NCM 117: Care of Clients with Maladaptive Patterns of Behavior PDF

NCM 117 Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) NURSING DEPARTMENT  LESSON 7: Grief, Anger, and Crisis NURSING DEPARTMENT ...

NCM 117 Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) NURSING DEPARTMENT  LESSON 7: Grief, Anger, and Crisis NURSING DEPARTMENT  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 1. Determine the variety of emotional response experienced by individuals; 1. Discuss loss and grief through its types, grieving process, dimensions, and cultural considerations;  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 3. Explain anger, aggression, and hostility in terms of expression, etiology, and cultural consideration; 3. Identify crisis based on its characteristics, types, and development; and  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 5. Value the role of the nurse in caring for people undergoing grief, anger issues, and crisis.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 7A EMOTIONAL RESPONSE  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines WHAT ARE EMOTIONS? ▪ from Latin verb emoverse, which means “to stir up” or “to move” ▪ psychophysiological reactions that define a person’s mood ▪ they have their own innate responses that are automatic and unique; often they provoke impulses.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines WHAT ARE EMOTIONS? ▪ If the emotions are intense, a disturbance in intellectual function occurs. When the situation is viewed as a challenge, emotions are more likely positive. If the event is evaluated as threatening or harmful, negative emotions are elicited. (Boyd, 2017)  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CATEGORIES OF EMOTIONS ▪ Negative ▪ Positive ▪ Borderline ▪ Nonemotions  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NEGATIVE EMOTIONS ▪ Occurs when there is a threat to, delay in, or thwarting of a goal or a conflict between goals: anger, fright, anxiety, guilt, shame, sadness, envy, jealousy, and disgust POSITIVE EMOTIONS ▪ Occurs when there is movement toward or attainment of a goal: happiness, pride, relief, and love  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines BORDERLINE EMOTIONS ▪ Somewhat ambiguous: hope, compassion, empathy, sympathy, and contentment NONEMOTIONS ▪ Connote emotional reactions but are too ambiguous to fit into any of the categories: confidence, awe, confusion, and excitement  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 7B LOSS & GRIEF  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 3, Chapters 10, Pages 151 - 169  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines OVERVIEW ▪ LOSS: an actual or potential situation in which something that is valued is changed or no longer available ▪ GRIEF: the total response to the emotional experience related to loss. It is manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines OVERVIEW ▪ BEREAVEMENT: the subjective response experienced by the surviving loved ones after the death of a person with whom they have shared a significant relationship ▪ MOURNING: the behavioural process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF LOSSES ▪ Physiologic Loss ▪ Safety Loss ▪ Loss of Security and a Sense of Belonging ▪ Loss of Self-esteem ▪ Loss related to Self-actualization  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines THEORIES OF GRIEVING  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines THEORIES OF GRIEVING  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines THEORIES OF GRIEVING ▪ George Engel ▪ Mardi Horowitz o Shock and disbelief o Outcry o Developing awareness o Denial and intrusion o Restitution o Working through o Resolution o Completin o Recovery  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines GRIEVING TASK ▪ Therese Rando ▪ William Worden o Recognize o Accepting the reality of loss o React o Working through the pain o Recollect and Reexperience of grief o Relinquish o Adjusting to an o Readjust environment o Reinvest o Emotional relocation  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF GRIEVING ▪ UNCOMPLICATED (NORMAL) ▪ Abbreviated: brief but genuinely felt. This can occur when the lost object is not significantly important or may have been replaced immediately by equally esteemed object. ▪ Anticipatory: occurs when people facing an imminent loss begin to grapple with the possibility of the loss or death in the near future  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF GRIEVING ▪ TRAUMATIC: normal grief responses experienced in combination with traumatic distress suffered as a result of a loved one dying in a way perceived to be frightening, horrifying, unexpected, violent and/or traumatic. Distress is extreme enough to impair daily functioning.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF GRIEVING ▪ COMPLICATED: a response outside the norm, occurring when a person is void of emotion, grieves for prolonged periods, or has expressions of grief that seem disproportionate to the event. The strategies to cope with the loss is maladaptive. ▪ Unresolved or Chronic: the person is frozen or stuck in a state of prolonged mourning (for more than 6 months)  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF GRIEVING ▪ COMPLICATED ▪ Inhibited: many of the normal symptoms of grief are sup- pressed, and other effects, including somatic, are experienced instead. ▪ Delayed: occurs when feelings are purposely or subconsciously suppressed until a much later time.