1
Q
Necessary Loss
A
part of life cycle, anticipated but intense
2
Q
Actual Loss
A
loss of valid person or item
3
Q
Perceived loss
A
client-defined loss; not obvious to others
4
Q
Maturational loss
A
expected developmental losses
5
Q
Situational loss
A
unanticipated external event loss
6
Q
Grief, Mourning, and Bereavement
A
Grief: inner emotional response
Mourning: outward display of loss
Bereavement: includes grief and mourning
7
Q
Factors that influence grief
A
- loss type and significance
- culture and ethnicity
- developmental stage
- interpersonal relationships
- spiritual/religious beliefs
- prior experiences
- socioeconomic status
8
Q
Kubler-Ross Five Stages of Grief
A
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
*Stages may occur in any order
9
Q
Worden Four Tasks of Mourning
A
- Accepting the reality of loss
- Experiencing emotional pain and loss
- Adapting to the absence
- finding meaningful connection while moving forward
*typically takes about 1 year
10
Q
Normal Grief
A
- emotional progression from anger to acceptance
- some acceptance by 6 months
- somatic complaints: chest pain, palpitations, headaches
11
Q
Anticipatory Grief
A
letting go before loss
12
Q
Maladaptive grief
A
- delayed/ inhibited grief
- distorted grief
- chronic/prolonged grief
- collective grief
13
Q
Care of the Dying
A
3 C’s
Care: interprofessional approach; physically, socially , spiritually
Comfort: to patient and family; explain to family what to expect
Contact: protect against abandonment and isolation
14
Q
Care givers self care
A
- diversonal activityies
- healthy diet
- exercise
- comfort zone
- a good cry (when and where)
- therapy
15
Q
Anxiety
A
apprehension, tension, or uneasiness from anticipation of unknown/ unrecognized danger
16
Q
Mild
level of anxiety
A
- increased perceptual field
- motivates
- enhances creativity and learning
17
Q
Moderate
level of anxiety
A
- focuses on immediate concern
- narrows perceptual field
- reduces learning and problem solving effectiveness
18
Q
Severe
level of anxiety
A
- feeling of impending doom
- significantly narrowed perceptual field
- impossible to learn or solve problems
- requires external direction
19
Q
Panic
level of anxiety
A
- associated with dread and terror
- disorganized personality
- inability to communicate or function
- risk of exhaustion and potential death
20
Q
Panic disorder
A
- recurrent panic attaks
- intense physical discomfort
- average onset in late 20s
- periods of remission and exacerbation
- potential suicide risk
21
Q
What is the #1 nursing intervention for Panic?
A
Safety first; stay with patient
22
Q
Phobia
A
persistent irrational fear of a specific object, activity, or situation
23
Q
Agoraphobia
A
intense fear of places difficult to escape
24
Q
Specific phobias
A
- heights (acrophobia)
- Closed spaces (claustrophobia)
- strangers (xenophobia)
25
Social Anxiety Disorder
fear of embarrassment, is unable to perform in front of others, believes others are judging
26
Generalized Anxiety Disorder
(GAD)
- Chronic excess worry
- somatic complaints
- restlessness, fatigue, irritability, concentration difficulties
- Diagnosed after 6 months of symptoms
27
Obsessions
unwanted, intrusive, persistent ideas, thoughts, impulses or images that cause marked anxiety or distress
28
Compulsions
unwanted, repetitive behavior patterns or mental acts such as praying or counting intended to reduce anxiety
29
Obsessive-Compulsive Disorder
recurrent obsessions/compulsions sever enough to cause significant distress or impairment
30
Body dysmorphic disorder
imagining defective body parts
31
Hoarding disorder
unable to part with possessions
32
Trichotillomania
hair pulling
33
Excoriation
skin picking
34
Treatment modalities of the nurse
- relaxation
- mindfullness/ meditation
- modeling
- thought stopping
- administering medication
- patient/family teaching
35
