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54 Cards in this Set
- Front
- Back
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Anxiety - Definition
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Anxiety - is a norm reaction to realistic danger or threat to biological integrity or self concept
Anxiety is an EMOTIONAL process; FEAR is cognitive |
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Panic
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Sudden overwhelming feeling of terror & pending doom
* Fight or Flight |
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Ego-syntonic
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Symptomatic behavior or beliefs that don't seem to bother the person (consistent with individuals self image)
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Ego- alien / Ego-dystonic
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Symptoms that are unacceptable to the person who has them and not compatiable with the person's view of self
(repulsive to self image) |
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Continuum of Anxiety responses
* Defense Mechanisms |
Unconscious- intrapsychic process used to ward off anxiety by preventing conscious awareness of feelings
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Panic disorders/Phobias
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NSG assesment
*Recurrent episodes *unpredictable *one incident more than one month of persistant concern of additional attacks *worry about consequences **Going crazy** Significant change in behavior 4 of the symptoms present; *Palpatations/pounding heart *Sweating *trembling/Shaking *SOB or smothering *feeling of choking *Chest pain or discomfort *Nausea / abd distress *feeling dizzy unsteady/faint *Derealization/depersonalization *fear of losing control or going crazy *fear of dying *parathesis *chills hotflashes |
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Agoraphobia
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Fear of being alone in open or public place where escape or getting help might be difficult
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Generalized anxiety disorder
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NSG asessment
Chronic excessive anxiety/worry about numerous things lasting more than six months with inability to control worry *Restlessness,keyed up,easily fatigued, difficulty concentrating,going blank,irritability,muscle tension,sleep disturbance *significant impairment in social occupational, or important functions |
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Predisposing factors to Panic & GAD
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Psychodynamic - EGO
cannot resolve conflict btwn super ego/ID; Ego defense mechanism causes maladaptive response to anxiety *congnitive - THINKING Distortions in thinking & perceiving accompany maladaptive behavior and emotional disorders Neurochemical - Norepinephrine |
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Transactional Model of Stress
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This theory of mulitple causations is presented in the transactional model of stress and adaptaion pg 567;Townsend
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Panic D/O & GAD
Diagnois and Outcomes |
D/O; Panic disorder;Powerlessness
Outcome; Recognize signs of escalating anxiety ; intervene before panic level *Maintain anxiety at managable/make independent decisions |
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Panic Disorders/GAD
NIC |
*explore decreased stressors/anxiety prevoking situations
*Talk to pt in calm/reassuring voice *safe environment *pt privacy *help pt use COGNITIVE RESTRUCTURING *Psycho therapy *Meds *relaxation therapy *exercise |
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Phobias
Nursing Assessments |
*Irrational fear of object (pt may realize it's unreasonable)
*Agoraphobia *Social phobia-fear of embarassed/critized *Specific phobia -fear of single object,activity,or situation |
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Predisposing factors PHOBIAS
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*Psychoanalytic - unconscious fears may be expressed in symbolic manner such as phobias
*Learning - conditioned response,direct learning,imagination *Cognitive- negative;irrational thinking beliefs produce anxiety reaction *Biological - Temperament involved; innate fears that one is born with influence responses throughtout life to specific responses *Life experiences- may set the stage for phobias later in life *Transactional Model |
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Diagnosis/Outcomes Phobic Disorder
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Diagnosis - Fear/Social isolation
Outcome: Functions adaptively in phobic situation/object without a panic anxiety Verbalizes a future plan of action for responding to a phobia |
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NSG Interventions Phobic Disorders
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Interventions for person experiencing anxiety
* Keep anxiety at manageable level *Help pt to function in presence of phobic object without panic anxiety * Systemic Desensitizing & Implosive Therapy -Flooding |
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Obsessive Compulsive
OCD |
Recurrent obsessions or compulsions that are severe enough to cause marked distress or signifcant impariment
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OCD - Assessments
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Obsessive- Thoughts/impulses/images that persist or recur cannot be dismissed (ego dystonic -senseless)
Compulsive - Repetitive/ritualistic behaviors,mental acts that a person is driven to perform to dec stess or prevent a dreaded event of situation **Person knows OCD are excessive,unreasonable can cause distress |
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OCD - Defense Mechanisms
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OCD is - EGO DYSTONIC
obsession = reaction formation compulsion = undoing *The ACT relieves anxiety** |
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Predisposing Factors to OCD
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Physchoanalytical- weak,underdeveloped egos;agressive impulses channeled into thoughts and behaviors that prevent aggression but increases anxiety & guilt
*Learning/Conditional - response to traumatic event *passive avoidance - staying away *active avoidance - provide relief Biological -Neuroanatomy;Physiology - depression & OCD commonalities *Biochemical - Serotonin may be influenced *Transactional Model - Stress adaptation multi factors |
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OCD - Diagnosis/Outcomes
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*Ineffective coping
*Ineffective role performance Outcome - *maintain anxiety at managable level without resorting to ritualistic behavior *adaptive coping strategies |
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NIC OCD
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Offer support
Be clear that pt can change Talk about feelings, obsessions,rituals **Gradually decrease time for ritualistic behavior** Help them gain independence Encourage pt to use techniques to manage & tol anxiety responses |
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PTSD
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Developement of characteristic symptoms following exposure to a severe, traumatic stressor involving a personal threat,to physical integrity or integrity of others
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PSTD Defense Mechanism
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Isolation/Regression
*Isolation - Fear of event remains conscious but feelings are removed *Repression - Unconsciously dissociates feelings associated with the event |
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PTSD Assessment
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*Re-experiencing traumatic events
*Intrusive recollections/flashbacks of the events *Depressions/guilt about survival *Irritability,difficulty concentrating/sleeping,hypervigilance,emotional numbing |
