Transcript Mental Health Nursing II NURS 2310

Mental Health Nursing II
NURS 2310
Unit 7
Psychiatric Crisis
Management
Objective 1
Reviewing the concepts associated
with stress and stressors
Stress = a state of bodily or mental tension
resulting from factors that tend to alter an
existent equilibrium; stress is necessary for
growth and development.
Stressors = anything that necessitates an
adaptive response on the part of the
individual
Adaptation = adjustment to or modification of
the environment for purposes of survival
Objective 2
Examining physical and
psychological responses to stress
Physical responses to stress:
General Adaptation Syndrome
 Biological responses

Psychological responses to stress:
Anxiety
 Grief

General Adaptation Syndrome
 Alarm reaction stage
– physiological responses of the fight-or-flight
syndrome are initiated

Stage of resistance
– physiological responses used as a defense in
attempt to adapt to the stressor

Stage of exhaustion
– prolonged exposure to the stressor to which
the body has become adjusted
– adaptive energy is depleted, and diseases of
adaptation may occur
Associated biological responses
 Immediate response
Activation of the sympathetic nervous
system
– pupils dilate
– respiration rate increases (dilated bronchioles)
– heart rate and blood pressure increases
– sweat glands increase production

Sustained response
Stimulation of the pituitary gland
– increases fluid retention and blood pressure
– basal metabolic rate increased
Objective 3
Reviewing the levels of
anxiety and associated
symptoms/behaviors of
each
Anxiety = a vague, diffuse apprehension that
is associated with feelings of uncertainty
and helplessness
 Low levels of anxiety are adaptive and can
provide the motivation required for survival
 Becomes problematic when the symptoms
escalate to a level that interferes with the
ability to meet basic needs
 Levels of anxiety
– Mild anxiety
– Moderate anxiety
– Severe anxiety
– Panic anxiety
Mild Anxiety
 Seldom a problem for the individual
 Associated with the tension experienced in
response to the events of day-to-day living
 Prepares people for action
– sharpens the senses
– increases motivation for productivity
– increases the perceptual field
– results in heightened awareness of the
environment

Learning is enhanced; individual is able to
function at an optimal level
Moderate Anxiety
 Perceptual field diminishes
 Less alert to events occurring within the
environment
 Attention span and ability to concentrate
decrease
 Needs direction to attend to own needs
 Requires assistance with problem-solving
 Increased muscular tension
 Restlessness
Severe Anxiety
 Perceptual field so greatly diminished that
concentration centers on one particular
detail only, or on many extraneous details
 Attention span extremely limited
 Difficulty completing even the simplest task
 Physical symptoms (headaches,
palpitations, and insomnia)
 Emotional symptoms (confusion, dread, and
horror)
 All overt behavior aimed at relieving the
anxiety due to extent of discomfort
Panic Anxiety
 Most severe form of emotional anxiety
 Symptoms include a sudden overwhelming
feeling of terror or impending doom
– Usually accompanied by behavioral, cognitive,
and physiological signs and symptoms that are
considered to be outside the expected range of
normalcy
– Individual is unable to focus on even one detail
within the environment
– Misperceptions are common
 Loss of contact with reality
 May experience hallucinations or delusions
Panic Anxiety (cont’d)
 Behavior ranges from wild and desperate
actions to extreme withdrawal
 Human functioning and communication with
others is ineffective
 Prolonged panic anxiety can lead to
physical and emotional exhaustion
– Life-threatening
Objective 4
Exploring various defense
mechanisms
Defense mechanisms are unconscious coping
strategies used to diminish anxiety and that
can hinder personality development when
used excessively or inappropriately
Types of defense mechanisms:
Compensation = covering up a real or perceived
weakness by emphasizing a trait one considers
more desirable
Denial = refusing to acknowledge the existence
of a real situation or the feelings associated
with it
Defense mechanisms (cont’d)
Displacement = the transfer of feelings from one
target to another that is considered less
threatening or that is neutral
Identification = an attempt to increase selfworth by acquiring certain attributes and
characteristics of an individual one admires
Intellectualization = an attempt to avoid
expressing actual emotions associated with a
stressful situation by using the intellectual
processes of logic, reasoning, and analysis
Defense mechanisms (cont’d)
Introjection = integrating the beliefs and values
of another individual into one’s own ego
structure
Isolation = separating a thought or memory
from the feeling tone or emotion associated
with it
Projection = attributing feelings or impulses
unacceptable to one’s self to another person
Rationalization = attempting to make excuses or
formulate logical reasons to justify
unacceptable feelings or behaviors
Defense mechanisms (cont’d)
Reaction Formation = preventing unacceptable
or undesirable thoughts or behaviors from
being expressed by exaggerating opposite
thoughts or types of behaviors
Regression = responding to stress by retreating
to an earlier level of development and the
comfort measures associated with that level of
functioning
Repression = involuntarily blocking unpleasant
feelings and experiences from one’s awareness
Defense mechanisms (cont’d)
Sublimation = rechanneling of drives or impulses
that are personally or socially unacceptable
into activities that are constructive
Suppression = the voluntary blocking of
unpleasant feelings and experiences from
one’s awareness
Undoing = symbolically negating or canceling
out an experience that one finds intolerable
Objective 5
Identifying behaviors
associated with maladaptive
coping
Coping = the process of responding to stress
or a potential stressor
Adaptive coping mechanisms = effective,
therapeutic ways of dealing with stress
Maladaptive coping mechanisms =
detrimental behaviors that decrease the
ability to cope with illness
– use of defensive mechanisms
– substance abuse
– eating disorders
– addiction (i.e. gambling)
– exacerbation of mental disorder
Objective 6
Describing
effective
coping
strategies to
decrease
psychological/
emotional
discomfort
Conscious coping strategies are purposeful
behaviors used to make an unfamiliar
situation controllable and predictable
Relaxation techniques are the most
commonly used conscious coping strategies
Relaxation techniques include:
 imagery
 relaxation strategies
– deep breathing exercises, meditation
– yoga, zen practices
therapeutic touch
 music therapy

