Rnur134 Mental Health Chpt 17 18

Front 1

What are the physical symptoms of a panic attack?

Back 1

* Palpitations, pounding heart, accelerated HR
* Sweating
* Trembling or Shaking
* SOA or Sensation of smothering
* Feeling of choking
* Chest pain or discomfort
* Nausea or Abdominal Distress
* Feeling Dizzy, Unsteady, Lightheaded, or Faint
* Derealization (Feelings of Unreality)
* Depersonalization (Feelings of Being Detached from Self)
* Fear of losing control or going crazy
* Fear of dying
* Paresthesias (Numbness or Tingling)
* Chills or Hot Flashes

At least 4 of the above must be present

Front 2

How are panic attacks characterized?

Back 2

Sudden Onset
4 Physical Symptoms of Anxiety
Dread/Doom/Fear of Death
Occurs w/ Panic Disorder, Social Phobia, Simple Phobia, PTSD

Front 3

List impacts of Panic Attacks on the physical body.

Back 3

Cardiac Disease
GI Disorders
Asthma
Vertigo

Front 4

What medical conditions can cause greater incidences of panic attacks?

Back 4

MI
Mitral Valve Prolapse
Complex Partial Seizures
Migraine Headaches
Hypoglycemia
Hypertension

Front 5

What are the physical symptoms of Generalized Anxiety Disorder

Back 5

* Increased Motor Tension
* Inability to Relax
* Hypervigilant
* Insomnia
* Upset stomach
* Frequent Urination
* Fatigue
* Diarrhea
* Absence of Panic Attacks
* Pain associated w/ muscle tension
* Never relaxed looking

Front 6

How is GAD characterized?

Back 6

Excessive anxiety & worry
Occurring more days than not
@ least 6 months duration
Presence of @ least 3 physical symptoms
Anxiety & Worry that interfere with normal, social, & occupational functioning

Front 7

Etiology for both Panic & GAD

Back 7

Psychodynamic theory - inability for ego to intervene id & superego.
Cognitive - negative self talk causes negative implications
Medical - caffeine
Biological - genetics, neuroanatomical, biochemical & neurochemical

Front 8

How are social phobias characterized?

Back 8

Marked fear of social/performance situations.
Embarrassing behavior exposes individual to scrutiny.
Situations avoided or endured w/ anxiety.
Tx: Therapy & SSRI's

Front 9

How are simple phobias characterized.

Back 9

Marked, persistent fear.
Excessive & Unreasonable fear.
Cued by object or situation
Situations avoided or endured w/ anxiety
Distressed about having phobia

Front 10

Possible treatments for Phobias

Back 10

Identify triggers
Distraction
Positive self-talk
Cognitive Behavioral Therapy (CBT)
Exposure therapy
Desensitization
Implosion Therapy

Front 11

Etiology: OCD & Psychoanalytical Theory (Freud)

Back 11

Clients have weak, underdeveloped egos. Aggressive impulses channeled into thoughts & behaviors.
Defense mechanisms used: Undoing, Rationalization (make excuses for), Intellectualization (devoid of emotion)

Front 12

Etiology: OCD & Learning Theory

Back 12

A conditioned response to a traumatic event. Event produces anxiety & discomfort & the individual learns to engage in behaviors that provide relief.

Front 13

Etiology: OCD & Biological Aspects

Back 13

Neurobiological disturbances may play a role.

Front 14

Etiology: OCD & Neuroanatomy

Back 14

There are abnormalities in various regions of the brain that have been implicated causing the OCD (Basal Ganglia & Frontal Cortex)

Front 15

Etiology: OCD & Biochemical

Back 15

Neurotransmitter serotonin implicated.

Front 16

What characterizes PTSD?

Back 16

Traumatic event preceding symptoms.
Individual response: Fear, Horror, Helplessness
Client re-experiences event in disturbing recollections, feeling/acting as though event is reoccurring, physiological distress during reoccurrance, physiological reactivity to similar cues.

Front 17

Symptoms of PTSD.

Back 17

Avoidance of associated stimuli.
Numbing of general responsiveness.
Estrangement / detachment.
Restricted affect.
Symptoms of increased arousal: sleep disturbance, irritability, poor concentration, exaggerated startle response.

Front 18

Etiology: PTSD & Psychosocial (Freud) related to the experience

Back 18

Tries to explain why some develop PTSD while others don't. Severity & Duration of stress? Amt of preparation for stress? Exposure to death? Sheer numbers affected? Amt of control over reoccurrence? Location?

Front 19

Etiology: PTSD & Psychosocial (Freud) related to the individual

Back 19

Degree of ego strength.
Effectiveness of coping resources.
Pre-existing Psychopathology.
Outcomes of previous stressors/traumas.
Behavioral Tendencies.
Current developmental stage.
Demographic factors.

Front 20

Etiology: PTSD & Psychosocial (Freud) related to the recovery environment

Back 20

Availability of social support.
Cohesiveness & protectiveness of family & friends.
Attitudes of society regarding the experience.
Cultural & subcultural influences.

Front 21

Etiology: PTSD & Learning Theory

Back 21

Negative reinforcement resulting in repetition of behavior.
Avoidance behaviors - won't be around person, location, etc.
Psychic numbing - won't allow self to feel feelings.

Front 22

Etiology: PTSD & Cognitive Theory

Back 22

Person is vulnerable when fundamental beliefs are invalidated by experiencing trauma & when a sense of helplessness & hopelessness prevail.

