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Psych - Unit 1 B

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olanjones's version from 2017-01-20 16:14

Crisis

Question Answer
Applying psychopathology to crisisan individual in crisis is unable to problem-solve, needs guidance/support; crisis intervention not aimed at major personality change/reconstruction but instead focused on goal of functionality
Goal for Crisis interventionReturn to previous level of normal functioning (minimum therapeutic goal), Attain functional level above the pre-crisis level (maximum therapeutic goal)
Crisis Development Phases1. Individual is exposed to a precipitating stressor 2. When previous problem-solving techniques do not relieve the stressor, anxiety increases further 3. All possible resources (internal/external) are called on to resolve the problem & relieve the discomfort 4. If resolution does not occur, the tension mounts beyond threshold/breaking point- major disorganization of individual can occur
Possible reactions to crisisSuicide; Homicide; Fear; Injury; Post-trauma syndrome; Ineffective community coping; Depression; Anxiety/Panic
Key risk factors in potential of violent behaviorPast history of violence; Client diagnosis; Current behaviors
Class 1: Dispositionalsituational, acute response to external stressor
Class 2: Crisis of anticipated life transitionsnormal life-cycle transitions that may be anticipated but over which the individual may feel a lack of control.
Class 3: Crisis resulting from traumatic stresscrisis precipitated by an unexpected external stressor over which person has little to no control & as a result, feels emotionally overwhelmed and defeated.
Class 4: Maturational/Developmental Crisisoccurs in response to situations that trigger emotions r/t unresolved conflicts in one’s life. These crises are of internal origin and dependency, value conflicts, sexual id, control & capacity for emot’l intimacy.
Class 5: Crisis reflecting psychopathologypreexisting pathology has been instrumental in creating crisis or when the psychopathology impairs or complicates adaptive resolution. Disorders such as personality disorders, anxiety disorders, bipolar & schizo disorders.
Class 6: Psychiatric ERcrisis situations when general functioning has been severely impaired & indiv. is rendered incompetent or unable to presume personal responsibility, Ex: acutely suicidal pt’s, drug OD, rxns to hallucinogenic drugs, uncontrollable anger & ETOH intox.
Phases of Crisis Intervention1. Assessment: precipitating factors 2. Planning of Therapeutic Intervention: individualized goals 3. Intervention: problem solving model 4. Evaluation of Crisis Resolution & Anticipatory Planning: evaluate outcome of crisis intervention to see if stated objective was achieved
Role of RNThrough crisis development nurse helps individual in crisis to develop more adaptive coping strategies for dealing with stressful situations in the future. Plan can be devised by nurse/physician/the two together or with input from client & tx team. All members should be made aware of behavior modification plan. Consistency is key for success.
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Crisis Intervention p 223

Question Answer
Stage 1. Psych / lethality assessmentrapid biosocial assmt
Stage 2. Rapidly establish rapporttherapeutic comm, flexibility, maintain positive mental attitude
Stage 3. Assessment of major probs or crisis preciptantsidentify precipitating event, identify situating leading up to, prioritize major problems for which help is needed, discuss current coping mech
Stage 4. Feelings and Emotionsvent/validate, therapeutic communication- ct explains story of current crisis situation, eventually N begins to cautiously/gradually challenge maladaptive beliefs, identify rational/adaptive options
Stage 5. Generate and explore alternativesexplore options, identify past copies strategies, problem solving
Stage 6. Implement action plancrisis-->resolution, develop concrete plan of action, plan restores equilibrium of ct., work through meaning of precipitating event.
Stage 7. Follow upPlan a follow-up visit, 1-month and 1-year anniversary
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Cognitive/Behavior Therapy

