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42 Cards in this Set
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- Back
- 3rd side (hint)
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What is anxiety?
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Universal feeling of uncomfortable apprehension or dread. It may be a response to internal or external stimuli. Symptoms may be physical, affective, cognitive, or behavioral.
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What is the difference between normal and abnormal anxiety?
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Difference is in intensity, cause, degree. Normal anxiety is appropriate to the situation and dissipates when the situation resolves.
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What are some physical symptoms of anxiety?
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-palpitations, heart racind
-BP and pulse changes -Difficulty breathing, SOB -Startle reaction, tremors -Weakness, twitching -GI distress, abdominal pain -Choking, gasping -Pale, flushed, sweating |
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What are some affective symptoms of anxiety?
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-edgy, uneasy fearful
-Nervous, tense, scared -Jittery, jumpy, terrified |
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What are some cognitive symptoms of anxiety?
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-Mind is hazy, dazed
-Feelings of unreality -Can’t concentrate or recall -Loss of objectivity -Fear of losing control -Difficulty reasoning -Self-consciousness |
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What are some behavioral symptoms of anxiety?
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-Flight, avoidance
-Restlessness -Immobility -Impaired coordination |
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What are the clinical differences between mild and moderate anxiety?
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Mild anxiety is the sensation that something is different with increased sensory stimulation. Moderate anxiety is a disturbing feeling that something is wrong with feelings of nervousness and agitation.
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What are the clinical differences between severe anxiety and panic?
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Severe anxiety involves difficulty thinking and reasoning. The patient will experience physiologic changes; primitive survival skills take over. Panic occur when the emotional-psychomotor realm predominates, and involves an adrenalin surge.
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Name 3 anxiety disorders identified by the DSM-IV
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-Panic disorders
-Agoraphobia -Obsessive-Compulsive Disorder -Generalized Anxiety Disorder -Phobic Disorders -Post Traumatic Stress Disorder -Acute Stress Disorder -Anxiety Disorder due to a general medical condition -Substance-induced anxiety disorder -Anxiety disorder NOS |
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What is a panic attack?
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An extreme, overwhelming form of anxiety that involves intense apprehension, fearfulness, or terror. It is also associated with fear of dying, going crazy, losing control with a strong urge to escape or flee.
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How long does a panic attack last?
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It builds to peak in 10-15 minutes. It rarely lasts longer than 30 minutes.
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What is the DSM-IV criteria for panic attack?
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Discrete period of intense fear or discomfort in which 4 or more of the following symptoms developed abruptly and reached a peak with 10 minutes:
- Palpitations, pounding heart or accelerated heart rate - Sweating - Trembling or shaking - Sensations or SOB - Chest pain - Nauseua - Derealization or depersonalization - Feeling dizzy, unsteady, lightheaded or faint - Fear of dying - Paresthesias - Fear of losing control or going crazy |
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What can a nurse do for a patient experiencing a panic attack?
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- Stay with the patient and remain calm
- Give clear, simple instructions - Non-stimulating environment - Reassurance - Administer PRN anxiolytic medications |
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What is the DSM-IV criteria for panic disorder?
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1. Recurrent unexpected Panic Attacks AND
2. At leas one of the attacks has been followed by 1 month or more of at least one of the following: - Persistent concern about having additional attacks - Worry about the implications of the attack or its consequences - A significant change in behavior related to the attacks May be diagnosed with or without agoraphobia |
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What are important factors of nursing assessment for panic disorder?
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- Determine patterns of attacks, symptoms, responses
- Mental status - Suicide assessment - Family functioning - Cultural factors - Cognitive thought patterns - Avoidance behavior patterns |
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What treatment is appropriate for a patient with panic disorder?
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Stabilize the patient by administering and monitoring medication. Determine comorbid conditions and suicide assessment and offer appropriate patient education.
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What treatments are given to patients with panic disorder?
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1. Cognitive restructuring
2. Interoceptive exposure technique 3. Behavioral therapy 4. Relaxation techniques |
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What is interoceptive exposure technique?
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Involves exposure to sensations experienced during a panic attack to evoke feared sensations and see that those sensations do NOT have to progress to panic attacks.
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How is behavioral therapy different from cognitive therapy as relates to treating panic disorder?
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Cognitive therapy involves restructuring thought processes. Behavioral therapy involves desensitization by breaking down fearful situations into small, manageable steps.
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What psychopharmacologic treatment is appropriate for panic disorder?
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1. SSRIs
2. SNRIs 3. TCAs 4. MAOIs |
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Name 2 benzodiazepines
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1. alprazolam (xanax)
2. lorazepam (Ativan) 3. clonazepam (Klonopin) 4. diazepam (Valium) |
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What are important patient education components to benzodiazepine treatment?
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Indicated for short-term use. Contraindicated in COPD, sleep apnea. Cigarette smoking increases clearance. Common side effects include sedation, confusion, dizziness. Other side effects include: rebound anxiety, risk of dependence, and withdrawal symptoms.
