Show:
Therapeutic Communication
Crisis Intervention
Anger and Aggression
Suicide
Neurocognitive Disorders
Substance Abuse and Addiction
100

What is this therapeutic technique? 

Acknowledging and indicating awareness is better then complimenting, which reflects the nurse’s judgement. 

Example: 

“Hello, Mr. J I notice that you made a ceramic ashtray in OT”

“I see you made your bed.”

Giving Recognition

100

What is an acute event perceived by the individual as distressing and in which coping mechanisms and support systems are inadequate to manage associated anxiety (Old coping mechanisms no longer work!!)

Crisis

100

What is the NUMBER ONE indicator that a client could or will be violent again in a treatment setting?

Past history of violence

100

What are low risk warning signs of suicide?

Give me 2!

RECOMMEND COUNSELING AND MONITOR FOR DEVELOPMENT OF WARNING SIGNS

  • Unemployment or recent financial difficulties
  • Divorce, separation, widowed
  • Social isolation
  • Prior traumatic life events or abuse
  • Previous suicide behavior
  • Chronic mental illness
  • Chronic debilitating physical illness
100

Mental state characterized by an acute disturbance of cognition, manifested by short-term (rapid onset) confusion, excitement, disorientation, and clouded consciousness.

Delirium

100

This is commonly deficient in chronic alcoholics. Replacement therapy is required to prevent neuropathy, confusion, and encephalopathy. What is the vitamin replacement?

 

Thiamine

200

What is this therapeutic communication technique?

Willingness to spend time with the patient and show interest on an unconditional basis helps to increase the patient’s feelings of self-worth

Example:

“I’ll stay with you a while.”

“We can eat our lunch together.”

“I’m interested in hearing your thoughts about the group you just attended.”

Offering Self

200

What class of crisis is this? 

Crisis precipitated by an unexpected external stressor over which the individual has little or no control and as a result of which they feel emotionally overwhelmed and defeated.

Class 3 Crises resulting from Traumatic Stress

200

What are some manifestations of anger?

Give me at least 3!

  • Frowning facial expression
  • Clenched fists
  • Low-pitched verbalizations forced through clenched teeth
  • Yelling and shouting
  • Intense eye contact or avoidance of eye contact
  • Hypersensitivity, easily offended
  • Defensive response to criticism
  • Passive-aggressive behaviors
  • Lack of control or overcontrolled emotions
  • Intense discomfort; continuous state of tensions
  • Flushed face
  • Anxious, tense, angry facial expression (affect)


200

What are high risk warning signs of suicide?

Give me 2

SEEK HELP FROM MENTAL HEALTH PROFESSIONL

  • Expressing feelings of being trapped with no way out
  • Increasing or excessive substance use
  • Rage, anger, seeking revenge
  • Acting recklessly, engaging impulsively in risky behavior
  • Withdrawing from family, friends, society
  • Dramatic changes in mood
  • Anxiety, agitation, abnormal sleep (too little or too much)
  • Expresses no reason for living, no sense of purpose in life
200

This med is used in Alzheimer's to slow progression of the disease, the side effects of this med include insomnia, dizziness, GI upset, and headache

Donepezil

200

What are some signs and symptoms of alcohol withdrawal? 

give me 3

Coarse tremor of hands, tongue, or eyelids nausea or vomiting, malaise or weakness, tachycardia, sweating, elevated BP, insomnia, headache, transient hallucinations

300

What is this therapeutic communication technique?

This encourages the patient to organize thoughts and put them into words and allows the patient time to think about the significance of events, thoughts, and feelings.

Example:

Patient: “My husband divorced me so I must be undesirable”

Nurse: (Silence)

Patient: “You know, when I think about it, no matter what my husband does I always assume it’s. my fault or it’s something wrong with me”

Using Silence

300

What class of Crisis is this?

Crisis situations in which general functioning has been severely impaired and the individual is rendered incompetent or unable to assume personal responsibility for their behavior. Examples include acute suicide risk, drug overdose, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger, and alcohol intoxication

Class 6 Psychiatric Emergencies

300

What are manifestations of aggression?

Give me at least 3


  • Pacing, restlessness
  • Threatening body language
  • Verbal or physical threats
  • Loud voice, shouting, use of obscenities, argumentative
  • Threats of homicide or suicide
  • Increase in agitation, with overreaction to environmental stimuli
  • Panic anxiety, leads to misinterpretation of the environment
  • Suspiciousness and defensive posturing
  • Angry mood, often disproportionate to the situation
  • Destruction of property
  • Acts of physical harm toward another person


300

What are VERY high risk signs of suicide?