Question Answer
Maladaptive behaviorOccurs when age, env’t, culture, and adaptive functioning get interfered with. Assumption that problematic behaviors occur when there has been inadequate learning & therefore can be corrected through provision of appropriate learning experiences
Premise of behavior txbasic assumption is that the connection between a stimulus and a response is strengthened or weakened by the consequences of the response
Negative reinforcementincreased probability that behavior will recur by removing desirable reinforcing stimulus (Time out=remove reinforcing attention)
Positive reinforcementincreased probability that behavior will recur by increasing desirable reinforcing stimulus (operant conditioning)
Aversive stimulusstimulus that decreases probability that behavior will recur "punisher"
Techniques for improving client behaviorshaping, modeling, Premack principle, extinction, contingency contracting, token economy, time out, reciprocal inhibition, overt sensitization, covert sensitization, systematic desensitization, flooding
Premise of cognitive txbased on the concept of pathological mental processing. Focus of tx is on the modification of distorted cognitions & maladaptive behaviors (Tx should be short-term, 12-16 weeks)
Goals of cognitive tx (Beck)Client will: 1. Monitor negative, automatic thoughts 2. Recognize connection between cognition, affect, behavior 3. Examine evidence for/against distorted, automatic thoughts 4. Sub more realistic interpretation for biased cognitions 5. Learn to identify & alter dysfunctional beliefs that predispose him/her to distort experiences
3 Components of cognitive txDidactic (teach about/how to self perform tx); Cognitive techniques (ways to recognize automatic thoughts/schemas & ways to modify them); Behavioral interventions (strategies to identify/modify maladpative cognitions & behaviors - Activity sched, Graded task assign, Behavioral research, Distraction)
Cognitive Behavior Therapy PrincipleWhat we think affects how we act and feel --> What we do affects how we think and feel --> What we feel affects what we think and do
Role of RNMany techniques are w/in scope of nursing practice; cognitive therapy requires understanding of educational principles & ability to use problem-solving skills to guide clients’ thinking through a reframing process
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Types of Cognitive Errors p 300-301

Question Answer
Arbitrary inferenceconclusion w/o facts, or facts to contrary
Overgeneralization/absolutist thinkingsweeping conclusions made based on one incident. All-or-nothing.
Dichotomous thinkinggood or bad, black or white
Selective abstractionmental filter. Based on only a selected portion of the evidence (usually negative
Magnificationovervaluing - significance
Minimizationundervaluing + significance
Catastrophic thinkingthinking the worst will happen
Personalizationperson takes complete responsibility for situation
Schemas/core belief categories1. Helplessness 2. Unloveability
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Behavior Techniques p291:

Question Answer
Shapingreinforcement given for increasingly closer approx of desired resp.
Modelinglearn new beh by imitating others
Premack principleuse desirable beh as incentive to change undesirable beh
Extinctionignore undesirable beh, remove positive reinforcement
Contingency contractingbeh change stated explicitly in writing. +/- reinforcers delineated. Flexibility important
Token economyreinforcers for desired behavior = tokens. Can be redeemed for designated privileges.
Time-outaversive stimulus/punishment. Reinforcement (attention) is removed.
Reciprocal inhibitioncounter-conditioning; eliminates by by introducing an incompatible and more adaptive beh
Overt sensitizationunpleasant consequences for undesired behavior. Antabuse.
Covert sensitizationimagine unpleasant symptoms with undesired beh
Systematic desensitizationhierarchy of anx-producing events through which ind progresses during therapy. Real-life desensitization.
FloodingImplosive therapy. Desensitize inds to phobic stimulus. Continuous presentation of phobic stimulus until it no longer produces anxiety.
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Communication

