ATI Ch 11, Anxiety Disorders Flashcards
What is normal anxiety?
A healthy response to stress essential for survival
Normal anxiety can become problematic when elevated or persistent.
What can occur when anxiety is elevated or persistent?
Behavior changes and impairment of function
These changes are known as anxiety disorders.
What are the levels of anxiety?
Mild, moderate, severe, panic
Each level has specific characteristics.
What are the characteristics of mild anxiety?
Restlessness, increased motivation, irritability
Mild anxiety can be motivating but may also lead to discomfort.
What are the characteristics of moderate anxiety?
Agitation, muscle tightness
Moderate anxiety can affect physical well-being.
What are the characteristics of severe anxiety?
Inability to function, ritualistic behavior, unresponsive
Severe anxiety significantly impacts daily activities.
What are the characteristics of panic anxiety?
Distorted perception, loss of rational thought, immobility
Panic anxiety can lead to overwhelming fear.
What is separation anxiety disorder?
Excessive fear or anxiety when separated from an emotionally attached individual
Common in children but can occur in adults.
What is specific phobia?
Irrational fear of a certain object or situation
Specific clinical names are used for different phobias.
What is monophobia?
Phobia of being alone
A type of specific phobia.
What is zoophobia?
Phobia of animals
Another type of specific phobia.
What is acrophobia?
Phobia of heights
A specific phobia that can cause significant distress.
What is agoraphobia?
Extreme fear of certain places where one feels vulnerable or unsafe
Often involves fear of being outdoors or on bridges.
What is social anxiety disorder?
Excessive fear of social or performance situations
Can lead to avoidance of social interactions.
What is panic disorder?
Experiencing recurrent panic attacks
Panic attacks are sudden periods of intense fear.
What is generalized anxiety disorder (GAD)?
Uncontrollable, excessive worry for at least 6 months
GAD affects daily functioning and quality of life.
What are obsessive-compulsive and related disorders classified as?
They are not actual anxiety disorders but have similar effects.
What characterizes obsessive-compulsive disorder (OCD)?
Intrusive thoughts of unrealistic obsessions and compulsive behaviors, such as repetitive cleaning or washing hands.
What is hoarding disorder?
Difficulty parting with possessions, leading to extreme stress and functional impairments.
Define body dysmorphic disorder.
Preoccupation with perceived flaws or defects in physical appearance.
Which gender is more likely to be affected by most anxiety disorders?
Females.
Which exception exists for the prevalence of hoarding disorder?
Hoarding disorder has a higher prevalence rate among males.
What genetic and neurobiological link is associated with anxiety and obsessive-compulsive disorders?
These disorders have a genetic and neurobiological link.
What are some acute medical conditions that can cause anxiety?
Hyperthyroidism or pulmonary embolism.
Why is it important to assess manifestations of anxiety in a medical facility?
To rule out a physical cause.
What can mimic anxiety disorders?
Adverse effects of many medications.
What types of experiences can contribute to the development of anxiety disorders?
Trauma or negative life experiences, such as adverse childhood experiences.
How do lifestyle choices affect anxiety disorders?
Poor diet, lack of exercise, and substance use can contribute.
What is substance-induced anxiety related to?
Current use of a chemical substance or withdrawal effects from a substance (alcohol).
What are the characteristics of separation anxiety disorder?
Excessive anxiety when separated from an emotional attachment, fearing something tragic will occur.
How does separation anxiety disorder affect daily activities?
The client’s anxiety disrupts the ability to participate in routine daily activities.
What physical manifestations can develop during or in anticipation of separation anxiety?
Headaches, nausea and vomiting, and sleep disturbances.
What is a specific phobia?
A fear of specific objects or experiences such as spiders, snakes, flying, or being in the dark
Specific phobias can lead to anxiety manifestations even by merely thinking about the feared object or situation.
What behaviors might a client with specific phobia exhibit to manage anxiety?
Attempt to decrease anxiety through the use of alcohol or other substances
This is a common coping mechanism among individuals with specific phobias.
What is agoraphobia?
Avoidance of certain places or situations that cause anxiety, disrupting daily life
Clients often fear situations that are out of proportion to the actual danger.
What impact does agoraphobia have on a client’s daily activities?
