Anxiety Flashcards
what is anxiety
a subjectively distressful experience activated by the perception of threat which has both a potential psychological and physiologic etiology and expression
what are the feelings of anxiety
discomfot
apprehension
dread related to anticipation of danger
what is the source of anxiety
often nonspecific
known or unknown stressors
what is pathologic anxiety
when fears and anxieties are excessive and interfere with functioning
how can anxiety present itself
episodic
chronic
mild to panic
adaptive (motivating)
functionally impairing
a symptom
a disorder
what is the fight or flight response
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
observable signs of fight o flight
tachycardia
disambiguation
bladder relaxation
tremors
blushing
xerostomia
delayed digestion
hyperacusis
3 stages of selyes general adaption syndrome
alarm
resistance
exhaustion
what is the alarm stage
fight or flight response activated the bdys resources respond to the stressor
what is the resistance stage
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
what is the exhaustion stage
intense continual stressor
body unable to continue compensating, susceptible to disease or death
what is the healthy function of fight or flight
negative feedback loop- production of stress hormones stops further production
we calm down after the initial; fight or flight SNS burst
what is unhealthy function of fight or flight
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
what is clinical threashold
observe and recognize anxiety in our patients
what is clinic perception
ability of the nurse to recognize anxiety based symptoms
what are symptomss of anxiety
fatigue
muscular tension
arousal
worry
irritability
phobia avoidance
compulsions
panic attacks
fight or flight symptoms
what are subtle symptoms of anxiety
impaired concentration
distracted
talkative
distracted during nsg assessment
physiological consequences are dependent upon…
symptom duration
symptom intensity
degree of functional impairment
what diseases are you at increased risk for morbidity with anxiety
cerebrovascular
atherosclerosis
ischemic heart
GI
HTN
resp
GU
what is a stressor (trigger)
an external pressure that an individual experiences
anxiety is the subjective emotional response to that stressor
anxiety is ….. while fear is …..
an emotional process
a cognitive one
what is mild anxiety
seldom a problem/not pathology
tension in response to day to day living
enhances senses
increases motivation for productivity
learning is enhanced
what is moderate anxiety
perceptual field beings to diminish
less alert to surroundings
decreased attention and concentration
muscular tension
restlessess
what is severe anxiety
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
what is panic anxiety
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
how do you want to communicate to someone who is having severe/panic anxiety
give clear and direct communication
what are some healthy adaptive coping strategies
minduflness
sublimination (channeling anxiety into work/productivity)
exercise
deep breathing
what are some ineffective maladaptive coping strategies
compulsive behaviors
substance abuse
avoidance
interpersonal violence
who is at risk
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
what are individual risk factors
temperament
environmental
genetic
physiologic
what is temperament
how an individual interacts in society
affects how society will interact w/ the individual
how is temeprament a risk factor for anxiety
selective mutism
specific phobia
social anxiety disorder
panic disorder
agoraphobia - avoiding crowds
GAD
what enviornmental factors are linked to physiologic and psychological manifestations
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
what is genetic vulnerablity
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
what is physiologic anxiety
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
what is PTSD
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
what is a truamatic event
event outside the range of usual human experience
whcih gendere is PTSD more comon in
women
symptoms of PTSD
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
risk for panic disorder
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
what is panic disorder
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
pt must have 4 of what symptoms for it to be a panic attack
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
what is separation anxiety
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
common behaviors of separation anxiety
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
common comorbidities associated w/ SA
panic disorder
social anxiety
specific phobias
depression
bipolar
what is ocd
obsessive thoughts that manifest as compulsive behavior
presence of obsessions, compulsions or both
behavior lasting > 1 hour is a problem
biological implications of ocd
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
what is obsession
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
what are compulsions
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
examples of compulsions
repeatedly washing hands
checking things
repeat an action
counting things
a preoccupation w/ symmetry
hoarding
what is the HAM-A scale
not a screening or disgnostic tool
rates how someone is managing their anxiety while in treatment
planning and implementation of anxiety (panic)
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
planning and implementation of fear
reassure pt of safety
include pt in making deciosns
encourage pt to explore underlying feelings
planning and implementation of ineffective coping
initially meet the pt’s dependence needs
provide structured schedule of activities
gradually limittime for riualistic behaviors
planning and implementation of disturbed body image
help pt see his/her body image is distorted
involve in activities that reinforce sense of self
make referrals to support groups
what are SSRIs and SNRIs considereed
1st and 2nd line agents
what is buspirone
an anxiolytic with no dependence
what is concern with benzos
dependence/tolerance
paradoxical rxn
sedation
resp depression
w/draw symptoms (taper)
cant take during pregnancy
what is hydroxyzine
an anithistamine similar to benadryl
reduces CNS activity
what are beta blockers used for with anxiety
performance anxiety
tramatic nightmares
take 1 hr before event
what is cognitive behaviroal thapy
model of therapy that uses evidence to challenge automatic negative thoughts that reinforce anxiety
typically 5-20 sessions
pt completes homework btwn sessions
what is individual psychotherapy
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
what is systematic desensitization
training in relaxation techniques
progressive expoure to a hierarchy of fear stimuli while in the relaxed state
what is implosion therapy
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
what is acceptance and commitment therapy
uses acceptance and mindfulness to increase the pts fleixibitly thereby decreasing avoidant and other behaviors that interfere with fxn
what is habitat reversal training
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
