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Does culture play a part in being anxious or not?
- YES!
- Cultural heritage or teaching may determine what is experienced as stressful, how the stress is expressed & what methods are used to deal with it.
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What are the 9 immature defense mechanisms?
- - passive aggressive
- - acting out
- - dissociation
- - devaluation
- - idealization
- - regression
- - splitting
- - projection
- - denial
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What is eustress?
stress experienced as positive
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What is distress?
Stress resulting from harm, loss, threat, difficulty.
Detrimental to health.
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What is stress?
non-specific response to any demand for adaptation.
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How long can someone experience crisis?
- 6 weeks-ish
- people can't tolerate it for much longer than that.
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How many phases of crisis are there?
Describe Phase 1
4
#1 problem or conflict threatens self concept, sense of adequacy.
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Describe phase 2 of crisis.
- stress continues
- trial & error of coping/defense mechanisms.
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Describe phase 3 of crisis.
Panic is when trial & error fails
Flight or withdrawal used
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Describe phase 4 of crisis.
If the problem still not resolved and anxiety continues to be overwhelming at severe panic levels, serious personality disorganization occurs.
Suicide, depression, subtances, violence
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What are some stress reduction methods?
- - Group or social support
- - meditation
- - self hypnosis
- - creative imagery
- - breathing exercises
- - proper nutrition
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What is cognitive reframing?
- - Finding alternative ways to view ideas, events & situation.
- - What you think is what governs your emotions.
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In regards to self awareness what must the nurse be aware of?
- - Own values
- - possible prejudices or counter transference
- - confront psychological issues- "areas remaining unhealed."
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What is the difference between anxiety and fear?
- Anxiety is a reaction to an unspecified danger
- fear is a reaction to a specific danger
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what are the 2 main goals of crisis intervention?
- - Safety
- - Anxiety reduction
(care, listen, monitor feelings, therapeutic communication, summarize often)
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Name 5 mature defense mechanisms?
- - Altruism
- - Sublimation
- - Humor
- - Suppression
- - Compensation
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What are the 6 less mature defense mechanisms (neurotic)
- - Repression
- - Displacement
- - Reaction formation
- - Conversion/Somatization
- - Undoing
- - Rationalization
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What is dissociation?
Interruption in some aspect of cognitive function so as to cut oneself off from a painful awareness.
- "Out of body experience"
- completely lose track of time
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What is Reaction Formation?
- Shifting of distressing emotion to its opposite.
"yay! I'm getting divorced, let party!"
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What is conversion/somatization?
Shifting energy of stress or anxiety into physical symptoms.
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What is undoing?
- Trying to "undo" by doing the opposite behavior.
i.e. becoming altruistic after murdering someone.
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What is rationalization?
- - justification
- - self deception - making an unacceptable behavior seem acceptable.
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What is passive aggressive?
- Resistance is covert
Procrastination, ineffectiveness, stubbornness
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What is acting out?
Potentially destructive
rather than processing feelings and talking, acts them out.
Physical harm to person when angry.
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What is devaluation?
May be to self or others.
i.e. putting someone else down so person looks good by contrast.
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What is idealization?
Overvaluing; putting on a pedestal.
When they fall off, own self esteem suffers as well.
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What is regression?
Reverting back to behavior from an earlier time; comforting but less mature.
Throws a temper tantrum because someone ate your cookie.
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What is splitting?
Unable to see good and bad together - only black & white, all or nothing.
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What is projection?
See in others what you cannot tolerate to see in self.
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What is denial?
Unconscious, refusal to accept reality or fact. Acting as if a painful event thought or feeling did not exist.
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What is altruism?
Meeting needs of others not martyrdom.
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What is sublimation?
substitution of aggressive and sexual impulses into socially acceptable behavior.
Like exercise!
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What is using humor as a defense mechanism?
laughing at, making jokes about painful feelings or situations.
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What is suppression?
Intentionally putting aside a painful or distressing situation or feeling.
Only truly conscious mechanism!
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What is compensation?
Avoiding feelings of inferiority due to personal deficits by excelling in another area.
She's good at sewing but I'm good at cooking.
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If you force a patient to take their meds, what are you committing?
Battery!
unless DTS/DTO
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If a patient refuses their meals & you tell them you'll give it to them in a shot, what are you doing?
Committing assault!
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Anxiety assessment intensity:
Describe Mild.
- - restlessness
- - irritability
- - tension relieving behaviors-fidgeting, nail biting, finger tapping
- - mild sense of discomfort
- - heightened mental focus, alertness!
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Anxiety assessment intensity:
Describe moderate.
- - muscle tension
- - heart pounding
- - ^ HR & RR
- - tremors, voice trembling
- - G.I. cramping or nausea
- - selective inattention
- - can still learn & problem solve; helps if another present.
- (Difficult to accomplish Daily Life)
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Anxiety assessment intensity:
Describe Severe.
