CRISIS AND CRISIS INTERVENTION

SITUATION THAT OCCURS WHEN AN INDIVIDAULS HABITUAL COPING ABILITY BECOMES INEFFECTIVE TO MEET THE DEMANDS OF THE SITUATION CHARACTERISTICS:
-LAST 4-6 WKS,SELF LIMITING -INDIVIDUALIZED , AFFECTING SUPPORT SYSTEM -CAN PROMOTE GROWTH AND NEW BEHAVIORS -PERSONS BECOMES PASSIVE AND SUBMISSIVE

STAGES OF CRISIS

DENIAL INCREASED TENSION AND ANXIETY DISORGANIZATION ATTEMPTS TO REORGANIZE / ATTEMPTS TO ESCAPE GENERAL REORGANIZATION

TYPES OF CRISIS 1.MATURATIONAL / DEVELOPMENTAL CRISIS 2. SITUATIONAL / ACCIDENTAL 3. SOCIAL CRISIS

GOAL OF THE NURSE- TO ENABLE THE PATIENT TO ATTAIN OLOF.

SITUATIONAL CRISIS

GRIEVING-4-8 WEEKS TO 1 YEAR

FOCUS ON HERE AND NOW PROVIDE SUPPORT AND ENCOURAGE VERBALIZATION AND EXPRESSION DABDA KEEP COMMUNICATION OPEN GIVE SENSE OF CONTROL AND DIGNITY

DYING

RAPE TRAUMA SYNDROME 3-4 WKS REORGANIZATION LONG TEM SELF BLAME , PHOBIAS , ANXIETY AND PSYCHOSOMATIC TENDENCIES PROVIDE FOR PHYSIOLOGICAL NEEDS FIRST AND REFER FOR MEDICOLEGAL

DOMESTIC VIOLENCE

BATTERED WIFE SYNDROME HUMILIATION , BEATING AND OTHER FORMS OF AGGRESSION ABUSIVE MEN LOW SELF-ESTEEM ABUSED WOMEN DEPENDENT PERSONALITY

THEY COME FROM ABUSIVE FAMILIES IMMATURE DEPENDENT AND NONASSERTIVE STRONG FEELINGS OF INADEQUACY

DOMESTIC VIOLENCE PRIORITY OF CARE PROVISION OF SHELTER STAGES

tension building acute battering aftermath honeymoon

CHILD ABUSE

INTENTIONAL PHYSICAL , EMOTIONAL, SEXUAL MISUSE /TRAUMA, OR INTENTIONAL OMISSION OF BASIC NEEDS(NEGLECT)(ABANDONMENT). USUALLY RELATED TO DIMINISHED/LIMITED ABILITY OF PARENTS TO COPE WITH, PROVIDE FOR OR RELATE TO CHILD

INDICATORS

S ERIOUS INJURIES IN VARIOUS STAGES OF HEALING ( INCONSISTENCIES) HEALTHY HAIR IN VARIOUS LENGTH AND ABDOMINAL INJURIES (SEVERE) A PATHY , NO REACTION D EPRESSION/DISTURBANCE IN PARENT CHILD INTERACTION E EXCESSIVE KNOWWLEDGE OF SEX

EMOTIONAL NEGLECT-FAILURE TO THRIVE

S ELF ESTEEM - LOW

CHILD ABUSE INTERVENTIONS

PROVIDE FOR PHYSICAL NEEDS FIRST MANDATORY REPORTING TO APPROPRIATE AGENCY NON JUDGEMENTAL Tx OF PARENTS.TEACH G AND D PROVIDE EMOTIONAL SUPPORT FOR THE CHILD(PLAY THERAPY) INITIATE PROSPECTIVE PLACEMENT PROPER DOCUMENTATION

Substance Abuse

Alcoholism

State of physical and psychological dependence on alcohol manifested by the individuals inability to refrain from drinking or control alcohol consumption lowered self esteem ----alcohol drinking ---guilt and anxiety(limited life goals,unreliable , impulsive and irresponsible)

liver can metabolize 20 ml of alcohol or 1 ounce of whisky over 90 minutes- can depress respiration and cause death
.1-.2% - low coordination .2-.3 % - presence of ataxia , tremors , irritability and tremors .3 above unconsciousness