Treatment modalities of the Psychiatric Nurse Practitioners
- EMDR, eye movement desensitization
- Systemic desensitization
- Implosion therapy (flooding)
- Group/family
- Response prevention
36
Antianxiety drugs
NO GRAPEFRUIT
**Antihistamines**
- hydroxyzine
**Benzodiazepines**
- LAM + PAM
**Buspirone**
**Beta blocker**
- propanolol
37
OCD Medications
"INE"
take 2-3 weeks to be effective; do not chew or crush ER
38
Stress
bodys response to any demand
39
General Adaptation Syndrome (GAS)
**Alarm Stage**:
- fight or flight response increases heart rate, pupils dilate, respirations and blood pressure increase
**Resistance Stage**:
- sustained optimal resistance to stressors
- overcoming stressors through adaptation
**Exhaustion Stage**:
- potential chronic stress
- resource depletion
- potential fatal outcomes
40
Stress Management
- Cognitive reframing
- Relaxation techniques: meditation, guided imagery, breathing
- Journaling
- Priority Restructuring
- Biofeedback Demonstration
- Assertiveness
- Art, pet, music, movement
41
Acute Stress Disorder
- Witness/ Experience life threatening event
- responds w fear, helplessness, horror
- **Lasts from 3 days - 1 month**
42
Post Traumatic Stress Disorder (PTSD)
- Symptoms can occur anytime following traumatic event
- **symptoms last more than 1 month**
- increased arousal
- hypervigilance
- inability to show feelings
- difficulty with sleep and concentration
43
Dissociative Disorder
absence of conscious awareness of familiar information
44
Causes of Dissociative Disorder
- No biological factors
- Psychosocial factors
- Unconscious defense mechanisms
- traumatic episodes
45
Dissociative identity Disorder
- presence of two or more distinct personality
- transition from one personality to the next is sudden
- host may not be aware of alters
- internal voice hearing
46
Dissociative Amnesia
- loss of memory of traumatic event
- Subtypes
- Localized
- Selective
- Generalized
47
Dissociative Fuge
- Sudden unexpected travel
- inability to recall past
- identity confusion
*Sean and Amy
48
Depersonalization/Derealization Disorder
-Depersoalization: Feeling detached from mental processes/**body**
- Deprealization: detached from your **enviroment**/ feeling the world isn't real
- causes significant distress or impairment
49
**Benzodiazepine Sedative Hypnotic Anxiolytics**
**Examples**
- lorazepam
- alprazolam
- clonazepam
- diazepam
**Antidote**
- FLUMAZENIL
**Action**
-CNS depressant
- increases inhibitory effect of GABA in the CNS
- decreases anxiety rapidly
- Used for panic and anxiety disorders
**Avoid**
- pregnant/breastfeeding
- respiratory depression
**Do Not**
- cut or chew
- discont abruptly
- take w alcohol
50
**Atypical Anxiolytics**
**Example**
- buspirone
**Action**
- exact action unknown
- binds to serotonin and dopamine
**Onset**
- 2-6 weeks
**NOT PRN MEDICATION**
**Uses**
- panic disorder
- OCD
- social anxiety disorder
- GAD
**Avoid**
- breastfeeding
- MAOI antidepressants
**Drug interactions**
- erythromycin
- ketoconazole
- St. Johns wort
- grapefruit
**Side effects**
- dizziness
- headache
- nausea
51
**Antihistamines**
**Examples**
- hydroxyzine pamoate
- hydroxyzine hydrochloride
**Characteristics**
- CNS depressant
- Antihistamine
**Uses**
- anxiety
- nausea
- skin rash
- allergies
**Nursing Considerations**
- Anticholinergic effects
**Avoid**
- alcohol
- MAOI antidepressants
**Monitor**
- mental status
- drowsiness
- avoiding driving
- maintain oral hygiene
52
Severity levels of psychological factors
**Mild**: increases medical risk (ex. medication adherence)
**Moderate**: aggravates medical condition (ex. anxiety stimulates asthma)
**Severe**: results in emergency room visit (ex. panic attack and chest pain)
**Extreme**: life threatening risk (ex. ignore heart attack symptoms)
53
Factitious Disorders
consciously pretending to be ill to meet emotional needs