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF GRIEVING ▪ COMPLICATED ▪ Exaggerated: occurs when someone in grief uses dangerous activities as a method to lessen the pain of grieving  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF GRIEVING ▪ DISENFRANCHISED: grieving over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. May be due to o a relationship that has no legitimacy o the loss itself is not recognized o the griever is not recognized o the loss involves social stigma  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines DIMENSIONS OF GRIEVING ▪ Cognitive Responses ▪ Emotional Responses ▪ Spiritual Responses ▪ Behavioral Responses ▪ Physiologic Responses  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CULTURAL CONSIDERATIONS ▪ Because cultural bereavement rituals have roots in several of the world’s major religions (i.e. Buddhism, Christianity, Hinduism, Islam, Judaism), religious or spiritual beliefs and practices regarding death frequently guide the client’s mourning.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ ASSESSMENT o Observe all dimensions of human response o Explore three critical components: 1. Adequate perception regarding the loss 2. Adequate support while grieving for the loss 3. Adequate coping behaviors during the process  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ DIAGNOSIS o Grieving o Complicated grieving o Risk for complicated grieving o Anticipatory grieving  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ OUTCOMES o Identify the effects of his or her loss o Identify the meaning of his or her loss o Seek adequate support while expressing grief o Develop a plan for coping with the loss o Apply effective coping strategies  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ OUTCOMES o Apply effective coping strategies o Recognize the negative effects of the loss on his or her life o Seek or accept professional assistance if need to promote the grieving process  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 7C ANGER, AGGRESSION & HOSTILITY  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 3, Chapters 11, Pages 127 - 183  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines OVERVIEW ▪ ANGER: a strong, uncomfortable emotional response to a provocation that is unwanted and incongruent with one’s values, beliefs, or rights ▪ HOSTILITY: verbal aggression; expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior ▪ PHYSICAL AGGRESSION: behavior in which a person attacks or injures another person or destroys property  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ANGER EXPRESSION ▪ Anger Suppression: (maladaptive) o feeling anxious when anger is aroused o acting as though nothing happened o withdrawing from people when angry o conveying anger nonverbally by body language o sulking, pouting, or ruminating  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ANGER EXPRESSION ▪ Unhealthy Outward Anger Expression: (maladaptive) o flying off the handle o expressing anger in an attacking or blaming way o yelling, saying nasty things o calling the other person names or using profanity o using fists rather than words to express angry feelings  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ANGER EXPRESSION ▪ Constructive Anger Discussion: o discussing the anger with a friend and family member even if the provocateur cannot be confronted at the time o approaching the person with whom one is angry and discussing the concern directly o using “I” language to describe feelings and request changes in another’s behavior  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ETIOLOGY ▪ NEUROBIOLOGIC CAUSES: o damage to the cerebral cortex o aggression-related gene (monoamine oxidase A) o low serotonin level o higher testosterone in males o low progesterone during menstruation  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ETIOLOGY ▪ PSYCHOANALYTIC: o suppression of emotions; limitation: studies does not support the theory of catharsis in reducing aggression ▪ BEHAVIORAL: o frustration-aggression hypothesis; limitation: not all situations in which one’s goal is blocked lead to anger or violence  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ETIOLOGY ▪ SOCIAL LEARNING: o children’s observations of aggressive behaviors among family members and violence in their communities foster a context for learning that aggressive behavior is an acceptable way of getting what they want ▪ GENERAL AGGRESSION MODEL (GAM) o a framework that accounts for the interaction of cognition, affect, and arousal during an aggressive episode  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CULTURAL CONSIDERATIONS ▪ Native American and Asian Cultures o see expressing anger as rude or disrespectful and avoid it at all costs ▪ People of color are overrepresented in interpersonal violence episodes o Note: race is not a factor but rather socioeconomic factors  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CULTURAL CONSIDERATIONS ▪ Terminologies of culture-bound anger syndrome: o Hwabyeong Korea o Bouffee delirante West Africa and Haiti o Amok Philippines, Malaysia, Laos o Cafard Polynesia o Mal de pelea Puerto Rico