Exam 2: NSG221/ NSG 221 (Latest 2024/ 2025 Update) Mental Health | Guide with Questions and Verified Answers| 100% Correct- Herzing
Exam 2: NSG221/ NSG 221 (Latest 2024/
2025 Update) Mental Health | Guide with
Questions and Verified Answers| 100%
Correct- Herzing
Q: Kubler-Ross Name of 5 Stages
Answer:
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Q: Kubler-Ross 5 Stages of Grief: Denial
Answer: - Denial is shock and disbelief regarding the loss.
Q: Kubler-Ross 5 Stages of Grief: Anger
Answer: - Anger may be expressed toward God, relatives, friends, or health care providers.
Q: Kubler-Ross 5 Stages of Grief: Bargaining
Answer: - Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss.
Q: Kubler-Ross 5 Stages of Grief: Depression
Answer:
- Depression results when awareness of the loss becomes acute.
Q: Kubler-Ross 5 Stages of Grief: Acceptance
Answer: - Acceptance occurs when the person shows evidence of coming to terms with death.
This model became a prototype for care providers as they looked for ways to understand and
assist their clients in the grieving process.
Q: Engel Name of 5 Stages of Loss
Answer: - Shock and Disbelief
- Developing Awareness
- Restitution
- Resolution of Loss
- Recovery
Q: Engel Stages of Loss: Shock & Belief
Answer: - Shock and disbelief: The initial reaction to a loss is a stunned, numb feeling accompanied by
refusal to acknowledge the reality of the loss in an attempt to protect the self against
overwhelming stress.
Q: Engel Stages of Loss: Developing Awareness
Answer: - Developing awareness: As the individual begins to acknowledge the loss, there may be crying,
feelings of helplessness, frustration, despair, and anger that can be directed at self or others,
including God or the deceased person.
Q: Engel Stages of Loss: Restitution
Answer: - Restitution: Participation in the rituals associated with death, such as a funeral, wake, family
gathering, or religious ceremonies that help the individual accept the reality of the loss and begin
the recovery process.
Q: Engel Stages of Loss: Resolution of Loss
Answer: - Resolution of the loss: The individual is preoccupied with the loss, the lost person or object is
idealized, and the mourner may even imitate the lost person. Eventually, the preoccupation
decreases, usually in a year or perhaps more.
Q: Engel Stages of Loss: Recovery
Answer: - Recovery: The previous preoccupation and obsession ends, and the individual is able to go on
with life in a way that encompasses the loss.
Q: Treatment for Alcohol Withdrawl Symptoms:
Answer:
Chlordiazepoxide (Librium)
Dosage: 50-100mg repeat in 2-4 hours if necessary, do not exceed 300 mg/day
Monitor vital signs and global assessments for effectiveness; may cause dizziness or drowsiness
Alcohol withdrawal is usually managed with a benzodiazepine anxiolytic agent, which is used to
suppress the symptoms of abstinence. The most commonly used benzodiazepines are lorazepam,
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Mourning Rituals Mourning is the outward expression of grief. Rituals of mourning include having a wake, sitting shiva, holding religious ceremonies, and arranging funerals.
Physiologic Loss Examples include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility.
Safety Loss Loss of a safe environment is evident in domestic violence, child abuse, or public violence. A person’s home should be a safe haven with trust that family members will provide protection, not harm or violence. Some public institutions, such as schools and churches, are often associated with safety as well. That feeling of safety is shattered when violence occurs on campus or in a holy place.
Loss of Security and a Sense of Belonging The loss of a loved one affects the need to love and the feeling of being loved. Loss accompanies changes in relationships, such as birth, marriage, divorce, illness, and death; as the meaning of a relationship changes, a person may lose roles within a family or group.
Loss of Self-Esteem Any change in how a person is valued at work or in relationships or by him or herself can threaten self-esteem. It may be an actual change or the person’s perception of a change in value. Death of a loved one, a broken relationship, loss of a job, and retirement are examples of change that represent loss and can result in a threat to self-esteem.
