Anxiety and Anxiety Disorders: Exam 2 Flashcards
A state of apprehension, dread, uneasiness, or uncertainty generated by a real or perceived threat whose actual source is unidentifiable
It is different from fear which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger
Is an emotional subjective response
Is commonly experienced by all human beings
Can be a healthy adaptive reaction
Can be considered pathological
Anxiety
When it alerts the person to impending threats
When it motivates the person to take action to solve a problem or to resolve a crisis
A healthy adaptive reaction
When it is disproportionate to the risk
Continues after the threat no longer exist
Interferes with functioning
Pathological
Comprise a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiological responses
Anxiety Disorders
Clients suffering from anxiety disorders demonstrate unusual behaviors such as:
Panic without reason
Unwarranted fear of objects or life conditions
Unexplainable or overwhelming worry
the wear and tear that life causes on the body
It occurs when a person has difficulty dealing with life situations, problems, and goals
Each person handles stress differently
Stress
An automatic physical reaction to stress mediated by the sympathetic nervous system
General Adaptation Syndrome
What are the 2 General adaptation syndrome stages that relate to an understanding of anxiety?
Adaptive
Maladaptive
________ is viewed as a nonspecific body response to any demand. Physical and __________ defenses are mobilized. The ______-___-_______ reaction occurs. Intense _______ is focused on the immediate threat or task. The body mobilizes to combat _____.
Stress
Psychological
Fight-or-Flight
Alertness
Stress
What are the 3 Stages of Reaction to stress?
Alarm reaction stage
Resistance stage
Exhaustion stage
Preparation for defense. What stage is this?
Alarm reaction stage
Blood shunted to areas needed for defense. What stage is this?
Resistance stage
Stores depleted; emotional components unresolved. What stage is this?
Exhaustion stage
Associated with the tension of everyday life
The person is alert, perceptual field is increased, learning is facilitated
Physiological responses are within normal limits
Affect is positive
What type of anxiety is this?
Mild Anxiety
Focus is on immediate concerns
The perceptual field is narrowed
Low-level sympathetic nervous system arousal occurs (increased pulse and respirations)
Tension and fear are experienced
What type of anxiety is this?
Moderate Anxiety
Focus is on specific details
Perceptual field is significantly reduced
Learning cannot occur
Sympathetic nervous system is aroused
Severe emotional distress is experienced
What type of anxiety is this?
Severe Anxiety
Dread and terror
Details are blown out of proportion
Personality is disorganized and unable to function
Physiological arousal interferes with motor activities
Overwhelming emotions cause regression to primitive or childlike behaviors
What type of anxiety is this?
Panic Anxiety (Panic attack)
Involves excessive worrying and high anxiety at least 50% of the time for 6 months or more
Quality of life is greatly diminished in older adults
Buspirone and serotonin-norepinephrine reuptake inhibitor (SSRI) are the most effective treatments
What is this disorder?
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) Symptoms:
Restlessness
Fatigue
Excessive anxiety and worry
Increased muscle aches or soreness
Impaired concentration
Irritability
Difficulty sleeping
Describe Panic Disorder:
-Discrete episodes of panic attacks; no stimulus for panic response
-Peaks in late adolescence and the mid 30s.
