NUR 289 study guide finals/Already Graded A+/ Molloy College

STUDY GUIDE – NUR 289 – – SECTION 1 – Understanding and Managing Responses to Stress 1. Immune Stress Responses ● Interaction between nervous system and immune system during alarm pha se of GAS(General Adaptation Syndrome by Hans Selye’s) ● Negatively affects body’s ability to produce protective factors 2. Mediators of Stress Response: ● Stressor: 2 types of stressor: a.Physical: -any environmental condition. Eg: pollution,fire,heavy snowfall, traffic ,noise, natural disaster and hungry ,infection and pain b.Psychological:--spouse or death in family,divorce, loss of a job, unmanageable debt, the death of a loved one, retirement, and fear of a terrorist attack. ● Perception:--is negative outlook that effect and stress increases eg: age,gender and culture. ● Individual temperament:--personality,genetics structure ● Social support: Support groups:buffer to stress Culture Spirituality and religious beliefs sharing same problem,share the same identity like church 3. Measuring Stress (Social Readjustment Rating Scale) holmes and rahe : Measure level of positive and negative stressful life events over a 1 year period. 4. Assessing coping styles (Rahe’s Four Personal Attributes for Coping) ● Health-sustaining habits (e.g., medical compliance, proper diet, relaxation, pacing one's energy) ● Life satisfactions (e.g., work, family, hobbies, humor, spiritual solace, arts, nature) ● Social supports ● Effective and healthy responses to stress 5.. Managing Stress Through Relaxation Techniques (Slide 10 & 11) 1. Deep breathing exercises 2. Progressive muscle relaxation 3. Relaxation response 4. Meditation 5. Guided Imagery 6. Biofeedback 7. Physical Exercise 8. Cognitive reframing: change the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs ("I can't pass this course") with more positive self-statements ("If I choose to study for this course, I will increase my chances of success. "What positive things came out of this situation or experience?"•"What did I learn in this situation?""What would I do in a different way?" 9. Journaling 10. Humor a. Distress: negative, draining energy that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue. Distress may be caused by such stressors as a death in the family, financial overload, or school/work demands. B. Eustress: positive, beneficial energy that motivates and results in feelings of happiness, hopefulness, and purposeful movement. Eustress is the result of a positive perception toward a stressor. Examples of eustress are a much-needed vacation, playing a favorite sport. Chp. 35 Integrative Care a.Conventional: Focuses primarily on curative actions implemented on a mostly passive patient. Allopathic, mainstream, orthodox, regular medicine, biomedicine. b. Complementary:Focus on the on the mind-body aspects of health, along with the active involvement of the patient. Integrated care/alternative (C.a.m) medicine: pt is the center of care and focus on prevention and wellness. Attends pt’s physical, mental needs. Directing at healing and consider whole pt( mind,body, spirit along with life style) 2. Consumers and Integrative Care (plus added notes given in class re: its use) ● Safety and efficacy: No stands or regulation garanty of effectivity of herbs. Also Herbs contain powerful ingredients that can damage the body if not taking properly. Money can be wasted with unproven cure. ● Cost: Less expensive than conventional care. ● Reimbursement: can be out of pocket, insurance doesn't cover them. ● Placebo effect: Basic in power of suggestion and believe that it will work. 3. Natural Products: Diet and Nutrition Herbal therapy: St. John wort, Ginkgo biloba, black cohosh, valerian, herbal teas. 4. Mind and Body Practices: ● Meditation ● Yoga ● Acupuncture ● Deep breathing exercises ● Guided imagery ● Hypnotherapy 5. Manipulative and Body-Based Practices ● Spinal manipulation: chiropractic ● Massage therapy: rubbing skin 6. Complementary Therapies –( Slide 10 only) ● Homeopathy : involves the use of micro doses of specific substances to effect health improvement. ● Naturopathy ● Aromatherapy: may cause complications for a pt with asthma. ● Energy therapies ● Therapeutic touch ● Healing touch Chp. 31 Psychological Needs of Patients with Medical Conditions 1. Psychological Responses to Serious Medical Conditions : 1. Depression:-- seeking help 2. Anxiety 3. Substance abuse 4. Grief and loss:permanent change in our body eg burns,hearing loss 