anxiety

Question 1

3 stages of reaction to stress

Answer 1

1. Alarm stage: hypothalamus notifies adrenal gland to release adrenline & norepinephrine for fuel, and to organs to prepare for potential defense
2. Resistance stage: GI tract is closed, lungs take in more air, heart beats faster & harder, muscles go into fight or flight or freeze mode,
3. Exhaustion stage: person is exhausted bc of negative response to stress & anxiety, body is depleted and may result in continous arousal of physiologic responses

Question 2

adaptive behaviors

Answer 2

can be positive, helps person to learn

ex: using imagery method to refocus attention on pleasant scene

Question 3

maladaptive behaviors

Answer 3

negative responses to anxiety which can lead to physiological s/s
ex: tension headaches, pain syndromes, reduced immunity

Question 4

4 levels of anxiety

Answer 4

1. mild: restlessness, increased motivation, irritability, motivates person to engage in goal-directed activity
2. moderate : agitation, muscle tightness, difficulty concentrating independently but can be re-directed, disturbing feeling that something is wrong
3. severe: inabilitity to function, ritualistic behavior, unresponsive, vitals increase , person is pacing, restlessness, irritibility, anger
4. panic: distorted perception, loss of rational thoughts, immobility, fight flight or freeze response, vitals are high, they are only worried about defending themselves

Question 5

when working with anxious pts, what is the first priority action?

Answer 5

assess pt’s anxiety level
allows nurse to determine proper and effective intervention

Question 6

nursing interventions for 4 levels of anxiety

Answer 6

1. mild: no direct intervention; teaching can be effective
2. moderate: make sure pt is following nurse directions. speak in short & easy to understand sentences; may need to redirect pt
3. severe: REMAIN W/PT; goal needs to be to lower anxiety to moderate to mild; talk in low, calm, soothing voice; have pt take deep even breaths
4. panic: PT SAFETY IS MAIN CONCERN; REMAIN W/PT; keep talking in calm manner; go to small, quiet, nonstimulating environment; reassure pt it’s anxiety, they’re safe & it will pass

Question 7

anxiolytic meds

Answer 7

most are benzodiazepines
needs to be short-term, ideally no longer than 4-6 weeks
high abuse risk

designed to be short term relief for anxiety so that they can deal with the crisis/situation and develop better coping skills

Question 8

name 2 stress-related disorders that develop bc of chronic stress that is repressed

Answer 8

eating disorders (anorexia nervosa & bulimia)

Question 9

postive reframing is…

Answer 9

turning the negative thoughts into postive ones

instead of “my heart is pounding. i think i am going to die” to “this is just anxiety, it will go away”

Question 10

decatastrophizing is…

Answer 10

where the therapist uses questions to reframe the situation more realistically

“what’s the worst thing that could happen”

Question 11

assertiveness training is…

Answer 11

*helps person take more control over life situations *& negotiate interpersonal situations & foster self-assurance

uses more “I” statements to identify feelings and communicate their needs to others (“i feel angry when you turn your back while i’m talking”)

Question 12

thought stopping is…

Answer 12

where pt says “stop” when their negative thoughts come and they distract themselves with a more positive message

they can use rubber band on the wrist or splash cold water on their face, etc

Question 13

with anxiety that develops later in life it is usually…

Answer 13

associated with another condition such as
* depression
* dementia
* physical illness
* medication toxicity/ withdrawl

Question 14

agoraphobia

Answer 14

pt avoids certain places/situations and their fear is usually disproportionate to the actual danger of the place or situation

Question 15

what population is anxiety most prevalent in?

Answer 15

• women
• people under the age 45 yrs

nearly 30% of people develop anxiety in their lifetime

Question 16

koro is based off of the belief that…

Answer 16

the man’s penis will retract into his abdomen and then die; asian belief

for women: fear that vulva and nipples will disappear

Question 17

susto is based off of the belief that…

Answer 17

there are supernatural spirits from dangerous places and cemeteries invades bodies and s/s are sadness, agitation, weight loss, weakness, heart rate changes

hispanic belief/culture

Question 18

the presence of anxiety is …

Answer 18

a warning that people are not dealing with stress effectively

people need to find effective coping skills and make needed changes to stress-inducing situations/feelings

those with anxiety disorders need to understand that meds are temporary relief and that treatment goal is to manage stress/anxiety NOT eliminate it

Question 19

panic disorder is diagnosed when pt

Answer 19

experiences frequent, unexpected panic attacks followed by at least 1 month of constant worry about future attacks

usually have no environmental trigger & 50% develop agoraphobia

Question 20

panic disorder t/x

Answer 20

CBT
deep breathing
relaxation

meds:
* benzodiazepines
* SSRIs
* tricyclic antidepressants
* clonidine & propanolol

Question 21

what are the three types of phobias?

Answer 21

1. agoraphobia
2. specific phobia (object or situations; ex: storms, blood, elevator, animals)
3. social anxiety/phobia

Question 22

phobia t/x

Answer 22

systematic desensitization: progressively expose pt to scary object until they are less anxious
flooding: rapid desensitization
goal is to get rid of fear within 1-2 sessions

meds: alprazolam, buspirone, imipramine, paroxetine, sertraline

Question 23

generalized anxiety disorder (GAD)

Answer 23

excessively worrying, feeling anxious at least 50% of time for 6 months or more
pt also feels at least 3 of s/s:
* uneasiness
* irritability
* muscle tension
* fatigue
* difficulty thinking
* sleep alterations

Question 24

GAD t/x

Answer 24

buspirone
SSRIs
SNRIs