-Diagnosed when recurrent, unexpected attacks followed by at least 1 month of concern/worry about future attacks
-Half of people with panic disorder have agoraphobia (fear of being in a situation where you can’t escape danger)
-Increase risk of suicide
-Avoidance behavior
-Primary Gain: relief of anxiety achieved by specific anxiety-driven behaviors
-Secondary Gain: attention received as a result of anxiety-driven behaviors
Assessment for Panic Disorder:
Hamilton Rating Scale for Anxiety
History
General appearance and motor behavior
Mood and affect
Thought process
Sensorium and intellectual processes
Judgment and insight
Self-concept
Roles and relationships
Physiological and self-care concerns
Nursing Diagnoses for Panic Disorder:
Risk for injury
Ineffective coping
Disturbed sleep patterns
Outcomes for Panic Disorder:
The client will be free from injury
The client will utilize effective coping mechanisms
The client will sleep at least 6 hours per night
Interventions for Panic Disorder:
Promote safety and comfort
Use therapeutic communication
Manage anxiety
Provide client and family education
Evaluation for Panic Disorder:
Individualized and based on the diagnoses and associated outcomes
Requires ongoing assessment to determine if outcomes were achieved
Intense illogical persistent fear of specific object or situation
Response is out of proportion to the situation or circumstance
Phobia
Categories of Phobias:
Agoraphobia
Specific phobia
Social anxiety or phobia
Categories of specific Phobias:
Natural environment
Blood – injection
Situational
Animal
Other types
Types of Behavioral Therapy:
Positive reframing
Assertiveness training
Systemic desensitization
Flooding
Exposure
Response prevention
A broad term covering a spectrum of illnesses that result from or worsen because of stress
Chronic stress can cause eating disorders such as anorexia and bulimia
What is this defining?
Stress Related Illnesses
Stress that is _______ or suppressed can cause ________ symptoms with no actual organic disease (somatic symptom disorders)
Ignored
Physical
_______ can exacerbate symptoms of many _______ illnesses.
Stress
Medical
What are the etiologies of anxiety?
Biological factors
Psycho-dynamic factors
Interpersonal factors
Behavioral factors
Anxiety results from improper functioning of body systems involved in the normal stress response
Genetics
Hyperactivity of the autonomic nervous system
What anxiety etiology is this?
Biological Factors
What are the neurotransmitters associated in biological factors?
Gamma-aminobutyric acid (GABA)
Norepinephrine
Serotonin
Cholecystokinin
Anxiety is a warning of danger
Anxiety and the personality are closely related
What anxiety etiology is this?
Psycho-dynamic Factors
What are the 3 types of anxiety?
Reality anxiety
Moral anxiety
Neurotic anxiety
Attainment of satisfaction and security
Anxiety is a response to external factors arising out of contact with other human beings
What anxiety etiology is this?
Interpersonal Factors
Responses to stressors are often the result of learned behaviors
Anxiety may result from the inability to achieve desired goals
What anxiety etiology is this?
Behavioral Factors
For the assessment of anxiety what to you include?
Data to determine level and stage of anxiety
What are the stages of signs/symptoms of anxiety?
Physical signs
Physiologic symptoms
Abnormal lab findings
Effective symptoms
Cognitive symptoms
Social symptoms
Spiritual symptoms
Physical signs of Anxiety:
increased BP
elevated respiration’s
increased HR
sweaty palms
diaphoresis
dilated pupils
dyspnea
nausea
vomiting
Physiological Symptoms of Anxiety:
Mimic symptoms of physical illness
Abnormal Lab Findings with Anxiety:
elevated adrenocorticotropic hormones
cortisol
catecholamine levels
hyperglycemia
Effective Symptoms of Anxiety:
depression
irritability
apathy
crying
anger
worthlessness
apprehension
helplessness
Cognitive Symptoms of Anxiety:
inability to concentrate
indecisiveness
inability to learn/reason
forgetfulness
Social Symptoms of Anxiety:
changes in communication
social withdrawal
Spiritual Symptoms of Anxiety:
feeling hopeless and despair
fear of death
inability to find life meaning
Nursing Diagnoses for Anxiety:
Anxiety
Fear
Ineffective individual coping
Powerlessness
Social isolation
Spiritual distress
Implementation for Anxiety:
Coping strategies
-Breathing exercises
-Guided imagery
-Meditation
-Listening to music
-Recreational activity
Psychopharmacology
Individual and group therapy
Psychopharmacology Associated with Implementation for Anxiety:
Selective serotonin reuptake inhibitors (SSRIs): Celexa, Lexapro, Prozac, Paxil, Zoloft
Tricyclic antidepressants: Elavil, Anafranil, Tofranil
Antihistamine: Benadryl, Atarax
Anti-epileptics: Tegretol, Neurontin, Depakote
Buspirone: Buspar
Benzodiazepines: Ativan, Klonopin, Xanax, Valium
turning negative messages into positive ones
Positive Reframing
making more realistic appraisal of situation
Decatastrophizing
learning to negotiate interpersonal situations
Assertiveness Training
Be aware of own level of anxiety
Remain calm
Establish a trusting relationship
Avoid trying to “fix” client’s problem
What are these associated with?
