Anxiety Disorders/Personality Disorders/Aggression Flashcards
What is GAD? What are some manifestations (4)? What is GAD not due to? In order to diagnose how many manifestations need to be present?
Persistent and excessive anxiety. Feeling restless, keyed up, fatigue, irritability. Substances, medical conditions (heart/resp problems), developmental disorder (FASD, ASD). Three or more.
What are obsessions? What are compulsions?
Ideas, intrusive and persistent thoughts. Behaviors that are performed repeatedly.
In all anxiety disorders people have insight into their irrational fears/obsessions/compulsions? True or false?
True
What is the treatment for OCD?
CBT and ERT
What is the underlying cause of all anxiety disorders?
Serotonin imbalance
What is social phobia? These people are highly sensitive to what?
Marked or intense fear of social situations. Criticism or disapproval.
Generalized vs Specific social phobia?
Specific = only avoid certain anxiety provoking situations. Generalized = avoid basically every social situation.
What is the first line of treatment for all anxiety disorders? And another treatment?
SSRI. CBT.
What is the treatment for specific phobias?
ERT
What is a panic disorder? How does a panic attack make a person feel? What do these people do to prevent attacks?
Fear of/presence of unexpected panic attacks. Person feels like they might be dying/having MI. Change behaviours.
What is agoraphobia?
Fear of leaving house/crowds
What type of medication can be effective for managing symptoms of a panic attackbut doesn’t treat the root cause?
Benzodiazepine
What disorders have ERT as treatments (3)
Agoraphobia, specific phobias, and OCD.
What is a therapeutic nursing response for a patient experiencing a panic attack?
“Slow down, you’re safe, take deep breaths”.
What is the first thing we need to get back to normal in someone having a panic attack?
Breathing.
What should a nurse do as an initial intervention to reorient a patient following a PTSD nightmare?
Stay with patient and reassure safety.
What is an acute stress disorder (ASD)?
Acute/transient response that is evident IMMEDIATELY after exposure to a traumatic event.
What is a risk factor for PTSD?
ASD
How long must someone deal with ASD before it is considered PTSD? (length of time for each to diagnose)
ASD is < 1 month. PTSD is > 1 month.
What are the four main categories of diagnostic criteria for someone with PTSD. How long must these manifestations be in place before the person can be diagnosed?
Re-experiencing (flash backs, nightmares), avoidance (avoiding things associated with the event), negative cognition/mood (self-blame, blame others, estrange from others), and arousal (hyperarousal, irritability, exaggerated startle response).
What is a priority nursing assessment of a patient with PTSD?
Suicide risk assessment.
What are the cluster A personality disorders (3)? Cluster A PD are described as…
Paranoid, schizoid, schizotypal. Odd/eccentric.
What are the cluster B personality disorders (4)? Cluster B PD are described as…
Borderline, histrionic, antisocial, and narcissistic. Dramatic/emotional.
What are the cluster C personality disorders (3)? Cluster C PD are described as…
Dependent, avoidant, and obsessive-compulsive. Anxious/fearful.
What are the main characteristics of paranoid personalty disorder (3)?
Mistrust of others, suspicious, and hold grudges/are litigious.
Three main characteristics of schizoid PD?
Introverted/aloof, lack desire for intimacy, and euthymic (inability to feel because they just do not care).
Three main characteristics of schizotypal PD?
Fixed delusions/odd beliefs/magical thinking, eccentric, flat/incongruent emotional responses.
Three main characteristics of borderline PD?
Pervasive pattern of unstable relationships, affective instability, impulsivity.
What is the biggest fear of a person with borderline PD?
Rejection/abandonment.
Individuals with BPD are more likely to take part in what kind of activities?
Self-injurious behaviour/self-mutilation/self-harm.
People with BPD - self-injurious behaviours are what? Why does this make them feel good? Is this done for attention?
Maladaptive coping mechanism. Makes them “feel”, a way to reconnect with their body. Endorphins are released and they feel calm/pleasure. No.
First line treatment for BPD?
Dialectical Behavior Therapy
Three main characteristics of antisocial PD?
Lack remorse, pervasive pattern of disregard for and violation of others’ rights, easily irritated/aggressive.
When can someone with antisocial PD be diagnosed? What must they have in order to be diagnosed?
18 years old. Must have a history of conduct disorder before age of 15.
People with antisocial PD are more likely to engage in what?
Alcohol/drug abuse.
Three main characteristics of histrionic PD?
Attention-seeking, persistent need for approval, and are outwardly charming, but have threatened self-esteem.
People with histrionic PD have likely experienced what?
Abuse.
Three main characteristics for narcissistic PD?
Inexhaustible need for admiration, grandiose sense of importance, strong sense of entitlement.
Three main characteristics for avoidant PD?
Avoid social situations, extremely low self-esteem, timid/shy.
Three main characteristics of dependent PD?
Adapt behavior to please others, let others assume responsibility for their decisions, extreme fear of separation.
What is someone with dependent PD vulnerable to?
Abuse
What has someone with dependent PD likely experienced?
Abuse
Three main characteristics of obsessive-compulsive PD?
Preoccupied with orderliness, difficulty delegating tasks, perfectionist.
What two ways can anger be expressed? Give examples of each
Verbal: yelling. Behavioural: clenching fists.
What is the number 1 risk factor for aggression?
Perceived disrespect.
How do we know behavior is escalating? STAMP…
Staring, Tone of voice, Anxiety, Mumbling, Pacing
What is Trauma Informed Practice (TIP)?
Takes in account that trauma experiences overwhelm an individual’s capacity to cope.
What types of trauma are there (5)? Example of each?
Single incident trauma - accident. Complex/repetitive trauma - ongoing abuse. Developmental trauma - child neglect. Intergenerational trauma - child of abused parent. Historical trauma - holocaust.
What is toxic stress? Who does this affect? What can these people end up with in the long-run?
Continuous stress-response (fight or flight/ANS) even when no harm is apparent. The person is permanently on high-alert. Children. Children can get learning disabilities.
What are good responses to aggressive behavior (8)?
Assess triggers, identify/treat underlying cause, detect early signs of agitation, stance, space, allow patient to express frustration, body language (open posture), and validate emotions.
What are some things we can do to de-escalate aggressive behavior (6)?
Calm, respectful, awareness of verbal/non-verbal communication, decrease stimulus, offer choice, no touching patient.
6 interventions for aggressive behaviour (least resistive to most resistive)?
Redirection, remove unsafe things from environment (things patient can throw), use PRN (opioid for withdrawal, nicotine patch), chemical restraint (PRN specifically ordered for sedation), seclusion, physical restraint.
How long does an RN have to get a cover order for restraints after implementing them?
12 hr
How often does a patient with restraints need to be monitored?
q 15-60 min, or 1:1 nursing.
Why are behavioral care plans good? (4)
Maintain safety of pt/staff, reduce frequency/intensity of aggressive behavior, prevent secondary complications from aggressive behavior, and can integrate violence prevention strategies into CP.
What are 5 predictors of violence?
Brain injury, substance abuse, missed doses of meds, and history of aggressive behavior.