Loss Related to Self-Actualization An external or internal crisis that blocks or inhibits striving toward fulfillment may threaten personal goals and individual potential. A person who wanted to go to college, write books, and teach at a university reaches a point in life when it becomes evident that those plans will never materialize or a person loses hope that he or she will find a mate and have children. These are losses that the person will grieve.
Kubler-Ross Name of 5 Stages 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
Kubler-Ross 5 Stages of Grief: Denial 1. Denial is shock and disbelief regarding the loss.
Kubler-Ross 5 Stages of Grief: Anger 2. Anger may be expressed toward God, relatives, friends, or health care providers.
Kubler-Ross 5 Stages of Grief: Bargaining 3. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss.
Kubler-Ross 5 Stages of Grief: Depression 4. Depression results when awareness of the loss becomes acute.
Kubler-Ross 5 Stages of Grief: Acceptance 5. Acceptance occurs when the person shows evidence of coming to terms with death.This model became a prototype for care providers as they looked for ways to understand and assist their clients in the grieving process.
Engel Name of 5 Stages of Loss 1. Shock and Disbelief2. Developing Awareness3. Restitution4. Resolution of Loss5. Recovery
Engel Stages of Loss: Shock & Belief 1. Shock and disbelief: The initial reaction to a loss is a stunned, numb feeling accompanied by refusal to acknowledge the reality of the loss in an attempt to protect the self against overwhelming stress.
Engel Stages of Loss: Developing Awareness 2. Developing awareness: As the individual begins to acknowledge the loss, there may be crying, feelings of helplessness, frustration, despair, and anger that can be directed at self or others, including God or the deceased person.
Engel Stages of Loss: Restitution 3. Restitution: Participation in the rituals associated with death, such as a funeral, wake, family gathering, or religious ceremonies that help the individual accept the reality of the loss and begin the recovery process.
Engel Stages of Loss: Resolution of Loss 4. Resolution of the loss: The individual is preoccupied with the loss, the lost person or object is idealized, and the mourner may even imitate the lost person. Eventually, the preoccupation decreases, usually in a year or perhaps more.
Engel Stages of Loss: Recovery 5. Recovery: The previous preoccupation and obsession ends, and the individual is able to go on with life in a way that encompasses the loss.
Treatment for Alcohol Withdrawl Symptoms: Chlordiazepoxide (Librium)Dosage: 50-100mg repeat in 2-4 hours if necessary, do not exceed 300 mg/dayMonitor vital signs and global assessments for effectiveness; may cause dizziness or drowsinessAlcohol withdrawal is usually managed with a benzodiazepine anxiolytic agent, which is used to suppress the symptoms of abstinence. The most commonly used benzodiazepines are lorazepam, chlordiazepoxide, and diazepam. These medications can be administered on a fixed schedule around the clock during withdrawal.
Medication that Maintains Abstinence From Alcohol: Disulfiram (Antabuse)500mg/day for 1-2 weeks, then 250 mg/dayTeach client to read labels to avoid products with alcohol.Disulfiram (Antabuse) may be prescribed to help deter clients from drinking. If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result
Physciologic Responses to Grief: Physiologic Responses to Grief:Physiologic symptoms and problems associated with grief responses are often a source of anxiety and concern for the grieving person as well as for friends or caregivers. Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent bereavement-associated symptoms
Behavioral Responses to Grief “Behavioral Responses to Grief:Behavioral responses to grief are often the easiest to observe. The grieving person may function “”automatically”” or routinely without much thought, indicating that the person is numb; the reality of the loss has not set in. Tearfully sobbing, crying uncontrollably, showing great restlessness, and searching are evidence of the outcry of emotions”
Spiritual Responses to Grief: Spiritual Responses to Grief:Closely associated with the cognitive and emotional dimensions of grief are the deeply embedded personal values that give meaning and purpose to life. These values and the belief systems that sustain them are central components of spirituality and the spiritual response to grief. Ministering to the spiritual needs of those grieving is an essential aspect of nursing care. Providing opportunities for clients to share their suffering assists in the psychological and spiritual transformation that can evolve through grieving.
