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106 Cards in this Set

  • Front
  • Back
What are the properties of Anxiety?
1) it's a universal phenomenon experienced by humans throughout the lifespan
2) It's an energy force
3) It promotes activity and prductivity
4) It can interfere with ADL if not properly controlled
Define Anxiety
Anxiety is a diffuse, highly unpleasant, often vague feeling of apprehension or uncertainty; produces effects in all body systems
Define adaptaptive coping
Adaptive coping is when the coping behavior resolves the anxiety
Define Palliative coping
Palliative coping behavior results in temporarily reducing the intesity of the anxiety (i.e. alcohol and drugs)
Define Maladaptive coping
Maladaptive coping behaviors are unsucessful effors in relieving the stressor; may further result in exacerbating the anxiety
Define Dysfunctional Coping Behaviors
Dysfunctional coping behaviors are those behaviors than can evoke psychotic features such as delusions
According to Peplau what are acting out behaviors with anxiety? Give examples.
Acting behaviors unconsciously displace our anxiety.

Examples would be: crying, laughing, jogging, talking.
According to Peplau what are somatizing behaviors with anxiety?
These are unconscious repression of anxiety that manifests itself as Back aches, Headaches, and pain.
According to Peplau what is freezing on the spot with anxiety?
Freezing is a complete withdrawal psychologically and emotionally from the anxiety
According to Peplau what is learning- problem solving behavior with anxiety?
Learning-Problem solving behaviors are those behaviors which are a conscious effort to reduce anxiety (this is the most adaptive style)
According to Freud what are the purposes of Defense mechanisms?
1) Reduce anxiety--maintain the ego
2) Protects self-esteem - Un/conciously
3) Necessary for survival - when used sparingly
According to Freud what can happen when one overuses or inappropriate use of Defense mechanisms?
Overuse/inappropriate use can lead to distortion in reality, produce self-deception; interfere with healthy mental functioning
Define suppression
Supression is the conscious denial/ voluntary exclusion of a situation or feeling.
Define rationalization
Rationalization consists of justifying the illogical or unreasonable idea,s actions or feelings by developing acceptable explanations that satisfies the beliefs of the listener.
Define fantasy in terms defense mechanism
Fantasy is a conscious creation to distort reality to protect the ego
Define identification
Unconscious assumption of the thoughts, mannerisms or behaviors of a person or group in order to decrease anxiety
Define internalization
Internalization is the taking on behaviors of others
Define undoing
Undoing is an act in which resolves an unconscious guilt
Define compensation
Compensation is the making up for deficits in one area by excelling in another area in order to raise or maintain self-esteem
Define reaction-formation
reaction-formation is the process of keeping unacceptable feelings or behaviors out of awareness by developing the OPPOSITE emotion or behavior
Define Sublimation
The unconscious process of substituting constructive and socially acceptable activities for strong impulse that are not acceptable in their original form, such as strong aggressive or sexual drives
Define Projection
Projection is the unconscious attributing of one's own intolerable wishes, emotions, or motivations to another person.
Define Denial
Denial is the disowning of an intolerable idea/experience...etc
Define Conversion
Conversion is an unconscious defense mechanism in which anxiety is expressed as physical symptom that ha no organic cause
Define repression
Repression is the exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness
Define dissociation
Emotional separation from anxiety
Define Regression
Regression is the retreating to an earlier developmental state.
Identify the following Defense Mechanism

Man forgets his wife's birthday after a fight.
Repression
Identify the following Defense Mechanism:

Woman who is angry with her boss writes a short story about a heroic woman.
Sublimation
Identify the following Defense Mechanism:
Man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments, and comes in late for meetings
Regression
Identify the following Defense Mechanism

Recovering alcoholic constantly preaches about the evils of drinking
Reaction-formation
Identify the following Defense Mechanism

Woman whose husband died 3 years earlier still keeps his clothes in the closet and talks about him the present tense
Denial
After flirting with her male secretary, a woman brings her husband tickets to a show
undoing
Five-year old girl dresses in her mother's shoes and dress and meets her father at the front door
Identification
What are the pathological results of anxiety?
1. the response to anxiety is disproportionate to the threat; unable to control worrying

2. the anxiety continues beyond the the threat

3. impairment in ADLs especially in memory and comprehension

4. Psyschosomatic effects - HA and pain
Define Anxiety disorder
Anxiety disorders are unmanaged, pathological, maladaptive response to anxiety to occurs on a continuum of mild, moderate, severe, panic
True or False:

Mild anxiety is always maladaptive
False:

Mild anxiety can increase alertness, enhance learning and problem solving
True or False:

There is a strong link between mind-body reaction when a person is under moderate anxiety
True:

If not managed, anxiety on this level can cause actual alterations in physiological integrity; Asthma, colitis, GI distress, dermatological conditions can all be brought about
Define Severe Anxiety disorder
Severe Anxiety is a generalized anxiety disorder that results in unrealistic and excessive worry and anxiety well beyond the threat that produces tension and autonomic hyperactivity
Define Panic attack/disorder
Panic attacks are UNEXPECTED, recurrent attacks of anxiety; symptoms mimic severe cardiac or respiratory distress.
TRUE or FALSE:

Panic disorders run in families.
True:
There is a strong genetic component to panic disorders
What is the current belief behind the cause of Panic disorders
an over abundance of GABA
Define Phobias
Phobia are IRRATIONAL, pathological, and disproportionate fear of objects or situations which cases a person to take extreme measures to avoid the situation
Define OCD
OCD is:
1. a recurrent obsessive intrusive/inappropriate thoughts;

2. usally compulsive stereotyped behaviors, that impairs ADLs,

3. any attempts to suppress compulsive behaviors generates more anxiety
Define PTSD
PTSD is an anxiety/fear resulting from traumatic expeiences resulting in a conditioned response due to sight/smell/sound from the experience. Exposure to the stimulus can cause a re-experience of the event.
Define Somatoform disorders?
Somatoform disorder is the transformation of anxiety into physical symptoms at an unconscious level.
TRUE or FALSE:

The symptoms of a person suffering from somatoform disorder have an organic etiology
FALSE

There are no organic etiology to explain for the symptoms despite numerous tests; this is due to a false body perception. Symptoms however are believed by the person to be real
Define Conversion disorder
Conversion disorder is a condition where patients present with neurological symptoms such as numbness, blindness, paralysis, or fits, but where no neurological explanation is possible
What are the 4 types of Dissociative disorders?
1. Depersonalization
2. Dissociative amnesia
3. Dissociative fuge
4. Dissociative Identity disorder (MPS)
Define Dissociative amnesia?
A type of amnesia that occurs when a person has the inability to remember significant personal information such as ID, name DOB, usually results from a traumatic experience such as an Assault.
Define Dissociative fuge
Dissociative fuge is an abrupt physical flight and traveling away from the field of conflict usually following a stressful event. AKA. Running away!
Define Dissociative identity disorder
This occurs when two or more distinct personalities emerge in one person, each unique in their own way. Usually this is preceded by abuse in childhood; physically, sexually, or emotionally.
When panic level has reached psychosis level what disorders can we expect?
1. mood disorders
2. schizophrenia
3. organic mental disorders
What assessments must a nurse make for treating anxiety disorders?
1. specific symptoms
2. level of anxiety
3. stressors
4. type of defense mechanisms used/not used
5. risk for suicide
6. coping style
7. available support systems
8. quality of relationships
9. secondary gains
Give examples of benzodiazepines used in treating anxiety
1. Xanax
2. Valium
3. Ativan
4. Klonopin
5. Librium
What is the action of benzodiazepines?
Stimulates GABA in the limbic system, decreases excitability
What must you watch out for when using benzodiazepines?
These meds can be habit forming so watch out for addiction and withdraw symptoms
What is the therapeutic effect of the drug Buspar?
Buspar controls conginitve symptoms of anxiety, helps with panic disorders by decreasing worrying
What is the therapeutic effect of Inderal
Inderal inhibits the relase of norepinepherine/epinephrine by blocking Beta receptors
Which antidepressants work for anxiety and what do they do?
TRICYCLICS; SSRI

These drugs regulate serotonin, reducing arousal and excitabiltiy
What is the therapeutic effect of the drugs Atarax and Vistaril?
The decrease subcortical centers in the brain which decreases agitations and anxiety
What is the therapeutic effect of amytal
Amytal dis-inhibits ego defenses, this is used in dissociative disorders; helps obtain repressessed memories with traumatic events
What interventions are used in treating a person with moderate to severe anxiety disorder?
1. assess level of anxiety
2. accept patients' feeling anxiety
3. provide emotional security
4. meet basic needs
5. avoid making demands or requiring decisions
6. promote sleep
7. provide medication
8. protect from impulsive acts
9. allow defenses
10. initially allow worry time
11. reduce physical stimulants
12. reduce environmental stimulants
13. treat physical complaints as matter of fact
14. provide rec. diversions
15. work in the here and now
16. provide feedback on anxious behavior
17. ID sources of anxiety
18. ID effects ineffective coping
19. explore secondary gains
20. explore alternate coping behaviors
What is Role Modeling in behavior modification?
Modeling adaptive behaviors through practice and initiation; ie. deep breathing, guided imagery, journaling, exercising.
What is operant conditioning in behavior modification?
Receiving of rewards for adaptive behavior; positive reinforcement
What is systematic desensitization in behavior modification?
Exposure to phobic stimulus in gradual amounts over time reducing emotional response
What is self-control in behavior modification?
Elimination of negative self-talk; reframing
What is aversion therapy in behavior modification?
It is a negative reinforcement by adding something negative due to negative behavior.
What are the 5 characteristics of Crisis?
1. it usually surrounds situations or events
2. It reflects perception and response of the person
3. it is self limiting; runs a definite course
4. occurs suddenly
5. produces disequilibrium
TRUE or FALSE:

A crisis is the same from one person to the next
FALSE:

Crisis is based on an individual's perception
What are the 3 types of primary appraisal?
1. irrelevant - not problematic
2. benign-positive- these are your good stress situations
3. stressful - based harm/loss, threat, or challenge
What are secondary appraisals?
An assessment of skills, resources, and knowledge a person has to deal with a crisis situation
How long can a crisis last for?
24-36 hours, initially but can last as long 4-6 weeks
TRUE or FALSE:
Crisis are chronic
False:
Crisis by definition are acute in nature
What are the effects of crisis on cognition?
Crisis can leave a person confused, disorganized, cause cognitive restriction, and preoccupation
What are the effects of crisis on the affective level?
Crisis can make a person anxious, panicked, depressed, and helpless
What are the effects of crisis on the behavioral level?
Crisis can make a person act out in excess, have bizarre behavior, and paralysis
What are the effects of crisis on the physiological level?
flight/fight---dry mouth, decrease urine output, decrease GI motility...etc
Describe what occurs at phase 1 of crisis
a person is initially exposed to the problem/crisis; problem-solving skills and defense mechanisms come in place in an effort to solve the problem and lower anxiety
Describe what occurs at phase 2 of crisis
If the usual defensive response fails, and if the threat persist, anxiety continues, to rise and produce feelings o f extreme discomfort. Individual functioning becomes become disorganized. Trial and error attempts at solving the problem and restoring a normal begins.
Describe what occurs at phase 3 of crisis
Resources are used, alternatives are explored to relieve the stressors
Describe what occurs at phase 4 of crisis
can go in 2 directions
1) effective resolution - situation is resolved
2) ineffective resolution - leads to further disorganization
Define Maturational crisis
a predictable intrinsic that all humans at all age spans experience
Define developmental crisis
Unresolved conflict; triggers related to unresolved conflict; old baggage to new situation
Define Adventitious crisis
Unplanned, accidental, these are disasters, accidental, national/global,
Define Psychopathological Crisis
Crisis brought about by preexisting psychopathology; schizophrenia; impaired adaptation
Define Psychiatric emergencies
Severe mental impairment such as psychosis--these usually require hospitalization
What 5 things must you assess for during crisis intervention?
1) the perception of the crisis
2) what support do they have for this crisis
3) what are their coping mechanisms--is it adaptive/maladaptive
4) what is their physiological response
5) What is the severity
What are the nursing goals for a pt in crisis?
ST: reduce immediate impact of crisis on the patient
LT: return to pre-crisis level of function
What nursing behaviors are needed for a pt in crisis?
1. Self-awareness
2. External control--be able to give structure and direction; provide safety
3.Decrease anxiety - offer self, give info, meet physiological needs/ADL
4. Offer support and hope
5. Be a problem solver, teacher..etc
What is the role of the nurse in the non-directive approach in crisis intervention?
Nurse is supportive of the patient's needs. Patient initiates their own plan of care. Nurse uses empathy, encourages expression of emotions, asks for clarification and encourage pts to accept suggestions
What is the role of the nurse in the Cooperative approach to crisis intervention?
Nurse and patient develop a plan of action. Nurse will use manipulation (using the own patients values to promote well being), reinforcement (giving positive feed back), promote self esteem
What is the role of the nurse in the Directive approach to crisis intervention?
Nurse is responsible for finding pt's problems. Nurse takes direct responsibility for finding solution to the patients problems; explore alternatives for the patient.
When is hospitalization necessary in crisis intervention?
Usually when a pt has a complete psychological collapse/psychotic break. Hospital gives a supportive-protective environment that decreases the potential for self harm
What evaluations must a nurse make to see if their interventions have worked?
1. Are they a harm to self/others
2. How are they function? is it lower, higher or same as before hospitalization. Lower function indicated interventions were not successful.
what is the benefit of benzodiazepine (valium, librium) for alcoholics?
Reduces acute withdrawal effects
what is the benefit of clonidine (Catapres) for alcoholics?
reduces the alpha effects of withdrawal (tachycardia!!)
What is the therapeutic benefit of Narcan (naloxne)
Narcan reverses respiratory distress especially with narcotics and opioid
What is the therapeutic benefit of Anabuse (Disulfiram)
Used for aversion therapy with alcohol; it is a bio-physical deterrent to alcohol use
What is the therapeutic benefit of methadone?
Methadone is an opioid antagonist; prevents effects of severe opiate withdrawl
What is the therapeutic benefit of Naltrexone
Naltrexeone is an opioid antagonist; blocks opioid receptors and decreases opiate craving
What is the therapeutic benefit of Suboxone (buprenopine and naloxone) sublingual tablets?
Suboxnone blocks the effects of opiates; suppresses symptoms of withdrawl and cravings
What is the therapeutic benefit of anticonvulsants (phenobarbital)?
Manages seizure activity associated with drug/alcohol withdrawal
What is the therapeutic benefit of thiamine, folic acids, mag sulfate
Reduces the effects of neuropathies associated with alcohol abuse
What is the therapeutic benefit of antipsychocotics Zyprexa and Haldol
reduces the effects of drug-induced psychosis
What is the therapeutic benefit of NSAIDS Ultram
manage pain for opiate withdrawl