Tell me all 5

  • Threatening to harm or end one’s life
  • Seeking or access to means: seeking pills, weapons, or others
  • Evidence or expression of a suicide plan
  • Expressing (writing or talking) ideation about suicide, wish to die or death
  • Hopelessness
300

This stage of Alzheimer's is characterized by the patient forgetting major life events like child’s bday. Unable to understand current events and cannot manage financials. Pt will deny a problem exist and instead lie with confabulation (imaginary events to fill memory gaps), social withdrawal, and they NEED HELP to remain safe.

Stage 4

300

Is a drug that can be administered as a deterrent to drinking to individuals who abuse alcohol. Ingestion of alcohol while taking this medication results in a syndrome of symptoms that produce substantial discomfort for the individual and even result in death if the blood alcohol level is high. 

What is this drug and what things should the patient avoid?

Disulfiram 

  • The pt should be aware of and avoid alcohol-containing substances
  • Such as liquid cough and cold preparations, vanilla extract, aftershave lotions, colognes, mouthwash, nail polish removers, and isopropyl alcohol
400

What is this non-therapeutic communication technique?

Conveys that the nurse already knows the outcome of a situation and minimizes the patient’s expressed concerns. It may discourage the patient from further expression of feelings if they believe the feelings will be downplayed or ridiculed

Example:

Patient: “My husband doesn’t love me anymore. I think he wants a divorce.”

Nurse: “I’m sure he must still love you. Everything will be fine.”

False Reassurance

400

What class of Crisis is this?

A crisis that is influenced or triggered by preexisting psychopathology. Examples of psychopathology that may precipitate crises include personality disorders, anxiety, disorders, bipolar disorder, and schizophrenia.

Class 5 Crises Reflecting Psychopathology

400

What are some de-escalation techniques a nurse could use?

Give me 3!

  • Calm voice
  • Walk outdoors or fresh aire
  • Helpful attitude
  • Reduction in demands
  • Identify consequences
  • Group participation
  • Open hands and nonthreatening posture
  • Relaxation techniques
  • Allow a phone call
  • Express concern
  • Offer food or drink
  • Reduce stimulation and loud noise
  • Decrease waiting times and request refusals
  • Verbal redirection and limit setting
  • Distract with a more positive activity (soft music, quiet room)
  • Time out/quiet time/open seclusion
  • Offer prn medication
400

What is some information you can give the family about a suicidal patient?

Give me 4

  • Take any hint of suicide seriously. Anyone expressing suicidal feelings needs immediate attention
  • Do not keep secrets, if a suicidal person says “promise you won’t tell anyone”, do not make that promise
  • Be a good listener, let the person know you are there for them and willing to help
  • Stress the importance of that person’s life to you. Emphasize in specific terms the ways in which the person’s suicide would be devasting to you and others.
  • Express concern for an individual who expresses thoughts about suicide.
  • Familiarize yourself with suicide intervention resources, such as mental health centers and suicide hotlines
  • Ensure that access to firearms or other means of self-harm is restricted
  • Communicate caring and commitment to providing support
  • Try to give the person hope, and remind the person that what they are feeling is temporary
  • Stay with the person
  • Show love and encouragement
  • Help the person seek professional help
  • Remove any items from the home with which the person may harm themselves
  • If there are children present, try to remove them from the home
  • Do not judge suicidal people, show anger toward them, provoke guilt in them or discount their feelings
400

This stage of Alzheimer's the patient misidentifies people and cannot recall name of spouse. Disorientated to time, day, and season. Cannot manage ADLs without assistances, urinary and fecal incontinence. Delusions are apparent (ex. They think they have to go to work, but they do not have a job). Sleeping is a problem, they start wondering, obsessiveness, agitation, and aggression. SYMPTOMS WORSEN in the late afternoon! (sundowning)** Institutional care is a possibility.

Stage 6

400

What phase of alcoholism is this:

  • Begins with blackouts- brief periods of amnesia that occur during or immediately following a period of drinking.
  • Alcohol is no longer a source of pleasure or relief for the individual but rather a drug that is required by the individual
  • Common behaviors include sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts. The individual typically feels enormous guilt and becomes very defensive about their drink. Excessive use of denial and rationalization is evident.

The Early Alcoholic Phase

500

What is the acronym SOLER?

S: Sit squarely facing the patient

O: Observe an open posture

L: Lean forward toward the patient

E: Establish eye contact

R: Relax

500

What are some nursing interventions for Nursing Diagnosis: Anxiety (Panic)/Fear?