Theories of Causation

Psychoanalytic -fixation to oral stage Learning -due to a learned behavior Biologic- inherited traits Socio-cultural -effects of mass media

Phases

pre alcoholic-social drinking prodromal becomes a need ; blackouts occur crucial cardinal symptom develops (lack of control over drinking) chronic phase the person becomes intoxicated all day

Outcome:

brain damage alcoholic hallucinosis death

behavioral problems

denial dependency demanding destructive domineering

withdrawal signs and symptoms

hallucinations,visual and tactile increased vital signs tremors sweating and seizure defense mechanisms: denial rationalization isolation projection

Alcohol Withdrawal Symptoms

tremulousness- up to 2 hours afterward hallucinations 12- 48 hours w/ N/V Grand Mal Seizures ( rum fits) 23 days

delirium tremens

severe memory disturbance,agitation and hallucinations few days 1-5 days hyperthermia, severe diaphoresis, hypertension and tachycardia. confusion disorientation, agitation , tremors and alterations in sensory perception administer librium / benzodiazepines monitor PR,BP and temp quiet , well lighted environment seizure precuation stay w/ patient orient, thiamine administration , anti convulsants, IV glucose

Wernickes Syndrome

confusion/disorientation opthalmoplegia ataxia/apathy thiamine deficiency IM /IV THIAMINE, ALC. ABSTINENCE

KORSAKOFFS PSYCHOSIS

THIAMINE AND NIACIN DEFICIENCY RETROGRADE ANTEROGRADE AMNESIA CONFABULATION AND LEARNING PROB. KORSAKOFFS PSYCHOSIS- LOSS OF REALITY TESTING , TASTE AND SMELL BALANCED DIET, THIAMINE AND ALC. ABSTINENCE

LONG TERM GOALS

COMMUNITY RESOURCES OTHER MEANS\ PERSONAL DECISION INCREASED SELF-ESTEEM NUTRITRION- INC VIT B AND C , CHO GROUP THERAPY, DEVELOP INSIGHT INEFFECTIVE INDIVIDUAL COPING

AVERSION THERAPY

ANTABUSE DELAY ALC. METABOLISM PNT MUST BE ALCOHOL FREE FOR 12 HOURS AVOID ALCOHOL CONTAINING FOODS/PRODUCTS -MOFFAVS

DRUG ADDICTION

PSYCHOLOGICAL AND PHYSIOLOGICAL DEPENDENCE ; INCREASING DOSES NEEDED TO MAINTAIN HIGH TOLERANCE ABUSERS -LOW FRUSTRATION TOLERANCE -NEED FOR IMMEDIATE GRATIFICATION TO ESCAPE ANXIETY

INTERVENTIONS

BEHAVIOR MODIFICATION (FIRMNESS, MATTER-OF-FACT ATTITUDE) DETOXIFICATION FIRST STEP IN REHABILITATION ADMINISTER MEDICATIONS AS ORDERED

ANTI HYPERTENSIVES;ANTI,ANXIETYADMINISTERED TO PATIENTS ABUSING STIMULANTS ANTIANXIETY ; ANTIDEPRESSANTSADMINISTERED TO PATIENTS WHO ARE ABUSING DEPRESSANTS

IMPLEMENTATION
OBSERVE FOR SIGNS AND SYMPTOMS TREAT SYMPTOMS OF OVERDOSE: MAINTAIN RESPIRATION IV THERAPY ADMINISTER NALOXONE ( NARCAN) LAVAGE FOR OVERDOSE ( SPEC SEDATIVES) DIALYSIS TO ELIMINATE BARBITURATES OBSERVE FOR WITHDRAWAL(SWEATING , AGITATION , PANIC) AND TREAT Sx