It may disrupt the client’s ability to maintain employment or participate in routine activities
Avoidance behaviors can significantly affect personal and professional life.
What is social anxiety disorder?
Excessive fear of embarrassment or poor performance in social situations
Clients often have difficulty speaking or performing in front of others.
What physical manifestations might a client with social anxiety disorder report?
Actual or factitious physical symptoms to avoid social situations
These symptoms can include sweating, shaking, or nausea.
What characterizes a panic attack?
Typically lasts minutes but may occasionally last longer
Panic attacks can be unpredictable and vary in duration.
What are some common manifestations during a panic attack?
- Palpitations
- Shortness of breath
- Choking sensation
- Chest pain
- Nausea
- Feelings of depersonalization
- Fear of dying or insanity
- Chills or hot flashes
Four or more of these symptoms must be present for a diagnosis.
What is generalized anxiety disorder (GAD)?
Characterized by uncontrollable, excessive worry for the majority of days over at least 6 months
GAD leads to significant impairment in one or more areas of functioning.
What are some manifestations of generalized anxiety disorder?
- Restlessness
- Muscle tension
- Avoidance of stressful activities
- Increased time and effort to prepare for stress
- Procrastination in decision-making
- Sleep disturbance
These symptoms can affect daily functioning and overall quality of life.
What is OCD?
The client attempts to manage intrusive thoughts or urges that cause anxiety through compulsive or obsessive behaviors
OCD stands for Obsessive-Compulsive Disorder, characterized by time-consuming obsessions or compulsions that impair social and occupational functioning.
What is hoarding disorder?
The client has an obsessive desire to save items regardless of value and experiences extreme stress with thoughts of discarding items
Hoarding behavior results in social and occupational impairment and often leads to an unsafe living environment.
What is body dysmorphic disorder?
The client attempts to conceal a perceived physical flaw and practices repetitive behaviors in response to anxiety
Common behaviors include mirror checking or comparison to others, leading to social and occupational impairment.
Name a standardized screening tool for anxiety.
Hamilton Rating Scale for Anxiety
Other tools include Fear Questionnaire, Panic Disorder Severity Scale, Yale-Brown Obsessive Compulsive Scale, and Hoarding Scale Self-Report.
What type of care is essential in patient-centered care for clients with anxiety disorders?
Providing trauma-informed care
This care considers the client’s experience and requires the nurse to be aware, sensitive, and responsive.
What is a structured interview used for in nursing care?
To keep the client focused on the present
It helps in managing anxiety and guiding the conversation effectively.
What comorbid condition should be assessed in clients with anxiety disorders?
Substance use disorder
Assessing for comorbid conditions is important for comprehensive care.
How should a nurse provide safety and comfort during a crisis period of anxiety?
By creating a calm, quiet environment
Clients in severe-to-panic-level anxiety are unable to problem-solve and focus.
True or False: Clients experiencing panic-level anxiety benefit from a structured environment.
True
A structured environment enhances physical safety and predictability.
What should a nurse do during the worst of the client’s anxiety?
Remain with the client to provide reassurance
This presence helps alleviate the client’s distress.
What assessment should be performed for clients with anxiety disorders?
Suicide risk assessment
Ensuring the safety of clients is a priority in nursing care.
What type of therapy employs a structured environment for clients?
Milieu therapy
It includes monitoring for self-harm and facilitating daily activities that encourage sharing and cooperation.
Fill in the blank: Therapeutic communication skills involve the use of _______ questions to help the client express feelings.
open-ended
This technique helps validate and acknowledge the client’s feelings of anxiety.
What is the role of client participation in decision-making regarding care?
To empower the client and enhance their engagement in their treatment
Client involvement is crucial for effective care.
What techniques can be used for relief of pain, muscle tension, and feelings of anxiety?
Relaxation techniques
These techniques can be employed as needed with the client.
What should be instilled in clients regarding outcomes?
Hope for positive outcomes
Avoid false reassurance.
How can a client’s self-esteem be enhanced?
Encouraging positive statements and discussing past achievements
This approach helps in building self-esteem.
What should clients be assisted in identifying that interferes with recovery?
Defense mechanisms
Recognizing these mechanisms can aid in the recovery process.
