Mental Health 2

Crisis

 time-limited and acute 

• 4-6 weeks

• Triggers coping response 

Crisis Risk Factors

• Unresolved loss

• Life stressors

• Mental and physical health issues 

• Excess fatigue or pain

• Age and developmental status

Types of Crisis

• Situation/External

• Unacticipated 

• Maturation/Internal

• New developmental stages 

• Adventitious 

• Natural and National Disasters

Crisis Nursing Care

• Handled immediately is # 1 goal

• Ensuring safety is # 1 task

• Decrease anxiety

Theraputic Interventions for Crisis

Primary- ID potential problem 

Secondary- ID interventions

Tertiary- provide support during recovery from severe crisis (ex. Outpatient, rehab centers, crisis stabilization centers, workshops)

Fight or Flight

crisis mode, HR, BP, RR all come up, eyes dialate, nonessential organs have blood shunted from them, increase in metabolism

Stress

hange in one's environment that is threatening or causes challenges 

• Leads to anxiety and dysfunctional behavior 

• Can be adaptive or maladaptive

Good Stress- anxiety before exam , keeps you sharp

Bad Stress- fail exam 

More demands = More coping skills needed

Acute Stress

• Apprehension

• Unhappy 

• Sorrow

• Decreased appetite 

• Increased HR, RR, BP

• Increase metabolism 

• Depressed immune

Chronic Stress

• Chronic anxiety or panic attacks 

• Depression

• Chronic pain

• Sleep disturbances 

• Weight fluctuation

• Increase risk for MI, stroke, and infection 

• Poor disease management

Adaptive Defense

Good defense mechanism

• Altruism and Sublimation

Sublimation

dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms

Altruism

dealing with anxiety by reaching out to others 

So-So defense mechanisms

• ADAPTIVE and MALADAPTIVE

• Supression

• Repression

• Regression

• Displacement

• Reaction formation

• Undoing

• Rationalization

• Dissociation 

• Denial

• Compensation

• Identification

• Intellectualization

Bad Defense Mechanisms

• MALADAPTIVE ONLY

• Conversion 

• Splitting

• Projection

Nursings Care for stress

Cognitive reframing- help pt look at irrational thoughts in a more realistic light, restructure thoughts in more positive way 

Journal writing- helps ease anxiety, increase confidence, and hope

Mild Anxiety

everyday living, irritability, increased HR

Moderate Anxiety

mild anxiety escalates, poor ability to think and problem-solving, increased HR, BP, keep directions simple

Interventions for mild and moderate anxiety

use therapeutic communication, use verbal and nonverbal language to demonstrate interest 

Severe Anxiety

field of view narrows, learning and function severely decrease, severe agitation, keep direction very simple, no education

Panic

 hyperventilation, confused, extreme agitation, no education

Interventions for severe/panic anxiety

do not ask question or educate, de-escalate, always remain with them, minimize stimuli, low pitch speak slowly

Nursing considerations for Anxiety

• Females at highest risk

• Provide safe environment 

• Place pt in quiet place, low stimulation

• Use therapeutic communication first, then escalate to meds and restraints 

• Encourage exercise 

• Set limits, talk slow and low

Types of Anxiety

• Separation anxiety

• Specific phobias

• Agoraphobia - fear of public spaces

• Social anxiety

• Panic disorder

• Generalized anxiety disorder 

Types of OCD

• Obsessive-compulsive disorder

• Hoarding 

• Body dysmorphic

Treatment for Anxiety Disorders

• First line of treatment is an SSRI 

• Benzodiazepines 

• Lorazepam (Ativan)

• Diazepam (Valium) 

• Not long-term because of respiratory depression and addiction

• Do not take with alcohol 

Paradoxical Response

• opposite reaction of anxiety treatment, increased HR, anxiety, insomnia, restlessness

Atypical Anxiolytic

• Buspirone

• St. John's wort, grapefruit juice, erythromycin, and ketoconazole INCREASE buspirone

Non-Benzo Treatment

• Given when pt has bad hx of drug use

• Beta blockers (Propranolol)

• Antihistamine

• Antiepileptic (Lamotrigine, valproic acid)

Treatment of Anxiety and OCD (CBT)

• Relaxation training

• Modeling

• Systematic desensitization

• Flooding 

• Response prevention 

• Thought stopping

Cycles of Violence

Tension-Building Stage

• Minor episodes of anger 

• Verbal and some minor physical violence (pushing and shoving)

• Victims usually tense during this stage and accept blame 

Acute Battering Stage

• Serious abuse takes place

Honeymoon stage 

• “Im sorry, ill never do this again”

Types of Violence

• Physical

• Emotional (most common)

• Sexual

• Financial

• Neglect