Professional Practice Issues
What is you evaluation/outcomes from professional practice issues?
Progress should be evaluated during each nurse-client interaction
Should focus on changes in lifestyle, behavior, feelings, level of anxiety, client’s understanding of the disorder, and view of the future.
_________ is unavoidable. It can serve many _______ functions. (Ex: what alerts us of danger.)
Anxiety
Positive
Clients may use ________ mechanisms, Fraud describes these as _________ attempts to control awareness of and to reduce _________. They are _______ distortions that a human uses __________ to maintain a sense of being and to maintain control of a situation.
Defense
Human
Cognitive
Unconsciously
Defense mechanisms are used to lessen _________ and to deal with stress. They arise from the _________ and the person isn’t aware that they are using them.
Discomfort
Unconscious
Defense mechanisms are _________ when they are _________ because it stops the person from leaning a variety of methods to _________ anxiety producing situations.
Harmful
Overused
Resolve
Mild anxiety = ________! Sensor stimulation that ______ and helps the person focus to learn, solve problems, _______, act, feel, and _______.
GOOD
Increase
Think
Protect
Moderate anxiety involves that __________ feeling that involves and notes that something is _________. Person becomes ________/agitated. Can still process information, solve problems, and learn new things. However, have difficulty ___________.
Disrupting
Wrong
Nervous
Concentrating
What should you ask during decatagtrophizing cognitive therapy? What kind of communication does these questions involve?
What is the worst that can happen?
Could you survive that?
Was it as bad as you imagined it being?
Involves therapeutic communication
What is the goal of decatagtrophizing cognitive therapy?
to promote a decrease in anxiety, not dismissing the patients feelings, but asking the patient to asses these feelings.
What does severe anxiety psychological responses include?
Headache
NVD
Trembling
Rigid stance
Vertigo (dizziness and feeling of passing out)
Pale skin
Increased HR
Chest pain
Panic anxiety (_____ ______) = feeling like they are disconnected from themselves (________________) and they believe that things aren’t real (________________). The nurse should reassure the client that they are safe and _______ the client by instructing them to take ______ breaths.
Panic Attack
Depersonalization
De-realization
Reassure
Deep
When the nurse is staying with the client, while allowing them personal space, what kind of intervention is this pertaining?
safe intervention
When talking with a patient who is suffering from anxiety, see clarification of what you observe. What is an example of this? What type of communication does this produce? Why is this good to do with the client?
Example: “you seem upset/agitated.”
Therapeutic Communication is used
This is designed to get the client to communicate what they are feeling.
What medication is used for acute anxiety?
Benzodiazapine: Atavan (MOST COMMON), Klonopin, Xanax, and Valium.
What medication is used for the maintenance of anxiety?
Buspirone: Buspar
What are the most commonly seen medications for anxiety?
Benzodiazapine: Atavan and Buspirone: Buspar
A form of behavior therapy and desensitization—or exposure therapy—based on the principles of respondent conditioning.
Flooding Cognitive Behavioral Therapy
Exposing the target patient to anxiety source without intention to cause danger
Exposure Cognitive Behavioral Therapy
Refraining from compulsion, avoidance, or escape behavior
Response Prevention Cognitive Behavioral Therapy