GIVE ME AT LEAST 3

  • Determine the degree of anxiety/fear present, and associated behaviors (laughter, crying, calm, or agitation, excited or hysterical behavior, expressions of disbelief or self-blame)
  • Note the degree of disorganization
  • Create as quiet an area as possible. Maintain a clam, confident manner. Speak in even tone using short, simple sentences
  • Develop a trusting relationship with the patient
  • Identify whether the incident has reactivated preexisting or coexisting situations (physical or psychological trauma)
  • Determine the presence of physical symptoms (numbness, headaches, tightness in chest, nausea, and pounding heart)
  • Identify psychological responses (anger, shock, acute anxiety, panic, confusion, denial). Record emotional changes.
  • Discuss with the patient the perception of what is causing the anxiety.
  • Assist the patient in correction any distortions in thinking. Share perceptions with the client.
  • Explore with the patient or significant other the manner in which the patient has previously coped with anxiety-producing events
  • Engage the patient in learning new coping behaviors (progressive muscle relaxation, thought-stopping)
  • Encourage use of techniques to manage stress and vent emotions such as anger and hostility
  • Give positive feedback when the patient demonstrates better ways to manage anxiety and is able to calmy and realistically appraise the situation
  • Administer medications as indicated: Antianxiety (diazepam, alprazolam, oxazepam) antidepressants (fluoxetine, paroxetine, bupropion)
500

For the Nursing Diagnosis: Risk for self-directed or other-direct violence, what would be the order of nursing interventions that a nurse would take if a patient was showing signs of anger/aggression?

  • Talking down: say “John, you seem very angry. Let’s sit down and talk about it.” Be attentive to safe physical distance from the patient and the nurse’s ability to exit. Promote a trusting relationship and may prevent patient’s anxiety from escalating while attending to the safety needs of the nurse as well
  • Physical outlets: suggest exercise, walking, or engaging in another activity that provides an acceptable outlet for energy. Offer to stay with the patient during this activity. Provides an effective way for the patient to release tension associated with high levels of anger.
  • Medication: if agitation continues to escalate, offer the patient choice of taking medication voluntarily. If they refuse, reassess the situation to determine whether harm to self or others is imminent
  • Call for assistance. Remove self and other patients from the immediate area. Call the violence code, push the panic button, call for the assault team, and follow other measures established by the institution.
  • Seclusion or restraints. If the patient is not calmed by talking down or by medication, use of mechanical restraints, seclusion, or both may be necessary.
  • Observation and documentation, hospital policy typically dictates the requirements for observation of the patient in restraints. Basic safety principles include that the patient in restraints should be observed throughout the period of restraints, every 15 minutes
  • Ongoing assessment, as agitation decreases, assess the patient’s readiness for restraint removal or reduction.
  • Debriefing, it is important when a patient loses control, for staff to follow up with a discussion about the situation.
500

What are nursing interventions for the Nursing Diagnosis: Risk for Suicide

*there's 9, give me 5

  • Ask the patient directly “Have you thought about harming yourself in any way? If so, what do you plan to do? Do you have the means to carry out this plan? How strong are your intentions to die? “How often do you think about suicide?”
  • Create a safe environment for the patient. Remove all potentially harmful objects from the patient’s access (sharp objects, straps, belts, ties, glass items, alcohol). Supervise closely during meals and medication administration. Perform room searches as necessary.
  • Maintain close observation of the patient. Depending on the level of suicide precaution, provide one-to-one contact, constant visual observation, or every 15-minute checks at irregular intervals. Place the patient in a room near the nurse’s station; do not assign a private room. Accompany off-unit activities if attendance is indicated. May need to accompany to the bathroom.
  • Maintain special care in the administration of medication, preventing saving up to overdose or discarding, and not taking
  • Make rounds at frequent, irregular intervals, especially at night.
  • Encourage the patient to express honest feelings, including anger.
  • Establish a trusting, therapeutic relationship to encourage open discussion of suicide
  • Collaborate with the patient to develop a safety plan that includes recognition of warning signs
  • Assess verbal and nonverbal clues to identify the likelihood that the patient intends to follow through with the established safety plan
500

This stage of Alzheimer's there are changes in thinking start to interfere with work performance and coworker’s notice. May get lost driving, difficulty recalling names, planning and organizing. Family and friends start to notice. 

Stage 3

500

This phase of alcoholism:

  • The individual has lost control of his or her use, and physiological addiction is clear.
  • Binge drinking
  • Drinking is the total focus and he or she is willing to risk losing everything that was once important to maintain the addiction
  • It is not uncommon for the individual to have experienced the loss of job, marriage, family, friends, and most especially self-respect

The crucial phase