Question Answer
Interpersonal communicationA transaction between the sender and the receiver. Both persons participate simultaneously
Elements influencing communicationCulture/religion; Values/attitudes/beliefs; Social status; Gender; Age/developmental level
Distances in interpersonal interactions- Intimate distance: closest distance that individuals allow between themselves and others
- Personal distance: distance for interactions that are personal in nature, such as close conversation with friends
- Social distance: distance for conversation with strangers or acquaintances
- Public distance: distance for speaking in public or yelling to someone some distance away.
Nonverbal communicationPhysical appearance/dress, Body movement/posture, Touch, Facial expressions, Eye behavior, Vocal cues/paralanguage
Therapeutic communication techniquesUsing Broad opening statement; Using General Leads
Reflecting; Sharing Observation; Acknowledging feelings; Clarifying; Verbalizing implied thoughts & feelings
Giving information; Presenting reality; Using silence; Exploring
Non-therapeutic techniquesUsing Reassuring clichés; Giving advice; Giving approval/disapproval; Agreeing/disagreeing
Requesting an explanation; Belittling the Patient feelings; Defending; Making Stereotyped comments
Changing the subject; Giving Literal Response; Denial; Challenging; Probing
Active listeningbeing attentive to what the client is saying, both verbally and nonverbally. Nonverbal behaviors designed as facilitative skills for attentive listening (SOLER).
SOLERSit squarely facing the client
Observe an open posture
Lean forward toward the client
Establish eye contact
Relax
Feedback is useful when itIs descriptive rather than evaluative (focuses on the behavior rather than on the client); Is specific rather than general; Is directed toward behavior that the client has the capacity to modify; Imparts information rather than offers advice; Is well timed
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Nurse/Client Relationship

Question Answer
Social relationshipsIs not focused on one person - Shared ideas, feelings, goals. May or may not have a goal (work relationship, friendships, etc)
Therapeutic relationshipsClient-centered, goal oriented - usually directed at learning & promotion of growth in client
Warning signs of blurred therapeutic boundariesFavoring a client, Keeping secrets, Changing dress style or Swapping assignments to care for a particular client, Giving special treatment, Spending free time with a client
TransferenceThe client unconsciously displaces to the nurse feelings formed toward a person from his or her past.
CountertransferenceRefers to the nurse’s behavioral and emotional response to the client. May be generated in response to transference feelings on the part of the client.
Phases of1. Preinteraction - Prep for encounter - Obtain client info. Examination of self
2. Orientation (Introductory) - Nurse/client meet, establish trust, formulate contract for intervention
3. Working - Therapeutic work accomplished during this phase, promote client change. Transference and countertransference can occur during this stage
4. Termination - Evaluate goal attainment, ensure therapeutic closure. Can be difficult phase for both. Main task = bring therapeutic conclusion to the relationship
Factors in BuildingEstablish: Rapport, Trust, Respect, Be genuine, Use Empathy
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Potpourri

Question Answer
Provider must renew orders for restraints w/in- <9 y/o= w/in 1 hr
- 9-17 y/o = w/in 2 hr
- 18+ w/in 4 hrs
- unless state law more restrictive-
- orders may be renewed according to these time limits for a max 24 hrs
In-person eval by provider after emergency restraintswithin 1 hr (specially trained nurses and PAs can do in consult w/ MD)
Stage 3 Sleep delta rhythmDelta, deep, VS fall, no eye movement
REM sleep beta rhythmdream cycle, eye movement, HR/RR increase, muscles hypotonic.
Limbic systememotional brain
Parietal lobesperception and interpretation of most sensory info
Temporal lobeshearing, short-term memory, sense of smell
Occipital lobesvisual reception & interpretation
Frontal lobesvoluntary body movement (inc movement that allows speaking, thinking, judgement, expression)
Medullaregulate HR, BP, RR, reflex centers for swallowing, sneezing, coughing, vomiting
Adult survivor of incest, characteristics p785- lack of trust
- low self-esteem
- poor sense of identity
- powerlessness
Adult survivor of incest, PC: p785 - PTSD
- sexual dysfunction
- somatic symptom disorders
- compulsive sexual behaviors
- depression, anxiety
- eating disorders
- substance disorders
- intolerance of/constant search for identity
Expressed response pattern rapesurvivor expresses feelings of fear, anger and anxiety thru crying, sobbing, restlessness, tension
Controlled response pattern rapefeelings masked/hidden, calm/subdued/flat affect
Compounded rape reactiondepression, SI, substance abuse, psychotic beh
Silent rape reactionsurvivor tells no one. Unresolved trauma may not be resolved until survivor faces another sexual crisis in her life that reactivates unresolved feelings.
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