Mood and Effect

Post Grieve Nursing Care and Mood and Effect

Mood and effect,concept of self and role & relationships.

  Physiological Background of Mood and Effects

  In assessing mood and affect, the nurse must remember that a wide anger. range of emotions is possible; from passivity The client may look frightened or scared or agitate and hostile depending on his or her experience. When the client experiences a flashback, he or she appears terrifies and may cry, scream, or attempt to hide or run away. When the client is dissociating, he or she may speak in a different tone of voice or appear numb with a vacant stare . The client may report intense rage or anger or feeling dead inside and unable to identify any feelings or emotions.

Thought Process and Content

    The nurse asks questions about the thought process and content. Clients who have been abused or traumatized report reliving the trauma, often through nightmares or flash backs. Intrusive, persistent thoughts about the trauma interfere with the client's ability to think about other things or to focus on daily living. Some clients report hallucinations or buzzing voices in their heads. Self-destructive thoughts and impulses as well as intermittent suicidal ideation are also common. Some clients report fantasies in which they take revenge on their abusers.

Sensorium and Intellectual Processes

    During assessment of sensorium and intellectual processes, the nurse usually finds that the client is oriented to reality except if the client is experiencing a flashback or dissociative episode. During those experiences, the client may not respond to the nurse or may be unable to communicate at all. The nurse also may find that clients who have been abused or traumatized have memory gaps, which are periods for which they have no clear memories. These periods may be short or extensive and are usually related to the time of the abuse or trauma. Intrusive thoughts or ideas of self-harm often impair the client's ability to concentrate or pay attention.

    Judgment and Insight The client's insight is often related to the duration of his or her problems with dissociation or PTSD. Early in treatment, the client may report little idea about the relationship of past trauma to his or her current symptoms and problems. Other clients may be quite knowledgeable if they have progressed further in treatment. The client's ability to make decisions or solve problems may be impaired.

Self concept

    The nurse is likely to find these clients have low self-esteem. They may believe they are bad people who somehow deserve or provoke the abuse. Many clients believe they are unworthy or damaged by their abusive experiences to the point that they will never be worthwhile or valued. Clients may believe they are going crazy and are out of control with no hope of regaining control. Clients may see themselves as helpless, hopeless, and worthless.

Roles and Relationships

    Clients generally report a great deal of difficulty with all types of relationships. Problems with authority figures often lead to problems at work, such as being unable to take directions from another or have another person monitor his or her performance Close relationships are difficult or impossible because the client's ability to trust others is severely compromised. Often the client has quit work or has been fired, and he or she may be estranged from family members Intrusive thoughts, flashbacks, or dissociative episodes may interfere with the client's ability to socialize with family or friends, and the client's avoidant behavior may keep him or her from participating in social or family events.

Physiologic Considerations

    Most clients report difficulty sleeping because of night mares or anxiety over anticipating nightmares. Overeating or lack of appetite is also common. Frequently, these chants use alcohol or other drugs to attempt to sleep or to blot out intrusive thoughts or memories

Data Analysis

    Nursing diagnoses commonly used in the acute care set ting when working with clients who dissociate or have PTSD related to trauma or abuse include the following:

• Risk for Self-Mutilation

Ineffective Coping

Post-Trauma Response

Chronic Low Self-Esteem

Powerlessness

    In addition, the following nursing diagnoses may be pertinent for clients over longer periods, although not all diagnoses apply to each client

• Disturbed Sleep 
• Pattern Sexual Dysfunction
• Rape Trauma 
• Syndrome Spiritual Distress.
• Social Isolation
• Outcome identification

Treatment outcomes for clients who have survived trauma or abuse may include the following

1. The client will be physically safe.

2. The client will distinguish between ideas of self-harm and taking action on those ideas.

3. The client will demonstrate healthy, effective ways of dealing with stress.

4. The client will express emotions nondestructively

5. The client wants to establish a social support system in the community intervention

Promoting the Client's Safety

    The client's safety is a priority. The nurse must continually assess the client's potential for self-harm or suicide and take action accordingly. The nurse and treatment team must provide safety measures when the client cannot do so . To increase the client's sense of personal control, he or she must begin to manage safety needs as soon as possible. The nurse can talk with the client about the difference between having self-harm thoughts and taking action on those thoughts: having the thoughts does not mean the client must act on those thoughts. Gradually, the nurse can help the client to find ways to tolerate the thoughts until they diminish in intensity.

    The nurse can help the client learn to go to a safe place during destructive thoughts and impulses so that he or she can calm down and wait until they pass. Initially, this may mean just sitting with the nurse or around others. Later, the client can find a safe place at home, often a closet or small room, where he or she feels safe. The client may want to keep a blanket or pillows there for comfort and pictures of a tape recording to serve as reminders of the present.Helping the Client Cope with Stress and Emotions Grounding techniques are helpful to use with the client who is dissociating or experiencing a flashback grounding.