrome ensues
What is ALCOHOL WITHDRAWAL SYNDROME?
- physiologic and behavioral symptoms after blood alcohol level drops
ALCOHOL withdrawal is typically more dangerous than withdrawal from other drugs
What is stage 1 of alcohol withdrawal syndrome?
How long does it last?
usually lasts about 6-12 hours after the last drink
What are s/s of stage 1 of alcohol withdrawal syndrome?
- positive tremors.
- Bp, temp and pulse increase,
What is stage 2 of alcohol withdrawal syndrome?
What are s/e of stage 2 of alcohol withdrawal syndrome
- hallucinations- can have life threatening DT’s (Delirium Tremens).
EXTREME increases in Bp, temp and pulse
When does stage 2 of alcohol withdrawal syndrome usually occur?
What drugs are often used to combat s/e of withdrawal
Ativan and Librium
UNDER MEDICAL SUPERVISION ONLY!
What are some medical complications of alcoholism?
FAS (Fetal Alcohol Syndrome)-
What is Wernicke’s Encephalopathy?
- Vitamin B1 (thiamine) deficiency
How do you treat Wernicke’s Encephalopathy?
give vitamin B1 supplementation
what are some common s/s of Wernicke’s Encephalopathy?
- impaired gait and mobility,
- altered levels of consciousness
- even coma.
What can Wernicke’s Encephalopathy lead to?
What is Korsakoff’s Psychosis?
Deficiencies on thiamine AND Niacin-
What does Korsakoff’s Psychosis cause?
degeneration of the cerebrum and the PNS
Dementia is permanent at this stage
WHat causes FAS (Fetal Alcohol Syndrome) ?
If mom drinks in excess during pregnancy
What can FAS (Fetal Alcohol Syndrome) cause?
- learning disabilities and/or mental retardation
- Low birth weight
- Heart defects Facial deformities
What is Critical in Treatment of Alcohol Abuse?
: Family involvement in treatment
Everyone in the family is affected
Family members are often guilty of “enabling” behavior protecting the user
What are those that do the enabling called ?
- because the behavior of that person is structured around managing and adapting to the users dysfunctional behaviors.
What kind of confrontation can be helpful in inducing the alcoholic to go for treatment?
Family and peer confrontation
WHat are some 12 step support groups?
What can they do?
- AA (Alcoholics Anonymous),
- Al-Anon (for the family of the alcoholic)
can help the family members learn NOT to be co-dependent anymore
What is substance abuse intervention?
a planned, structured family meeting to confront the user about how his/her behavior has affected each family member
The user is not usually told about this ahead of time
Letters are written and read to the user
When does treatment for alcohol abuse have the best chance of working
- if the client admits he/she has a problem, and aggress to go to treatment VOLUNTARILY.
- An adult cannot be made to get or go into a treatment facility unless done so by a court!
How are kids and teens placed into an alcohol abuse treatment center?
- by the signature of a parent,
- but time will be limited based on amount of treatment needed for each individual client, insurance, etc…
What are differant Alcohol abuse Dx tests?
blood alcohol study
Urine drug screen
In blood alcohol study, at what level is an overdose?
0.3% requires overdose treatment Above
What is likely when the blood Alcohol level is 0.4%?
death is likely
At what blood alcohol level is it legally considered intoxication?
- varies from state to state,
- usually above 0.05%-0.08%
What is a urine drug screen?
drug metabolites can be identified for days or weeks after use, depending on the specific drug
- Samples are witnessed by a staff member and kept under the “chain of custody”-
- each person handling the sample will sign a specific document that accompanies the sample to the lab
What is hair analysis?
substances can be determined up to one year after only 2-3 days of use