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42 Cards in this Set
- Front
- Back
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What is Anxiety?
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•An uncomfortable feeling that occurs in response to the fear of being hurt or losing something valued.
•Normal anxiety dissipates when the threat diminishes •Anxiety is considered abnormal if –It is out of proportion to the event –It interferes with social, occupational or familial functioning Usually starts in the 20’s more with females |
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Panic Disorder
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•Recurrent panic attacks
•Usually affects young adults •Can occur with or without agoraphobia - fear of being in places or situations from which escape might be difficult or embarrassing •Sudden onset, unexpected, intense fear, a feeling of doom, catastrophic thinking may manifest in respiratory, cardiovascular symptoms |
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Panic Disorder Symptoms/Signs
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•Palpitations, Inc rate
•Sweating •Shaking •SOB •Feeling of choking •CP or discomfort •N,V, ABD distress •Dizzy, unsteady, lightheaded •Derealization •Depersonalization •Fear loosing control •Fear of dying, going crazy •Paresthesia •Chills/hot flashes |
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Generalized Anxiety Disorder (GAD)
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•Chronic, unrealistic and excessive worry and anxiety for more days than not, 6 months or longer and impair social, occupational or familial functioning
Serotonin is decreased Norepherine is increased GABA is decreased (allowing for increased cellular excitability) |
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Generalized Anxiety Disorder (GAD)
Signs/Symptoms |
•Excess anxiety and worry to many events that are difficult to control
•Restlessness, on edge •Easily fatigued •Mind going BLANK, difficulty concentrating •Irritability •Muscle tension •Sleep disturbance •Depressive symptoms and somatic complaints are likely |
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Generalized Anxiety Disorder (GAD) Nursing Interventions
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*•Stay with client
*•Offer reassurance •Calm, nonthreatening approach •Simple brief communications •Low stimuli in environment •Sedating medications when oredered •Explore reason for anxiety when symptoms has reduced •Teach relaxation methods |
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Phobias
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Phobic disorders: Fear of Losing Control
•Behavioral patterns that develop as a defense against anxiety •Underlying anxiety is displaced on to something concrete that can identified and then avoided •Avoidance is generalized to situations other than realistic danger •The feared object may or may not be symbolic of the underlying anxiety= fear of loosing control |
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Social Phobia
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•Fears most social situations (excessive)
•Fear of situations, anticipates feeling humiliated, embarrassed, under the scrutiny of others •Can adversely affect quality of life- 1 in 8 people experience social phobias •Exposure to the fear induces sweating, tachycardia, dyspnea, sweating |
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Agoraphobia (without panic)
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•Most common and most serious
•Fear of being away from home and of being alone in public places where they may need help and may not be able to get away •Peak times- ages 20-30’s •Will avoid public places, crowds •Avoidance many dominate life In agoraphobia person may become dependent on family and homebound |
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Specific Phobias
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•Marked, persistent and excessive or unrealistic fear when in the presence of OR when anticipating an encounter with a feared object or situation
- Snakes, Drowning, Cars, Height, etc. |
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Characteristics in Phobic Disorders
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•Behavioral- Fear of losing control leads to: Avoidance of the object or situation that increases their anxiety
•Social Characteristics: •Very draining on the family due to their dependency and helplessness Secondary gains occur as person avoids more and more responsibilities of life and others take them on. |
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Most common Types of Phobias
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•Animals
•Natural •Blood- injection- injury •Situational •Other |
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Care plan for Phobias
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•Reassure patient of safety
•Explore threat to integrity •Discuss realities of the situation •Include client in decisions about treatment Flood/implosion or desensitization •Encourage understanding of irrational thinking |
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Obsessive- Compulsive Disorders
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•Recurrent obsessions or compulsion severe enough or time consuming enough to cause a significant impairment