- - somatic symptoms worsen, HA, dizziness
- - insomnia
- - hyperventilation
- - feeling of impending doom
- - dazed and confused
- - problem solving & learning not possible
- - reduced perceptual field
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Anxiety assessment intensity:
describe panic
- - severe trembling
- - dilated pupils
- - hyperactive or immobilized
- - may be unable to speak coherently
- - may hallucinate or be dillusional
- - experience total terror
- - may run or be danger to self or others
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What are the types of anxiety?
- Normal, necessary for survival, motivation
- Acute, "State of anxiety" r/t specific situation, loss, or crisis
- Chronic, "trait anxiety", not able to trust that they will be okay. s/s overreaction, chronic fatigue, insomnia, discomfort in relationships & everyday life.
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What are the stages of GAS? (General Adaptation Syndrome)
Describe each stage.
- 1. Alarm reaction - "fight or flight" prepares body for physical activity, decreases effectiveness of immune system
- 2. Resistance - body adapts i.e. anorexia = v desire for physical activity
- 3. Exhaustion - resistance is reduced, immune system is collapsed & heart attach r/t HTN
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Who is Hans Hugo Bruno Selye?
What did he do?
- "Father of stress"
- coined the term stress
- came up with GAS (General Adaptation Syndrome)
response to stress is whole body, not just local.
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What is the DSM IV?
- A diagnostic manual with 5 axis' & over 300 diagnoses.
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What is included in Axis 1 of DSM IV?
Give an example.
- Major clinical disorder
- - bipolar, schizophrenia, alcohol dependence, MDD, PTSD, GAD
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What is in Axis II of the DSM-IV?
Give example.
Personality disorders & Mental retardation
- obsessive compulsive personality disorder
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What is included in Axis III of the DSM-IV?
Give an example.
General medical conditions
-arthritis, HTN, diabetes, hepatitis
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What is Axis IV of the DSM-IV?
Give an example
Environmental/Psychosocial factors
- Divorce, unemployed, no transportation
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What is Axis V of the DSM-IV?
Give example.
GAF- Global assessment of functioning, 2 numbers represented as a fraction.
- 1st # - what the assessor has gauged your current functioning level (1-100).
- 2nd # - What the assessor has deemed your past years functioning level (1-100) prior to incident.
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What are the legal requirements for an involuntary admission?
- - Admission initiated by someone else
- - 2 or more MD's needed to determine need
- - Need to be DTS and or DTO (danger to self or others)
+ Right to a hearing if admitted +
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Name the benzos to be given for anxiety.
What is the #1 concern?
- Xanax - alprazolam
- Librium - chlordiazepoxide
- Valium - diazepam
- Tranxene - clorazepate
- Ativan - lorazepam
- Serax - oxazepam
They are addicting! To be used short term
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Besides benzos, what other drugs can be used for anxiety?
- Buspar
- Benadryl
- Vistaril
- Inderal
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What are the 4 types of crisis'?
- Maturational crisis - new development stage reached w/o completing the previous 1.
- Life transitions - new developmental stage reached with no experience: 1st day of school
- Advantitious crisis - Disaster!
- Situational crisis - external situation where one is not prepared to go thru. Death of a loved one.
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In caring for someone with anxiety or crisis what should the nurse avoid?
- - Needing to be needed!
- - Pts need to do for themselves
Don't set unrealistic goals for the pt. or yourself.
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What are the 3 levels of care with crisis intervention?
- Primary
- Secondary
- Tertiary
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With crisis intervention what is involved in primary care?
- Prevention
- - Recognize potential problems in relation to how pt. normally handles stress
- - Teach coping skills: meditation, relaxation, problem solving, decision making
- - Assist pt. in evaluating the reaction of life changes to decrease stress
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In crisis intervention what is involved in the secondary level of care?
Reduce stressors during a crisis "damage control".
- Assess w/client her/his problems, coping methods, support & resources
- Set goals
- Plan interventions
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With crisis prevention, what is involved with the tertiary level of care?
- usually in structural environment.
- Goal: Prevent further deterioration & regain optimal functioning
- Includes - rehab centers, intensive outpatient programs, partial hospital programs
- More restrictive environment
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What are the 11 patient rights in a psych setting?
- - right to treatment
- - right to refuse
- - Least restrictive environment
- - communicate w/ ppl outside
- - right to no unnecessary restraints
- - right to independent psych eval and status review
- - right to protection from abuse
- - right to have an informed consent & withdrawal
- - Right to confidentiality of records
- - Right to due process
- - Right to individualized treatment plan
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When can a nurse give meds to a psych patient?
An informed consent
*Except if pt. is a danger to self or others*
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In regards to legal issues & psych, what are the confidentiality mandates?
- Can't give status updates!
- Someone looking for a psych patient needs to be directed to administration.
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In regards to legal issues, what must the nurse report?
Abuse, suicide, intent to harm.
- Duty to warn - the person, the person being threatened and the police
- *Never promise to keep secrets*
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