Front 23

Etiology: PTSD & Biological Aspects

Back 23

Previous trauma victims are more likely to develop symptoms after a stressful life event.
Kindling - Ppl who suffered previous trauma more likely to become exposed to future trauma bc they may be inclined to reactive behaviors associated w/ original trauma.

Front 24

Treatment modalities for Anxiety Disorder due to a General Medical Condition:

Back 24

Benzo's
SSRI Antidepressants

Front 25

What is the appropriate medications that can be given to treat PTSD?

Back 25

Propranolol or Clonidine

Front 26

Characteristics of Somatoform Disorders:

Back 26

Convert anxiety into physical symptoms.
Physical symptoms w/out organic disease.
Reflect interaction between mind/body.
May cause serious impairments in social & occupational functioning.

Front 27

What are some types of Somatoform Disorders?

Back 27

Somatization disorder
Pain disorder
Conversion disorder
Hypochondriasis
Body dysmorphic disorder

Front 28

What is required in the dianosis of a somatoform disorder?

Back 28

Multiple organ systems
Early onset & chronic course without development of physical signs or structural abnormalities.
No clinical laboratory abnormalities commonly associated with general medical condition.

Front 29

Characteristics of Pain Disorder

Back 29

Pain in 1 or more sites w/ significant impairment in 1 or more areas of functioning.
Psychological factors may play important role in onset, severity, exacerbation, or maintenance of pain.

Front 30

Characteristics of Conversion Disorder

Back 30

Exhibits 1 or more symptoms that affect voluntary motor or sensory function.
Causes significant distress in social, occupational, or other areas of functioning.
Common forms include blindness, paralysis, seizures, deafness, or abnormal motor movements.

Front 31

Characteristics of Hypochondriasis

Back 31

Fears having (or idea of having) a serious medical problem.
Misinterpretation of symptoms persist despite medical eval.
Preoccupation w/ illness.
Causes significant distress in everyday functioning.

Front 32

Characteristics of Body Dysmorphic Disorder

Back 32

Preoccupation w/ an imagined defect in appearance.
Slight anomoly has excessive response.
Causes significant distress in everyday functioning.
ie. nose covers whole face

Front 33

Characteristics of Facitious Disorder

Back 33

Intentionally produces physical or psychological signs to assume the sick role.
Behavior satisfies need for secondary gain.
ie. married couple, one cheats, other becomes sick to gain attention

Front 34

Explain dissociative amnesia & dissociative fugue.

Back 34

DA - can't remember personal information, ie. student id #
DF - travel away from home w/ no recollection of past

Front 35

Explain DID

Back 35

Split personality

Front 36

Explain depersonalization disorder

Back 36

persistent/recurrent episodes of feelings of detachment from self.

Front 37

Nursing Process for ALL ANXIETY DISORDERS

Back 37

Assessment ?'s:
Is there a medical diagnosis?
What does pt think causing anxiety?
What happens before anxiety?
How often have symptoms occurred before?
What did pt do to alleviate symptoms in past?
Relationship between anxiety & diet, exercise, living habits, meds, WD's from addictive substances, medical problems?
Recent life changing events?
Family issues?
Are there actual changes in pts mental status?
What thoughts are disturbing to pt?
Support system?
How can support system help decrease anxiety?
What part of anxiety reaction troubles pt most?

Front 38

Appropriate Anxiety Nursing Diagnosis

Back 38

Anxiety
Ineffective Coping
Post-Trauma Syndrome
Stress Overload
Risk-Prone Health Behavior
Fear
Grieving
Powerlessness
Hopelessness

Front 39

Interventions for Anxiety

Back 39

Treatment should be multi-modal
Therapeutic use of voice
Teaching anxiety-mgmt breathing techniques
Long-term psychotherapy

Front 40

Nursing Actions for Anxiety

Back 40

Assist pt to recognize anxious behavior by reflecting familiar aspects of his behavior.
Check pt often
Calm manner & use short declarative sentences in soft but firm voice.
Move pt to smaller environment w/ less stimuli.
Make changes in your voice & look for mirroring.
Encourage expression of feelings about illness, dependency & concerns.
Allow full expression as appropriate but prevent endless recital w/ reinforces anxiety.
Help identify threats/stressors that may be removed.
Anxiety=narrowed perception so pt may have difficulty w/ decisions, problem-solving, attending or remembering.
Teach pt to monitor thoughts that come before anxious feelings.
Teach positive self-statements.
Teach to question rationality of anxiety.
Teach breathing & relaxation techniques.
Teach thought stopping techniques.
Teach pt to use imagery on being successful in anxiety-provoking situation.
Use interventions to help pt gain control.

Front 41

Anxiety outcomes

Back 41

Pt will report anxiety when present using words.
Pt will rate & report level of anxiety 0-10 scale.
Pt will determine circumstances causing anxiety.
Pt will identify though patterns & determine if rational or irrational & worries or useful for problem solving.
Pt will utilize anxiety mgmt techniques.
Pt will control "not useful" thinking.
Pt will control "not useful" behaviors.
Pt will decrease somatic complaints.
Pt. will express hostility & anger appropriately.
Pt will alter diet, exercise, living habits, or meds to reduce anxiety.
Pt will utilize support systems.
Pt will exhibit ways to get needs met.