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NUR 210 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

what is anxiety

A

a subjectively distressful experience activated by the perception of threat which has both a potential psychological and physiologic etiology and expression

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2
Q

what are the feelings of anxiety

A

discomfot
apprehension
dread related to anticipation of danger

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3
Q

what is the source of anxiety

A

often nonspecific
known or unknown stressors

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4
Q

what is pathologic anxiety

A

when fears and anxieties are excessive and interfere with functioning

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5
Q

how can anxiety present itself

A

episodic
chronic
mild to panic
adaptive (motivating)
functionally impairing
a symptom
a disorder

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6
Q

what is the fight or flight response

A

activation of SNS
adrenal cortex releases adrenalin
heart speeds up…blood circulates faster
lungs dilate to increase o2 in blood
liver releases stored glucose for quick energy
pupils dilate to see better
digestion slows to conserve energy

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7
Q

observable signs of fight o flight

A

tachycardia
disambiguation
bladder relaxation
tremors
blushing
xerostomia
delayed digestion
hyperacusis

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8
Q

3 stages of selyes general adaption syndrome

A

alarm
resistance
exhaustion

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9
Q

what is the alarm stage

A

fight or flight response activated the bdys resources respond to the stressor

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10
Q

what is the resistance stage

A

parasympathetic nervous system activated to reduce the reaction some form of homeostasis while other systems remain hyperactive to ensure readiness to continue fight or flight

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11
Q

what is the exhaustion stage

A

intense continual stressor
body unable to continue compensating, susceptible to disease or death

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12
Q

what is the healthy function of fight or flight

A

negative feedback loop- production of stress hormones stops further production
we calm down after the initial; fight or flight SNS burst

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13
Q

what is unhealthy function of fight or flight

A

when cortisol and norepinephrine are chronically overproduced, the HPA axis eventually becomes desensitized to the negative feedback telling it to calm down
chronic stimulation of the hypothalamus, pituitary gland and adrenal glands result in more cortisol and stress

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14
Q

what is clinical threashold

A

observe and recognize anxiety in our patients

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15
Q

what is clinic perception

A

ability of the nurse to recognize anxiety based symptoms

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16
Q

what are symptomss of anxiety

A

fatigue
muscular tension
arousal
worry
irritability
phobia avoidance
compulsions
panic attacks
fight or flight symptoms

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17
Q

what are subtle symptoms of anxiety

A

impaired concentration
distracted
talkative
distracted during nsg assessment

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18
Q

physiological consequences are dependent upon…

A

symptom duration
symptom intensity
degree of functional impairment

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19
Q

what diseases are you at increased risk for morbidity with anxiety

A

cerebrovascular
atherosclerosis
ischemic heart
GI
HTN
resp
GU

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20
Q

what is a stressor (trigger)

A

an external pressure that an individual experiences
anxiety is the subjective emotional response to that stressor

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20
Q

anxiety is ….. while fear is …..

A

an emotional process
a cognitive one

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21
Q

what is mild anxiety

A

seldom a problem/not pathology
tension in response to day to day living
enhances senses
increases motivation for productivity
learning is enhanced

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22
Q

what is moderate anxiety

A

perceptual field beings to diminish
less alert to surroundings
decreased attention and concentration
muscular tension
restlessess

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23
Q

what is severe anxiety

A

concentration centers on one particular detail only or on many extraneous details
perceptual fields diminishes greatly
attn span is extremely limited
physical symptoms: headache, insomnia, GI distress
emotional symptoms: dread, confusion
all behavior aimed at relieving anxiety

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24
Q

what is panic anxiety

A

unable to focus on even 1 detail within the environment
loss of contact w/ reality may occur: sometimes hallucinations
feeling of terror: “I’m going insane” and “I’m dying”
human functioning and communication with others are ineffective
prolonged panic anxiety can lead to exhaustion and be life threatening

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25
Q

how do you want to communicate to someone who is having severe/panic anxiety

A

give clear and direct communication

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26
Q

what are some healthy adaptive coping strategies

A

minduflness
sublimination (channeling anxiety into work/productivity)
exercise
deep breathing