Emotional Responses to Grief Emotional Responses to Grief:Anger, sadness, and anxiety are the predominant emotional responses to loss. Guilt over things not done or said in the lost relationship is another painful emotion. Emotional responses are evident throughout the grieving process. A common first response to the news of a loss is to be stunned, as though not perceiving reality. Emotions vacillate in frequency and intensity
Cognitive Responses to Grief: “Cognitive Responses to Grief:Questioning & Trying to Make Sense of the Loss: The nurse might hear the following questions: “”Why did this have to happen? He took such good care of himself!”” “”Why did such a young person have to die?”” “”She was such a good person! Why did this happen to her?””Attempting to Keep the Lost One Present: Belief in an afterlife and the idea that the lost one has become a personal guide are cognitive responses that serve to keep the lost one present. Carrying on an internal dialogue with the loved one while doing an activity is an example of this. This method of keeping the lost one present helps soften the effects of the loss while assimilating its reality.”
Cultural Considerations After Death: African Americans African Americans: Typically, the deceased is viewed in church before being buried in a cemetery. Mourning may also be expressed through public prayers, black clothing, and decreased social activities. The mourning period may last a few weeks to several years.
Cultural Considerations After Death: Muslim Americans Muslin Americans: Islam does not permit cremation. It is important to follow the five steps of the burial procedure, which specify washing, dressing, and positioning of the body. The first step is traditional washing of the body by a Muslim of the same gender
Cultural Considerations After Death: Haitian Americans “Haitian Americans: Some Haitian Americans practice vodun (voodoo), also called “”root medicine.”” Derived from Roman Catholic rituals and cultural practices of western Africa, vodun is the practice of calling on a group of spirits with whom one periodically makes peace during specific events in life. The death of a loved one may be such a time. This practice can be found often throughout the American South and in some communities within New York City”
Cultural Considerations After Death: Chinese Americans Chinese Americans: The largest Asian population in the United States, the Chinese have strict norms for announcing death, preparing the body, arranging the funeral and burial, and mourning after burial. Burning incense and reading scripture are ways to assist the spirit of the deceased in the afterlife journey. If the deceased and his or her family are Buddhists, meditating before a shrine in the room is important. For 1 year after death, the family may place bowls of food on a table for the spirit.
Cultural Considerations After Death: Native Americans Native Americans: A tribe’s medicine man or priestly healer, who assists the friends and family of the deceased to regain their spiritual equilibrium, is an essential spiritual guide. Ceremonies of baptism for the spirit of the deceased seem to help ward off depression of the bereaved. . To designate the end of mourning, a ceremony at the burial grounds is held during which the grave is covered with a blanket or cloth for making clothes. Later, the cloth is given to a tribe member. A dinner featuring singing, speech-making, and contributing money completes the ceremony.
Cultural Considerations After Death: Hispanic Americans Hispanic Americans: They may pray for the soul of the deceased during a novena (9-day devotion) and a rosary (devotional prayer). They manifest luto (mourning) by wearing black or black and white while behaving in a subdued manner. Respect for the deceased may include not watching TV, going to the movies, listening to the radio, or attending dances or other social events for some time. Friends and relatives bring flowers and crosses to decorate the grave.
Cultural Considerations After Death: Vietnamese Americans Vietnamese Americans: Vietnamese Americans are predominately Buddhists, who bathe the deceased and dress him or her in black clothes. They may put a few grains of rice in the mouth and place money with the deceased so that he or she can buy a drink as the spirit moves on in the afterlife. The body may be displayed for viewing in the home before burial. When friends enter, music is played as a way to warn the deceased of the arrival.
Cultural Considerations After Death: Filipino Americans Filipino Americans: Most Filipino Americans are Catholic, and depending on how close one was to the deceased, wearing black clothing or armbands is customary during mourning. Family and friends place wreaths on the casket and drape a broad black cloth on the home of the deceased. Family members commonly place announcements in local newspapers asking for prayers and blessings on the soul of the deceased.