5. Denial 6. Fear of dependency:--refusal to accept treatment, they feel angry,embarrassed 2 . Nursing care with Medical Conditions :-Factors that : ● Interfere with medical treatment ● Pose health risk ● Cause stress related pathophysiological changes: fight or flight DSM-IV-TR diagnosis include both psychological factors and general medical conditions 3. Human Rights Abuses Secondary to Stigmatization :-- ● Patients stigmatized by: Mental illness HIV-positive status Transgender surgeries or treatment ● Potential results of stigma: Inadequate care, avoidance of contact Failure to fully investigate somatic complaints Although someone may complain a lot you still have to investigate Worsening of physical illness, undue stress Death 4. Psychiatric Liaison Nurse (added notes in class):---- Chp. 32 Care for the Dying 1. Hospice and Palliative Care: ● Dr. Elizabeth Kubler Ross ● Goal is quality, compassionate care for people facing a life limiting illness or injury ● Team oriented approach to expert medical care, pain management, an emotional and spiritual support. ● Tailored to patient’s needs and wishes ● Support to pt loved ones included: giving choices, forces personal control, offers intervention and respect. 2. Hospice Care: ● Available to everyone regardless of age, diagnosis, or the ability to pay. ● Requires a physician best clinical judgement that the pt is terminally ill with a life expectancy of 6 months or less. ● Pt chooses hospice care rather than curative treatment. 3. Nursing Goals in End-Of-Life Care: ● Practice the art of presence ● Assess for spiritual issues ● Provide palliative symptom management ● Become an effective communicator ● Counsel about anticipatory grieving ● Practice good self care ● The four gifts of resolving relationships:Forgiveness, Love, Gratitude, Farewell. 4. Styles of Confronting the Prospect of Dying: Seven Motifs ● Struggle: Living and dying are struggle ● Dissonance: dying is not leaving ● Endurance: triumph of inner strength ● Incorporation: belief system accommodates death ● Coping: working to find a new balance: support strength and coping ● Quest: seeking meaning in dying: supportive and listening ● Volatile: unresolved and unresigned:understands the past conflicts 5. Four Tasks of Mournig: Grief Reactions, Bereavement, and Mourning (study only Grief) Grief: the reaction to loss: Normal response to a significant love. Includes depressed mood, insomnia, anxiety, poor appetite, loss of interest, guilt, dreams about the deceased, poor concentration. Other Normal Experiences during Bereavement (added notes in class) Period of grieving following a death. Somatic distress is normal Preoccupation with the regimen of the disease, very repetitive how the deceased died. Repetid visualization of the deceased, changes in behavior Maladaptive Grieving: (study only Delayed Grief: ) Delayed Grief: The term Delayed Grief is used to describe grief that is postponed and resurfaces sometime later. It is not unusual, after a loss, that there are many things that must be done. Often people decide that they “must be strong” for all those around them and suppress their own feelings of pain and loss, so that they can be there for others. Some people feel that the best way to handle their personal loss is to “keep busy” with work or other endeavors, rather than taking time to go through the grief process. The problem with grief is that if you fail to take action to deal with your personal emotional pain, and instead suppress it, it waits deep inside to haunt you later. 6. Dr. Kubler-Ross’s 5 Stages of Dying: ● Denial ● Anger ● Bargaining ● Depression ● Acceptance STUDY GUIDE – NUR 289 – FINAL EXAM – SECTION 2 – FALL 2018 Chp. 15 Anxiety and Obsessive-Related Disorders 1. Levels of Anxiety :------ Normal anxiety:Motivate to study more. Provide energy. Makes you prepare. Prompt constructive behavior. Protective factor for danger. a. Mild anxiety: Reality in sharp Focus Grasp info Can solve problem S.E: uneasy, restless, some tension, tapping b. Moderate anxiety: Perceptual field narrows grasp Less info Can Solve problem S.E: Pounding heart, High B.P., High P, GI discomfort, urinary urgency, H/A c. Severe anxiety: Perceptual field greatly reduced Focus on one particular detail Can't solve problem S.E: Hyperventilate, Increased breathing d. Panic: Unable to process/concentrate Lose touch with reality Can't solve problem S.E: marked disturbed behavior, stuttering, irritated, bizarre behavior, pacing, visual hallucinations, impulsive, uncoordinated, exhaustion. 