Unit 2 BLKBD 1

Chapter 33
Therapeutic Groups
Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Characteristics That Influence a Group
Size Defined purpose
Degree of similarity among members

Rules Boundaries Content (what is said in the group) Process (underlying dynamics among group members)
Therapeutic Factors Common to All Groups

Instillation of hope
Universality
Imparting of information Altruism Corrective recapitulation of primary family group Development of socializing techniques Imitative behavior Interpersonal learning Group cohesiveness Catharsis Existential resolution
3
Phases of Group Development
Orientation phase Working phase Termination phase
Group Member Roles
Task roles Maintenance roles Individual roles
Group Leadership Responsibilities
Initiating Maintaining Terminating
Styles of Leadership
Autocratic leader
Democratic leader Laissez-faire leader
Basic Level Registered Nurse (Cont.)
Symptom-management groups Stress-management groups
Therapeutic community meeting groups

Support and self-help groups
Dealing with Challenging Member Behaviors
Monopolizing member Complaining member who rejects help Demoralizing member Silent member
Chapter 34
Family Interventions
Characteristics of Family Function
Ability to provide for safety of members Quality of resources and support systems Underlying issues Cultural concerns Developmental needs
11
Characteristics of Family Function (Cont.)
Patterns of behavior and interaction Responses to stressors
Ability to interact with support services

Parenting skill Relationships and interactions Overall flexibility or resilience
12
Types of Families
Nuclear family Single parent family Unmarried biological or adoptive family Blended family Cohabitating family
Extended family
13
Family Functions
Management Boundaries
Clear
Diffuse or enmeshed
Rigid or disengaged
Communication Emotional-supportive
Socialization
14
Overview of Family Therapy
Insight-oriented family therapy

Focuses on developing increased self, other, and family awareness among family members
Behavioral family therapy

Focuses on changing behaviors of family members to influence overall patterns of family interactions
15
Concepts Central to Family Therapy
Identified patient Family triangles
16
Nursing Process
Diagnosis
Implementation
Counseling and communication techniques
Nonjudgmental manner promotes open and flexible communication Perspective of each family member is elicited and heard
Pharmacological interventions
17
Outcomes Identification
Reduce dysfunctional behavior of individual family members and resolve or reduce conflicts Mobilize family resources, encourage adaptive family problem-solving behaviors, improve familys communication skills, heighten awareness and sensitivity to other family members emotional needs
Strengthen familys ability to cope with major life stressors and traumatic events, including chronic physical or psychiatric illness
Improve integration of family system into societal system
18
Chapter 10
Understanding and Managing Responses to Stress
Introduction
Definition of stress Stress responses and psychiatric disorders The interface between stress and all health alterations
20
Early Stress-Response Theories
Fight-or-flight response
Body prepares for situation that individual perceives as threat to survival New research indicates that men and women have different neural responses to stress
21
Stress Responses
Neurotransmitter Stress Response Serotonin synthesis more active May impair serotonin receptor sites and brains ability to use serotonin Immune Stress Response Interaction between nervous system and immune system during alarm phase of GAS
Negatively affects bodys ability to produce protective factors
22
Mediators of the Stress Response
Stressors
Physical Psychological
Perception Individual temperament Social support

Support groups
Culture
Spirituality and religious beliefs
23
Managing Stress Through Relaxation Techniques

Deep breathing exercises Progressive muscle relaxation Relaxation response Meditation Guided imagery
Biofeedback
Physical exercise Cognitive reframing
Journaling
Humor
24 Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
Chapter 15
Anxiety and ObsessiveCompulsive Related Disorders
Anxiety
Anxiety Apprehension, uneasiness, uncertainty, or dread from real or perceived threat Fear Reaction to specific danger Normal anxiety Necessary for survival Levels of Anxiety
Mild anxiety
Moderate anxiety Severe anxiety Panic
26
Defenses Against Anxiety
Defense mechanisms
Automatic coping styles
Protect people from anxiety Maintain self-image by blocking
Feelings
Conflicts
Memories
Can be healthy or unhealthy
27
Clinical Picture
Separation anxiety disorder

Developmentally inappropriate levels of concern over being away from a significant other
Panic disorder
Panic attacks
Agoraphobia
Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing
Specific phobias
28
Clinical Picture (Cont.)
Social anxiety disorder

Severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others
Generalized anxiety disorder

Excessive worry that lasts for months
Other anxiety disorders

Substance-induced anxiety disorder Anxiety due to a medical condition
29
Obsessive-Compulsive Disorders
Obsessions
Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
Compulsions
Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety
Obsessive-compulsive disorder Body dysmorphic disorder Hoarding disorder
30
Anxiety Disorders
Epidemiology Comorbidity Etiology

Biological
Genetics
Neurobiological
31
Application of the Nursing Process
Assessment
General assessment of symptoms
Self-assessment
Assessment guidelines: anxiety and obsessive-compulsive disorders
Nursing diagnosis Outcomes identification
Planning
32
Application of the Nursing Process (Cont.)

