Anxiety Flashcards
Anxiety
feeling of apprehensive, uneasiness, uncertainty, or dread resulting from a real or perceived threat
T/F Normal anxiety is health rxn necessary for survival
T
What are the levels of anxiety?
- Mild
- Mod
- Severe
Describe mild anxiety
- occurs in the normal experience of everyday living allowing an individual to perceive reality in sharp focus
What are some physical Sx of mild anxiety?
- Slight discomfort
- Restlessness
- Irritability
- Tension-relieving behaviors (ex. nail biting)
Describe moderate anxiety
sees, hears, and grasps less info
- ability to think clearly is hampered, but learning and problem solving can still take place although not at an optimal level
What are some Sx of mod anxiety?
- tachypnea
- tachycardia
- diaphoresis
- gastic discomfort
- headache
- urinary urgency
- voice tremors and shaking
Describe severe anxiety
focusing on 1 particular detail or many scattered details and have difficulty noticing what is going on in the env even when someone else pts it out
What are some Sx of severe anxiety?
- headache
- Nausea
- Dizziness
- Insomnia
- hyperventilation
What is the most extreme level of anxiety and results in dysregulated behavior?
panic
What are some Si/Sx of panic?
behavior becomes
- erratic
- uncoordinated
- impulsive
Which of the 2 defense mechanisms are always healthy methods of coping?
sublimation and altruism
What are some physical Sx of Separation anxiety disorder?
GI disturbances and headaches
What is a persistent irrational fear of a specific obj, act, or situation that leads to a desire for avoidance or actual avoidance?
specific phobia
Describe social anxiety disorder (SAD)
severe anxiety or fear provoked by exposure to a social or a performance situation that could be evaluated negatively by others
What are some RFs for SAD?
Childhood mistreatment and adverse childhood events
Describe agoraphobia
intense anxiety or fear about being places or situation from which escape might be difficult or embarrassing or in which help might not be available
What are the key Sx of GAD?
Putting things off and avoidance
Define obsessions
thoughts, impulses or images that persist and recut so that they cannot be dismissed from the mind even thought the individual attempts to do do
Define Complusions
ritualistic behaviors an individuals feels drive to perform in an attempt to reduce anxiety or prevent an imagined calamity
What is separation anxiety disorder?
people exhibit developmentally inapprop. levels of concern over being away from significant other
What is common finding in adults with separation anxiety disorder?
difficulties with romantic relationships and are often unmarried
List all the defense mechanisms
- Regression
- Suppression
- Dissociation
- Projection
- introjection
- Sublimation
- Displacement
- Denial
- Rejection
- Compensation
- Conversion
- Identification
- Intellectulization
- Rationalization
- Rxn
- Splitting
- Undoing
T/F We all know when we are using a defense mechanism
false, they are not always apparent
What is the diff. with adaptive and maladaptive use of defense mechanisms?
Adaptive use helps people lower anxiety to achieve goals in acceptable ways and maladaptive use occurs when one or several are used in xs, particularly in the overuse of immature defenses
Sara has an unconscious hostility toward her daughter is overprotective and hovers over her from harm, interfering w/ her normal growth and development
Rxn formation
Steven loses a promotion starts complaining to others, hands in sloppy work, misses appts, and comes in late for meetings
Regression
Ken forgot his wife’s birthday after a marital fight
Repression
An individual drinks ETHOL when self-esteem is low to temporarily diffuse discomfort
Compensation
What is the diff between repression and suppression?
repression is unconscious while suppression is conscious
” I didn’t get the job b/c the boss doesn’t like me.”
Rationalization
Claire’s husband died 3 yrs earlier still keeps his clothes in the closest and talks about him in the present tense
Denial
Susan experienced abuse during childhood and needs to separate from reality, so she is perpetually disconnected from reality
Dissociation
Laura feels a lump in her breast shortly before leaving for a 3-wk vacation puts the info in the back of her mind until after returning from her vacation
Suppression
Dani is a 26-yr old woman who initially values her acquaintances yet invariably becomes disillusioned when they turn out to have flaws
Splitting
Darla has repressed an attraction toward other women, so she refuses to socialize b/c she fears another woman will make homosexual advances toward her
Projection
Lily is unable to acknowledge fear os her father becomes fearful of animals
Displacement
Mike becomes blind after seeing his wife flirt w/ other women
Conversion
This is the transference of emotions associated w/ a particular person, obj, or situation to another nonthreatening person, obj, or situation
Displacement
This refers to the unconscious rejection of emotionally unacceptable feat. and attributing them to others
Projection
This is the inability to integrate the (+) and (-) qualities of oneself or other into a cohesive image
Splitting
What is the key ft. of panic disorder?
panic attacks
What is the outcome for priority Dx of Severe Anxiety aeb sudden onset of fear impending doom or dying, increase RR and HR, SOB, and dizziness?
panic attacks will become less intense and time between episodes will lengthen so that pt can fxn at the usual level
What is the key pathological feat. of GAD?
excessive worry
What is the outcome for a priority Dx of ineffective coping rt to persistent anxiety, fatigue, and difficulty concentrating?
pt will maintain role performance
Do obsessions and compulsions exist together and occur w/ each other?
they can exist independently, but they most occur together
Tiffany has had 5 nose surgeries, 3 breast augmentations and is in the office to get liposuction and botox. She still claims she is not perfect and sees her dermatologist 5x/mo. What are her actions associated w/?
body dysmorphic disorder
Which neurotransmitters regulate anxiety? Which of the following is the common focus of antianxiety meds?
