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106 Cards in this Set
- Front
- Back
What are the properties of Anxiety?
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1) it's a universal phenomenon experienced by humans throughout the lifespan
2) It's an energy force 3) It promotes activity and prductivity 4) It can interfere with ADL if not properly controlled |
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Define Anxiety
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Anxiety is a diffuse, highly unpleasant, often vague feeling of apprehension or uncertainty; produces effects in all body systems
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Define adaptaptive coping
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Adaptive coping is when the coping behavior resolves the anxiety
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Define Palliative coping
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Palliative coping behavior results in temporarily reducing the intesity of the anxiety (i.e. alcohol and drugs)
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Define Maladaptive coping
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Maladaptive coping behaviors are unsucessful effors in relieving the stressor; may further result in exacerbating the anxiety
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Define Dysfunctional Coping Behaviors
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Dysfunctional coping behaviors are those behaviors than can evoke psychotic features such as delusions
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According to Peplau what are acting out behaviors with anxiety? Give examples.
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Acting behaviors unconsciously displace our anxiety.
Examples would be: crying, laughing, jogging, talking. |
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According to Peplau what are somatizing behaviors with anxiety?
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These are unconscious repression of anxiety that manifests itself as Back aches, Headaches, and pain.
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According to Peplau what is freezing on the spot with anxiety?
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Freezing is a complete withdrawal psychologically and emotionally from the anxiety
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According to Peplau what is learning- problem solving behavior with anxiety?
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Learning-Problem solving behaviors are those behaviors which are a conscious effort to reduce anxiety (this is the most adaptive style)
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According to Freud what are the purposes of Defense mechanisms?
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1) Reduce anxiety--maintain the ego
2) Protects self-esteem - Un/conciously 3) Necessary for survival - when used sparingly |
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According to Freud what can happen when one overuses or inappropriate use of Defense mechanisms?
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Overuse/inappropriate use can lead to distortion in reality, produce self-deception; interfere with healthy mental functioning
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Define suppression
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Supression is the conscious denial/ voluntary exclusion of a situation or feeling.
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Define rationalization
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Rationalization consists of justifying the illogical or unreasonable idea,s actions or feelings by developing acceptable explanations that satisfies the beliefs of the listener.
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Define fantasy in terms defense mechanism
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Fantasy is a conscious creation to distort reality to protect the ego
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Define identification
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Unconscious assumption of the thoughts, mannerisms or behaviors of a person or group in order to decrease anxiety
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Define internalization
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Internalization is the taking on behaviors of others
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Define undoing
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Undoing is an act in which resolves an unconscious guilt
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Define compensation
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Compensation is the making up for deficits in one area by excelling in another area in order to raise or maintain self-esteem
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Define reaction-formation
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reaction-formation is the process of keeping unacceptable feelings or behaviors out of awareness by developing the OPPOSITE emotion or behavior
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Define Sublimation
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The unconscious process of substituting constructive and socially acceptable activities for strong impulse that are not acceptable in their original form, such as strong aggressive or sexual drives
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Define Projection
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Projection is the unconscious attributing of one's own intolerable wishes, emotions, or motivations to another person.
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Define Denial
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Denial is the disowning of an intolerable idea/experience...etc
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Define Conversion
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Conversion is an unconscious defense mechanism in which anxiety is expressed as physical symptom that ha no organic cause
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Define repression
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Repression is the exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness
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Define dissociation
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Emotional separation from anxiety
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Define Regression
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Regression is the retreating to an earlier developmental state.
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Identify the following Defense Mechanism
Man forgets his wife's birthday after a fight. |
Repression
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Identify the following Defense Mechanism:
Woman who is angry with her boss writes a short story about a heroic woman. |
Sublimation
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Identify the following Defense Mechanism:
Man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments, and comes in late for meetings |
Regression
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Identify the following Defense Mechanism
Recovering alcoholic constantly preaches about the evils of drinking |
Reaction-formation
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Identify the following Defense Mechanism
Woman whose husband died 3 years earlier still keeps his clothes in the closet and talks about him the present tense |
Denial
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After flirting with her male secretary, a woman brings her husband tickets to a show
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undoing
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Five-year old girl dresses in her mother's shoes and dress and meets her father at the front door
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Identification
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What are the pathological results of anxiety?