2. Separation anxiety disorder: Developmentally appropriate levels of concern over being away from a significant other. It could happen to people over 18 y/o, Adult population Symptoms: Interfere with normal activities Insomnia GI Problems H/A Shy and impairment 3. Panic Disorder: Panic attacks 4. Phobias: Agoraphobia: Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing. 5. Specific phobias: Social phobias (Social anxiety disorder): severe anxiety or fear provoked by exposure to a social or a performance situations that will be evaluated negatively by others. 6. Generalized Anxiety Disorder : excessive worry that last for months 7. Obsessive-Compulsive Disorders (Slide 11 only): a. Obsessions: Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind. b. Compulsions: Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety. 8. Body Dysmorphic disorder: preoccupation with a defected image portrait. 9. Hoarding disorder: accumulation of belongings with little value, prevent a normal life. People can visit, unsafe, and unsanitary. 10. Hair pulling and Skin picking disorders: eyelashes, skin picker lead to sores, scars, infections. Lead to disability, social stigma, alter appearance. 11. Nursing Diagnoses: Anxiety, coping, low self esteem, risk for injury 12. Outcomes Identification: Identify the problem Determine the level of anxiety: mild, moderate, severe, panic. Access to self/ culture speech 13. Implementation (includes nursing interventions) Mild to moderate levels of anxiety Severe to panic levels of anxiety Counseling Teamwork and safety: address goal/ maximize safety. Provide consistent care. Promotion of self care activities: Make sure provide adequate fluid/ food/ Self care (personal hygiene) sleep. 14. Pharmacological Interventions: Buspar( vistaril): Hydroxyzine: Anti Anxiety agent/non addictive/ non habiting forming Benzodiazepines: Anti Anxiety agents: anxiolytics and Pt./Family Teaching for Benzodiazepines 15. Advanced Practice Interventions Cognitive therapy Behavioral therapy Relaxation training Modeling Sytematic desensitization Flooding: A type of behavior therapy; a therapeutic strategy at the beginning of therapy in which the patients imagine the most anxiety-producing scene and fully immerse (flood) themselves in it. Response prevention Thought stopping 16. Handout on Defense Mechanisms + Marcus Engel‘s Book “I’m Here” a. Denial: Involves escaping unpleasant, anxiety causing thoughts, feelings, wishes, or needs by ignoring their existence. b. Displacement: Is the transference of emotions associated with a particular person, object, or situation to another non threatening person, object, or situation. c. Intellectualization: is a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing. d. Projection: Refers to the unconscious rejection of emotionally unacceptable features and attributing them to others. e. Rationalization: Consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener. f. Reaction formation: is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion. g. Regression: is reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited. h. Repression: An unconscious exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness. i. Sublimation: Unconscious process of substituting mature and socially acceptable activity for immature and unacceptable impulses. j. Suppression: is the conscious denial of disturbing situation or feeling. For example, Jessica has been studying for the state board examination for a week solid. She says” I wont worry paying my rent until after my exam tomorrow” Chp. 22 Substance Related/ Addictive Disorders 1. Addiction (definition) chronic disease of the brain (genetic born dissociation). It effect rewards, motivation, memory, learning perception, judgement, decision making Psychological, social and behavioural characteristics :--- Inability to Abstain Impairment in Behavioural control Craving for drugs Diminishing recognition of significant problem consequences Dysfunctional Emotional responses 2. Tolerance:--increasing amount substances get desired effect 3. Withdrawal :physiological symptoms that occur when chemical decrease in blood stream 4. Definition of Substance Dependence: can be defined as continuing to use a substance even though negative consequences result from doing it. Cigarettes/ Nicotine meets criteria for substance. 5. CAGE : questionnaire paper give it to alcoholic to say yes or no about question like they think to quit alcohol. 