Crisis and Anxiety

Emotional conflicts dealt with actions, rather than feelings?

Behavior that is avoidant and lacks energy, suggesting a depressed mood

Emotional conflict dealt with by excessive daydreaming as a substitute for relationships/actions

A concious or unconcious attempt to make up real or imagined inferiority or inadequacies.

Elements of intrapsychic conflict are disguised and discussed symbolically through physical symptoms

Projected thoughts are false, fixed ideas

The unconcious avoidance of disagreeable realities by ignoring or refusing to recognize them

Attributing exaggerated negative qualities to oneself or others

Shift of emotion from a person/object to a more acceptable substitute.

The separation/splitting off of mental/behavioral processes from concious awareness or identity

The unconcious adoption or patterning of personality characteristics of an admired other

Excessive reasoning or logic used to avoid experiencing disturbinng feelings

Taking into self (symbolically) of loved/hatred attitudes, ideals, wishes, or persons

Separation of ideas from the feelngs associated with them

Attributing one's emotionally unacceptable thoughts or impulses to another

The false attribution to others of one's own unacceptable feelings, impulses, or thoughts.

Attempts to justify feelings, motives, or behavior that otherwise would be unreasonable or illogical.

Development of opposite attitudes and behavior patterns to what one really feels or would like to do.

Partial or symbolic return to more infantile patterns of reacting or thinking

Involuntary exclusion of a painful or conflictual thought, impulse, or memory

Viewing people and situations as being all good or all bad

An unacceptable drive/behavior is diverted into socially acceptable form.

Intentional exclusion of material from conciousness. May lead to repression.

Act or communication that partially/symbolically negates a previously conciously intolerable experience.

Drowsiness/sedation, ataxia, dizziness, feelings of detachment, increased irritablility or hostility, antereograde amnesia

tolerance, dependency, rebound insomnia/anxiety

Actively helpful, caution patient when using machinery, caution patient with activity, prevent falls, discourage social isolation, be alert for disinhibition, observe if patient is able to recall events tht occur while taking drug, only short term use, discontinue using a slow taper, administer with meals

Nausea, Headache (analgesic), Confusion (decrease dose), Gross psychomotor impairment (decrease dose), Depression (decrease dose, antidepressent), Paradoxical rage reaction (discontinue drug)

Contraindicated in patients with drug or alcohol abuse

1. Tolerance develops to the antianxiety effects of barbiturates.
2. They are more addictive.
3. They cause serious & even lethal withdrawal reactions.
4. They are dangerous in overdose & cause central nervous system (CNS) depression.
5. They have a variety of dangerous drug interactions.

1. Warning or threat phase (no warning is worse)
2. Impact phase
3. Rescue or heroic phase (altruism is prominent)
4. Remedy or honeymoon phase (optimism high)
5. Inventory phase (discouragement and fatigue)
6. Disillusionment phase (abandonment and resentment)
7. Reconstruction or recovery phase (reexamine life prioriteis)

To return to pre-crisis level of functioning

suicidal, psychotic, violent behaviors

The release of feelings that takes place as the patient talks about emotionally charged areas.
Example: "Tell me about how you have been feeling since you lost your job"

Encouraging the patient to express more clearly the relationship among certain events.
Example: "I've noticed that after you have an argument with your husband you become sick and can't leave your bed"

Influencing a person to accept an idea or belief particularly the belie that the nurse can help and that the person will in time feel better.
Example: Many other people have found it helpful to talk about this and I think you will to.

Giving the patient positive responses to adaptive behavior.
Example: That's the first time you were able to defend yourself with your boss, and it went very well. I'm so pleased that you were able to do it."

Encouraging the use of healthy, adaptive defenses and discouraging those that are unhealthy and maladaptive.
Example: "Going for a bicycle ride when you were so angry was very helpful because when you returned you and your wife were able to talk things through"

Examining alternative ways of solving the immediate problem
"You seem to know many people in the computer field. Could you contact some of them to see whether they might know of available jobs?"

Environmental manipulation
General support
Generic approach
Individual approach

Interventions that directly change the person's physical or interperrsonal situation. Provides situational support, or removes the stressor. Serves as a liason between patient and social support agencies.

Provides individuals with the feeling that the nurse is on their side and will help them. The nurses demonstration of warmth, acceptance, empathy, and caring results in this type of support.

Designed to reach individuals at high risk and large groups of people as quickly as possible. It applies a specific method to all people facing a similar crisis, such as assisting disaster victims to work through the grieving process.

Similar to the diagnosis and treatment of a specific problem in a specific patient. Effective with all types of crises and in combination of crises or when homicidal or suicidal risk exists. Interventions are aimed at facilitating cognitive and emotional processing of the traumatic event and at improving coping.

Associated with the tensions of everyday life. Increased perceptual field and learning is enhanced. Physiological responses within normal limits. Affect is positive.
Interventions: Cognitive strategies, stress managment education, problem-solving approach

Focus is on immediate concerns. Difficulty staying attentive and being able to learn, but can be directed to focus.
Interventions: Relaxation techniques, assist in using problem solving approach, teach about coping strategies, encourage verbalization of feelings

Significant reduction in perceptual field. Focus on specific detail only. All behavior is aimed at relieving anxiety, much direction is needed to focus on another area.
Interventions: Offer presence and support, encourage physical activity (stimulate large muscle groups and release energy from "fight or flight" response), structure tasks and exercise, HELP CALM PATIENT, THEN MEDICATION

Decrease environmental stimuli, stay with patient using quiet voice, assist patient to perform relaxation breathing, provide structure for client

restlessness, fatigue, difficulty concentrating, irritablility, muscle tension, sleep disturbances

palpitations, sweating, trembling, shortness of breath, chocking sensation, chest pain, fear of losing control, fear of dying, altered sense of reality

Aimed at relief of acute panic symptoms. Assist client to take control of own life situation and accept those situations of which they have no control of.

intense anxiety, acute anxiety in crowds, fear of losing control, fear of inability to escape or find a secure place, avoiding situations, fear of being alone (usually in a crowd)

Repetitive compulsive behaviors are an effort to reduce anxiety.

ASD: lasts from 2 days to 4 weeks and occurs within 4 weeks of traumatic event
PTSD: Lasts for more than 1 month and may last for years

Difficulty initiating or maintaining sleep

Excessive sleepiness or seeking excessive amounts of sleep (narcolepsy, sleep apnea, restless legs)

Unusual to desirable behaviors that occur during sleep (nightmare, sleep terror, enuresis (wetting the bed), sleep walking)

normal sleep at the wrong time (jet lag, shift work)

Determine cause of disturbance, perform actions that promote sleep and rest, sleep hygiene

A chronic syndrome of multiple somatic symptoms (physical symptoms) that cannot be explained medically, but suggest medical disease. It is associated with psychosocial distress and long-term seeking of healthcare assistance. Any organ system may be affected.

Somatization, conversion disorder, body dysmorphic, pain disorders, hypochondriasis

Aimed at assisting the client to learn to cope with stress by means other than preoccupation with physical symptoms. Help the client to correlate appearance of the physical symptoms with times of stress. Need to do physical examination.

A loss or change in bodily functioning resulting from a psychological conflict. Bodily symptoms cannot be explained by any known medical disorder or pathophysical mechanism. Relative lack of concern "la belle indifference"

Aimed at recovery of lost function. Assist with ADLs until the function is regained.