27
Q

what are some ineffective maladaptive coping strategies

A

compulsive behaviors
substance abuse
avoidance
interpersonal violence

28
Q

who is at risk

A

most prevalent subgroup of mental illness in US
12 mo prevalence: 18.1% adults and 25.1% children
avg age onset: 11 y/o
women are 60% more likely than men to have significant anxiety
white appears more vulnerable compared to black or hispanic

29
Q

what are individual risk factors

A

temperament
environmental
genetic
physiologic

30
Q

what is temperament

A

how an individual interacts in society
affects how society will interact w/ the individual

31
Q

how is temeprament a risk factor for anxiety

A

selective mutism
specific phobia
social anxiety disorder
panic disorder
agoraphobia - avoiding crowds
GAD

32
Q

what enviornmental factors are linked to physiologic and psychological manifestations

A

stress event of loss, death, or a profound change is seen in separation anxiety
development of phobias seen from parental overprotectiveness, parental loss or separation, physical or sexual abuse
childhood maltreatment and adversity during childhood are risks for social anxiety disorder
physical and sexual abuse are common with panic disorder
stressful life events in early childhood are a risk factor for agoraphobia

33
Q

what is genetic vulnerablity

A

neuroanatomy, neural circuits, neurotransmitter systems are genetic
twin studies: separation anxiety disorder saw a 73% heritability rate among a sample of 6y/o twins
some ppl more vulnerable to anxiety and some more resistant to stress

34
Q

what is physiologic anxiety

A

children w/ separation anxiety show a sensitivity to respiratory complications
vasovagal syncope when exposed to needles for blood draws
medical conditions: cancer, heart disease, COPD, diabetes

35
Q

what is PTSD

A

an extended reaction to an extreme trauma which is likely to cause pervasive distress to almost anyone
natural/manmade disasters, combat, serious accidents, witnessing violent death or others, being the victim of torture or abuse, terrorism, rape or other crimes
“shell shock” “soldiers heart” “post traumatic neurosis”
more than 1/2 of all individuals will experience a traumatic event in their lifetime, but less than 10% will develop PTSD
neurotransmitters be,eived to be dysregulated (norepi, dopamine, GABA)
dysfunction in the HPA axis r/t chronic stress and or traumatic event

36
Q

what is a truamatic event

A

event outside the range of usual human experience

37
Q

whcih gendere is PTSD more comon in

A

women

38
Q

symptoms of PTSD

A

dissociated
amneasia
flashbacks
intrusive recollections
emtional numbness r/t event
nightmares
substance abuse
explosiveness
self-destruction
verbalization of survival guilt
guild ab behavior that was required for survival

39
Q

risk for panic disorder

A

genetic vulnerability
tendency toward neg emotions
hx or trauma
respiraotry disturbances (asthma, COPD, smoking)
fearful spells that do not fully meet criteria for panic attack

40
Q

what is panic disorder

A

characterized by recurrent panic attacks onset which is unpredictable
tense apprehension, fear, terror, often associated with feelings of impending doom and accompanied by intense physical discomfort
symptoms are sudden
not triggered by situations
panic attacks last minutes, nervousness and apprehension betwn attacks

41
Q

pt must have 4 of what symptoms for it to be a panic attack

A

palpitations, pounding heart, or accelerated hr
sweating
trembling or shaking
sensations of sob or smothering
feelings of choking
chest pain or discomfort
nausea or ad distress
feeling dizzy, unsteady, lightheaded or faint
chills or heat sensations
paresthesia
derealization or depersonalization

42
Q

what is separation anxiety

A

excessive fear or anxiety r/t the separation from an individual to whom an individual is attached
interferes w/ social, academic, occupational or other areas of functioning
most commonly diagnosed aroundage 5 or 6 when a child goes to school
43% pf those diagnosed are 18 y/o and older
more common in girls than boys
diagnosed after lasting 4 weeks in children and adolescent, 6 mo in adults