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1. the response to anxiety is disproportionate to the threat; unable to control worrying
2. the anxiety continues beyond the the threat 3. impairment in ADLs especially in memory and comprehension 4. Psyschosomatic effects - HA and pain |
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Define Anxiety disorder
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Anxiety disorders are unmanaged, pathological, maladaptive response to anxiety to occurs on a continuum of mild, moderate, severe, panic
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True or False:
Mild anxiety is always maladaptive |
False:
Mild anxiety can increase alertness, enhance learning and problem solving |
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True or False:
There is a strong link between mind-body reaction when a person is under moderate anxiety |
True:
If not managed, anxiety on this level can cause actual alterations in physiological integrity; Asthma, colitis, GI distress, dermatological conditions can all be brought about |
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Define Severe Anxiety disorder
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Severe Anxiety is a generalized anxiety disorder that results in unrealistic and excessive worry and anxiety well beyond the threat that produces tension and autonomic hyperactivity
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Define Panic attack/disorder
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Panic attacks are UNEXPECTED, recurrent attacks of anxiety; symptoms mimic severe cardiac or respiratory distress.
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TRUE or FALSE:
Panic disorders run in families. |
True:
There is a strong genetic component to panic disorders |
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What is the current belief behind the cause of Panic disorders
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an over abundance of GABA
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Define Phobias
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Phobia are IRRATIONAL, pathological, and disproportionate fear of objects or situations which cases a person to take extreme measures to avoid the situation
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Define OCD
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OCD is:
1. a recurrent obsessive intrusive/inappropriate thoughts; 2. usally compulsive stereotyped behaviors, that impairs ADLs, 3. any attempts to suppress compulsive behaviors generates more anxiety |
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Define PTSD
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PTSD is an anxiety/fear resulting from traumatic expeiences resulting in a conditioned response due to sight/smell/sound from the experience. Exposure to the stimulus can cause a re-experience of the event.
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Define Somatoform disorders?
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Somatoform disorder is the transformation of anxiety into physical symptoms at an unconscious level.
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TRUE or FALSE:
The symptoms of a person suffering from somatoform disorder have an organic etiology |
FALSE
There are no organic etiology to explain for the symptoms despite numerous tests; this is due to a false body perception. Symptoms however are believed by the person to be real |
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Define Conversion disorder
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Conversion disorder is a condition where patients present with neurological symptoms such as numbness, blindness, paralysis, or fits, but where no neurological explanation is possible
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What are the 4 types of Dissociative disorders?
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1. Depersonalization
2. Dissociative amnesia 3. Dissociative fuge 4. Dissociative Identity disorder (MPS) |
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Define Dissociative amnesia?
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A type of amnesia that occurs when a person has the inability to remember significant personal information such as ID, name DOB, usually results from a traumatic experience such as an Assault.
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Define Dissociative fuge
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Dissociative fuge is an abrupt physical flight and traveling away from the field of conflict usually following a stressful event. AKA. Running away!
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Define Dissociative identity disorder
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This occurs when two or more distinct personalities emerge in one person, each unique in their own way. Usually this is preceded by abuse in childhood; physically, sexually, or emotionally.
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When panic level has reached psychosis level what disorders can we expect?
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1. mood disorders
2. schizophrenia 3. organic mental disorders |
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What assessments must a nurse make for treating anxiety disorders?
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1. specific symptoms
2. level of anxiety 3. stressors 4. type of defense mechanisms used/not used 5. risk for suicide 6. coping style 7. available support systems 8. quality of relationships 9. secondary gains |
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Give examples of benzodiazepines used in treating anxiety
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1. Xanax
2. Valium 3. Ativan 4. Klonopin 5. Librium |
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What is the action of benzodiazepines?
