Anxiety

Question 1

What are characteristics of anxiety?

Answer 1

Anxiety is fed by fear

Influenced by need to control fear

Encourages avoidance of fearful stimuli

Question 2

How can anxiety disorders be managed?

Answer 2

Acute management

Cognitive Behavioural Therapy

Problem solving

Behavioural therapy

Pharmacology

Counselling

Relaxation therapy

Question 3

What are some nursing strategies for acute management for: Hyperventilation, panic attacks,

Answer 3

Hyperventilation
Calm coaching, cupped hands, paper bag, timed breathing, use the nose

Panic Attacks
The ten commandments

Short, simple and audible sentences;
“Listen to my voice. Take some slow deep breaths. In, two, three; out two, three. Anxiety is taking over here. Listen to me so we can calm it down.”

Reduce stimuli

Stay with the person

Question 4

What are the 6 steps of problem solving?

Answer 4

Step 1. Identifying the problem
Step 2. Generating solutions through brainstorming
Step 3. Evaluating the solutions
Step 4. Choosing the optimal solution
Step 5. Planning
Step 6. Reviewing

Question 5

What are some longer term nursing strategies for trauma informed care and psychological formulations?

Answer 5

Taking a historical view

Understand what the person is experiencing through the context of why

Insight offers treatment direction

Predisposing factors (what has led to the problem)

Precipitating factors (triggers)

Perpetuating factors (what makes things worse)

Protective factors (what helps)

Question 6

What are some longer term nursing strategies for reflection and relaxing?

Answer 6

Practice relaxation
Help the individual identify their strengths

Encourage client to identify: (ABC)
Antecedent – What happened prior?
Behaviour – What did you do?
Consequences – What happened next?

Question 7

What should a nurse not do when helping with someone with anxiety?

Answer 7

Take over

Dismiss

Falsely reassure

Question 8

What are the two theories related to anxiety?

Answer 8

Biological and learning

Question 9

What is the biological theories hypothesises?

Answer 9

The evolutionary argument

Genetic inheritance

Altered brain chemistry

Question 10

What is the learning theories hypothesises?

Answer 10

Cognition theory

Socio-ecological theory

Question 11

What are the different types of anxiety disorders?

Answer 11

Generalised Anxiety Disorder

Panic Disorder

Specific Phobia

Social phobia

Somatoform Disorders

Acute Stress Disorder

Obsessive Compulsive Disorder

Post Traumatic Stress Disorder

Agoraphobia

Question 12

What is panic disorder defined as?

Answer 12

Defined as strong physical responses that often leave the person in fear of dying or losing control.

Question 13

What is specific Phobia defined as?

Answer 13

A marked and persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific object or situation e.g. heights, animals, seeing blood. Exposure to phobic stimulus almost invariably provokes an immediate anxiety response which might take the form of a panic attack

Question 14

What is a social phobia defined as?

Answer 14

Social phobia often called social anxiety disorder goes beyond shyness. Features include hypersensitivity to criticism, negative evaluation or rejection. Often have difficulty being assertive have low self-esteem and feelings of inferiority. This can result in avoidance and poor social skills. Severe social phobia may result in having no interpersonal relationships, isolation and can lead to suicidal ideation, DSM-5 has specific diagnostic criteria for this.

Question 15

What is somatoform disorders?

Answer 15

Somatoform Disorders focuses on physical symptoms in anticipation of a serious illness or disease
People often have a strong conviction that they are seriously ill and will frequent hospitals and medical centres in attempts to find a solution

Question 16

What is acute distress disorder?

Answer 16

A transient response to a severe trauma the characteristic symptoms of anxiety, dissociation and other intense autonomic arousal occur within 1 month after exposure to the stressor.

Question 17

What are the symptoms of acute distress disorder?

Answer 17

3 or more of the following symptoms;

Numbing, detachment or no emotional response.

Being in a daze,

Derealisation (A feeling that you and/or your surroundings are not real and/or experience your surroundings through a diffused light, fog or mist.)

Depersonalisation (An altered sense of one’s physical being. Includes feelings outside of one’s body, physically cut off or distanced from people, floating, observing oneself from a distance, like one is in a dream, or one’s body is physically changed in shape or size.)

Dissociative amnesia (The primary symptom of dissociative amnesia is the sudden inability to remember past experiences or personal information. Some people with this disorder also might appear confused and suffer from depression and/or anxiety.)

Must persistently re-experience the traumatic event in at least 1 of the following ways;

Re-current images

Re-current thoughts or dreams

Illusions

Flashbacks

Distress

The symptoms must last at least 2 days and can persist for up to 4 weeks after the trauma if the symptoms persist beyond 1 month after the trauma it then becomes PTSD

Question 18

What are triggers for Post traumatic stress disorder?

