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111 Cards in this Set
- Front
- Back
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Mild Anxiety Symptoms
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restlessness, increased motivation, irritability
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Moderate Anxiety Symptoms
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Agitation, muscle tightness
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Severe Anxiety Symptoms
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inability to function, ritualistic behavior, unresponsive
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Panic Anxiety
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Distorted perception, loss of rational thought, immobility
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5 Types of Anxiety Disorder
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Panic, phobias, OCD, generalized anxiety disorder, stress-related disorders
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Panic Disorder
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Experiences recurrent panic attacks
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Phobias
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PT fears a specific object or situation to an unreasonable level
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OCD
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PT has intrusive thoughts of unrealistic obsessions and tries to control these thoughts w/compulsive behaviors (for example, repetitive cleaning of a particular object or washing of hands)
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Generalized Anxiety disorder (GAD)
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PT exhibits uncontrollable, excessive worry for more than 6 months
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Acute Stress Disorder
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Exposure to a traumatic event causes numbing, detachment, and amnesia about the event for not more than 4 weeks following event
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PTSD
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Exposure to a traumatic event causes intense fear, horror, flashbacks, feelings of detachment and foreboding, restricted affect, and impairment for longer than 1 month after the event. Symptoms may last for years
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RF for Anxiety Disorders
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(OCD has = prevalence in M/F) but all others are much more likely to occur in women
-expo to traumatic event -can be due to an acute medical condition, like pulmonary embolism -substance-induced anxiety can be related to current use of chem substance, or to w/drawal symptoms from a substance (alcohol) |
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Panic Disorder episode lasts for?
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15-30 minutes
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Panic Disorder episodes - 4 or more of symptoms present
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Palpitations
SOB Choking/smothering sensation Chest pain nausea feelings of depersonalization fear of dying or insanity chills or hot flashes |
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Agoraphobia + panic disorder
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Fear of being in places where previous attacks have occurred.
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Social Phobia
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PT has fear of embarrassment, is unable to perform in front of others, has a dread of social situations, believes that others are judging him negatively, and has impaired relationships
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Agoraphobia
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PT avoids being outside and has an impaired ability to work or perform duties
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OCD
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PT has intrusive thoughts or unrealistic obsessions and tries to control these thoughts w/compulsive behaviors, such as repetivive cleaning of object/washing hands
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Generalized Anxiety Disorder
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Exhibits uncontrollable, excessive worry for more than 6 months
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GAD At least 3 of following physical symptoms are present
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Fatigue
Restlessness Probs w/concentration Irritability Increased muscle tension Sleep disturbances |
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First symptoms of acute distress disorder
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Symptoms occur w/in 4 weeks of traumatic event
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First Symptoms PTSD
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Onset symptomsis delayed at least 3 months from event, and onset may not occur until years afterward
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Duration Acute Stress Disorder
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Symptoms last 2 days to 4 weeks
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Durations PTSH
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Symptoms last more than one month.
-Acute= < 3 months - Chronic = > 3 months |
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Re-experience of event Acute Distress Disorder
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PT persistently reexperiences event through:
Distress when reminded of event Dreams or images Reliving through flashbacks |
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Re-experience of event PTSD
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PT persistenly experiences event thru:
-Recurrent intrusive recollect of event Dreams or images Reliving thru flashbacks, illusions, of hallucinations |
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Acute Distress Disorder Symptoms
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Dissociative symptoms - amnesia of traumatic event, absent emotional response, decreased awareness of surroundings, depersonalization
-Symtoms of severe anxiety, such as irritability, sleep disturbance |
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PTSD - Symptoms
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Increased arousal - irritability, difficult w/concentration, sleep disturbance
Avoidance of stimuli associated w/ trauma, such as avoiding ppl, inability to show feelings |
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Standard Screening tools
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Hamilton rating scale for anxiety
Modified speilberger state anxiety scale |
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Nursing Care for PTSD/Acute stress Disorder
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-Structured interview to keep PT focused on present
-Provide safety and comfort to PT during crisis period, as PTs in severe to panic level anxiety are unable to problem solve and focus |
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Milieu Therapy for PTSD/Acute stress Disorder
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-Structured environment for physical safety and predictability
-Monitoring for and protection from self harm - Daily activities that encourage PT to share and be cooperative -Use of thera communicationskills - open ended qs, to help PT express feelings of anxiety and to validate + acknowledge those feelings -PT participation in decison making regarding care -Relax techniques for pain, muscle tension, and feelings of anxiety Instill hope for + outcomes Enhance self-esteem w/positive statements Assist PT to ID defense mechanisms that interfere w/ recovery -Postpone health teaching until after acute anxiety resides. |
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Cognitive Reframing for anxiety
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Anxiety response can be decreased by changing cognitive distortions. This therapy assists the PT to ID negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.