43
Q

common behaviors of separation anxiety

A

tantrums
crying
screaming
complaints of physical problems
clinging behaviors
reluctant or refusal to attend school
nightmares involving the person of separation
younger children shadow person they don’t want to be separated from
adolescents may refuse to sleep away from home
specific phobias
depressed mood

44
Q

common comorbidities associated w/ SA

A

panic disorder
social anxiety
specific phobias
depression
bipolar

45
Q

what is ocd

A

obsessive thoughts that manifest as compulsive behavior
presence of obsessions, compulsions or both
behavior lasting > 1 hour is a problem

46
Q

biological implications of ocd

A

brain structure- limbic system
neurotransmitter hypothesis- decreased levels of serotonin
possible endocrine correltation- increased corisol levels
possible genetic link- twin sitdues suggest a possible link

47
Q

what is obsession

A

recurrent and persistent thoughts, urges or images that are experienced at some time during the disturbance as intrusive and unwanted, in most individuals it causes marked anxiety or distress

48
Q

what are compulsions

A

inability to fulfill the ritual is commonly associated w/ profound anxiety
excessive time engaged in the repetitiuos thoughts or behaviors interfere with the individuals daily life

49
Q

examples of compulsions

A

repeatedly washing hands
checking things
repeat an action
counting things
a preoccupation w/ symmetry
hoarding

50
Q

what is the HAM-A scale

A

not a screening or disgnostic tool
rates how someone is managing their anxiety while in treatment

51
Q

planning and implementation of anxiety (panic)

A

stay with client during panic anxiety
maintain calm nonthreatening approach
keep the immediate surroundings low in stimuli
teach pt signs of escalating anxiety and explore cause after anxiety has been reduced

52
Q

planning and implementation of fear

A

reassure pt of safety
include pt in making deciosns
encourage pt to explore underlying feelings

53
Q

planning and implementation of ineffective coping

A

initially meet the pt’s dependence needs
provide structured schedule of activities
gradually limittime for riualistic behaviors

54
Q

planning and implementation of disturbed body image

A

help pt see his/her body image is distorted
involve in activities that reinforce sense of self
make referrals to support groups

55
Q

what are SSRIs and SNRIs considereed

A

1st and 2nd line agents

56
Q

what is buspirone

A

an anxiolytic with no dependence

57
Q

what is concern with benzos

A

dependence/tolerance
paradoxical rxn
sedation
resp depression
w/draw symptoms (taper)
cant take during pregnancy

58
Q

what is hydroxyzine

A

an anithistamine similar to benadryl
reduces CNS activity

59
Q

what are beta blockers used for with anxiety

A

performance anxiety
tramatic nightmares
take 1 hr before event

60
Q

what is cognitive behaviroal thapy

A

model of therapy that uses evidence to challenge automatic negative thoughts that reinforce anxiety
typically 5-20 sessions
pt completes homework btwn sessions

61
Q

what is individual psychotherapy

A

supportive psychotherapy is deisgned to help pt identify their personal strengths and explore adaptivecoping mechanisms
helps pt identify, explore, and resolve internal psychological conflicts that are contributing to anxiety

62
Q

what is systematic desensitization

A

training in relaxation techniques
progressive expoure to a hierarchy of fear stimuli while in the relaxed state

63
Q

what is implosion therapy

A

therapist floods the pt with info concerning situations that trigger the pts anxiety by describing anxiety provoking situations in vivid detail
technique works best for specific phobias
contraindicated if extreme anxiety would be detrimental to pt’s health

64
Q

what is acceptance and commitment therapy

A

uses acceptance and mindfulness to increase the pts fleixibitly thereby decreasing avoidant and other behaviors that interfere with fxn

65
Q

what is habitat reversal training

A

system of positive and negative reinforcement in an effort to modify the hair pulling behavior
individual leanrs to become more aware of the hair pulling identifies times of occurrence and sustitues a more adaptive coping strategy

66
Q
A

NUR 210 (10 decks)

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