IDENTIFY TYPE SEIZURE PREC KEEP AIRWAY ON HAND DETOXIFY GRADUALLY

METHADONE OR NALTREXONE USED FOR LONG TERM MAINTENANCE AND ACUTE NARCOTIC WITHDRAWAL DECREASING DOSES OF DRUG SUBSTITUTE

PROMOTE PHYSICAL HEALTH IMPLEMENT MEASURES FOR PERSONALITY DISORDERS AND MANIPULATIVE BEHAVIOR TREAT UNDERLYING EMOTIONAL PROBLEMS ASSIST CLIENTS WITH REHABILITATION

STIMULANTS

COCAINE METHAMPHETAMINE DEXEDRINE WEIGHT LOSS ,HYPERACTIVITY INCREASED V.S. ,LOSS OF APPETITE,EUPHORIA, AGITATION IRRITABILITY, DILATED PUPILS

STIMULANTS

WITHDRAWAL:

DEPRESSION, IRRITABILITY, PSYCHOSIS,

COCAINE(PERFORATED NASAL SEPTUM AND MINOR RESPIRATORY ARREST) -PSYCHOMOTOR AGITATION AND SEIZURE- WITHDRAWAL s/s

NARCOTICS

MORPHINE HEROIN DEMEROL DILAUDID CODEINE

-METHADONE FOR MAINTENANCE AND DETOXIFICATION

NARCOTICS

SIGNS AND SYMPTOMS PINPOINT PUPILS DROWSINESS INCOORDINATION RESPIRATORY DEPRESSION WITHDRAWAL IRRITABILITY, TREMORS , PANIC,CRAMPS, NAUSEA, HYPERTENSION, HALLUCINATIONS, DELUSIONS, WATERY EYES, RUNNY NOSE

BARBITURATES

PHENOBARBITAL RESP DEPRESSION , DEC. V.S., NYSTAGMUS AND DECREASE MENTAL ALERTNESS WITHDRAWAL SEIZURES, TREMORS, DELIRIUM , ANXIETY SODIUM BICARBONATE TO PROMOTE EXCRETION

HALLUCINOGENS

LSD, PCP,MESCALINE DILATED PUPILS, HALLUCINATIONS, DELIRIUM, FLASHBACKS, CONFUISON AND HYPERACTIVITY NO WITHDRAWAL SMALL DOSES OF VALIUM / HALDOL,TALK DOWN, MAINTAIN AIRWAY AND CONTROL SEIZURES

CANNABIS

FATIGUE, PARANOIA,PSYCHOSIS,EUPHORIA, INCREASED APPETITE, DISORIENTATION WITHDRAWAL INSOMNIA, HYPERACTIVITY, ANOREXIA DISAPPEAR IN 5-8 HOURS

TALK DOWN

AUTISM

IMPAIRMENT IN COMMUNICATION SKILS, PRESENCE OF STEREOTYPED BEHAVIOR, INTEREST AND ACTIVITIES WITH ASSOCIATED IMPAIRMENT IN SOCIAL INTERACTIONS SENSORY INTEGRATION AND SOCIAL INTERACTIONS TREATABLE BUT NOT CURABLE IMPAIRED INTERPERSONAL FUNCTIONING CAUSED BY BRAIN ANOXIA AND MEDICATIONS/DRUGSA/R

AUTISM

RESISTANCE TO NORMAL TEACHING METHODS AND RESISTS CHANGE IN ROUTINE ECHOLALIA CRYING TANTRUMS SPINNING SUSTAINED ODD PLAY NO EYE CONTACT ATTACHMENTS TO INANIMATE OBJECTS

COMMON PROBLEMS

TANTRUMS WITH HEADBANGING -PLACE HEAD PROTECTION AND ENSURE SAFETY; SANDWICH HUG MAY BE USED COMMUNICATION- ALL VOWELS, USE OF SHORT SENTENCES AND PERFORM ENGAGEMENT ROUTINES PROVIDE CONSISTENCY PRIORITY- RISK FOR INJURY

MOOD DISORDERS

DISTURBANCES IN EMOTIONAL AND BEHAVIORAL RESPONSE PATTERNS. RANGES FROM ELATION AND AGITATION TO SEVERE DEPRESSION AND SERIOUS POTENTIAL FOR SUICIDE