When should health teaching be postponed?
Until after acute anxiety subsides
Clients experiencing panic attacks or severe anxiety may be unable to concentrate or learn.
What resources should be identified for clients who have anxiety?
Counseling, group therapy, and other community resources
These resources can provide support to clients.
What is the purpose of cognitive behavioral therapy?
To decrease the anxiety response by changing cognitive distortions
This therapy involves cognitive reframing to help clients identify and replace negative thoughts.
What is the goal of behavioral therapies?
To teach clients ways to decrease anxiety or avoidant behavior
Behavioral therapies also provide opportunities to practice techniques.
What does relaxation training aim to control?
Pain, tension, and anxiety
Refer to the chapter on Stress Management for techniques.
What is modeling in therapy?
A demonstration of appropriate behavior in a stressful situation
The goal is for the client to imitate this behavior.
What is systematic desensitization?
A process that begins with mastering relaxation techniques followed by exposure to anxiety-producing stimuli
The client gradually tolerates greater levels of the stimulus until anxiety no longer interferes with functioning.
What does flooding involve?
Exposing the client to a great deal of an undesirable stimulus
This aims to turn off the anxiety response and is useful for clients with phobias.
What is the focus of response prevention?
Preventing the client from performing a compulsive behavior
The intent is that anxiety will diminish as a result.
What does thought stopping teach clients?
To say ‘stop’ when negative thoughts or compulsive behaviors arise
Clients learn to substitute a positive thought and eventually use the command silently.
What should be monitored for in clients with anxiety?
Manifestations of anxiety
This includes physical, emotional, and behavioral signs of anxiety.
What lifestyle management strategies can help clients with anxiety?
- Nutritional strategies (healthy diet)
- Exercise
- Avoiding excessive caffeine or substance use
These strategies promote overall well-being and can mitigate anxiety symptoms.
What should be evaluated regarding coping mechanisms for anxiety?
Coping mechanisms that work and do not work
Learning new methods may enhance anxiety management.
What should clients do regarding medication adjustments?
Notify the provider of worsening effects and do not adjust medication dosages
Clients should consult the provider before making any changes to medication.
What are some major medications used to treat anxiety disorders?
- Benzodiazepine sedative hypnotic anxiolytics
- Atypical anxiolytic/nonbarbiturate anxiolytics
- Selected antidepressants
These medications target different aspects of anxiety disorders.
Name three benzodiazepine sedative hypnotic anxiolytics.
- Lorazepam
- Alprazolam
- Clonazepam
These medications are commonly prescribed for anxiety relief.
What is the first line of treatment for anxiety and obsessive-compulsive disorders?
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are effective in managing symptoms of anxiety and OCD.
List two selective serotonin reuptake inhibitors (SSRIs).
- Paroxetine
- Sertraline
SSRIs are preferred due to their favorable side effect profile.
What are serotonin norepinephrine reuptake inhibitors (SNRIs) used for?
Treating anxiety disorders
SNRIs can be effective alternatives to SSRIs.
Name two SNRIs.
- Venlafaxine
- Duloxetine
These medications can also help with depressive symptoms.
What are tricyclic antidepressants (TCAs) used for?
Treatment of anxiety disorders
TCAs are less commonly used due to their side effects.
List two tricyclic antidepressants (TCAs).
- Amitriptyline
- Imipramine
These medications can be effective but require careful monitoring.
What are monoamine oxidase inhibitors (MAOIs) used for?
Treatment of anxiety disorders
MAOIs are effective but have dietary restrictions and interactions.
Name one MAOI.
Phenelzine
MAOIs can be effective for treatment-resistant cases.
What role do antihistamines play in anxiety treatment?
They can be used as anxiolytics
Antihistamines like hydroxyzine can provide short-term relief.
Name two antihistamines that can be used for anxiety.
- Hydroxyzine pamoate
- Hydroxyzine hydrochloride
These medications can help manage acute anxiety symptoms.
What are beta blockers used for in anxiety treatment?
Managing physical symptoms of anxiety
Propranolol is commonly used for performance anxiety.
What is the role of anticonvulsants in anxiety management?
They may be used as adjunctive therapy
Gabapentin and Pregabalin are examples that can help with anxiety symptoms.