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Behavioral therapies for anxiety
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Teach PTs ways to decrease anxiety or avoidant behavior and allow an opportunity to practice techniques
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Behavioral Therapy Techniques for anxiety
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relaxation training
modeling - allows PT to see demonstration of approp behavior. Goal - pT imitates behavior. Systematic desensitization - mastering relaxation techniques. Then PT exposed to increasing levels of an anxiety-producing stimulus (either imagined or real) and used relaxation to overcome anxiety. Goal - PT tolerates gresater and greater level of stimulus until anxiety no longer interferes w/functioning. |
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Flooding technique for anxiety
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Exposes PT to great deal of an undesirable stimulus to attempt to turn off anxiety response
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Response Prevention for anxiety
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Focuses on preventing PT from performing a compulsive behavior with the intent that anxiety will diminish
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Thought Stopping for anxiety
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Teaches PT to say "stop" when neg thoughtsor compulsive behaviors arise, and substitute a positive thought. The goal of therapy is that with time - PT uses command silently.
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Meds for Anxiety
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Antidepressants (sertraline - zoloft, amitriptyline - elavil)
Sedative Hypnotic Anxiolytics (diazepam - valium) Serotonin Norepinephrine reuptake inhibitors (venlafaxine - effexor) Nonbarbituate Anxiolytics (buspirone) |
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Other meds used for anxiety (3)
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Beta blockers and antihistamines
Anticonvulsants used for mood stabilizer |
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Depression
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Mood affective disorder that is a widespread issue, raking high among causes of disability.
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Depression Comorbidities
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-Anxiety disorders (70% major depressive disorders - higher risk for suicide + disability)
-Schizophrenia -Substance abuse (do to relieve symptoms and/or self-treat mental health disorders) -Eating disorders -Personality disorders |
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Major Depressive Disorder
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MDD is a single episode or recurrent episodes of unipolar depression (not assoc w/mood swings from major depression to mania) resulting in a significant change in a PT's normal functioning (social, occupational, self-care) accompanied by at least 5 of following specific symptoms which occur every day for minimum of 2 weeks and last most of day
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MDD five symptoms at least
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-Depressed mood
-Dif sleeping/excessive sleeping -Indecisiveness -Decreased ability to concentrate -Suicidal ideation -Increase od decrease motor activity - Inability to feel pleasure -Increase or decrease in wt of more than 5% of total body wt over 1 month |
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MDD can be diagnosed with 5 specific disorders
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-Psychotic features
-Atypical features -Postpartum onset - Seasonal Characteristics -Chronic features |
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Psychotic Features MDD
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presence of auditory hallucinations (for ex - voices telling PT is sinful) or presence of delusions (for example PT thinking has fatal disease)
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Atypical features MDD
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Changes in appetite or wt gain, excessive daytime sleep
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Postpartum Set MDD
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A depressive episode that begins w/in 4 wks of childbirth and may include delusions, which may put the newborn infant at high risk of being harmed by mother
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seasonal characteristics
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SAD - occurs during winter may be treated w/light therapy
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Chronic features
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depressive episode that lasts over 2 years
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Dysthymic Disorder
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a milder form of depression that usually has an early onset, such as in childhood or adolescence, and lasts at least 2 years in length for adults (1 year in length for children). Dysthymic disorder contants at least 3 symptoms of depressiong and may later in life become MDD
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MDD Acute Phase - symptoms + treatment
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-Treatment is generally 6 to 12 weeks in duration
- Hospitalization may be required -Reduction of depressive symptoms is the goal of treatment - Suicide potential is determined and safety precautions implemented -One-to-one observation may be indicated |
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MDD Maintenance phase - increased ability to function