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Stimulates GABA in the limbic system, decreases excitability
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What must you watch out for when using benzodiazepines?
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These meds can be habit forming so watch out for addiction and withdraw symptoms
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What is the therapeutic effect of the drug Buspar?
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Buspar controls conginitve symptoms of anxiety, helps with panic disorders by decreasing worrying
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What is the therapeutic effect of Inderal
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Inderal inhibits the relase of norepinepherine/epinephrine by blocking Beta receptors
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Which antidepressants work for anxiety and what do they do?
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TRICYCLICS; SSRI
These drugs regulate serotonin, reducing arousal and excitabiltiy |
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What is the therapeutic effect of the drugs Atarax and Vistaril?
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The decrease subcortical centers in the brain which decreases agitations and anxiety
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What is the therapeutic effect of amytal
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Amytal dis-inhibits ego defenses, this is used in dissociative disorders; helps obtain repressessed memories with traumatic events
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What interventions are used in treating a person with moderate to severe anxiety disorder?
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1. assess level of anxiety
2. accept patients' feeling anxiety 3. provide emotional security 4. meet basic needs 5. avoid making demands or requiring decisions 6. promote sleep 7. provide medication 8. protect from impulsive acts 9. allow defenses 10. initially allow worry time 11. reduce physical stimulants 12. reduce environmental stimulants 13. treat physical complaints as matter of fact 14. provide rec. diversions 15. work in the here and now 16. provide feedback on anxious behavior 17. ID sources of anxiety 18. ID effects ineffective coping 19. explore secondary gains 20. explore alternate coping behaviors |
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What is Role Modeling in behavior modification?
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Modeling adaptive behaviors through practice and initiation; ie. deep breathing, guided imagery, journaling, exercising.
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What is operant conditioning in behavior modification?
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Receiving of rewards for adaptive behavior; positive reinforcement
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What is systematic desensitization in behavior modification?
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Exposure to phobic stimulus in gradual amounts over time reducing emotional response
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What is self-control in behavior modification?
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Elimination of negative self-talk; reframing
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What is aversion therapy in behavior modification?
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It is a negative reinforcement by adding something negative due to negative behavior.
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What are the 5 characteristics of Crisis?
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1. it usually surrounds situations or events
2. It reflects perception and response of the person 3. it is self limiting; runs a definite course 4. occurs suddenly 5. produces disequilibrium |
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TRUE or FALSE:
A crisis is the same from one person to the next |
FALSE:
Crisis is based on an individual's perception |
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What are the 3 types of primary appraisal?
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1. irrelevant - not problematic
2. benign-positive- these are your good stress situations 3. stressful - based harm/loss, threat, or challenge |
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What are secondary appraisals?
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An assessment of skills, resources, and knowledge a person has to deal with a crisis situation
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How long can a crisis last for?
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24-36 hours, initially but can last as long 4-6 weeks
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TRUE or FALSE:
Crisis are chronic |
False:
Crisis by definition are acute in nature |
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What are the effects of crisis on cognition?
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Crisis can leave a person confused, disorganized, cause cognitive restriction, and preoccupation
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What are the effects of crisis on the affective level?
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Crisis can make a person anxious, panicked, depressed, and helpless
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What are the effects of crisis on the behavioral level?
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Crisis can make a person act out in excess, have bizarre behavior, and paralysis
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What are the effects of crisis on the physiological level?
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flight/fight---dry mouth, decrease urine output, decrease GI motility...etc
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Describe what occurs at phase 1 of crisis
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a person is initially exposed to the problem/crisis; problem-solving skills and defense mechanisms come in place in an effort to solve the problem and lower anxiety
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Describe what occurs at phase 2 of crisis
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If the usual defensive response fails, and if the threat persist, anxiety continues, to rise and produce feelings o f extreme discomfort. Individual functioning becomes become disorganized. Trial and error attempts at solving the problem and restoring a normal begins.