Fill in the blank: The atypical anxiolytic used for anxiety treatment is _______.
Buspirone
Buspirone is effective for chronic anxiety management.
What should be monitored for in client education?
Manifestations of anxiety
This includes recognizing signs such as restlessness, excessive worry, or physical symptoms.
What are some components of lifestyle management for anxiety?
Nutritional strategies, exercise, avoiding excessive caffeine or substance use
A healthy diet and regular physical activity can significantly improve mental health.
What should be evaluated regarding the client’s coping strategies?
Coping mechanisms that work and do not work for controlling anxiety
Identifying effective strategies can help the client manage anxiety more effectively.
What should clients avoid when it comes to medication adjustments?
Do not adjust medication dosages without consulting the provider
This ensures safety and proper management of anxiety symptoms.
True or False: Clients should notify the provider of worsening effects.
True
Prompt communication can lead to timely adjustments in treatment.
Fill in the blank: The use of alternative stress relief and coping mechanisms might __________ medication effectiveness and decrease the need for medication.
increase
This suggests that non-pharmacological strategies can support medication treatment.
What should clients learn in addition to evaluating their current coping mechanisms?
New methods for managing anxiety
Expanding one’s toolkit for coping can provide more options in stressful situations.
What role do defense mechanisms play in anxiety management?
They are coping strategies the client currently uses
Understanding these can help in identifying areas for improvement.
What are the major medications used to treat anxiety disorders?
Benzodiazepines, Buspirone, Beta Blockers, SSRIs, SNRIs, TCAs, MAOIs, Antihistamines, Anticonvulsants
Each medication serves different mechanisms and therapeutic effects.
What type of medication is Buspirone?
An anxiolytic used to treat anxiety disorders
It is specifically effective for generalized anxiety disorder.
True or False: SSRIs are commonly used to treat anxiety disorders.
True
SSRIs help by increasing serotonin levels in the brain.
Fill in the blank: _______ are a class of medications that can be used to treat anxiety disorders and include medications like fluoxetine and sertraline.
SSRIs
SSRIs stand for Selective Serotonin Reuptake Inhibitors.
What is the role of Beta Blockers in treating anxiety disorders?
They help manage physical symptoms of anxiety, such as rapid heartbeat
Often used in performance anxiety situations.
List three examples of medications classified as SNRIs.
- Venlafaxine
- Desvenlafaxine
- Duloxetine
SNRIs are Serotonin-Norepinephrine Reuptake Inhibitors.
What type of medication is TCA?
Tricyclic Antidepressants
They are sometimes used when other treatments are ineffective.
What does MAOI stand for?
Monoamine Oxidase Inhibitor
MAOIs are used less frequently due to dietary restrictions.
Fill in the blank: Antihistamines can be used to treat anxiety disorders due to their _______ properties.
sedative
Commonly used antihistamines for this purpose include diphenhydramine.
What is the function of anticonvulsants in the treatment of anxiety disorders?
They help stabilize mood and reduce anxiety symptoms
Examples include gabapentin and pregabalin.
What are the 5 medications that treat Trauma and Stressor Related Disorders?
BB, SSRIs, SNRIs, TCAs, MAOIs
What is the prototype medication for benzodiazepine sedative hypnotic anxiolytics?
Alprazolam
List other medications that are classified as benzodiazepine sedative hypnotic anxiolytics.
- Diazepam
- Lorazepam
- Chlordiazepoxide
- Clorazepate
- Oxazepam
- Clonazepam
What is the expected pharmacological action of benzodiazepines?
Benzodiazepines enhance the inhibitory effects of gamma-aminobutyric acid in the central nervous system.
What are the therapeutic uses of benzodiazepines?
- Short-term treatment for generalized anxiety disorder
- Panic disorder
What are other uses of benzodiazepines?
- Seizure disorders
- Insomnia
- Muscle spasm
- Alcohol withdrawal
- Induction of anesthesia
- Amnesic prior to surgery or procedures
What are common complications associated with benzodiazepines?
Central nervous system (CNS) depression including sedation, lightheadedness, ataxia, and decreased cognitive function.
What client education should be provided regarding the use of benzodiazepines?