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-Treatment is generally 4-9 months in duration
- Relapse prevention thru education, medication therapy, and psychotherapy is the goal of treatment. |
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MDD Continuation phase - remission of symptoms
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-This phase may last for years
- Prevention of future depressive episodes is the goal of treatment |
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Risk factors for depression
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-Family hx, personal hx most SIGNIFICANT RF
-2x common female 15-40 than males -Older pts -very common over 65 but harder to recognize - Neurotransmitter deficiency (like serotonin deficiency) -Stressful life events -medical illness -female in postpartum period -poor social support network -comorbid substance abuse |
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Depression + older adult
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-Older pts -very common over 65 but harder to recognize. Some symptoms that look like depression are: memory loss, confusion, and behavioral problems such as social isolation or agitation. PTs may seek health care for somatic symptoms that is actually untreated depression
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Subjective data of depression
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-Anergia
-Anhedonia -Anxiety -Sluggishness, feeling unable to relax/sit still -Vegetative signs -Somatic reports |
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Anergia
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lack of energy
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Anhedonia
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lack of pleasure in normal activities
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Vegetative signs
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change in eating patterns(Mdd=anorexia/dyshymia - increased intake)
Change in bowel habits (constipation) Sleep disturbances decreased interest in sexual activity |
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Physical findings depression
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Affect - sad w/blunted affect
-poor grooming/lack hygeine -psychomotor retardation -Socially isolated - no effort to interact -Slowed speech, decreased verbalization, delayed response |
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Psychomotor retardation
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slowed phys movemnt, slumped posture more common but psychomotor agitation (restlessness, pacing, finger tapping) can also occur
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Depression:Mileu therapy --> self care
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Monitor PT's ability to perform activities of daily living and encourage independence as much as possible
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Depression - communication
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relate therapeutically w/PT who is unable or unwilling to communication
-make time to be with, even if doesn't speak -make observations rather than asking direct Qs -Give directions in simple, concrete sentences since PT w/depression may have difficulty focusing on and comprehending long sentences -Give PT sufficient time to respond |
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Depression - counseling assists with...(6)
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-Problem solving
-increasing coping abilities -changing negative thinking to positive -increasing self-esteem -assertiveness training -using available community resources |
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Client teaching for all antidepressants
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-Do NOT discontinue
-Medications may take 1 to 3 weeks for therapeutic effects for initial response with up to 2 months for maximal response -Avoid hazardous activities, such as driving or operating heavy equiptment machinery |
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SSRI Client Teaching
(Celexa - Citalopram) (Prozac - fluoxetine) (Sertraline - zoloft) |
- Side Effects may include: nausea, headache, and CNS stimulation (agitation, insomnia, anxiety)
- Sexual dysfunction may occur - notify MD if intolerable - Follow healthy diet, as wt gain can occur w/long-term use |
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Tricyclic Antidepressants
(Amitriptyline - Elavil) |
Advise PT to change positions slowly to minimize dizziness from orthostatic hypotension
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Monoamine Oxidase Inhibitors (MAOIs)
(Phenelzine - Nardil) |
-To minimize anticholinergic effects - advise PT to chew sugarless gum, eat foods high in fiber, and increase flud intake to 2-3 L/day from food and beverage sources
-Advise PT to avoid foods w/tyramine (ripe avocados+figs, fermented or smoked meats, liver, dried or cured fish, most cheeses, some beer and wine, and protein dietary supplements) |
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Foods w/tyramine
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(ripe avocados+figs, fermented or smoked meats, liver, dried or cured fish, most cheeses, some beer and wine, and protein dietary supplements)
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Sedative Hypnotic Anxiolytics (Benzodiazepines)
[Diazepam (valium)] + [Lorazepam(ativan)] |
-watch for CNS depression, -sedation, lightheadedness, ataxia, and decreased cognitive dysfunction
-Avoid use of other CNS depressants - like alcohol -avoid hazardous activities (driving machinery) -Caffeine interferes w/desired effects of med -Advise PT who has been taking these medications regularly and in high doses to taper the dose over several weeks to prevent withdrawal symptoms |