*really do feel sick but there isn't anything wrong*
54
Gains
**Primary Gain**: reduce anxiety
**Secondary Gains**: Attention person gains from "sick role"
55
Factitious Disorders by Proxy
**Munchausen Syndrome**
intentionally causing illness/injury to another person
56
Malingering
**A LIE**
simulating illness for personal gain (money, time off work)
- differs from factitious disorders by presence of planned rewards
57
Examples of Factitious Self-induced symptoms
- self inflected wounds
- injection or insertion of contaminates substances
- manipulating a thermometer
- urinary tract manipulation
- wrongful use of medications
58
Myasthenia Gravis
chronic, progressive autoimmune disorder of the peripheral nervous system
59
Somatic Symptom Disorder
Chronic syndrome of *multiple somatic symptoms* such as pain, gastrointestinal, sexual functioning, neuro
60
Conversion disorders
- loss or change in body function from psychological conflict
- *La belle indifference* (lack of concern to symptoms)
61
If pt. is having pseudoseizure what do you do?
nothing.
leave the patient be and don't bring any attention to them
62
Define Crisis
disruption of normal psychological homeostasis
- normal coping mechanisms fail
- results in inability to function as usual
- acute and time-limited (4-6 weeks)
63
Outcome of Crisis
**Return the pt. to the pre-crisis level of functioning**
Depends on:
- realistic perception of the event
- adequate situational supports
- adequate coping mechanism
64
What are the different types of crisis?
**Situational**
- arise from unanticipated events (one person) ex. terminated from job
**Maturational**
- new developmental stage; old coping skills no longer effective ex. entering adolescence
**Adventitious**
- natural disaster crime or violence with multiple victims ex. hurricane
65
Why is Critical Incident Stress Debriefing so important?
**care for the first responders and care providers do it for the team**
helps to prevent burnout/depression from event
66
What are different types of abuse?
**Half of all Americans have experienced violence in their family**
- physical abuse
- sexual abuse
- emotional abuse
- neglect
- economic abuse
67
Characteristics of a perpetrator
- Survivor of abuse
- own needs more important than others
- poor social skills
- low-self esteem
- control family finances
- substance abuse
68
Who are People that are Vulnerable to abuse?
**Women**
- pregnant women
- women becoming independent
- high risk when leaving relationship
**Children** (Mandatory Reporting)
- younger than 3
- special needs
- product of unwanted pregnancy
**Older Adults** (Mandatory Reporting)
- poor mental/physical health
69
What happens in the Cycle of Violence?
**Phase 1**: tension building
- Anger, blaming
**Phase 2**: Actue Battering
- grab, slap, shoving
**Phase 3**: Honeymoon stage
- tries to make amends, forgiveness, promises wont happen again
70
Examples of Coping responses
- Repeatedly leave and return
- Passive acceptance
- Alcohol, drugs
- Dissociation
71
What kind of injuries should you look for in abuse pt.
- soft tissue injuries (chest, abdomen, buttocks, back)
- fractures
- bruises in different stages
72
What are the different stages of Rape-trauma syndrome
**Acute Phase** (2 weeks)
- expressed reaction: crying anger
- controlled reaction: calm, numb
- somatic reaction: later than 2 weeks, bruising, soreness
**Long-term Reorganization phase**
- flashbacks, sexual dysfunction
73
What are the specialized sexual assault services?
**Sexual Assault Nurse Examiners (SANEs)**
- RNs w specialized training in caring for circumstances
**Sexual Assault Response Team (SART)**
74
What are the 5 Steps of the SA Examination?
1. Head to toe physical assessment
2. detailed genital exam
3. evidence collection
4. documentation of findings
5. treatment, discharge
Psychosocial Nursing
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