6. Codependency (Enabling Behaviors) / Family assessment :cluster of behaviour/ over responsible behaviour ● significant other has over-responsible behaviour(doing too much) ● Doing for others what others can do for selves ● Define self worth in terms of caring for others 7. Self Assessment :-addicted stigma, non judgemental ,supportive feeling. Lose a job, poverty, lose relationship. 8. Signs of Alcohol Withdrawal and Alcohol Withdrawal Delirium 6 to 8 hr signs 1. insomnia 2. Impaired cognitive behaviour 3. Restlessness 4. Irritability 5. Anorexia -lack of appetite 6. Anxiety 7. Headache 8. anxious 9. Tremors of the hand 10. visual,tactile hallucination 11. Disorientation 12. 1:1 supervision 13. fluctuation level of consciousness: hyper excited 14. Tremors of the tongue 24 to 48 hr 14. Well lit room and quiet room 15. Sweating 16. Increase pulse and B.P 17. Nausea 18. Hypersensitivity to noises 19. Fever greater than 101 20. Seizure 21. Peaks 48 to 78 hr 22. disturbance in sensory perception 9. Central Nervous System Stimulants: Common signs of Stimulant Abuse ● Dilated pupils ● Dry oral nasal cavity ● Excessive of motor activity ● Chest pain ● Irregular pulse ● Lower caffeine, nicotine 10. Opiates - Opiates Withdrawal/Opiate Intoxication Most different behaviour and signs,empath physical pain and psychological ne , methadone and fentanyl patch. OPIOID WITHDRAWAL:- ● Increase BP, T ● Increase Pulse, Respiration,temperature, ● Diaphoresis:sweating, ● Insomnia ● Runny nose Opiate Intoxication: ● Decreased bp: hypotension ● Decreased p ● Respiratory depression ● Slowed speech ● Pinpoint pupils 11. Nursing Diagnosis :- ○ ineffective coping ■ Risk for depression ■ Risk for suicide ■ Self Care deficit ■ Risk for other directed violence ■ Risk for falls 12. Implementation: Brief Interventions ● FRAMES F :- -FEEDBACK OF PERSONAL RISK R:- -RESPONSIBILITY A:-- ADVICE TO CHANGE M:-- Menu of ways to decrease substance use E:-- EMPATHY S:-- SELF EFFICIENCY /SELF SUFFICIENT ● Pharmacological Interventions for Alcoholism := OPIATES NICOTINE ALCOHOL WITHDRAWAL Methadone Wellbutrin 34 ban *ativan- lorazepam *Suboxone chantix librium-chlordiazepoxide *Subutex *zyban tegretol-carbamazepine Antabuse:-Disulfiram= when consuming alcohol Treat Narcotic overdose= narcan 13. Evaluation ● Decreased denial ● Improve family relationship ● Improve healthy relationship ● Increase time and abstinence 14. Nursing Process :---- A.A. (Alcoholics Anonymous: ● Support ● Spirituality ● Sobriety ● Sponsorship ● Similarity ● Structure for decay. 15. Alcoholics Anonymous: follows 3 basic concept: 1. Pt. powerless over their education assistance to their use. 2. Pt. not responsible for their disease-responsible for recovery 3. Pt. do not blame other, face their problem don't face:- denial ● AL-Anon friends and family member of alcohol abuser ● Alateen-- teenager alcohol abuser ● Nar-Anon:-narcotic addicted family ● Gamblers Anonymous Chp. 23 Neurocognitive Disorders 1.Delirium – Clinical Picture 1. Alteration in level of consciousness 2. Disorientation :-false believed-nurse don't argue with patient 3. Anxiety 4. Agitation 5. Poor memory 6. Delusional thinking 7. Hallucinations:--disturbance in sensory perception such as visual 8. Delirium is a medical emergency,rapid and onset 2. Nursing Process delirium: Overall Assessment: Four cardinal features of delirium 1. Acute onset and fluctuating course 2. Reduced ability to direct, focus, shift, and sustain attention 3. Disorganized thinking 4. Disturbance of consciousness Sundowning :--okay during the day 3. Delirium Cognitive & perceptual disturbances difficult for them to engage ● Illusions: Miss interpretation of environment. Ex: a curtain in the room and get confused that a person is there. ● Hallucinations : False sensory stimuli. Visual is most common. Sometime tactile. Hypervigilance. 4. Delirium Physical needs: self care deficit. Poor memory 5. Moods and physical behaviors : Mood change dramatically, Mood swings. People are wandering 6. Nursing Diagnosis delirium : Risk for injury Acute confusion( pt pull out their IV) Risk for deficient fluid 7. Outcomes Identification delirium: Implementation and Evaluation ● Prevent physical harm due to confusion, aggregation or fluid and electrolyte imbalance. ● Perform comprehensive nursing assessment to aid in identifying cause. ● Assist with proper health management to eradicate underlying cause. ● Use supportive measures to relieve distress. 