BIPOLAR DISORDERS

MOOD DISORDERS WHICH MAYBE OBSERVED AT ANY GIVEN TIME, BOTH OF WHICH MAYBE PRESENT SIMULTANEOUSLY( Bipolar , mixed) or symptoms of one may alternate with the other (Cyclothymia) . characterized by episodes of: -mania-hyperactivity , excitement,agitation, decreased need for sleep, impaired ability to concentrate -depression under activity, apathy, profound sadness, guilt and low self esteem

depression- psychodynamics

response to real or imagined loss anger and aggression towards self resulting from feelings of guilt about negative or ambivalent feelings introjection occurs(incorporation of a loved or hated object or person into ones own ego)

types:

MAJOR DEPRESSION SEVERE LASTS 2 WKS. DYSTHYMIA- LESS SEVERE 2YEARS OR > DEPRESSION NOT OTHERWISE SPECIFIED

2 DAYS 2WEEKS

MAINTAIN THERAPEUTICALLY SAFE ENVIRONMENT

SUPPORTIVE PROF. ATTITUDE ONGOING ASSESSMENT ENCOURAGING AND REASSURING

ECT AS ORDERED ADMINISTER MEDICATIONS- ANTI DEPRESSANTS / ESKALITH SHOW CONFIDENCE AND WORK WITH PATIENT

BIPOLAR DISORDER

AFFECTIVE DISORDER , ELATION AND GRANDIOSITY DEFENSE AGAINST UNDERLYING DEPRESSION/LOW SELF ESTEEM TESTING AND MANIPULATIVE BEHAVIOR INDICATIVE OF LOW SELF- ESTEEM STRONG TENDENCY TO RECUR TESTING , MANIPULATIVE , DEMANDING BEHAVIOR

BIPOLAR DISORDERS

heredity important factor AS WELL AS BIOCHEMICAL failure of individual to function successfully in preserving internal emotional equilibrium between unconscious wishes and impulses vs moral conscience precipitated by deep, emotionally traumatizing loss

inconsistent or abusive parenting withdrawal of physical nurturance

BIPOLAR DISORDERS

mania flight from reality to escape inner conflict, depression is the result of failing to deal adequately with conflict mania and depression to gain attention , approval and emotional support oral, greedy and demanding repression and suppression rationalization , projection and introjection grandiosity and fantasizing a nurturing parent

SUBTYPES OF BIPOLAR D/O

MANIC SEVERE , LASTS 1 WK HYPOMANIC LESS SEVERE ,4 DAYS BIPOLAR 1 WITH HISTORY OF MANIA BIPOLAR 2 NO HISTORY OF MANIA CYCLOTHYMIA- EPISODES OF HYPOMANIA AND DEPRESSION THAT LAST 2 YEARS

MANIC TYPE

EUPHORIA 1ST SIGN ELATED BEHAVIOR MOOD INCREASE, DELUSIONS OF GRANDEUR AND SELFIMPORTANCE. IRRITABITY W/ DELUSION OF PERSECUTION EASY DISTRACTIBILITY AND FLIGHT OF IDEAS DECREASED SLEEP AND FOOD

DEPRESSED TYPE

INTEREST IS LOW SELF ESTEEM - LOW DEPENDENCY ENERGY IS LOW FATIGUE

ELATION - MANIA

SUICIDAL

INTERVENTIONS

PSYCHOTHERAPY NOT EFFECTIVE PATIENT UNREACHEABLE EMPHASIZE BEING RATHER THAN DOING RELATE FROM A NON COMPETITIVE FRAME OF REFERRENCE DEVELOP REALISTIC ADULT RELATIONSHIPS AND CONTRACTS FOR CHANGE PROVIDE FOR SAFETY AND UNDERSTANDING

INTERVENTRIONS

SIMPLIFY ENVT. SET LIMITS COMMUNICATE FIRM UNAMBIVALENT CONSISTENT APPROACH. MEE MEET PHYSICAL NEEDS FIRST ENCOURAGE REST ADMINISTER LITHIUM EAT NA RICH FOOS AND INCREASE FLUIDS