Objective 7
Defining psychiatric crisis
Crisis = a sudden event in one’s life that
disturbs homeostasis and during which
usual coping mechanisms cannot resolve
the problem
Types of emotional crisis include:
 Dispositional crises
 Crises of anticipated life transitions
 Crises resulting from traumatic stress
 Maturational/developmental crises
 Crises reflecting psychopathology
 Psychiatric emergencies
Characteristics of a crisis:





Crisis occurs in all individuals at one time or
another and is not necessarily equated with
psychopathology
Crises are precipitated by specific identifiable
events
Crises are personal by nature; what may be
considered a crisis situation by one individual may
not be so for another
Crises are acute, not chronic, and will be resolved
in one way or another within a brief period
A crisis situation contains the potential for
psychological growth or deterioration
Phases in the development of a crisis:
Phase I – Exposure to a precipitating stressor
 anxiety increases; previous problem-solving skills
are employed
Phase II – Previous problem-solving techniques fail
 anxiety increases further; discomfort exists;
feelings of confusion prevail as coping skills are
exhausted
Phase III – Internal and external resources used
 use of new problem-solving techniques
Phase IV – Tension mounts to the breaking point
 anxiety may reach panic levels; cognitive
functions are disordered; emotions are labile;
behavior may reflect the presence of psychotic
thinking; major disorganization of the individual
with drastic results often occurs
Objective 8
Identifying types of
psychiatric crisis
Suicidal thinking or behaviors
Homicidal thinking or behaviors
Acute psychotic symptoms
Sudden change in mental status
Violence resulting from a mental disorder
Objective 9
Exploring components of crisis
intervention
Crisis intervention = the provision of emergency
psychological care to clients in order to
restore their level of functioning and to
prevent or decrease potential negative effects
of the crisis
– requires problem-solving skills that are often
lacking in the client due to the level of anxiety
accompanying disequilibrium
– assistance with problem-solving during the crisis
period preserves self-esteem and promotes
growth with resolution
– provide guidance and support to help mobilize the
resources needed to resolve the crisis
Crisis intervention consists of:

Preventing clients in crisis from harming
themselves or others

Administering medications

Providing a supportive, therapeutic
environment
Objective 10
Identifying clients at risk for suicide

Diagnosed mental disorder
– Depressive disorder
Previous suicide attempt
 Family history of suicide
 Gender

– Females more likely to attempt suicide
– Males more likely to complete suicide

Age
– Adolescents more likely to attempt suicide
– Individuals age 65 or older more likely to
complete suicide
Caucasians
 Substance abuse


Socioeconomic status
– Highest socioeconomic class
– Lowest socioeconomic class

Occupational
– Professional health care personnel
– Business executives

Single, divorced, or widowed individuals
– Isolation
Any type of loss
 Physical illness
 Hopelessness
 Impulsive and/or aggressive tendencies

Objective 11
Identifying warning symptoms and
preventative nursing interventions
for individuals who are at risk for
suicide
Warning Symptoms
 8 out of 10 people who kill themselves have
given definite warnings about their intentions
– Approach all suicidal behavior with the gravity of
the potential act in mind
– Attention should be given to the possibility that
the individual is issuing a cry for help
– Between 50% and 80% of all people who
ultimately kill themselves have a history of a
previous attempt

People who want to kill themselves are
typically suicidal only for a limited time
– Most suicidal people are ambivalent about their
feelings regarding living or dying
Warning Symptoms (cont’d)
 Suicidal persons are not necessarily psychotic
or otherwise mentally ill
– Unable to see an alternative solution to what is
considered an unbearable problem
– Most suicides occur within 3 months after the
beginning of “improvement”
 Individual has gained the energy to carry out suicidal
intentions
Preventative Nursing Interventions
 Provide effective and appropriate clinical care
 Encourage use of family support and
community resources
 Assist in restricting access to highly lethal
methods of suicide
 Provide education with regards to problemsolving, conflict resolution, and nonviolent
handling of disputes
 Ensure arrangement are in place so that
suicidal individual is not left alone
 Establish therapeutic rapport