8. Dementia: Gradual cognitive decline 1. Progressive deterioration of cognitive functioning and global impairment of intellect 2. No change in consciousness 3. Difficulty with memory, problem solving, and complex attention 9. Normal aging and differences from ● Forgetting day, recalling later ● Occasional bad discussion ● Sometimes forgetting right word to use ● Occasional losing things ● Missing monthly payment Dementia ● Unable to manage budget ● Misplacing things and unable to retrace steps ● Poor judgment and decision making, not remembering the season ● Difficulty having a conversation 10. Nursing Process dementia : Defense mechanisms ● Denial ● Confabulation ● Preservation ● Avoidance of questions 11. Alzheimer’s Disease Symptoms :-- 1. Memory impairment( apraxia) 2. Disturbances in executive functioning ( affect planning, organizing and extra thinking) 3. Aphasia (Difficult speaking, lost of language ability, difficulty finding the right words, bubbles 4. Apraxia: lost of purposes movements/ unable to perform familiar or purpose test 5. Agnosia: lost ability to recognize objects, sounds or people. 6. Agraphia: inability to write 7. Hyperorality: put everything in mouth 8. Hypermetamorphosis: Touch everything insight “picking on things” 12. Stages of Alzheimer’s Disease :--- 1. Preclinical AD 2. Mild cognitive impairment (MCI) Start getting depress 3. Dementia due to AD: get agitated, get violent , paranoiac, accusatory, delusions 13 Nursing Process alzheimer: Nursing Diagnoses; ● Risk for injury ● Confusion ● Impaired verbal communication ● Impaired memory ● Self care deficit ● Caregiver role strain ● Anticipatory grieving(losing the partner) support, compassionate. ● Impaired nutritional balance 14 Outcomes Identification alzheimer: ● Wandering (restrict access to exit) ● Caregiver role strain(suggest counseling) ALzheimer SUPPORT GROUP. Family can get home care aid ● Maintain safety ● Help communication their needs ● Identify yourself everytime walk into room ● Speak slow/ short simple words ● Use god eye contact ● Be near patient ● Focus in one piece of info at the time ● Talk about familiar things ● Help remenanse (remember things) ● Manage their feeling ● Put clocks, photos and calendars. ● Get rest periods ● GET THEM TO DO AS MUCH AS POSSIBLE ● GIVE THEM DIRECTIONS AND STRUCTURE 15. Pharmacological Intervention alzheimer: Disease modifying: Does Not cure disease. Slow the disease down, Increase acetylcholine levels. FDA approved for Alzheimer disease. ● Aricept ● Nomenda ● Cognex ● Exelon-patches ● Razadyne Interventions Diagnostic Testing alzheimer : To determine Differences between depression reversible sleep poorly and awaken early morning,difficulty concentrating, forgetfulness,inattention ,gradually due to stress or crisis and dementia not reversible,progressive,behaviour may worsen in evening,impaired memory,agnosia,slowly,over months DEMENTIA: mini mental exam(20 questions) STUDY GUIDE – NUR 289 –FINAL EXAM – SECTION 3– FALL 2018 Chp. 26 Crisis and Disaster 1. Crisis 1. · Profound disruption of normal psychological homeostasis 2. · Normal coping mechanisms fail 3. · Results in inability to function as usual 4. · Acute and time-limited (does not last forever, last for short period of time 4-6 weeks average) 5. · Crisis is a struggle for equilibrium and adaptation 6. · Can threaten personality organization 7. · Present an opportunity for personal growth 2. Outcomes of Crisis --- Depend on ● Realistic perception of the event: People vary in the way they absorb/process ● Adequate situational supports Crisis intervention: short term therapeutic process that focuses on rapid resolution of the immediate crisis using available resources. ● Adequate coping mechanisms Coping skills vary We learn to cope through life experience, culture, opportunities, modally behaviors 3. Types of Crisis: A. Maturational : New developmental stage is reached Old coping skills no longer effective Leads to increased tension and anxiety not copying yourself B. Situational: Arise from events that are: Extraordinary, external, often less C. Adventitious: Unplanned and accidental: Natural disaster, National disaster(ex. war, riots, act of terrorism, air plane crash), crime of violence(murder, assault, bombing, child abuse). 