Crisis
Trauma & Stress
Anger & Violence
Disruptive Disorders
Suicide
Assessment
100
One of the main priorities of crisis intervention is?
Safety!
Ensure both the patient and anyone in the immediate area is safe
100
Eustress is what? How would you describe this to a patient?
Eustress is what makes us work hard to reach our goals. It also pushes us to repair broken relationships, improve in our area of work and utilize creative problem solving.
100
When dealing with angry patients in a common area (cafeteria, courtyard, etc) what is the first action the nurse should take?
Remove other patients/visitors to maintain a safe environment
100
Characteristics of a child with oppositional defiant disorder (ODD) include what?
often loses temper
easily annoyed
argues with authority figures
defies or refuses rules deliberately annoys others
blames others for their mistakes or misbehaviors
vindictive in nature
100
When a patient is expressing suicidal ideations the nurse should follow up with with initial nursing intervention?
Complete suicide/safety assessment
100
The nurse would document this patient's affect as what?
Flat
200
A patient is making statements suggestive of suicidal ideations, such as "I wish I could sleep forever."
What is the priority intervention?
Safety/Suicide Assessment
200
Risk factors for PTSD include what?
Age, female gender, personal or family history of mental illness, TBI, lower education level, multiple factors occurring at the same that increase risk of PTSD
200
List strategies to help avoid anger/frustration with patients on an inpatient unit.
Maintain consistency/structure
Avoid staff splitting ( stick with the rules, do not allow extra privilege's)
Have a schedule to follow which patients can easily read/follow
200
Clinical manifestations of conduct disorder include what?
bullies, initiates physical fighting ( usually with a weapon of some sort), hurts animals, stole nontrivial items, forced someone into a sexual activity, fire setting, deliberate destruction of property, and running away
200
When a patient is expressing suicidal ideations their precaution level (15 minute checks, constant observation, 1:1) is based on what?
the severity of the suicidal ideations or attempt
for example, if a patient recently attempted suicide they would likely require 1:1 level of observation for their safety
200
The patient states "I know you can hear my thoughts and are telling all of the other patients about them" is an example of what?
Thought Broadcasting
300
What are the types of crisis and examples of each?
Developmental: arriving at a new stage-- marriage, birth a new child, retirement, manor career changes, etc
Situation: loss of a job, death of a loved one, moving, pregnancy (often when unwanted), financial strain, divorce, change in school. Any loss or change threatening a person's self-concept and self-esteem.
Adventitious: similar to situation but on a larger scale. Natural disasters, terrorists attacks, airplane crashes, train derailment, shootings in public areas, massive crime sprees, etc
Existential: questioning of life
300
How might a nurse expect a patient to act if they are diagnosed with Reactive Attachment Disorder?
Or
Disinhibited Reactive Attachment Disorder?
Reactive Attachment Disorder: closed off, harm time forming relationships, will push people away
Disinhibited Reactive Attachment Disorder: overfriendly, wants to build relationships with everyone, will have poor boundaries
300
The number one predictor of violence is?
Previous violence
300
How is ODD classified?
Mild- one setting
Moderate- two settings
Severe- three or more settings
300
What are factors that influence a patient to NOT attempt suicide?
Hope- reasons to live, looking to the future, a job, family support, children, plans for the future, etc
300
The nurse is caring for a patient recently admitted with depression. The patient tells the nurse, "please don't tell anyone, but I wish I was dead." What is the priority nursing intervention?
A full suicide screening
400
What are the various components to the phases of crisis?
Phase 1: a person feels threatened, anxiety increases = defensive mechanisms and problem solving actions
Phase 2: threat continues, anxiety and discomfort continue to rise- may become disorganized. attempted to solve the problem continue
Phase 3: problem solving failed, anxiety may be at panic levels-- starts to feel the autonomic response of fight or flight. May need to reevaluate needs
Phase 4: problem is not solved, coping skills have been ineffective and the person may feel overwhelmed. Serious changes to personality, depression, confusion, violence and suicidal behaviors may develop
400
How might a patient present if having an acute episode of PTSD?
Flashbacks
Avoidance behaviors
Alteration in arousal
Persistent negative alterations in cognition and mood
May have dissociative episodes or feelings of "detachment"
400
The priority intervention from a nurse who suspects abuse (outside of keeping the patient safe and not leaving them alone) is what?
Nurses are mandated reporters. There does not need to be concrete evidence, only suspicion to report
400
Which theory is the most beneficial to use when treating conduct disorder or ODD?
Behavioral ( Skinner, Pavlov or Watson)
400
A client admits to suicidal thoughts and states, “I have thought about how I would do it.” What part of this assessment findings would indicate an immediate concern.
a specific plan, access to the means, and intent to act
400
If the nurse asks a patient, what would you do if you found a wallet while walking through the store? Which components of the mental health assessment are they collecting data for?
Judgement and Insight
500
Identify primary, secondary, and tertiary interventions for patients experiencing a crisis.
We can use violence as an example
Primary prevention strategies focus on stopping violence from happening in the first place.
Secondary prevention focuses on intervening after violence occurs to prevent it from happening again.
Tertiary prevention refers to actions that focus on addressing the long-term consequences of violence occurring in the first place. Tertiary programs include supporting survivors of childhood violence
500
Clients with PTSD should avoid what drug class due to their high risk of substance abuse (self-medicating)?
Benzo's
500
What are some nursing interventions to include in a pre-crisis phase of aggression?
Encourage use of coping skills
PRN
Time away (open seclusion)
Deep breathing
500
What is one factor that differentiates IED from ODD or Conduct Disorder
Remorse; patient's with IED usually have remorse
500
What are the various stages of observation and examples of when each may be used
Low - 15 minute checks
Moderate- close observation (eye sight)
High- within arms length; requires hospitalization
500
What is the difference between a delusions and a hallucination?
Delusions are thoughts of disbelief
Hallucinations are based on the 5 senses