•Obsessions: unwanted, intrusive persistent ideas, thoughts, impulses or images that cause marked anxiety or distress •Compulsions: unwanted repetitive behaviors, patterns, mental acts •People with OCD feel forced from within to do the behavior- it is consuming •Affective Characteristics: •Shame about their behavior •Control is #1 •Feel if do not do the compulsive behavior, something bad will happen •Cognitive Characteristics: •Preoccupied, can not get thoughts out of their minds •Social characteristics: Family strain |
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Care plan for OCD
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•Identify that which increases anxiety
•Meet dependency/encourage independence *•Beginning- time for rituals •Do not be judgmental •Give structure •*Gradually limit time for rituals •Give positives for non-ritualistic behavior •Thought interruption techniques |
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Post Traumatic Stress Disorder
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•Anytime a trauma occurs, the potential to develop PTSD exists
•In severe trauma, the patient confronts extreme helplessness and terror and the possibility of annihilation •Ordinary coping are ineffective, and person can not resist or escape •May be sudden shock or repetitive stress •Disaster workers are at risk due to constant exposure to violence, disfigurement PTSD sufferers are normal people who have experienced abnormal events Nurses at risk for acute and chronic PTSD •Behavioral Characteristics hyper alertness aggressiveness or bizarre behavior •Triggering events( events, smells, music, touch) -Variables include characteristics that relate to: -The traumatic experience -The individual -The recovery environment |
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Care plan for clients with PTSD
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*•Assign same staff
•Non threatening, friendly •Respect wishes, be consistent *•During flashbacks: stay. Offer reassurance •Obtain history from others of the trauma •Own pace to disclose= debrief •Discuss coping strategies •Vulnerability and ‘place’ in world |
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Treatment Modalities
- Cognitive Therapy |
- Cognitive therapy for anxiety is brief and time limited, usually lasting 5-20 sessions
- Major part of treatment consists of encouraging the client to face frightening situations to be able to view them realistically, and talking about them is one way of achieving this |
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Treatment Modalities
- Behavior Therapy - Systematic Desensitization |
- Client is gradually exposed to the phobic stimulus, either in a real or imagined situation
- Reciprocal inhibition - Described as the restriction of anxiety prior to the effort of reducing avoidance behavior |
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Treatment Modalities
- Behavior Therapy - Implosive Therapy (Flooding) |
Client must imagine situations or participate in real-life situations that he or she finds extremely frightening, for a prolonged period of time
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Treatment Modalities
- Psychopharmacology - Anxiolytics |
- For panic and generalized anxiety disorders
- Benzodiazepines have been used with success in the treatment of generalized anxiety disorder - Clients must be warned against discontinuation of the drug and should be tapered off the medication at the end of therapy |
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Treatment Modalities
- Psychopharmacology - Antidepressants |
Dosage of these drugs must be titrated slowly because clients with panic disorder appear to be sensitive to the overstimulation caused by SSRIs
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Treatment Modalities
- Psychopharmacology - For phobic Disorders - Anxiolytics |
Benzodiazepines have been successful in the treatment of social phobia
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Treatment Modalities
- Psychopharmacology - Antihypertensive Agents |
Effectiveness of beta-blockers and alpha-receptor agonists in the amelioration of anxiety symptoms
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Somatoform Disorders
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- Are characterized by physical symptoms suggesting medical disease, but without demonstrable organic pathology or known pathophysiological mechanism to account for them
- Classified as mental disorder - Dissociative disorders are defined by a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment - Amnesia is most common Physical symptoms suggestive of physical disease but without demonstrative medical pathology |
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Somatoform Disorders:
ASTHMA |
- Most common prescribed medications are broncodilators and corticosteroids
•Heredity •Allergies •Psychosocial influence: increase in anxiety and depression, fearful |
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Somatoform Disorders:
CANCER |
•Heredity
•Environmental •Psychosocial Influences: Personality type C •“nice guy’ disease •Apologetic, passive, no negative emotion, overly cooperative •Calm exterior |
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Somatoform Disorders:
