psych exam 1- abuse, anger, aggression, crisis, violence, grief, suicide

_______ is the emotional response to frustration of desires, threat to one’s emotional or physical needs, or a challenge

anger

________ is an action or behavior that results in verbal or physical attack

aggression

what are the biological risk factors for anger

genetic predisposition, neurobiological (brain injury), and neurotransmitters

how can someone be genetically predisposed to anger

they have low expression of the MAOA gene

how can neurotransmitters affect anger

serotonin can either increase or decrease anger, dopamine through the reward pathway is associated with anger (addiction), GABA inhibits anger

what are the cognitive risk factors for anger

behavioral (learned) or social learning (imitation)

________ is an objectionable act that involves intentional use of force that results in, or has potential to result in injury to another person

violence

all violence = _______

aggression

not all aggression = ________

violence

comorbitities of violence

PTSD, coexistence with BPD, psychosis, substance use

anger and hostility are risk factors for ________ and may be predictive of hospitalizations for multiple chronic illnesses such as _______

chronic illness; hypertension and cardiovascular disease

why can substance use increase violence

it disinhibits the prefrontal cortex which holds oyu back

low expression of the MAOA gene causes higher _______, which causes _____

norepinephrine; high BP

predictive characteristics of aggression and violence

involuntary hospitalization, suspiciousness, impulsivity, agitation, unwillingness to follow unit rules

what vitamin deficiencies are assoicated with anger

vitamin D, magnesium, zinc, omega 3

what vitamin deficiencies are associated with irritability

vitamin b12 and iron

what are some interventions for managing imminent aggression and violence

PRN meds, avoidance of seclusion and restraints, be assertive not aggressive, lorazepam, haloperidol, diphenhydramine/benztropine, and olanzapine

what is the number one sign of mmenent violence

hyperactivity

what is the number one predictor of violence

previous history

________ is involuntary confinement of a patient alone in a room, or area from which the patient is physically prevented from leaving

seclusion

________ is any manual method, physical, or mechanical device, material, or equipment that immobilizes or decreases the ability of a patient to move his or her arms, legs, body, or head freely

restraints

indication of restraints or seclusion

harm to self or others

how often do you check ROM and circulation when a patient is in restraints

every 15 minutes

how soon does the doctor have to be there for restraint assessment

within 1 hour

________ is any form of nonconsensual sexual activity (unwanted advances or sexual harrassment)

sexual violence or assault

_____ women have been raped

1 in 4

______ % of the 1:4 women have been raped before age 25

79%

____% of the 1:4 women have been raped before age 18

40

_____ men have been raped

1:26

_______ is repeated unwanted contact

stalking

_____ of people that have been stalked was by previous partners

40

_____ women have been stalked

1:3

______ men have been stalked

1:6

only ____% of rapes are by strangers

8.5

long term effects of sexual violence

depression, suicide, anxiety, fear, difficulties with functioning, low self esteem, somatic complaints, substance abuse, self mutilation, psychosis, compulsive sexual behavior, eating disorders

______ abuse “kills” the spirit and decreases the want to make emotional contact with others

emotional

_______ abuse can cause emotional abuse

physical

______ abuse is controlling someone’s financial resources or freedoms

economic

________ is a situation that puts stress on a family with a violent member and increases domestic violence risk

crisis

_______ is any household member violent towards another

perpetrator

most vulnerable age for child abuse and neglect

children less than 4 and those with mental, physical, or emotional disabilities

what is the most common type of child abuse

neglect

_______ is a failure to protect or provide basic needs for a child; acts of omission

child neglect

______ is severe spanking, hitting, kicking, shoving, or any physical action causing nonaccidental injury; acts of comission (includes sexual and emotional)

physical abuse

comorbidity of child abuse

anxiety, depression, suicidal ideation, PTSD, substances

risk factors for child abuse

child is seen as different, fragile, reminds the parent of someone they dislike, doesn’t live up to parent’s fantasy, unwanted, emotional bonding interrupted because of prematurity or prolonged illness

