Psych Wk2 Part I

cdunbar4's version from 2017-01-22 18:27

Crisis & Disaster

Question Answer
Crisis definedsudden event that causes imbalance in homeostasis; cannot be resolved by usual coping mechanisms.
Crisis are acute or long-term? About how long should they last?acute; 4-6 weeks
Who experiences crisis?Everyone. Crisis is not pathological, but represents a struggle for equilibrium & adaptation.
Phase 1 in development of a crisisindividual is exposed to a precipitating stressor. Anxiety increases; previous problem-solving techniques are employed.
Phase 2 in dev. of a crisiswhen previous problem-solving techniques do not relieve stressor, anxiety increases further
Phase 3 in dev. of a crisisall possible resources, both internal and external, are called on to resolve the problem & relieve the discomfort.
Phase 4 in dev. of a crisisif resolution doesn't occur, tension mounts & major disorganization of individual with drastic results occurs: anxiety reaches panic levels.
Maturational/developmental crisisanticipated life transition (Erikson's 8 stages: if you don't move on well from one stage to the other, there is going to be crisis in your life).
Situational crisisdispositional, events that happen, but are NOT anticipated, things that are part of life. Reflects psychopathology, psychiatric ER (Ex. death of a loved one, divorce, being fired from a job, change in body image d/t loss of body part or function).
Adventitious crisis (3 kinds)nature, crisis from traumatic stress, crime, terrorist attack.
Goal of crisis interventionprevious level of normal functioning (minimum therapeutic goal) and above the pre-crisis level
1st & 2nd step in crisis interventionrapid, but thorough psychosocial assessment; establish rapport
3rd & 4th step in crisis interventionID major problems or crisis precipitants; deal with feelings & emotions
5-7 steps in crisis interventiongenerate & explore alternatives; implement an action plan; follow-up post-crisis
Role of nurse in crisis interventionpt.-centered care, rapid assistance for individuals or groups who have an urgent need; initial task of the nurse is to promote SAFETY; initial intervention: ID current problems, take active role with client & help to set realistic/attainable goals.
Assessment for victims of disasterrisk & protective factors; accumulation of unresolved issues; concurrent mental & physical issues; excessive fatigue or pain; age & developmental stage; support system; prior experience with stress & crisis.
Planning for victims of disasternursing diagnosis: short-term no longer than 1-3 days, focus on crisis, realistic and manageable.
Evaluation for victims of disasterreassessment if client has been successful in reaching objectives. For instance, has client escaped serious injury, or have injuries been resolved? Does client demonstrate appropriate problem-solving skills?

Somatic & Dissociative Disorders

Question Answer
Somatic symptom disorderscharacterized by physical symptoms that suggest medical disease, but w/o a pathology or known pathophysiological mechanism to account for them
Dissociationperson day dreams, fantasizes, zones out
Illness anxiety aka "hypochondriasis"Very obsessive and intrusive thoughts making it difficult for patients to dismiss fears even if they realized it is not true. May be related to depression and obsessive compulsive disorder.
Factitiousfabrication of symptoms or self-inflicted injury to assume the sick role. Two types: Munchausen and Munchausen imposed on another.
Conversionloss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism. Most obvious/classic sx’s are those that suggest neurological disease. Some instances may be precipitated by psychological stress.
Malingeringno medical problem, they will fake that they hurt themselves to get their way. *NTK difference b/t this and factitious.
(DID) Dissociative Identity Disorderrare, but the worst one. The presence of two or more distinct personality states that recurrently take control of behavior.
Predisposing factors somatic disorders1st degree relatives; ↓ levels of serotonin & endorphins; brain dysfunction of impaired info. processing; psychodynamic: some view illness anxiety disorder as an ego defense mechanism as it is easier to feel something is wrong with the body then your self; family dynamic: some families have a hard time expressing feelings verbally.
Predisposing factors DIDpossible dissociative amnesia may be r/t neurophysiological dysfunction; Freud believed that these behaviors occured when people repress distressing mental contents from conscious awareness; psychological trauma: physical, sexual, psychological abuse; maladaptive stress/adaptation
Nursing Interventions• Monitior physician’s ongoing assessments, lab reports, & other data to be sure organic pathology is ruled out. • ID primary or secondary gains that the physical sx may be providing to the client. • Do not focus on the disability and encourage client to be as independent as possible. Intervene only when client requires assistance. • Maintain nonjudgmental attitude when helping client. The physical sx is not w/in the client’s conscious control & is very real to them. • Do not allow the client to use the disability as a manipulative tool to avoid participation in therapeutic activities. Withdraw attn. if client continues to focus on physical limitation.

Personality Disorders

Question Answer
Cluster A "PSS"Paranoid, Shizoid, Shizotypical - behaviors are described as odd or eccentric
Paranoiddistrust & suspicious toward others based on unfunded beliefs
Shizoidaloof, emot’l detachment, no interest in close relationship, indifference to praise or criticism
Schizotypicalmagical thinking, ideas of reference, perceptual distortions
Cluster B "BAHN"Borderline, Antisocial, Histrionic, Narcissistic - behaviors are dramatic, emotional or erratic
Borderlineinstability of affect, identity & relationships, splitting behavior, manipulation, impulsiveness & fear of abandonment-often tries self injury/suicide.
Antisocialtotal disregard for other with exploitation, repeated unlawful actions, deceit, & does not accept personal responsibility.
Histrionicemotional attention-seeking behavior, center of attn., seductive & flirtatious
Narcissisticarrogance, grandiose view of self-importance, need for consistent admiration, lack of empathy for others & strains most relationships; often sensitive criticism→ psychopaths
Cluster C "ADO"Avoidant, Dependent, Obsessive Compulsive - anxious or fearful traits; insecurity & inadequacy
Avoidantsocial inhibition, avoidance of all situations that require interpersonal contact, despite wanting close relationships d/t extreme fear of rejection, very anxious in social situation.
Dependentextreme dependency in close relationship with an urgent search to find a replacement when one relationship ends.
Obsessive Compulsiveperfectionism with focus on orderliness & control to the extent that the individual may not be able to accomplish a given task.
Symptomatology associated with borderline personality disorder Their affect is one of extreme intensity & behavior reflects frequent changes which can occur minutes-days. Usually have a single, dominant affective tone, such as depression, which can change periodically to anxious agitation or outbursts of anger.
Other symptoms associated with borderline personality disorders chronic depression; inability to be alone; clinging & distancing; splitting; manipulation; self-destructive behaviors; impulsivity.
Symptomatology associated with antisocialpattern of socially irresponsible, exploitative & guiltless behavior that reflects a general disregard for the rights of others. They exploit & manipulate others for personal gain & are not concerned with obeying the law. Difficulty sustaining consistent employment & in developing relationships.
Predisposing factors for borderlineBiochemical imbalances; genetic decrease in serotonin; childhood trauma; theory of object relations
Predisposing factors for antisocialmore common among first degree biological relatives of those with the disorder than among the general population; family dynamics (chaotic home env’t, parental deprivation during the 1st 5 years of life, separation d/t parental delinquency, presence of inconsistent/impulsive parents, physical abuse as a child).

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