4. Phases of Crisis( Caplan) (study only phases 3&4) Phases of Crisis Phase 3 1. Trial-and-error attempts ty elevate to severe to panic Ex: studying every night and studying with a buddy failed 2. Anxiety can escalate to severe level or panic 3. Automatic relief behaviors mobilized (i.e., withdrawal and flight) 4. Some form of resolution may be devised (i.e., compromising needs or redefining situation Phases of Crisis Phase 4 1. Problem is unsolved and coping skills are ineffective 2. Overwhelming anxiety 3. Possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior 5. Application of the Nursing Process Assessment: General assessment:-assess for suicidal thoughts Assessment of perception of precipitating event: Assessment of situational supports: who give u support Assessment of personal coping skills:how u cope in the past ,what will work u Self assessment:nurse need to constantly monitor feeling and thought when dealing with patients with crisis. self awareness of your negative feelings and reaction. role crisis (unrealistic goal for patients)about ur self not letting ur father on day care Diagnosis of Ineffective coping, anxiety--moderate to sever ,ability to solve problem is usually impaired , risk for suicide Outcomes Identification make goal like manage their stress,good decision,judgement or decrease in ing should be realistic outcome based on their culture and personal value. Implementation: Basic Level: 1. Patient safety is first priority if the patient in suicidal or homicidal. 2. Anxiety reduction --techniques are used Crisis intervention:-it is patient who solve the problem,not support the patient during this: 1. Primary Care:- community health providing. promote mental health to decrease any mental illness to decrease the incidence of pat effective coping skills 2. Secondary care.:--establish intervention during a crisis to prevent prolonged anxiety-doing scanning/ assessing from long term anxiety, 3. Tertiary Care :---provide support crisis providing counselling or support group 7. Critical Incident Stress debriefing - purpose of its use: Following trauma exposure, an individual experiences both physical and psychological symptoms. Critical incident stress debriefing is a process that allows survivors to both processes and reflects on what has happened to them. ex: Sudden death, including those which occur in the line of duty, as well as coworker/colleague suicide, Incidents involving children, Serious injury, such as from shootings, attacks, threats to the safety and well-being of an individual, both physically and psychologically, Any situation which is distressing, dramatic or profoundly changes or disrupts an individual's physical or psychological functioning. 1. Introductory phase:purpose the meeting explain ,overview and confidentiality assured Assess the impact of the critical incident on the " 2. Fact phase : pt discuss facts of incidence tell the incidence and describe their involvement "Identify immediate issues surrounding problems involving 'safety' and 'security.'" 3. Thought phase:first thing come in their mind about incidence "Use defusing to allow for the ventilation of thoughts, emotions, and experiences associated with the event and provide "validation" of possible reactions." 4. Reaction phase : talk worse thing abt that happen what was painful abt it"Predict events and reactions to come in the aftermath of the event." 5. Symptom phase: symptoms u had after experience eg scared fear "Conduct a "Systematic Review of the Critical Incident" and its impact emotionally, cognitively, and physically on survivors. 6. Teaching phase :guidance s offered regarding "Bring "closure" to the incident, and "anchor" or "ground" the individual to community resources to initiate or start the rebuilding process." 7. Re entry phase:review all the material discuss debriefing "Debriefing assists in the "re-entry" process back into the community or workplace." By addressing the critical event, along with the individual's reaction to it, the survivor may be better able to regain his or her self of safety, security, and wellbeing. This, in turn, allows them to return to normal life with greater equanimity and less stress. Chp. 28 Child, Older Adult, and Intimate Partner Abuse 1.Types of abuse: 1. Physical abuse: push someone, bitting, punching, hitting, chicking, stopping, bump,slapping ,burning 2. Sexual abuse: sexual/ contact, mentally ill, physical disabled, consent 3. Emotional abuse: hostility, humiliating, isolating, intimidating, threatening 4. Neglect: failure to provide ED for children, not providing nurturance, not providing medication -physical,emotion,educational,emotional and medical needs. 