_____% of child fatalities are before age 3

66

_____ % of child abuse is done by the parents

89

___% of child abuse is done by unmarried people or relatives

11

characteristics of abusive parents

history of child abuse, family authoritarianism, harsh punishments, low self esteem, social isolation, poor coping skills, low frustration tolerance, experiencing a crisis, unrealistic expectations of the child, severe mental illness, substance use, poor impulse control

what is the most common form of abuse

intimate partner violence

______ intimate partner abuse is to criticize, insult, humiliate, or ridicule; destroy another’s property, threaten/harm pets, control time/spending/isolation

psychological

______ is more constant than physical abuse, which is episodic

psychological

risk factors for intimate partner violence

pathological jealousy, substance or alcohol abuse, resentment towards pregnancy, partner trying to be independent

when does intimate partner violence escalate

during pregnancy

cycle of intimate partner violence

tension building, serious battering, honeymoon, repeat

what happens when tension is building with intimate partner violence

abuser has minor explosion; verbally and minor hitting, victim feels like they’re walking on eggshells

what happens during the serious battering phase of intimate partner violence

tension become unbearable; victim might cover up or ask for help

what happens during the honeymoon phase of intimate partner violence

loving behavior like gifts, promises to change, and the victim is trusting

______ is failure to provide basic needs, physical, emotional, or financial abuse of someone older than 60

elder abuse

risk factors for elderly abuse

older age especially greater than 75, poor mental and/or physical health, impaired ADLs, cognitive disability, dependency on caregiver, isolation, stressful events, history of intergenerational conflict

common age for abusive men

14-24

what to DO for abuse interview

conduct in private, be direct honest and professional, use language the patient understands, and ask the patient to clarify when words aren’t known, be understanding and attentive, inform patient when making a referral, assess safety and help reduce danger

what to NOT do during the abuse interview

try to prove abuse, display horror/anger/disapproval, place blame or make judgements, allow patient to feel at fault, probe for answers, conduct interview with a group

what is one of the most important steps in caring for any person experiencing violence

a trusting nurse-patient relationship

symptoms of sexual abuse in children

sexualized behavior, sexual knowledge or aggression, actin out sexual interactions, masturbation, sexual promiscuity in older children, PTSD, somatic complaints, feelings of guilt

symptoms of emotional abuse

low self esteem, reported feelings of inadequacy, anxiety and withdrawal, learning difficulties, poor impulse control

symptoms of neglect

undernourished, dirty, poorly clothed, inadequate medical care such as lack of vaccines and untreated medical or dental conditions

primary prevention of abuse

measures taken to prevent occurrence (coping, increasing self esteem, lowering stress)

secondary prevention of abuse

early intervention in abusive situations to decrease their disabling or long term effects (screenig those at risk)

tertiary prevention of abuse

after abuse occurred, facilitating healing and rehabilitation, provide support, assisting survivors to achieve optimal level of safety, health, and well being

______ is the reaction to a loss

grief

______ is the period of grieving after a death

bereavement

_______ refers to things people do to cope with grief

mourning

feelings with grief

emptiness and loss

intensity of grief

intense sadness or anger that occurs in waves and gradually decreases

self esteem during grief

intact; reorganization tasks may impact sense of self

thoughts of death with grief

may focus on someday reuniting

feelings of major depressive disorder

depressed mood and anhedonia

intensity of major depressive disorder

constant

self esteem with major depressive disorder

worthlessness and self loathing

thoughts of dying with major depressive disorder

focused on ending pain and may develop a plan

_____ grief is directly after the loss

acute

nursing care for acute grief

support positive expectations for future

______ is prolonged grieving and reactive distress that can lead to impairment of relationships, occupational performance, and ADLs

persistent complex bereavement disorder

________ grief is not congruent with a socially recognized relationship

disenfranchised

when does a crisis occur

when there is a perceived challenge or threat that overwhelms the capacity of the individual to cope effectively with the event

what happens to the patient with a crisis

THEY LOSE THE ABILITY TO FUNCTION

what are positive outcomes of a crisis

realistic perception of event, adequate situational supports, and adequate coping mechanisms

what are the 4 stages of FEMA’s management continuum

mitigation, preparedness, response, recovery

_______ is the intentional act of killing onself

suicide

_______ is suicide related behaviors and thoughts of attempting

suicidality

________ is thinking or planning one’s own death

suicidal ideation

________ is engaging in self injury behavior with the intention of death

suicide attempt

_______ is voluntary, apparent attempt (suicidal gesture) where the aim is NOT death

parasuicide

______ is the probability that a person will successfully complete suicide

lethality

_______ is self harm where the purpose is not culturally or socially sanctioned

non-suicidal self injury

myth or fact: people who talk about suicide don’t complete it

myth

myth or fact: many people who commit have given warnings

fact

myth or fact: suicide happens without warning

myth