STUDY GUIDE & BLUEPRINT
EXAM 2 RNSG 2213 Sum I
Chapter 9
Restraints: the direct application of physical force to a person without his or her permission to
restrict his or her freedom of movement. The physical force may be human or mechanical or
both. Only for the shortest time necessary
nursing responsibilities precise documentation every 1-2 hours, when necessary, when faceto-face occurs (within 1 hour and q8h/ q4h child), when order is renewed(q4h/q2h) child, etc
? time frame practitioner come in face to face: within 1 hour.
Debriefing session within 24 hours after release from seclusion or restraint
A person can be detained in a psychiatric facility for 48 to 72 hours on an emergency basis until a
hearing can be conducted to determine whether or not he or she should be committed to a facility
What is meant by having the least restrictive environment? It means that a client does not
have to be hospitalized if he or she can be treated in an outpatient setting or in a group home.
It also means that the client must be free of restraint or seclusion unless it is necessary.
When does a patient have the right to refuse medication or treatment? Yes
How can a nurse minimize risk of legal liability? Precise documentation, close supervision of pt
Practice within the scope of state laws and nurse practice act
Collaborate with colleagues to determine the best course of action
Use established practice of standards to guide decisions and actions
Always put the client’s rights and welfare first
Develop effective interpersonal relationships with clients and families
Accurately and thoroughly document all assessment data, treatments, interventions, and
evaluations of the client’s response to care
What are freedoms with voluntary institutionalization versus involuntary institutionalization?
Involuntary: Cannot leave but can refuse meds/tx
Voluntary: can leave ama
What is false imprisonment
If you tell someone that I’m going to send you to your room or knock you out with a med and follow
through? What type of false imprisonment, assault, battery?
Imprisonment: “He was walking into other patient’s rooms so we had to restrain him during the night.
What is negligence? Unintentional tort. Many times batter and false imprisonment are 2
charges charged together as 2 charges for one event
Elements to prove malpractice:
Duty
Breach of Duty
Injury or Damage
Causation
Chapter 11
Anger and hostility: what is anger and is it ok to be angry?
Hostility: verbal aggression
Physical aggression: involves attack on or injury to another person or destruction of property
What are phases of aggression? Triggering Event/Escalation/ Crisis Point/ Recovery/ Post-Crisis
Depression
Triggering Phase: Approach in nonthreatening, calm manner, convey empathy, listening,
encourage verbal expression of feelings, Suggest pt go to a quieter area, use PRN meds,
suggest a walk
Know these and what would you expect to have happen if any of these phases occur? Ex: Call
for security, walk with the patient, etc.
Escalation Phase: aggression management Take control; firm directions calm voice, direct to
quiet area for time out, offer PRN meds, let pt know aggression is unacceptable, nurse or staff
will help maintain/regain control, if ineffective, obtain help from other staff-show of force
Try to avoid CRISIS point. Show fist and cursing is escalation and intervention would be a show of force,
talk them down, comfort, relaxation techniques, deep breathing, slow breaths encouraged give meds
Crisis phase: inform pt that behavior is out of control and staff is taking control to provide
safety and prevent injury. Use of restraint if necessary,
Recovery Phase: Talk about situation or trigger, help pt relax or sleep, explore alt to aggressive
behavior, document injury, debrief staff
Postcrisis phase: remove pt form restraint or seclusion to rejoin milieu(social environment),
calmly discuss behavior without lecturing or chastising, allow pt to return to activities, groups,
and so forth, focus on appropriate expression of feelings, resolution of problems or conflicts in
nonaggressive manner
Chapter 12
What are characteristics of family violence? encompasses spouse battering; neglect and
physical, emotional, or sexual abuse of children; elder abuse; and marital rape. In many cases,
family members tolerate abusive and violent behavior from relatives they would never accept
from strangers. In violent families, the home, which is normally a safe haven of love and
protection, may be the most dangerous place for victims.
• Social isolation • Abuse of power and control • Alcohol and other drug abuse •
Intergenerational transmission process
What are some safety questions that can be asked on the health history? Do you feel safe at
home? Are your children safe at home?
Are your family and friends concerned for your safety?
Do you ever feel threatened?
If you felt threatened or unsafe, is there someone you can call? Night or day?
Do you have a safe place to go if you need to?
Do you have a plan if suddenly your situation becomes unsafe?