5. Economic abuse:control access to economic resources --withhold financial, improper exploitation of funds, illegal take away funds. 2. Occurrence of Violence 1. Perpetrator:-those who initiate violence their need more important -sibling,partner 2. Vulnerable person:-is the family member upon whom abuse penetrated survivor ,victim children older adult-alzheimer difficult to handle ,women and mentally ill 3. Crisis situation :-that put family with a violent member. 3. Characteristics of Perpetrators: Consider their own needs more important than needs of others Poor social skills Extreme pathological jealousy May control family finances 4. Cycle of Violence ● Tension building stage: abuser--verbally abuse,minor hitting and victim-feel helpless,complaint ● Acute battering stage:--victim try to cover up injury or look for help and tension become unbearable and provoke an incident to get it over ● Honeymoon stage :--abuser show love, gifts and make promise not to do again. victim -trusting and hoping 5. Characteristics of Vulnerable Persons: Women ● Pregnancy may trigger or increase violence ● Violence may escalate when wife makes move toward independence ● Greatest risk for violence when the woman attempts to leave the relationship 6. Characteristics of Vulnerable Persons Children ● Younger than 3 years ● Perceived as different ● Remind parents of someone they do not like ● Product of an unwanted pregnancy ● Interference with emotional bonding between parent and child 7. Characteristics of Vulnerable Persons Older Adults ● Poor mental or physical health ● Dependent or perpetrator ● Female, older than 75 years, white, living with relative ● Elderly father cared for by a daughter he abused as a child ● Elderly women cared for by a husband who has abused her in the past 8. Application of the Nursing Process:--- (added notes in class on verbal approaches) ● Level of anxiety : mild, moderate, severe, panic ● Coping mechanisms: How cope in the past? and how cope now? ● Available support systems: Get family, friends involve ● Signs and symptoms of emotional trauma: Ask for suicidal thoughts ● Signs and symptoms of physcical trauma: Obtain as much info as possible: trauma, injury of head, neck, and extemeties) ● Self assessment: Be aware of your own personal believe and feelings(abortion, etc) need to be empathetic, understanding and trusty.Examine the negative feeling or anger we might have ● interview process and setting--- Do not use the words abuse or violence --- When interviewing` the patient it should be in private 9. Assessment : 1. Everyone has to be screened 2. Use Tact understanding 3. You want to be calm 4. You want to establish an area of trust 5. Let them tell their story without interrupting them 6. Reassure that they did not do anything wrong 10. Nursing process CONT:-- ● Diagnosis: risk for injury, anxiatym inefective coping, social isolation, ineffective relationship, risk for violence ● Outcome identification: Absence of any symptoms after the trauma: ● Look for abuse protection ● Look for abuse recovery: healing, physical and psychological injury. 11. Implementation 1 Reporting abuse ● Legally mandated reporters of and suspected or actual cases ● Report with 24 to 48 hours ● Document injuries using diagrams,maps photos 2 Counseling—safety plan ● Crisis of dimension ● Victim has to have a safety plan that includes a destination (safe house/shelter), transportation, back items ● Use code is children are involved ● Rapid escape 3 Case management ● Social worker ● Nurse ● Coordinate services 4 Therapeutic environment ● Visit by a clinician to a home ● Provide economic social support ● Family therapy 5. Promotion of self-care activities ● in steps to leave the abuser ● Referrals of organizations 6. Health teaching and health promotion ● Identify those at risk 12. Advanced Practice Interventions :-- Individual psychotherapy (for victim): ● Goal: empowerment, independence, light options, increase self-esteem, address skill chain simulant, work with feelings of grief ● For perpetrator: this therapy in mandated court Family psychotherapy (abuser and victim)--increase independence promote life options ● Learn to maximize positive interactions,increase self esteem ● Identify any destructive behavior patterns ● Learn communication response Group psychotherapy--decrease isolation ● People going through the same thing ● Decrease isolation for the victim ● Decrease self esteem ● Learn how to problem solve ● For the abuser, they will learn anger management and verbally