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Serotonin Norepinephrine Reuptake Inhibitors
[Venlafaxine (Effexor)] |
Side effects include nausea, weight gain, and sexual dysfunction
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Nonbarbituate Anxiolytics
-Busprione (Buspar) |
-Onset of therapeutic effects may take 2-4 weeks
-Nonbarbituate anxiolytics may be used for long-term management of depression -does NOT cause CNS depression |
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Depression Therapies
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cognitive-behavioral therapy, group therapy, and family therapy
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Alternatives/Complementary therapies for depression
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St. John's wort, light therapy
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St. John's Wort
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a plant product (hypericum perforatum), not regulated by US FDA - relieves symptoms of mild depression
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Considerations of St. John's Wort
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-Adverse effects include photosensitivity, skin rash, rapid HR, GI distress, and abdominal pain
-Can increase/reduce levels of some medications if taken concurrently. The PT should inform the provider if taking it |
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St. John's Wort medication interactions
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Potentially fatal serotonin syndrome can result if St. John's Wort is taken w/SSRIs, MAOIs, atypical antidepressants, such as nefazodone (serzone) or venlafaxine (effexor), and tricyclic antidepressants, such as amitriptyline (elivil) and clomipramine (anafranil). Foods containg TYRAMINE SHOULD BE AVOIDED.
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Light Therapy
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1st line treatment for seasonal affective disorder (SAD), light therapy inhibits nocturnal secretion of melatonin
-->exposure of face to 10,000-lux light box 30 minutes a day, once or in 2 divided doses |
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Therapeutic Procedures for depression
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ECT, Transcranial magnetic stimulation, vagus nerve stimulation
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ECT - electroconvulsive therapy
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can be useful for some PTs w/depression.
Nursing Actions - specially trained nurse is responsible for monitoring the PT before and after this therapy |
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Transcranial magnetic stimulation (TMS)
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New therapy using electromagnetic stimulation of the brain; it may be helpful for depression that is resistant to other forms of treatment
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Vagus Nerve Stimulation (VNS therapy system)
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Implanted device that stimulates the vagus nerve. It can be used for clients who have depression that is resistant to at least four antidepressants medications
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Exercise + depression
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30 minutes of exercise daily for 3-5 days each week improves symptoms and may help to prevent relapse. Even shorter intervals of exercise are helpful. Exercise should be regarded as an adjunct to other therapies for PT w/major depressive disorder.
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Bipolar Disorder
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Mood disorders w/recurrent episodes of depression and mania
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When does bipolar disorder emerge?
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Late adolescence/early adulthood but can be diagnosed in the school-age child. B/C side effects of medication and bipolar disorder symptoms can mimic the symptoms of Attnention deficit hyperactivity disorder (ADHD) - children not diagnosed until after age 7
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Behaviors of mania
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Psychotic, paranoid, and/or bizarre behavior
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Phase Acute (characteristic of Acute mania) Treatment
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Treatment generally 6-12 weeks in duration
Hospitalization may be required reduction of mania symptoms is the goal of treatment risk of harm to self or others is determined 1-1 supervision may be indicated |
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Phase - Maintenace (characteristics - increased ability to function)
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Treatment is generally 4-9 months in duration
Relapse prevention through education, medication therapy, and psychotherapy is the goal of treatment |
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Phase - Continuation (characteristics - remission of symptoms)
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Treatment generally continues thruout the PTs lifetime
Prevention of future manic episodes is the goal of treatment |
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Behaviors shown with bipolar disorder
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Mania, hypomania, mixed episode, rapid cycling
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Mania
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An abnormally elevated mood, which may also be described as expansive or irritable; usually requires inpatient treatment.