Cultural Considerations After Death: Japanese Americans Japanese Americans: Buddhist Japanese Americans view death as a life passage. Close family members may bathe the deceased with warm water and dress the body in a white kimono after purification rites. For 2 days, family and friends bearing gifts may visit or offer money for the deceased while saying prayers and burning incense.
Assessment of Coping After Death: Assessment of coping after death and therapeutic response:Effective assessment involves observing all dimensions of human response: what the person is thinking (cognitive), how the person is feeling (emotional), what the person’s values and beliefs are (spiritual), how the person is acting (behavioral), and what is happening in the person’s body (physiologic).While observing client responses in the dimensions of grieving, the nurse explores three critical components in assessment:Adequate perception regarding the lossAdequate support while grieving for the lossAdequate coping behaviors during the process
Diagnoses Associated with Anger Diagnoses Associated with Anger:Aggressive behavior is also seen in clients with dementia, delirium, head injuries, intoxication with alcohol or other drugs, and antisocial and borderline personality disorders. Violent patients tend to be more symptomatic, have poorer functioning, and show a marked lack of insight compared with nonviolent patients. Some clients with depression have anger attacks. These sudden intense spells of anger typically occur in situations in which the depressed person feels emotionally trapped.Intermittent explosive disorder (IED)is a rare psychiatric diagnosis characterized by discrete episodes of aggressive impulses that result in serious assaults or destruction of property. The aggressive behavior the person displays is grossly disproportionate to any provocation or precipitating factor
Name of Each of the 5 Stages of Escalation TriggeringEscalationCrisisRecoveryPostcrisis
Stages of Escalation: Triggering Triggering: An event or circumstances in the environment initiates the client’s response, which is often anger or hostility. Restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, anger
Stages of Escalation: Escalation Escalation: The client’s responses represent escalating behaviors that indicate movement toward a loss of control. Pale or flushed face, yelling, swearing, agitation, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to solve the problem or think clearly
Stages of Escalation: Crisis Crisis: During an emotional and physical crisis, the client loses control. Loss of emotional and physical control, throwing objects, kicking, hitting, spitting, biting, scratching, shrieking, screaming, inability to communicate clearly
Stages of Escalation: Recovery Recovery: The client regains physical and emotional control. Lowering of voice; decreased muscle tension; clearer, more rational communication; physical relaxation
Stages of Escalation: Postcrisis Postcrisis: The client attempts reconciliation with others and returns to the level of functioning before the aggressive incident and its antecedents. Remorse; apologies; crying; quiet, withdrawn behavior
Disruptive Behavior Disorders Related to Anger: List of Them Oppositional Defiant Disorder (ODD),Conduct DisorderIntermittent, Explosive Disorder, Kleptomania, & Pyromania
Disruptive Behavior Disorders Related to Anger: Kleptomania Kleptomania is characterized by impulsive, repetitive theft of items not needed by the person, either for personal use or monetary gain. Tension and anxiety are high prior to the theft, and the person feels relief, exhilaration, or gratification while committing the theft.
Disruptive Behavior Disorders Related to Anger: Pyromania Pyromania is characterized by repeated, intentional fire-setting. The person is fascinated about fire and feels pleasure or relief of tension while setting and watching the fires.
Risk Factors for Complicated Grief Some experiences increase the risk of complicated grieving for the vulnerable parties. These experiences are related to trauma or individual perceptions of vulnerability and include:Death of a spouse or childDeath of a parent (particularly in early childhood or adolescence)Sudden, unexpected, and untimely deathMultiple deathsDeath by suicide or murder
Workplace Bullying and Regulations Workplace Bullying & Regulations:In 2016, the JCAHO added workplace bullying, also known as lateral or horizontal violence, to this initiative. Bullying is defined as abusive conduct, such as verbal abuse, threatening, intimidating or humiliating behaviors, and work interference (sabotage), which prevents work from getting done.Several action steps have been suggested to accomplish this new standard of behavior, including:A code of conduct outlines acceptable and inappropriate/unacceptable behaviorA process for managers to handle disruptive or unacceptable behaviorEducation of all team members on expected professional behaviorZero tolerance for unacceptable behaviors, meaning all persons are held accountable
Outcomes for Aggressive Clients Expected outcomes for aggressive clients may include the following:1.The client will not harm or threaten others.2.The client will refrain from behaviors that are intimidating or frightening to others.3.The client will describe his or her feelings and concerns without aggression.4.The client will comply with treatment.