What are characteristics of abusers? An abusive husband often believes his wife belongs to
him (like property) and becomes increasingly violent and abusive if she shows any sign of
independence, such as getting a job or threatening to leave. Typically, the abuser has strong
feelings of inadequacy and low self-esteem as well as poor problem-solving and social skills. He
is emotionally immature, needy, irrationally jealous, and possessive. He may even be jealous of
his wife’s attention to their own children or may beat both his children and his wife. By bullying
and physically punishing the family, the abuser often experiences a sense of power and control,
a feeling that eludes him outside the home. Therefore, the violent behavior is often rewarding
and boosts his self-esteem.
Emotional, physical abuse or neglect esp. those in relationship violence
What are some warning signs (characteristics of the one doing violence) of relationship
violence? Huge needs for attention and control, they don’t have a high self-esteem, they want to
control somebody else
Emotionally abuses you insults, makes belittling comments, or acts sulky or angry when you initiate an
idea or activity
Tells you with whom you may be friends or how you should dress, or tries to control other elements of
your life
Gets jealous for no reason
Drinks heavily, uses drugs, or tries to get you drunk
Acts in an intimidating way by invading your personal space such as standing too close or touching you
when you don’t want that
Cannot handle sexual or emotional frustration without becoming angry
Does not view you as an equal: sees self ass smarter or socially superior
Guards masculinity by acting tough
Is angry or threatening to the point that you have changed your life or yourself so you won’t anger him
Goes through extreme highs and lows: is kind one minute, cruel the next
Berates you for not getting drunk or high, or not wanting to have sex
Is physically aggressive, grabbing and holding you or pushing and shoving
What is emotional abuse? Hostility, includes name-calling, belittling, screaming, yelling,
destroying property, and making threats as well as subtler forms, such as refusing to speak to or
ignoring the victim.
What is physical abuse? ranges from shoving and pushing to severe battering and choking and
may involve broken limbs and ribs, internal bleeding, brain damage, and even homicide.
What is financial abuse? Make the partner completely financial dependent
What are some issues with childhood abuse? Perpetuates in to the next generation. The
abused become the abusers. They may develop PTSD
What is an example of the honeymoon phase, tension building etc: see cycle of violence
A typical pattern exists; usually, the initial episode of battering or violence is followed by a
period of the abuser expressing regret, apologizing, and promising it will never happen again.
He professes his love for his wife and may even engage in romantic behavior (e.g., buying gifts
and flowers). This period of contrition or remorse is sometimes called the honeymoon period.
The woman naturally wants to believe her husband and hopes the violence was an isolated
incident. After this honeymoon period, the tension-building phase begins; there may be
446arguments, stony silence, or complaints from the husband. The tension ends in another
violent episode after which the abuser once again feels regret and remorse and promises to
change. This cycle continually repeats itself
Chapter 13
What is the difference between PTSD and acute stress disorder?
Acute: immediate onset or within a few weeks lasts about one month
PTSD:
When might PTSD occur? Months after event or longer
What might cause PTSD? Natural disaster, accident, death, witness an event
What are major elements of PTSD? night terrors, hyper arousal, reliving the event, having
disassociation with the people or places of the event, irritability or aggression
Chapter 14
What are the stages of the adaptation syndrome? (Selye’s) alarm, Resistance, exhaustion
Anxiety levels: know them and what might be characteristics
What is desensitization? Slowly expose the client to what is causing the anxiety and increase
exposure
Why is medication and therapy used together? Better results
Why is caffeine to be avoided with generalized anxiety disorder? Due to its stimulant
properties
What is agoraphobia? Afraid to go outside
Chapter 15
Is the client aware of behaviors with OCD? yes
What is body dysmorphic disorder? Always want body to be better as in models and
bodybuilders
Therapeutic communication for clients with OCD
Offering support and encouragement to the client is important to help him or her manage
anxiety responses. The nurse can validate the overwhelming feelings the client experiences
while indicating the belief that the client can make needed changes and regain a sense of
control. The nurse encourages the client to talk about the feelings and describe them in 576as
much detail as the client can tolerate. Because many clients try to hide their rituals and keep
obsessions secret, discussing these thoughts, behaviors, and resulting feelings with the nurse is
an important step. Doing so can begin to relieve some of the “burden” the client has been
keeping to him or herself.
Treatment for OCD behavioral therapy, SSRI