Essay psych nursing chapter 2 exam

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NURSING 3340: STUDY GUIDE FOR EXAM II

TEST BLUEPRINT
Crisis theory, assessment, & intervention – 3 items chpt. 20
Stress, anxiety, defense mechanisms, and disorders related to stress/anxiety – 8 items chpt. 10
Depression and prevention of suicide – 8 items chpt. 15
Bipolar affective disorder –4 items chpt. 16
Dealing with anger, aggression, and violent behavior – 4 items chpt. 24
Medications – 8 note cards
Total – 35 items

GUIDELINES FOR CONTENT REVIEW

1. Crisis theory
A. Levels of crisis
Phase 1: Person confronted by conflict that threatens self-concept responds with increased anxiety.
Phase 2: If the usual defensive response fails and if threat persists, then anxiety escalates. Trial-and-error begins.
Phase 3: If the trial-and-error attempts fail, then anxiety can escalate to severe and panic levels.
Phase 4: If the problem is not solved and new coping skills are ineffective, then anxiety can overwhelm the person and lead to serious illness; assess for suicidal thoughts.

B. Elements of assessment in crisis situations:
(1) Patient’s perception of precipitating event
(2) Patient’s situational supports
(3) Patient’s personal coping skills
(4) Risk of harm to self if patient is overwhelmed by circumstances
(5) Risk of harm to others if aggressive behavior is used to cope with stress

2. Concepts of stress/anxiety – emphasize: pg. 167 table 11-1
Stress and our responses to it are central to psychiatric disorders and the provision of mental health care (Eustress & Distress)
A. Assessment of behaviors suggestion: mild, moderate, severe, and panic levels
B. Interventions appropriate for mild/moderate and severe/panic levels of anxiety
Intervention
Mild (normal experience, alertness):
Identify Anxiety: Anticipate provoking situations. Comm. Skills

Moderate (perception narrow)

Severe (focus is unproductive)
Calm manor, remain with, minimize stimuli environment, low pitched, firm, and affirmative slow voice, reinforce reality, and attend to physical and safety needs: goal.

Panic (cant process events)

Follow-up plan & agreement
Develop & formulate an action plan
Generate & explore alt.
Deal with feeling & emotions
Id Major problems
Est. rapport & rapidly est. relationship
Plan & conduct crisis assessment

C. Identification of specific defense mechanisms used to deal with anxiety, and how these represent healthy/unhealthy ways of coping

3. Psychiatric disorders – need basic knowledge of clinical picture for each.
A. Anxiety disorders: (most basic emotion) from a real or perceived threat whose actual source is unknown or unrecognized.
FEAR = Is a reaction to a specific danger.
Main mediator: serotonin, norepinephrine, GABA
(1) Common phobias: specific objects or situations
Social Anxiety Disorders (SAD)
(2) Panic disorder (pg 168) Feelings of terror, Suspension of normal function
Severely limited perceptual field, Misinterpretation of reality
Increased rates of suicide and suicide attempts
(3) Generalized anxiety disorder (Chronic: ^ 6months)
S&S: restless, fatigue, poor concentration, irritability, & sleep disturbances
(4) Obsessive (thought) compulsive (behavior) disorder: OCD aka everything is dirty wash hands constantly etc..
(5) Posttraumatic stress disorder: (helpless/powerless)
Usually occurs after a traumatic event outside the range of usual human experience
Therapy: CBT, SSRIs, family/group therapy B. Depression
a. Kids as young as 3yr have been diagnosed.
b. Girls more vulnerable than boys
c. Combo of psychotherapy + psych meds is most effective
(1) Affect/mood See (6b)
(2) Alterations in thinking See (5)
(3) Emotions and self-concept See (6b)
(4) Patterns of communication
a. Speak and comprehend very slowly; mute (extreme depression)
(5) Problematic behaviors
a.
Sleep disturbances
Appetite disturbance
Fatigue
V sex drive
Psychomotor probs
Variation in mood
X concentrate
Forgetful
Anhedonia

b.
(6) Risk for self-harm/suicide
a. ALWAYS evaluate
b.
c. Mood,…