Implementation
Mild to moderate levels of anxiety Severe to panic levels of anxiety

Counseling Teamwork and safety Promotion of self-care activities
33
Implementation
Antidepressants Anti-anxiety drugs Other classes
Psychobiological interventions Integrative therapy Health teaching
34
Other Interventions
Cognitive therapy Behavioral therapy

Relaxation training Modeling Systematic desensitization Flooding Response prevention Thought stopping
Cognitive-behavioral therapy
Chapter 26
Crisis and Disaster
Crisis
Profound disruption of normal psychological homeostasis Normal coping mechanisms fail Results in inability to function as usual Acute and time-limited Type of Crisis
Maturational
New developmental stage is reached Old coping skills no longer effective Leads to increased tension and anxiety
37
Types of Crisis (Cont.)
Situational
Arise from events that are
Extraordinary External Often unanticipated
Adventitious
Unplanned and accidental
Natural disaster National disaster Crime of violence
38
Outcomes of Crisis
Depend on
Realistic perception of the event Adequate situational supports
Crisis intervention
Adequate coping mechanisms
39
Phases of Crisis Phase 1
Conflict or problem
Self-concept threatened
Increased anxiety Use of problem-solving techniques and defense mechanisms Resolve conflict or problem Reduce anxiety
40
Defense mechanisms fail Threat persists Anxiety increases Feelings of extreme discomfort Functioning disorganized Trial-and-error attempt to solve problem and restore normal balance
41
Trial-and-error attempts fail Anxiety can escalate to severe level or panic Automatic relief behaviors mobilized (i.e., withdrawal and flight)
Some form of resolution may be devised (i.e., compromising needs or redefining situation)
42
Problem is unsolved and coping skills are ineffective Overwhelming anxiety
Possible serious personality disorganization, depression, confusion, violence against others, or suicidal behavior
43

Assessment
General assessment Assessment of perception of precipitating event Assessment of situational supports Assessment of personal coping skills Self assessment Ineffective coping
Outcomes identification
Implementation
Basic level
Patient safety Anxiety reduction
Nursing Process (Cont.)
Crisis intervention
Primary care Secondary care Tertiary care
45
Chapter 17
Somatic Symptom Disorders
Clinical Picture
Somatic symptom disorder (SSD)

Illness anxiety disorder (previously hypochondriasis) Conversion disorder Psychological factors affecting medical condition
Factitious disorder
47
Somatic Symptom Disorder
Distressing symptoms Maladaptive response Without significant physical findings and medical diagnosis Suffering is authentic High level of functional impairment
48
Illness Anxiety Disorder
Misinterpretation of physical sensations Overconcerned for health and preoccupied with symptoms Extreme worry and fear
Course of illness chronic and relapsing
49
Conversion Disorder
Neurological symptoms in the absence of a neurological diagnosis

Presence of deficits in voluntary motor or sensory functions Common symptomsparalysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy La belle indiffrence versus distress
50
Assessment
Psychosocial factors Coping skills
Spirituality and religion

Secondary gains Cognitive style Ability to communicate feelings and emotional needs
Dependence on medication
Self-assessment
51

Nursing diagnosis
Ineffective coping
Outcomes identification Interventions

Psychosocial interventions
Promotion of self-care activities Assertiveness training
Psychobiological interventions
Health teaching and health promotion
52
Factitious Disorders
Artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury Goal of assuming a sick role Malingering
53
Chapter 12
Schizophrenia and Schizophrenia Spectrum Disorders
Schizophrenia
Epidemiology Lifetime prevalence of schizophrenia is 1% worldwide No difference related to
Race
Social status
Culture Comorbidity
Substance abuse disorders

Nicotine dependence
Anxiety, depression, and suicide Physical health or illness
Polydipsia
55
Etiology
Biological factors
Genetics
Neurobiological
Dopamine theory Other neurochemical hypotheses
Brain structure abnormalities Psychological and environmental factors

Prenatal stressors Psychological stressors Environmental stressors
56
Course of the Disorder
Prodromal Responses to treatment
57
Phases of Schizophrenia
Phase I Acute
Onset or exacerbation of symptoms
Phase II Stabilization
Symptoms diminishing Movement toward previous level of functioning
Phase III Maintenance

At or near baseline functioning
58
Assessment
During the prepsychotic phase General assessment

Positive symptoms
Negative symptoms Cognitive symptoms Affective symptoms
59
Positive Symptoms
Alterations in thinking
Delusions False, fixed beliefs Concrete thinking Inability to think abstractly
Alterations in speech Associative looseness

Clang associations Word salad Neologisms Echolalia
60
Positive Symptoms (Cont.)