Answer 18

military combat, violent personal assault, disaster, accidents, childhood sexual abuse for example

Question 19

What is the definition of generalised anxiety disorder?

Answer 19

Excessive anxiety & worry occurring more days than not for a period of at least 6 months, about a number of events or activities. The individual finds it difficult to control the worry

Question 20

What is Obsessive Compulsive disorder defined as?

Answer 20

Recurrent obsessions or compulsions that are severe enough to be time consuming (they take more than one hour a day) or cause marked distress or significant impairment

Question 21

What are some physical responses to anxiety?

Answer 21

Hyperventilation

Diversion of blood flow

Instinctive (primitive brain) survival mode

Dissociation

Stress Hormones

Changes in metabolism, insulin production and digestive system

Muscle tension

Racing Heart

Rapid breathing

Fear

Increased blood pressure

Dilated pupils

Muscle fatigue from tension

Sweating

Clenched jaw

Irritation of digestive tract

Immune system suppression

Question 22

What can people with panic disorder experience?

Answer 22

Physiological; tachycardia, sweating, shaking, dyspnoea, chest pain, dizziness, nausea, tingling and a sense of depersonalisation

Psychological; a sense of imminent death or doom, fear of losing consciousness, engaging in rapid safety behaviours i.e phoning ambulance

People with panic disorder tend to focus on symptoms rather than the cause and help focuses on safety, avoidance and dependency rather than context

Question 23

What is panic disorder?

Answer 23

Unpredictable experiences of intense, episodic surges of anxiety

Question 24

Panic Disorder

Answer 24

Symptoms- intense serge if anxiety, psychological worry and physical symptoms, tachycardia, tight chest, shaking, dizziness and nausea
Treatment- management of panic attack, stay with the person, breathin coaching
long term- CBT, education

Question 25

Social Phobia

Answer 25

Symptoms- pronounced, persistent fear of social situations, especially where they fear criticism regarding failure, performance
Treatment-

Question 26

Agoraphobia

Answer 26

Symptoms- fear of not being able to escape an area e.g. mall if becoming anxious.
Treatment- panic management

Question 27

Specific Phobia

Answer 27

Symptoms- disappropriate fear of risk to an object or situation poses.
Treatment- CBT with gradual exposure

Question 28

Adjustment Disorder

Answer 28

Symptoms- intense stress response to a potential or actual serious illness or significant event
Treatment- support of psychological stress/distress
mindful, solution focused nursing no need for pharmacological intervention

Question 29

Acute Stress Disorder

Answer 29

Symptoms- similar to PTSD except shorter time frame of symptoms exhibited
Treatment- trauma focused CBT

Question 30

Post Traumatic-Stress Disorder

Answer 30

Symptoms- presents following direct witness to a traumatic event
Treatment- trauma focused CBT, trauma focused therapy, SSRI’s or SNIR’s potentially

Question 31

Obsessive Compulsive Disorder

Answer 31

Symptoms- intrusive thoughts that become obsessed with associated behaviour aim to reduce feelings of anxiety associated with thoughts
Treatment- CBT, SSIR’s

Question 32

Generalised Anxiety Disorder

Answer 32

Symptoms- constant, excessive worry that is not specific
Treatment- education and active monitoring non-facilitated self-help, guided self-help, CBT, SSRI
applied relaxation

Question 33

Outline causes of anxiety disorder

Answer 33

genes, trauma, and nurture

Question 34

Panic Attack

Answer 34

Symptoms- feeling of doom, death, or panic. increased heart rate, increase resps BP, pupils dilate, chest pains, tingling in extremities
Nursing management- remain with the person, remain calm, reasure they will not faint, die or loose control, encourage to continue breathing

Question 35

Hyperventilation

Answer 35

Symptoms- rapid, shallow breathing, may be associated with dizziness, tingling in extremities
Nursing management- guided breathing, paper bag, cupped hands.

Question 36

Therapeutic/interpersonal use of self; Anxiety

Answer 36

psychoeducation, relaxation and distraction, mindfulness, validation of experience, encouraging social support, trauma informed care.

Question 37

Cognitive behavioural therapy; Anxiety

Answer 37

helps make sense of consumers experiences, values, beliefs, attitudes and day to day thoughts in the context of emotional and behavioral response.

Question 38

Antidepressants; Anxiety

Answer 38

useful in managing associated mood disorders. do not provide an immediate response

Question 39

Mood stabilizers; Anxiety

Answer 39

useful in managing associated mood disorder do not provide an immediate response