o Iich’aa Navajo  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ ASSESSMENT o Predictors: involuntary hospitalization suspiciousness impulsivity agitation unwillingness to follow unit rules  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ ASSESSMENT o Observable precursors: staring and eye contact tone and volume of voice anxiety mumbling pacing  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ ASSESSMENT o Impaired communication o Physical condition o Social factors o Milieu and environmental factors  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ DIAGNOSIS o Risk for Self-Directed Violence o Risk for Other-Directed Violence  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ INTERVENTION o Communication and development of therapeutic nurse- patient relationship 1. Listening to the patient’s illness experience and concerns 2. Validating 3. Providing choices  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ INTERVENTION o Cognitive interventions 1. Providing patient education 2. Developing prevention strtegies  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ INTERVENTION o Milieu and environmental interventions 1. Reducing stimulation 2. Creating a culture of nonviolence  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ INTERVENTION o Managing Imminent Aggression and Violence 1. De-escalation 2. Administering and monitoring PRN medications 3. Avoiding the use of seclusion and restraint  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines APPLICATION OF NURSING PROCESS ▪ EVALUATION o The patient regains or maintains control over aggressive or potentially aggressive thoughts, feelings, and actions. o Evidence of a reduction in risk factors o Examination of the interactions of the aggressor, victim, and environment  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 7D CRISIS  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 1, Chapters 3, Pages 52 - 53  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CRISIS ▪ a time-limited event that triggers adaptive or non-adaptive responses to maturational, situational, or traumatic experiences. It results from stressful events for which coping mechanisms fail to provide adequate adaptive skills to address the perceived challenge or threat. ▪ a state of temporary disequilibrium ▪ self-limiting; 24-36 hours or may last 4-6 weeks  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF CRISIS CRISIS PREDICTABILITY FACTORS Maturational or expected internal Developmental Situational unexpected internal/external Adventitious, Traumatic, or unexpected external Social  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines TYPES OF CRISIS: Examples Maturational Situational Adventitious Quarter-life crisis Death of a loved one Man-made disasters Midlife crisis Loss of a job Natural disasters Later life crisis Illness Violence  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines PHASES OF CRISIS A problem arises that contributes to increase in anxiety levels. The anxiety initiates the usual problem-solving techniques of the person. The usual problem-solving techniques are ineffective. Anxiety levels continue to rise. Trial-and-error attempts are made to restore balance.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines PHASES OF CRISIS The trial-and-error attempts fail. The anxiety escalates to severe or panic levels. The person adopts automatic relief behaviors. When these measures do not reduce anxiety, anxiety can overwhelm the person and lead to serious personality disorganization, which signals the person is in crisis.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CRISIS INTERVENTION ▪ GOAL: o return the client to a precrisis level o reestablish optimum level of functioning (OLOF) ▪ APPROACHES: o directive intervention o supportive intervention  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CRISIS INTERVENTION ▪ BALANCE THE FACTORS! o assess perception of the situation o assess coping mechanisms o assess support system: use people who can help size matters (the bigger the better, the more the merrier) availability  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Vince Harry A. Pinto, RN Thank you! +639093232790 [email protected]  NCM 117 Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) NURSING DEPARTMENT  LESSON 8: Abuse and Violence NURSING DEPARTMENT  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 1. Analyze the way in which the cycle of abuse and violence inhibits individuals from leaving abusive relationships; 1. Examine the incidence of domestic violence (intimate partner, child, and elder abuse), rape, and community violence;  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 3. Discuss the seriousness of abuse violence by determining laws that prohibits such acts; and 3. Determine treatment options and the role of the nurse in caring for victims of abuse and violence.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 8A OVERVIEW  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 3, Chapters 10, Pages 151 - 169  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines OVERVIEW ▪ ABUSE: wrongful use or maltreatment of another person ▪ VIOLENCE: extreme aggression and involves the use of strong force or weapons to inflict bodily harm to another person and in some cases to kill. It connotes greater intensity and destruction than aggression. All violence is aggression, but not all aggression is violence.