Other disorders of thought or speech
Religiosity
Magical thinking
Paranoia Circumstantiality Tangentiality
Cognitive retardation
Alogia, or poverty of speech Flight of ideas Thought blocking
Thought insertion
Thought deletion
61
Alterations in perception
Depersonalization Derealization Hallucinations
Auditory
Command Visual
62

Alterations in Behavior
Catatonia Motor retardation Motor agitation
Echopraxia Negativism
Impaired impulse control

Gesturing or posturing Boundary impairment
Stereotyped behaviors
Waxy flexibility
63
Negative Symptoms
Affect
Flat
Blunted Inappropriate Bizarre
64
Cognitive Symptoms
Difficulty with
Attention Memory Information processing Cognitive flexibility Executive functions
65
Affective Symptoms
Assessment for depression is crucial

May herald impending relapse
Increases substance abuse Increases suicide risk Further impairs functioning
66
Outcomes Identification
Phase I Acute
Patient safety and medical stabilization
Phase II Stabilization
Help patient understand illness and treatment Stabilize medications Control or cope with symptoms
Phase III Maintenance

Maintain achievement Prevent relapse Achieve independence, satisfactory quality of life
67
Planning
Phase I Acute
Best strategies to ensure patient safety and provide symptom stabilization
Phase II Stabilization Phase III Maintenance

Provide patient and family education Relapse prevention skills are vital
68
Interventions
Acute Phase
Psychiatric, medical, and neurological evaluation
Psychopharmacological treatment Support, psychoeducation, and guidance Supervision and limit setting in the milieu
Monitor fluid intake
Stabilization and Maintenance Phases

Medication administration/adherence Relationships with trusted care providers
Community-based therapeutic services
69
Interventions Counseling and communication techniques

Hallucinations Delusions Associative looseness Health teaching and health promotion
Psychobiological Interventions
Antipsychotic medications
First-generation Second-generation Third-generation
70
First-Generation Antipsychotics
Dopamine antagonists (D2 receptor antagonists)
Target positive symptoms of schizophrenia

Advantage
Less expensive than second generation
Disadvantages
Extrapyramidal side effects (EPS)
Anticholinergic side effects Tardive dyskinesia Weight gain, sexual dysfunction, endocrine disturbances
71
Second-Generation Antipsychotics
Treat both positive and negative symptoms
Minimal to no extrapyramidal side effects (EPS) or tardive dyskinesia

Disadvantage tendency to cause significant weight gain
72
Third-Generation Antipsychotic
Aripiprazole (Abilify)
Dopamine system stabilizer

Improves positive and negative symptoms and cognitive function
Little risk of EPS or tardive dyskinesia
73
Potentially Dangerous Responses to Antipsychotics

Anticholinergic toxicity Neuroleptic malignant syndrome (NMS) Agranulocytosis
74
Adjuncts to Antipsychotic Drug Therapy
Antidepressants Mood stabilizing agents
75
Other Interventions
Individual and group therapy Psychoeducation
Medication prescription and monitoring

Basic health assessment Cognitive remediation Family therapy
76

Unit 2 BLKBD 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Unit 2 BLKBD 1

Uploaded by

Copyright:

Available Formats

Chapter 33

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Characteristics That Influence a Group

Size Defined purpose

Degree of similarity among members

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Therapeutic Factors Common to All Groups

Phases of Group Development

Orientation phase Working phase Termination phase

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Group Member Roles

Task roles Maintenance roles Individual roles

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Group Leadership Responsibilities

Initiating Maintaining Terminating

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Basic Level Registered Nurse (Cont.)

Symptom-management groups Stress-management groups

Therapeutic community meeting groups

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dealing with Challenging Member Behaviors

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Characteristics of Family Function

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Characteristics of Family Function (Cont.)

Patterns of behavior and interaction Responses to stressors

Ability to interact with support services

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Overview of Family Therapy

Insight-oriented family therapy

Behavioral family therapy

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Concepts Central to Family Therapy

Identified patient Family triangles

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Early Stress-Response Theories

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Negatively affects bodys ability to produce protective factors

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Mediators of the Stress Response

Perception Individual temperament Social support

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Managing Stress Through Relaxation Techniques

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Defenses Against Anxiety

Can be healthy or unhealthy

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Separation anxiety disorder

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Clinical Picture (Cont.)

Social anxiety disorder

Generalized anxiety disorder

Other anxiety disorders

Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.