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Describe what occurs at phase 3 of crisis
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Resources are used, alternatives are explored to relieve the stressors
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Describe what occurs at phase 4 of crisis
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can go in 2 directions
1) effective resolution - situation is resolved 2) ineffective resolution - leads to further disorganization |
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Define Maturational crisis
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a predictable intrinsic that all humans at all age spans experience
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Define developmental crisis
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Unresolved conflict; triggers related to unresolved conflict; old baggage to new situation
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Define Adventitious crisis
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Unplanned, accidental, these are disasters, accidental, national/global,
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Define Psychopathological Crisis
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Crisis brought about by preexisting psychopathology; schizophrenia; impaired adaptation
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Define Psychiatric emergencies
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Severe mental impairment such as psychosis--these usually require hospitalization
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What 5 things must you assess for during crisis intervention?
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1) the perception of the crisis
2) what support do they have for this crisis 3) what are their coping mechanisms--is it adaptive/maladaptive 4) what is their physiological response 5) What is the severity |
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What are the nursing goals for a pt in crisis?
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ST: reduce immediate impact of crisis on the patient
LT: return to pre-crisis level of function |
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What nursing behaviors are needed for a pt in crisis?
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1. Self-awareness
2. External control--be able to give structure and direction; provide safety 3.Decrease anxiety - offer self, give info, meet physiological needs/ADL 4. Offer support and hope 5. Be a problem solver, teacher..etc |
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What is the role of the nurse in the non-directive approach in crisis intervention?
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Nurse is supportive of the patient's needs. Patient initiates their own plan of care. Nurse uses empathy, encourages expression of emotions, asks for clarification and encourage pts to accept suggestions
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What is the role of the nurse in the Cooperative approach to crisis intervention?
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Nurse and patient develop a plan of action. Nurse will use manipulation (using the own patients values to promote well being), reinforcement (giving positive feed back), promote self esteem
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What is the role of the nurse in the Directive approach to crisis intervention?
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Nurse is responsible for finding pt's problems. Nurse takes direct responsibility for finding solution to the patients problems; explore alternatives for the patient.
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When is hospitalization necessary in crisis intervention?
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Usually when a pt has a complete psychological collapse/psychotic break. Hospital gives a supportive-protective environment that decreases the potential for self harm
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What evaluations must a nurse make to see if their interventions have worked?
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1. Are they a harm to self/others
2. How are they function? is it lower, higher or same as before hospitalization. Lower function indicated interventions were not successful. |
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what is the benefit of benzodiazepine (valium, librium) for alcoholics?
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Reduces acute withdrawal effects
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what is the benefit of clonidine (Catapres) for alcoholics?
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reduces the alpha effects of withdrawal (tachycardia!!)
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What is the therapeutic benefit of Narcan (naloxne)
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Narcan reverses respiratory distress especially with narcotics and opioid
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What is the therapeutic benefit of Anabuse (Disulfiram)
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Used for aversion therapy with alcohol; it is a bio-physical deterrent to alcohol use
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What is the therapeutic benefit of methadone?
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Methadone is an opioid antagonist; prevents effects of severe opiate withdrawl
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What is the therapeutic benefit of Naltrexone
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Naltrexeone is an opioid antagonist; blocks opioid receptors and decreases opiate craving
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What is the therapeutic benefit of Suboxone (buprenopine and naloxone) sublingual tablets?
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Suboxnone blocks the effects of opiates; suppresses symptoms of withdrawl and cravings
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What is the therapeutic benefit of anticonvulsants (phenobarbital)?
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Manages seizure activity associated with drug/alcohol withdrawal
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What is the therapeutic benefit of thiamine, folic acids, mag sulfate
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Reduces the effects of neuropathies associated with alcohol abuse
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What is the therapeutic benefit of antipsychocotics Zyprexa and Haldol
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reduces the effects of drug-induced psychosis
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What is the therapeutic benefit of NSAIDS Ultram
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manage pain for opiate withdrawl
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