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Hypomania
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Less severe episode of mania that lasts at least 4 days accompanied by 3-4 symptoms of mania. Hospitalization, however, is not required, and the PT w/hypomania is less impaired.
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Mixed Episode
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A manic episode and an episode of major depression experienced by the PT simultaneously. The PT has marked impairment in functioning and may require admission to an acute care mental health facility to prevent self-harm or other-directed violence.
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Rapid Cycling
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4 or more episodes of acute mania w/in 1 year.
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Bipolar I Disorder
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PT has at least 1 episode of mania alternating with major depression
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Bipolar II Disorder
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The PT has 1 or more hypomanic episodes alternating with major depressive episodes
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Cyclothymia
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The PT has at least 2 years of repeated hypomanic episodes alternating w/minor depressive episodes
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Various depressive disorders (3)
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bipolar 1 disorder, bipolar II disorder, cyclothymia
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Substance abuse + bipolar
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PT w/substance abuse issues tends to experience more rapid cycling of mania than do PTs who are not abusing
Substance use is often used as self-med. Can have direct impact on the onset of a mental health disorder, especially if a T is predisposed. |
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Comorbidities assoc w/bipolar disorder
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Substance abuse, anxiety disorders, eating disorders, ADHD
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BIPOLAR Risk factors
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physical illness, such as delirium due to head injury
substance abuse - such as coke or methamphetamine overdose |
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Relapse
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Use of substances (alcohol, drugs of abuse, caffein) can lead to episode of mania
- sleep disturbances may come before, be associated with, or be brought on b y an episode of mania |
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Acute Phase nursing care
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Focus = safety + maintain health
-provide safe enviro -assess for suicide -decrease stimulation w/out isolating PT if possible. Be aware of enviro noises which can escalate PT's behavior. Certain cases - seclusion may be only way to safely decrease stimulation for this PT -implement frequent rest periods -observe closely -Provide outlets for physical activity. Do not involve activities that last long time or that require a high level of concentration and/or detailed instructions -maintenace self-care needs -Communication |
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Acute Phase -Maintenance of self-care needs includes:
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- Monitoring sleep, fluid intake, and nutrition
- Provide poratble, nutritious food, since PT may not be bale to sit down to eat -Give step-by-step reminders for hygeine and dress |
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Acute Phase - Communication
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Use a calm, matter-of-fact, specific approach
-give concise explanations -Provide for consistency among staff members -Avoid power struggles, and do not react personally to the PT comments Listen to and act on legitimiate PT grievances Reinforce nonmanipulative behaviors |
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Medications for Bipolar
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Lithium carbonate (eskalith)
Antiepileptic agents that act as mood stabilizers --> valporic acid, clonazepam (klonopin), lamotrignie (lMIXRol), neurontin, and topax/topiramate Antidepressants benzodiazepines |
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Meds for bipolar for sleep impairment related to mania
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Used on a short term basise -- benzodiazepines lorazepam (ativan)
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Major depressive disorder and bipolar
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Antidepressants - such as SSRI fluoxentine
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Therapeutic Procedures of Bipolar
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ECT = may be used to subdue extreme manic behavior - especially when pharmacologic therapy- such as lithium, has not worked. May also be used for PTs who are suicidal or those with rapid cycling
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True manic state
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usually will not stop moving and does not eat, drnk, or sleep. Can become a medical ER
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True manic state - nursing actions
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prevent self harm, decrease activity, promote adequate nutrition, ensure a minimum of 4-6 hr a night, assist PT w/self care needs, manage meds appropriately
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