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crisis intervention chapter 23
occurs when a person experiences a traumatic or overwhelming event, any stressfull event can trigger this
crisis
often occurs when a person misperception of the stressor, has poor coping skills or an ineffective or unavailable support system
crisis
usually occurs between 4-6 weeks
crisis
whats the goal?
to assist the person to resolve the immediate problem and regain emotional equilibrium
this is the key feature of crisis
anxiety, the persons failed attempts to cope heighten the anxiety
the outcome of crisis is either
-decompensation to a lower level of functioning, or adaptation and return to a previous level of functioning.
person is usually open to learning new ways of problem solving, the focus of the intervention will be on the problem or stressor.
Types of crises:
normal stresses of development (adolescence)
maturational or developmental
sudden traumatic event, usually occuring with the loss of an established support (divorce)
situational
unexpected event (hurricane)
adventitious
crisis prevention
preparing for maturational changes, balanced way of life (diet, exercise, fun), meditation, prayer, message, etc
role of the intervener:
be empathetic, clarify messages, respect personal space, remain calm, ignore challenging questions or statements, use non-threatening non-verbal cues.
-is an active participant , but doesn't take over the problem-solving, unless the patient is suicidal or homicidal.
the intervener
the intervener helps the person:
analyze the stressful event, express feelings, explore ways to deal with the problem, seek support, prevent future crises.
nursing process in a crisis:

Assessment-
have the person talk about preceding the distress, have the patient discribe their feelings, assess support systems, assess coping skills, determine potential for self harm.
planning-
allow the person to do what he can for himself, be directive if person is  distraught or confused.
implementation-
assist the person is having a realistic perception of the event, support appropriate coping mechanisms, identify support systems.
evaluation-
has the person regained emotional equilibrium, is the person able to identify S&S of relapse and preventive behaviors.
Schizophrenia and other thought disorders chapter 15:
etiology:
genetic influences-

multiple genes on different chromosomes interactwith each other in complex ways to create vulnerability for schizophrenics.
neurochemical changes-

neuroanatomic changes-
to much dopamine causes schizophrenia and to little dopamine can cause parkinsons.

seratonin and dopamine regulator.

the new class of drugs help the negative symptoms of schizo and the older drugs help the positive symptoms of schizophrenia.
signs and symptoms:

the disorganization dimension-
disorganized speech, disorganized behavior, incongruous affect(ex. laughing when talking about sad events)
the psychotic dimension:
a false beleif held to be true even with evidence to the contrary
delusion
a sense perception for which no external stimulus exists
hallucinations
the negative dimension:
loss of speech
alogia
a reduction in the expression, range and intensity
affective blunting
reduced motivation in ability to initiate tasks such as social contects grooming and other activities of daily living
avolition
inability to experience pleasure in activities that usually produce it
anhedonia
sub types of schizophrenia
dominant hallucinations and delusions, no disorganized speech, or behavior, catatonia or inappropriate effect present
paranoid
disorganized speech and behavior and inappropriate affect, grimacing, mannerisms and other odities of behavior.
disorganized
motor immobility (waxy flexability, or stupor)agitation, negativism, mutism, posturing, stereotyped movements, prominent mannerisms, echolalia, and ecchoproxis.
catatonic
has active phase symptoms, no one clinical presentation dominates
undifferentiated
no active phase symptoms, but does have social isolation or withdrawal, role functionimpairment, odd behavior or beleifs, poor personal hygiene, no energy or initiative, blunt.
residual
comorbities and dual diagnoses
50-75% of persons with severe mental illness also have substance abuse problems (20's to mid 30's)

-when a client has a serious mental illness in addition to a substance abuse disorder.
interdisciplinary goals and treatment

overall goals of treatment for thought disorders:
safety in all settings, stabilization on antipsychotic medications, client and family education, physical care of the client, psychosocial support of client and family
pharmacological interventions
traditional conventional antipsychotics- extrapyramidal side effects (EPS)
tardive dyskanesia (TD)
Neuropleptic malignant syndrome (NMS)
atypical (novel) antipsychotics
Psychosocial Interventions
millieu management
individual and group therapy
cognitive and behavioral therapy
vocational rehabilitation
continuum of care
discharge planning
care in the community
assertive community treatment (ACT)
Intensive case management (CM)
the nursing process with client with thought disorders:
assessment
mood and cognitive state
potential for violence
social support
knowledge
bursing diagnosis
planning
implementation
intervening in disturbed thoughts/sensory
managing violent behavior
lessening social isolation
promoting adherence to medication regimen
promoting improved individual coping skills
strengthening family process
providing client and family education
evaluation
is an unexplained discomfort tension apprehension or uneasiness occuring when a person feels threatened it can be real or imagined
anxiety
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