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What is obsessive-compulsive disorder?
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Severe obsessions/compulsions that take up more than 1 hour per day and interfere with functioning.
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What are obsessions?
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Unwanted, recurrent, intrusive thoughts. The most common obsession is the fear of contamination.
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What are compulsions?
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Ritualistic, repetitive behaviors that relieve anxiety. Some common examples include hand washing, checking, praying, counting.
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What is the DSM-IV diagnostic criteria for OCD?
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Either obsessions or compulsions that, at some point during the course of the disorder, the person has recognized as excessive or unreasonable. The obsessions or compulsions caused marked distress, are time consuming (take more than 1 hour a day), or significantly interfere wtih the person's normal routine, work, or relationships.
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What treatments are available for OCD?
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1. Behavioral therapy (Exposure and Response-Prevention)
2. Partial hospitalization 3. Medication (SSRIs, SNRIs, TCAs, MAOIs) 4. Relaxation techniques 5. Support groups 6. ECT 7. Deep brain stimulation 8. Psychosurgery |
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What is exposure and response-prevention behavioral therapy?
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The patient must refrain from engaging in compulsive responses when exposed to the object/situation that triggers obsessions. Then the patient writes down what happens as a result of behavioral restraint. The patient also learns to manage intense anxiety.
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Name 3 nursing interventions for OCD
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1. Provide for basic needs
2. Ask specific questions about thoughts, behaviors 3. Maintain accepting attitue 4. Allow time to carry out ritualistic behavior 5. Explain unit routines, expectations, changes 6. Monitor suicidal thoughts, behavior 7. Set realistic expectations and identify progress 8. Monitor medication |
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What are appropriate nursing interventions for OCD?
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- Provide for basic needs
- Ask specific questions about thoughts, behaviors - Maintain accepting attitude - Allow time to carry out ritualistic behavior - Explain unit routines, expectations, changes - Monitor suicidal thoughts, behavior - Set realistic expectations and identify progress - Monitor medication |
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What is generalized anxiety disorder?
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Common disorder with characeristic excessive worry. The onset may be gradual or acute, but generally occurs in the early 20s. It may involve immunosuppression. Comorbidities include panic disorder and substance abuse.
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What is the DSM criteria for GAD?
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Excessive anxiety and worry the person finds difficult to control that occurs more days than not for at least 6 months, about a number of events or activities. Anxiety and worry are associated with 3 of the following:
- restlessness or feeling keyed up or on edge - being easily fatigued - difficulty concentrating or mind going blank - irritability - muscle tension - sleep disturbance Anxiety and worry is not confined to features of an Axis I disorder, and cause significant distress or impairment in social, occupational, or other important areas of functioning. |
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What are the 3 categories of GAD signs and symptoms?
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1. Excessive physiologic arousal
2. Distorted cognitive processes 3. Poor coping |
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What treatments are available for GAD?
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1. Relaxation techniques
2. Psychotherapy 3. Cognitive therapy 4. Biofeedback training |
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What are the available pharmacologic treatments for GAD?
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BuSpar
Benzodiazepines SSRIs TCAs |
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What is posttraumatic stress disorder?
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PTSD occurs after experiencing or witnessing a serious traumatic and potentially life-threatening event. The patient suffers persistent and recurrent flashbacks, reliving events, nightmares, and avoidance.
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What is the difference between acute and chronic PTSD?
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"Acute" if duration of symptoms is less than 3 months. "Chronic" if duration of symptoms is 3 months or more.
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Can is still be PTSD if onset of symptoms doesn't occur until 6 months after the stressor?
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Yes -- it's then called PTSD with delayed onset.
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What are signs and symptoms of PTSD
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- Anger
- Poor impulse control - Chronic anxiety and tension - Avoidance of people, places, things associated with traumatic experience - Emotional detachment or numbness - Depersonalization - Difficulty concentrating - Insomnia |
- Inability to recall details of traumatic event
- Labile affect - Hypervigilance - Social withdrawal - Decreased self esteem - Hopelessness - Sense of being permanently damaged - Relationship problems - Survivor guilt |
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What are available treatments for PTSD?
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Psychotherapy
Exposure therapy Stress management Relaxation techniques Group therapy Pharmacologic treatment |
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What distinguishes PTSD in children and adolescents?
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-Symptoms depend on developemental age at trauma exposure, trauma type, and time until treatment initiated
- Trauma experienced during pre/peri-verbal development can have serious, lifelong manifestations - May have idiosyncratic response to medications |
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What are some nursing interventions for PTSD?
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- Encourage the patient to express grief and gain coping skills
- Deal with displays of anger - Encourage patient to assess angry outbursts - Help patient regain control over angry impulses - Encourage verbal vs. physical expressions of anger - Medication issues |
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