- NE
- SE
- Dopamine
- GABA- common focus of meds
- EP
When a potential anxious pt is brought into in by their fam member what is your first priority in your assessment?
whether the anxiety is primary or secondary to another medical condition
What is important to consider about the pt and their Si/Sx?
they are the expert, so the assessment should be pt-centered
What is an assessment tool you can use to determine if the pt is experiencing anxiety?
Severity Measure for GAD
What are some nursing DX for anxiety?
- anxiety
- ineffective coping
- chronic low self-esteem
- Self-mutilation
Rhonda comes into the clinic ashamed of her appearance, believes that she is looks absolutely disgusting, and embarrassed by her psoriasis, what is your nursing Dx?
chronic low-esteem
Liam comes into the clinic with skin excoriation due to washing his hands every 20 mins, what is your nursing Dx?
self-mutilation
Jenny haf a panic attack out of the blue for 10 minutes which then subsided, scared everyday because her attacks are unexpected, what is your nursing Dx?
anxiety
Shannon cannot go to social gatherings and complains that her anxiety interferes with her work, what is your nursing Dx?
ineffective coping
After my Dx, what is important in my implementation step?
determine what level of anxiety the pt is experiencing
Jared can still solve problems but has in the inability to concentrate, what are some nursing interventions?
- help him to focus and solve problems by asking open-ended questions, giving broad openings
- evaluate his past coping styles
- offer activities that may temporarily relieve feelings of inner tension
Jill is unable to solve problems and has no idea what is going on in her env, what are some nursing interventions?
- provide safety
- prevent exhaustion
- guide her to a quiet env
- meds
- restraints/ seculsion
How should I communicate with Jill who is unable to solve problems and cannot grasp the env around her?
firm, short, and simple statements
Which class of meds are the first line of defense for anxiety?
Antidepressants
List all the antidepressants (SSRIs)
- Celexa
- Lexapro
- Luvox
- Prozac
- Paxil
- Zoloft
Which 2 SNRIs are effective for anxiety?
Cymbalta and Effexor
When giving antidepressant for anxiety, what is a common finding?
some may initially increase anxiety
Can you give an Nardil for anxiety? Rationale
Nardil is an MAOI and is contraindicated for pts w/ anxiety b/c they cannot consume tyramine and the pt may or may not abide by this dietary restriction which can lead to hypertensive crisis
What do anxiolytics treat in those w/ anxiety disorders?
somatic and psychological Sx
Why are benzodiazepines given most commonly?
because they have a quick onset of action
Since benzodiazepines are addictive, how are these meds given?
they are given for only a short period, only until other medications or treatments reduce Sxs
What is my nursing intervention when a pt is taking Ativan or Klonopin?
monitor for
- sedation
- ataxia
- decreased cognitive fxn
What type of pts are benzodiazepines contraindicated for? Rationale
- Substance use disorder- CNS depression
- Elderly- risk of delirium, falls, and fractures
What about pregnant woman can they take benzodiazepines?
this has to be weighted by the risk of fetal exposure vs the risk of untreated anxiety
What are some risk does a mom put her baby in if she takes benzodiazepines?
increases risks for cleft lip and palate
Which non-benzodiazepine is an alt med?
Buspirone (BuSpar)
Why would a dr. prescribe BuSpar vs Ativan for a pt?
BuSpar is not addictive unlike Ativan, so therefore it can be given long-term
What are some side effects BuSpar?
- Nausea
- Dizziness
- Headache
- Nervousness
- Excitement
- Syncope
What type of pts is BuSpar contraindicated?
- renal impaired
2. hepatic impaired
How long does it take to see the full therapeutic effects of BuSpar?
2-4 wks
What other meds are given for anxiety disorders?
- Beta blockers
- Antihistamines
- Anticonvulsants
- Antipsychotics
What is the reason a pt with anxiety may receive a beta blocker?
beta blockers block receptors that cause the heart to beat faster, so therefore they reduce physical manifestations of anxiety by decreasing HR and reducing blushing
What is the reason a pt with anxiety may receive Gabapentin or Lyrica?
helps manage GAD and SAD
What is the use of antihistamines w/ anxiety disorders?
they lower anxiety levels and helpful in treating pts with substance use problems
If Samantha has severe anxiety and is self-medicating with ETHOL and has long-term use of Kava. What test should you order? Why?
Liver enzymes b/c kava inhibits P450 which metabolizes potential toxic compounds in the liver
List the Benzodiazepines
- Ativan (lorazepam)
- Klonopin (clonazepam)
- Librium ( chlorodizepoxide)
- Serax (oxazepam)
- Tranxene (diazepam)
- Xanax (Alprazolam)