SPECIFIC INTERVENTION TECHNIQUES

PROVIDE UNDERSTANDING PACING AND LEADING-GEN . INTERVENTION PROVIDE FOR SAFETY PROVIDE EMOTIONAL CONFRANTATION AND COGNITIVE RESTRUCTURING

DIFFERENTIATION:
MANIA

DEPRESSION

COLORFUL AGGRESSION OUTWARDS LITHIUM NON-STIMULATING MILLIEU QUIET ACT./AVOID COMPETITIVE MATTER OF FACT

SAD AGGRESION INWARDS ECT STIMULATING MILLEU MONOTONOUS ACT. COUNTING KIND FIRMNESS

SUICIDE

VIOLENCE , SELF DIRECTED ; RISK FOR

SELF DESTRUCTIVE BEHAVIOR(INTROJECTION)ANFER AND RAGE TURNED INWARDS OR INTO AN ATTEMPT TO PUNISH OTHERS MOST COMMON AS DEPRESSION IS LIFTING 1014 DAYS AFTER ANTI DEPRESSANT MEDICATIONS/ NEW SIGNS OF ENERGY OR IMPROVEMENT INDIVIDUAL FEELS GUILTY AND OVERWHELMED SUICIDE SEEN AS RELIEF AMBIVALENCE MAY LEAD TO CRY FOR HELP OR ATTENTION ATTEMPTS TO COPE FAIL-HOPELESSNESS AND HELPLESSNESS

RISK FACTORS: SEX WHITE MALE DIVORCED CAUCASIAN UNSUCCESSFUL PREVIOUS ATTEMPT IDENTIFICATION WITH SOMEONE WHO COMMITED SUICIDE CHRONIC ILLNESS DEPRESSION/DEPENDENT PERSONALITY AGE (18-25 AND >40) , ALCOHOLISM LETHALITY OF PREVIOUS ATTEMPTS/LOSSES

KEY POINTS

ONE ON ONE MONITORING FREQUENT UNSCHEDULED ROUNDS SAFE ENVIRONMENT(REMOVE ALL POTENTIALLY DANGEROUS ITEMS MONITOR FOR SIGNS DISCUSS ALL BEHAVIOR WITH TEAM MEMBERS INTERVENE QUICKLY AND CALMLY DURING ATTEMPTS PROVIDE AFMILY THERAPY / GIVE CLIENT SENSE OF CONTROL OTHER RHAN SUICIDE(PROB.SOLVING ,DECISION MAKING,SUICIDE CONTRACT)

ORGANIC CONDITIONS
DELIRIUM

DEMENTIA

DISORIENTATION

ACUTE ALL AGES CLOUDED SENSORIUM REVERSIBLE

IMPAIRMENT OF MEMORY CHRONIC ELDERLY CLEAR SENSORIUM IRREVERSIBLE

ALZHEIMERS DISEASE

PRESENCE OF SENILE PLAQUES THAT DESTROYS NEURONS LEADING TO DECREASED ACETYLCHOLINE. degenerative neurological disorder characterized by loss of cognitive function and disturbances in behavior AGNOSIA AMNESIA APRAXIA APHASIA ANOMIA AGRAPHIA

PHASES

FORGETFULNESS PHASE- DIFFICULTY REMEMBERING APPOINTMENTS ADVANCE PHASE DIFFICULTY IN REMEMBERING PAST EVENTS BUT NOT RECENT TERMINAL PHASE- DEATH IN 1 YEAR PRIORITY NSG DX -ALTERED THOUGHT PROCESS NEED FOR REOROIENTATION

areas affected

judgement-unable to think abstractly anf formulate concepts, paranoia affect-agitation and inc. in activity,depression memory- forgetfulness cognition-short attention span orientation-inability to perform ADL and night wandering

Implementation

provide calm predictable environment and regular routine(clear simple explanations, clock and calendar, color code ,) COGNEX provide for safety (night light call light, low bed , half bed rails, distract and redirect during wandering, avoid restraints) reduce anxiety and agitation walking, exercising, socializing, remain calm and stay w/ patient during catastrophic reaction improve communication and promote independence in ADL promote good nutrition,balance of activity and rest and teaching and support to caregivers