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CYCLE OF ABUSE ▪ Stage 1: initial episode of the bat- tering or violence ▪ Stage 2: honeymoon period; the abuser expresses regret, apologi- zing, and promising it will never happen again  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CYCLE OF ABUSE ▪ Stage 3: relationship continue in a normal way by pretending that everything is alright ▪ Stage 4: arguments, stony silence, or complaints may be heard  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 8B FAMILY VIOLENCE (DOMESTIC ABUSE)  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 3, Chapters 12, Pages 187 - 196  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines FAMILY VIOLENCE ▪ encompasses spouse battering; neglect and physical, emotional, or sexual abuse of children; elder abuse; and marital rape ▪ In violent families, the home may be the most dangerous place.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CHARACTERISTICS OF VIOLENT FAMILIES ▪ Social Isolation ▪ Abuse of Power and Control ▪ Alcohol and other Drug Abuse ▪ Intergenerational Transmission Process  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines INTIMATE PARTNER VIOLENCE ▪ It is the mistreatment or misuse of one person by another in the context of an emotionally intimate relationship i.e spouses or partners  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Republic Act 9262 ▪ “Anti-Violence Against Women and Their Children Act of 2004.” ▪ It is hereby declared that the State values the dignity of women and children and guarantees full respect for human rights. The State also recognizes the need to protect the family and its members particularly women and children, from violence and threats to their personal safety and security.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CHILD ABUSE ▪ It is the intentional injury of the child. It can include physical abuse or injuries, neglect or failure to prevent harm, failure to provide adequate physical or emotional care or supervision, abandonment, sexual assault or intrusion, and overt torture or maiming.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Republic Act 7610 ▪ “Special Protection of Children Against Abuse, Exploitation and Discrimination Act.” ▪ The State shall intervene on behalf of the child when the parent, guardian, teacher or person having care or custody of the child fails or is unable to protect the child against abuse, exploitation and discrimination or when such acts against the child are committed by the said parent, guardian, teacher or person having care and custody of the same.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ELDER ABUSE ▪ It is the maltreatment of older adults by family members or others in a caregiver role. It may include physical and sexual abuse, psychological abuse, neglect, self-neglect, financial exploitation, and denial of adequate medical treatment.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines House Bill 7030 ▪ House Bill 7030 or the “Anti-Elder Abuse Act” provides penalties for abuses committed against the elderly. ▪ Approved on the third and final reading last February 2019. This proposed law which seeks to penalize with jail time and fines in accordance with the Revised Penal Code abuses against senior citizens that range from physical, psychological, economic, sexual, and neglect and abandonment.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 8C RAPE and SEXUAL ASSAULT  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 3, Chapters 12, Pages 196-198  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Republic Act 8353: The Anti-Rape Law of 1997 Rape is committed:” 1) By a man who shall have carnal knowledge of a woman under any of the following circumstances: a) Through force, threat, or intimidation; b) When the offended party is deprived of reason or otherwise unconscious;  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Republic Act 8353: The Anti-Rape Law of 1997 c) By means of fraudulent machination or grave abuse of authority; and d) When the offended party is under twelve (12) years of age or is demented, even though none of the circumstances mentioned above be present.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Republic Act 8353: The Anti-Rape Law of 1997 2) By any person who, under any of the circumstances mentioned in paragraph 1 hereof, shall commit an act of sexual assault by inserting his penis into another person’s mouth or anal orifice, or any instrument or object, into the genital or anal orifice of another person.