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PSTD Assessment Con't
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* symptoms > 1 month causing significant interference in function
(<1 month = acute stress d/o) *Disorder occurs at any time; 3 months after trauma/months/years later *Diagnostic criteria box (574;Townsend) |
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PSTD Theory
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Psychosocial
*traumatic experience *Individual (ego-strength,coping skills,preexisting psychopathology Recovery environment Biological; previous trauma may result in symptoms after a stessful event |
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PTSD Diagnosis/Outcome
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Post traumatic syndrome
Complicated grieving Outcome: Experience fewer flashbacks,intrusive recollections,nightmares *Demonstrate adaptive coping strategies; put trauma in past **Relaxation Therapy** |
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NSG Interventions PTSD
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Aim at providing assistance with;
*intergration of trauma into his or her persona *renewing significant relationships *Est meaningful goals for the future *progressing through the grief process *developing a sense of optimism |
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Treatment Modalities Anxiety D/O
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Individ therapy
Cognitive therapy Behavior therapy - systemic desensitization;Implosive therapy Group/fam therapy Psychopramacology - Antidepressants for OCD |
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Somatoform Disorders
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Anxiety that is repressed and results in presence of real physical symptoms for which there is no evidence of medical illness
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Somatization
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Process of expressing a mental condition as a disturbed bodily function
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Conversion
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Express emotional conflict through the development of physical symptoms (sensorimotor)
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Symbolism
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everything that occurs is a symbol of the pt's own thoughts
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PAIN disorder assessment
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Severe & prolonged pain causing significant distress & impairment
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Primary Gain - Positive
PAIN |
Reinforcement for somaticizing through added attention,sympathy,and nurturing (Pain disorder symptoms enable client to avoid unpleasant activity)
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Secondary Gain - Positive
PAIN |
Reinforcement by avoiding difficult situations because of physical complaint (Pain promotes emotional support & attention)
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Tertiary Gain
PAIN |
Focus of family switch to him/her and away from conflict in the family (Pain - the physical symptoms take such a position that the real issue is disregarded and remains unresolved)
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Hypochondiasis Disorder Assessment
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Preoccupied with the fear of contracting or having a disease
Fear becomes disabling with no organic pathology Anxiety,depression OCD traits common |
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Conversion Disorder Assessment
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Loss or change in body function resulting from psychological conflict unexplained by medical disorder or pathophysiology
"Classic" conversion symptoms are NEURO symptoms that occur after extreme stress Pt. expresses lack of concern "la belle indifference" with severe impairment, a clue that the problem is psychological |
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Body Dysmorphic Disorder
Assessment |
Exaggerated belief that the body is deformed or defective
Depression & OCD are common |
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Predisposing factors to Somatoform Disorders
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Genetic - hereditary factors possible in somatization,conversion,hypochondriasis disorders
Physchodynamic Theory: Hypochondriasis- Ego defense mechanism. Physical complaints = low self esteem Conversion - Results from unacceptable emotions converted into physical symptoms Learning theory - Somatic complaints reinforced when sick person is excused from unwanted duties (primary gain) Sick person becomes prominent focus of attention (secondary gain) Conflict shifts to ill person and away from issues (tertiary gain) Hypochondriasis - past experiences with illness predispose the person (learned) |
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Family Dynamics - predisposing factor somatoform
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Somatization brings stability to the family and positive reinforcement to child
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Biochemical - Predisposing factor somatoform
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Decreased levels of serotonin & endorphins = pain disorder
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Transactional Model/Stress and Adaptation
(Somatoform Disorders) |
Multiple causes & will need lots of therapy
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Dissociative Disorders
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Involve the disruption in consciousness with significant impairment in memory,identity or perception of self
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Dissociative Amnesia
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Inability to recall important information
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Dissociative Fugue
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Sudden, unexpected travel away from home with inabilty to recall one's past
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Dissociative Identity Disorder
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Exsistence of 2 or more personalitites in one person
ie - child abuse / child not dealing with abuse |
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Depersonalization
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Characterized by feeling of detachment or estrangment from one's self
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Dissociative Fugue Assessment
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Sudden unexpected travel from home or customary place
*Unable to recall personal ID often assumes new ID *Occurance of severe psychological stress or excessive alcohol use often precipitates the fugue behavior |
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Dissociative Identitity Disorder
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Existence of 2> distinct personalities states recurrently take control of pt's behavior
Transition usually sudden, dramatic & precipitated by stress Psychological trauma - traumatic events overwhelm the individual DID used as a 'survival' strategy |
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Depersonalization Disorder
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Depersonalization in perception of self
*Feeling of detachment/estrangment from oneself *Derealization alteration in the perception of external environment *Anxiety,depression,fear of going insane,somatic complaints,disturbance in subjective sense of time |
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Predisposing Factors Dissociation Disorders
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Genetics - possible in DID
Neurobiological - dissociative amnesia & fugue maybe related to neurophysiological dysfunction EEG abnormal in DID Psychodynamic - FREUD, Repression dissociation behaviors are a defense against unresolved painful issues Psychological Trauma DID-many personalities to cope (survival strategy) |