CORONARY HEART DISEASE |
•Hereditary
•Environmental •Psychosocial Influences: Type A personality •#1- competitive drive •#2- continual sense of time urgency •Compared to Type B •Less prone to CHD - Risk factors for CHD are cigarette smoking, obesity, sedentary lifestyle •Not less successful, just don’t feel competitive or have a sense of time urgency - Type D Personality - The distressed personality - Have a tendency to experience negative emotions and the inability to express feelings in social situations - Treatment are vasodilators, beta-adrenergic blocking agents, calcium channel blockers, antihyperlipidemic agents |
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Somatoform Disorders:
PEPTIC ULCER |
•Hereditary
•Environmental •Psychosocial factors: •Higher levels of stress and frustration, worriers, depression and anxiety - Factors are cigarette smoking and regular use of aspirin, alcohol, steroids, and nonsteroidal antiinflammatory drugs (NSAIDS) - Excessive worriers and seem to have more times of crises than most people - Pessimists - Expect the worst of the situation - Type A |
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Somatoform Disorders:
ESSENTIAL HYPERTENSION |
•Heredity
•Environmental •Physical •Psychosocial influences: complaint, congenial and compulsive; chronice stress- angry - Type A Personality |
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Somatoform Disorders:
MIGRANES |
Psychosocial influences:
Perfectionist Hard workers, intelligent, high expectations on themselves Delegation is difficult Close to Type A |
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Somatoform Disorders:
ULCERATIVE COLITIS |
- Orderly, punctual, difficulty expressing anger or being assertive
- Onset and exacerbations often associated with stress or trauma |
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Care plan for Psychophysiological Disorder
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Complete assessment
•Client with problem solving •Discuss problem solving •Positive reinforcement of good coping skills •Assess level of anxiety •Explore fears •Keep a diary •Identify needs that are met through the sick role •Teach passive, aggressive assertive behaviors •Teach stress management |
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5 Types of Somatoform Disorders
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•Pain Disorder-pain that cannot be explained organically
•Somatization Disorder- multiple physical complaints involving many body systems •Hypocondriasis- preoccupation with the fear of or belief of having a serious disease and it becomes disabling- in spite of reassurance of ones healthy status; may MD shop •Conversion Disorder- loss of or change in body function due to a psychological conflict; Sensorimotor symptoms such as paralysis, blindness seizures, false pregnancy. •Primary and Secondary Gain !! •La belle indifference- seen in conversion disorder-may seem nonchalant about their symptoms - Denial is the main defense mechanism. |
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Body dysmorphic disorder
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•Exaggerated belief that the body is deformed or defective in some way
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Care Plan for Somatoform Disorders
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•Monitor data
•Identify gains •Gradually decrease dependence •New complaint will be referred •Discuss alternate coping skills •Recognize for things other than physical symptoms |
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Dissociative Disorders
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•Disruption of the integrated functioning of the consciousness, memory, identity, or perception of the environment.
•Occurs when anxiety is overwhelming and the self becomes disorganized •Amnesia •Fugue state •Identity Disorder •Depersonalization |
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Rare Dissociative Disorders
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•Fugue
•Dissociative Identity disorder •Depersonalization - Dissociative amnesia |
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Fuge
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Occur during war, natural disasters, intense psychosocial stress
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Dissociative Identity disorder
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•At least two personalities exist in the same person, each with its own memory, values, emotional patterns, behaviors. Usually a history of sever abuse
•Goal is to integrate the personalities - Integration - Blending of all the personalities into one - Abreaction - Remember with feeling - Can be so painful that clients may actually cry, scream, and feel the pain that they felt at the time of the abuse |
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Depersonalization
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- ½ adults will experience at one time
- Feelings of being detached from one’s body or thoughts. Feel like they are living in a dream. |
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Dissociative Amnesia
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Memory loss R/T an acute traumatic event
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