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 8D COMMUNITY VIOLENCE  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 3, Chapters 12, Pages 198 - 199  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines COMMUNITY VIOLENCE ▪ Bullying, including cyberbullying ▪ Ostracism ▪ Hazing, or initiation rites ▪ Community violence: killings, maulings, etc. ▪ Terrorist attack  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 8E OBLIGATIONS of the NURSE  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REPORTING ▪ A study in 2017 indicates that routine screening rates of intimate partner violence have been consistently low. ▪ Development of guidelines or regulation with clearly defined parameters, including documentation of screening is needed. o properly document and preserve evidences…  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines SELF-AWARENESS ▪ Overcome the myths about abuse ▪ Questions about abuse will offend the client or fear that incorrect interventions will worsen the situation ▪ Woman who stays in abusive relationship might deserve or enjoy the abuse or that abuse between husband and wife is private ▪ Abuse is a societal or legal, not a health, problem  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines SELF-AWARENESS ▪ Nurses must be prepared to listen to their client’s story, no matter how disturbing, and support and validate the client’s feelings. ▪ Nurses must remember that he or she cannot fix or change things; the nurse’s role is to listen and convey acceptance and support for the client ▪ Nurses with personal histories of abuse or trauma must seek professional assistance first.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines HANDLING ▪ These clients have many strengths they may not realize. The nurse can help them move from being victims to being survivors. ▪ Nurses should ask all women about abuse. Some will be offended and angry, but it is more important not to miss the opportunity of helping the woman who replies, “Yes. Can you help me?”  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines HANDLING ▪ The nurse should help the client focus on the present rather than dwell on horrific things in the past. ▪ Usually, a nurse works best with either the survivors of abuse or the abusers themselves. Most find it too difficult emotionally to work with both groups.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Vince Harry A. Pinto, RN Thank you! +639093232790 [email protected]  NCM 117 Care of Clients with Maladaptive Patterns of Behavior (Acute and Chronic) NURSING DEPARTMENT  LESSON 9: NEURODEVELOPMENTAL DISORDERS NURSING DEPARTMENT  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 1. Identify formerly diagnosed neurodevelopmental disorders; 1. Distinguish key symptoms of neurodevelopmental disorders: intellectual disability, autism spectrum disorder, and attention- deficit/hyperactivity disorder;  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 3. Discuss the etiology of neurodevelopmental disorders; 3. Determine treatment options for clients with intellectual disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder;  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines LEARNING OUTCOMES: After this session, you should: 5. Apply the nursing process to the care of a client with intellectual disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder; and 5. Identify related neurodevelopmental disorders.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines REFER TO YOUR TEXTBOOK: Unit 4, Chapters 22, Pages 419 - 435  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 9A OVERVIEW  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NEURODEVELOPMENTAL DELAY ▪ the child’s development in attention, cognition, language, affect, and social or moral behavior is outside the norm and is manifested by delayed socialization, communication, peculiar mannerisms, and idiosyncratic interests.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 9B FORMERLY DIAGNOSED DISORDERS  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines RETT’S DISORDER ▪ a pervasive developmental disorder characterized by the development of multiple deficits after a period of normal functioning ▪ it occurs almost exclusively in girls, is rare, and persists throughout life ▪ develops between birth and 5 months of age ▪ the child loses motor skills and begins showing stereotyped  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines RETT’S DISORDER ▪ the child loses motor skills and begins showing stereotyped movement instead ▪ she loses interest in the social environment and severe impairment of expressive and receptive language becomes evident as she grows older  https://youtu.be/H2iKz1Cx-HQ?si=9OCcVIOGhhX82orv  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines CHILDHOOD DISINTEGRATIVE DISORDER ▪ a pervasive developmental disorder, characterized by marked regression in multiple areas of functioning after at least 2 years of apparently normal growth and development ▪ typical age of onset is between 3 ad 4 years, more often in boys ▪ Nonspecific anxiety or agitation is common  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ASPERGER’S DISORDER ▪ a pervasive developmental disorder characterized by impairments of social interaction and restricted interests or behaviors ▪ there is no language or cognitive delays; motor clumsiness is common ▪ occurs more often in boys, and the effects are generally lifelong  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 9C INTELLECTUAL DISABILITIES  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines INTELLIGENCE The ability to… ▪ Learn from experience: The acquisition, retention, and use of knowledge is an important component of intelligence. ▪ Recognize problems: To put knowledge to use, people must be able to identify possible problems in the environment that need to be addressed.