verbalize their anger constructively Chp. 29 Sexual Assault 1 Clinical Picture: Acute Stress Disorder and PTSD Acute stress disorder ● Symptoms occur immediately after the assault ● Occur 3 day to one month after the assault Posttraumatic stress disorder (PTSD) ● Symptoms occur after one month after the trauma ● Both are psychological reaction to a serious trauma ● The serious trauma is the sexual assault Symptoms for both: Re-experiencing: ● Repeated living of the event, constantly remembering event ● Flash back ● Recurring images ● Memories ● Vivid dreams ● Frightening thoughts Avoidance : Avoid similar situation. Feel numb/ depress 2. Psychological Effects of Sexual Assault 1. Depression 2. Suicide 3. Anxiety 4. Fear 5. Difficulties with daily functioning 3. Effects of Incest:--- ● Negative self image ● Depression ● Eating disorders ● Personality disorders ● Self destructive behaviors ● Substance abuse ● Self mutilation Hyperarousal: can get easily tense ● hypervigilance, scanning their surroundings ● difficulty concentrating ● easily startled ● angry outburst ● tense 6. Low self-esteem 7. Sexual dysfunction 8. Somatic complaints (Physical) 9. Denial 4. History of Sexual Abuse in Psychiatric patients (added notes in class) ● Document color, size, location and narrative of pt. ● Use maps, photos ● Take several sample ● Date last mestrual period ● Hx of any sexual transmitters diseases ● Provide detail of procedure to pt ● Allow pt to participate in the procedure and decisions ● Dont shower before exam 5. Application of the Nursing Process: First thing you want to assess when the patient is depressed is if they are suicidal/ homicidal ideation. General assessment:Assessment of perception of precipitating event ● Ask the patient what lead up to the event ● The more the problem is defined the more effective the resolution ● Get as much information as possible Level of anxiatey( mild, moderate, severe, panic) Coping mechanisms: Assessment of personal coping skills ● Ask the patient what coping skills help you ● Or ask what do you do to feel better? ● Assessing past and present coping skills Available support systems: Assessment of situational supports ● Get family, friend involve: ● Ask who can be helpful in this time ● If they don’t have anyone to rely on they can use a counselor or a therapist- temporary support system until relationships are established Signs and symptomps of emotional trauma: Ask for suicidal ideation thoughts Signs and symptomps of physical trauma: Obtain as much info as possible of the injury of the head, neck, extremeties. Self-assessment ● Be aware of our own feeling and thoughts when dealing with a patient going through a crisis ● Recognize own anxiety level ● Be aaware of personal beliefs ● We need to emphatic, understand and build trust. 6. Best Practice Guidelines: Examination involves five steps. Confirm consent is needed for photos and different procedure 1. Head-to-toe physical assessment for signs of injury 2. Detailed genital examination 3. Evidence collection and preservation 4. Documentation of physical findings 5. Treatment, discharge planning, and follow-up care 7. Nursing Process (cont’d) (Slides 15 & 16) Diagnosis : Rapee trauma syndrome(sustained as maladaptive response to a force virtual of sexual act against the victim will and consent) Anxiatey, inefective coping(fear), social isolation, inefective relationship Outcomes identification: Absence of any residual symptoms after trauma ● Look for sexual abuse recovery(healing of physical and psychological injuries. ● Healing: People feel right to be protected ● Relief of anger ● Recovery shown as feel of enpowerment ● Hope and confort in relationship Interventions: Counseling: safe center(sexual assult) explain that may not be the right choice that made them vulnerable to the situation but they are not having the right to blame themselves. Talk avoid what could be avoid in the future Focus on controlled behavior Consult is not jugdemental, allow to talk (space, time) Promotion of self care activities Case Managment: SW, NURSES, DRs, case workers, btw 24-48 hrs after the scene. ● Advanced practice intervention Psychotherapy Observe the signs for PSTD, depression, suicidal, behavior change 8. Evaluation Sexual assault survivors are considered to be recovered if they are relatively free of any signs or symptoms of acute stress disorder and PTSD. ● Less somatic complaints ● Eating well ● Sleeping well ● Psychological and physically well Show Less