Oppositional Defiant Disorder Oppositional defiant disorder (ODD) consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. ODD is diagnosed only when behaviors are more frequent and intense than in unaffected peers and cause dysfunction in social, academic, or work situations. The disruptive, defiant behaviors usually begin at home with parents or parental figures and are more intense in this setting than settings outside the home.
Intermittent Explosive Disorder Intermittent explosive disorder (IED) involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts, usually lasting less than 30 minutes. During these episodes, there may be physical injury to others, destruction of property, and injury to the individual as well. The intensity of the emotional outburst is grossly out of proportion to the stressor or situation. In other words, a minor issue or occurrence may result in rage, aggression, and assault of others. The episode may occur with seemingly no warning. Afterward, the individual may be embarrassed and feel guilty or remorseful for his or her actions. But that does not prevent future impulsive, aggressive outbursts.
Conduct Disorder Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. These children and adolescents have significantly impaired abilities to function in social, academic, or occupational areas. Symptoms are clustered in four areas: aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules. Children with conduct disorder often exhibit callous and unemotional traits, similar to those seen in adults with antisocial personality disorder.
Principles of Limit Setting Limit setting involves the following three steps:Inform clients of the rule or limit.Explain the consequences if clients exceed the limit.State expected behavior.Providing consistent limit enforcement with no exceptions by all members of the health team, including parents, is essential.For limit setting to be effective, the consequences must have meaning for clients—that is, they must value or desire recreation time, for this example
Professional Response to Impaired Colleague The issue of reporting colleagues with suspected substance abuse is an important and extremely sensitive one. It is difficult for colleagues and supervisors to report their peers for suspected abuse. Substance abuse by health professionals is serious, however, because it can endanger clients. Nurses have an ethical responsibility to report suspicious behavior to a supervisor and, in some states, a legal obligation as defined in the state’s nurse practice act. Nurses should not try to handle such situations alone by warning the coworker; this often just allows the coworker to continue to abuse the substance without suffering any repercussions.
Risk Factors in Substance Abuse Disorders Children of alcoholic parents are at higher risk for developing alcoholism and drug dependence than are children of nonalcoholic parents. This increased risk is partly the result of environmental factors, but evidence points to the importance of genetic factors as well. In addition to the genetic links to alcoholism, family dynamics are thought to play a part. Children of alcoholics are four times as likely to develop alcoholism compared with the general population.Cultural factors, social attitudes, peer behaviors, laws, cost, and availability all influence initial and continued use of substances.
Nursing Interventions for Substance Abse Nursing interventions for clients being treated for substance abuse include teaching clients and families about substance abuse, dealing with family issues, and helping clients learn more effective coping skills
Alcohol Withdrawal Symptoms: Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake. Symptoms include coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium, called delirium tremens. Alcohol withdrawal usually peaks on the second day and is over in about 5 days. This can vary, however; and withdrawal may take 1 to 2 weeks.Because alcohol withdrawal can be life-threatening, detoxification needs to be accomplished under medical supervision
Opiate Withdrawal Symptoms: be precipitated by the administration of an opioid antagonist. Initial symptoms are anxiety, restlessness, aching back and legs, and cravings for more opioids. Symptoms that develop as withdrawal progresses include nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia. Symptoms of opioid withdrawal cause significant distress, but do not require pharmacologic intervention to support life or bodily functions
Strategies for Helping Client Anger Management. The treatment of aggressive clients often focuses on treating the underlying or comorbid psychiatric diagnosis such as schizophrenia or bipolar disorder. Successful treatment of comorbid disorders results in successful treatment of aggressive behavior. Although not a treatment per se, the short-term use of seclusion or restraint may be required during the crisis phase of the aggression cycle to protect the client and others from injury. Many legal and ethical safeguards govern the use of seclusion and restraint