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ▪ Solve problems: People must then be able to take what they have learned to come up with a useful solution to a problem they have noticed in the world around them. INTELLIGENCE QUOTIENT ▪ a total score derived from a set of standardized tests or subtests designed to assess human intelligence  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines IQ SCALE INTERPRETATION OF IQ SCORE above 130 Very gifted 121-130 Gifted 111-120 Above average intelligence 90-110 Average intelligence 80-89 Below average intelligence 70-79 Cognitively impaired  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines INTELLECTUAL DISABILITY ▪ a disability characterized by significant limitations in both intellectual function and in adaptive behavior that covers many everyday social and practical skills ▪ onset: before 18 years old ▪ occurs in 1% of the population, higher rates in low- and middle- income countries  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ETIOLOGY ▪ Most common cause: genetic syndromes ▪ chromosomal changes or defects (e.g. Down syndrome) ▪ exposure to toxins during pregnancy (e.g. fetal alcohol syndrome) ▪ heredity ▪ medication conditions ▪ environmental influences ▪ However, 50% of the cases have unknown cause.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NURSING MANAGEMENT  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ASSESSMENT ▪ Current adaptive skills, intellectual status, and social functioning ▪ Developmental history ▪ Support systems ▪ Other comorbid conditions  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines DIAGNOSIS ▪ May include: ▪ Ineffective Coping ▪ Delayed Growth and Development ▪ Interrupted Family Process  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines PLANNING and EVALUATION ▪ overall goal: an optimum level of functioning for the family and eventual independent functioning within a normal social environment for the child ▪ achieving independence in adulthood may be delayed but not impossible  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines INTERVENTION ▪ Promote coping skills: ▪ building strengths, adapting to change, and maintaining or achieving a higher level of functioning ▪ Patient education: special education ▪ Parent education: family therapy, parent training  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines Lesson 9D AUTISM SPECTRUM DISORDER  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines AUTISM SPECTRUM DISORDER ▪ a disorder that includes diagnoses previously categorized as different types of a pervasive developmental disorder (PDD), characterized by pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotypical behavioural patterns.  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines BEHAVIORS COMMON IN ASD ▪ Not responding to own name by 1 year ▪ Doesn’t show interest by pointing to objects or people by 14 months of age ▪ Doesn’t play pretend games by 18 months of age ▪ Avoids eye contact ▪ Prefers to be alone ▪ Delayed speech and language skills ▪ Obsessive interests  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines BEHAVIORS COMMON IN ASD ▪ Upset by minor changes in routine ▪ Repeats words or phrases over and over ▪ Flaps hands, or rocks or spin in a circle ▪ Answers are unrelated to questions ▪ Unusual reactions to sounds, smells, or other sensory experiences  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines RISK FACTORS ▪ Five times more prevalent in boys than in girls ▪ Identified in 18 months and no later than 3 years of age ▪ Relative with autism or autistic traits  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ETIOLOGY ▪ No known specific cause ▪ Hypotheses: ▪ Shared genetic etiology between autism spectrum disorder and schizophrenia ▪ Higher levels of lead and mercury and lower levels of antioxidants ▪ Maternal autoantibodies in the fetal brain; neurogenesis  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines MEDICAL MANAGEMENT ▪ Therapy: ▪ Special education and language therapy ▪ Cognitive behavioral therapy (for anxiety and agitation) ▪ Pharmacologic: No approved treatment ▪ Antipsychotics – for specific target symptoms ▪ Naltrexone, clomipramine, clonidine, and stimulants – to diminish self-injury and hyperactive and obsessive behaviors  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines NURSING MANAGEMENT  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines ASSESSMENT ▪ Physical Health Assessment  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines DIAGNOSIS ▪ Potential nursing diagnoses includes: ▪ Self-Care Deficits ▪ Delayed Growth and Development ▪ Disturbed Sleep Pattern ▪ Anxiety ▪ Disturbed Thought Processes ▪ Social Isolation  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines PLANNING and EVALUATION ▪ Long-term goal: achieve the highest level of functioning ▪ Short-term goals: ▪ Reduce self-injurious behavior by 50% ▪ Reduce behavioural symptoms (e.g. stereotyped motor behaviors) ▪ Promote learning and development, particularly the acquisition of language skills  JMJ Marist Brothers NCM-N 117 NOTRE DAME OF MARBEL UNIVERSITY College of Arts and Sciences Care of Clients with Maladaptive NURSING DEPARTMENT Patterns of Behavior Alunan Avenue, Koronadal City, South Cotabato, 9506 Philippines INTERVENTION ▪ Physical Health Interventions ▪ Develop a list of activities for the child to post in his or her bedroom (effective for some children) ▪ Drawings or symbols may be useful for no