- Observe for manifestations
- Notify the provider if effects occur
- Avoid hazardous activities
- Avoid concurrent use of alcohol and other CNS depressants
- Be aware of next-day sedation with long half-life medications
What is anterograde amnesia in the context of benzodiazepine use?
Difficulty recalling events that occur after dosing.
What are the symptoms of acute oral toxicity from benzodiazepines?
- Drowsiness
- Lethargy
- Confusion
What are the symptoms of acute IV toxicity from benzodiazepines?
- Respiratory depression
- Severe hypotension
- Cardiac arrest
What nursing actions should be taken for oral toxicity of benzodiazepines?
- Gastric lavage
- Administration of activated charcoal or saline cathartics
What medication is used to counteract sedation and reverse adverse effects of benzodiazepines?
Flumazenil
What should be monitored in a patient experiencing benzodiazepine toxicity?
- Vital signs
- Maintain patent airway
- Provide fluids to maintain blood pressure
What is a paradoxical response to benzodiazepines?
Insomnia, excitation, euphoria, anxiety, rage.
What are withdrawal effects from benzodiazepines?
- Anxiety
- Insomnia
- Diaphoresis
- Tremors
- Lightheadedness
- Delirium
- Seizures
What is a recommended action after taking benzodiazepines regularly and in high doses?
Taper the dose over several weeks using a prescribed tapered dosing schedule.
Why are benzodiazepines contraindicated in certain populations?
- Teratogenic effects
- Transmitted through human milk
- Contraindicated in sleep apnea, respiratory depression, and/or glaucoma
What is the classification of benzodiazepines under the Controlled Substances Act?
Schedule IV
What precautions should be taken when administering benzodiazepines?
- Use cautiously in clients with liver disease or history of substance use disorder
- Assess fall risk for older adults
What interactions should be avoided with benzodiazepines?
CNS depressants such as alcohol, barbiturates, and opioids.
Fill in the blank: Benzodiazepines can cause respiratory depression when combined with _______.
[CNS depressants]
What should be done when discontinuing benzodiazepines taken regularly for long periods?
Taper the dose over several weeks using a prescribed dosing schedule.
This approach helps to reduce withdrawal symptoms.
When should benzodiazepines be administered to minimize GI upset?
With meals or snacks.
This can help alleviate gastrointestinal discomfort.
What is essential for clients to remember regarding medication discontinuation?
Avoid abrupt discontinuation of treatment to prevent withdrawal manifestations.
Abrupt withdrawal can lead to significant discomfort and health risks.
How should sustained-release tablets be taken?
Swallow whole; avoid chewing or crushing.
Chewing or crushing can lead to improper dosing.
Why should benzodiazepines be kept in a secure place?
Due to potential for misuse.
Misuse can lead to dependency and other complications.
What can develop during and after treatment with benzodiazepines?
Dependency.
Dependency may require careful management and monitoring.
What should clients do if they experience indications of withdrawal?
Notify the provider.
Early notification can help manage withdrawal symptoms effectively.
Fill in the blank: Clients should take the medication as prescribed and not change the dosage or frequency without _______.
[approval of the prescriber].
This ensures safe and effective treatment.
What type of anxiolytic is buspirone?
Atypical anxiolytic / nonbarbiturate anxiolytic
What is the prototype medication for atypical anxiolytics?
Buspirone
What is the expected pharmacological action of buspirone?
Binds to serotonin and dopamine receptors
How long does it typically take for the initial effects of buspirone to be felt?
1 week
What is the full therapeutic effect timeline for buspirone?
Up to 4 weeks
Is buspirone suitable for PRN usage?
No
What are common CNS effects of buspirone?
- Dizziness
- Nausea
- Headache
- Lightheadedness
- Agitation
What is a contraindication for buspirone?
Concurrent use with MAOI antidepressants
What can result from the concurrent use of buspirone and MAOIs?
Hypertensive crisis
What are potential interactions with buspirone?
- Erythromycin
- Ketoconazole
- St. John’s wort
- Grapefruit juice
What should clients be educated to avoid when taking buspirone?
- Erythromycin
- Ketoconazole
- Herbal preparations with St. John’s wort
- Grapefruit juice
How should buspirone be administered?
At the same time every day
When should buspirone be taken to prevent gastric irritation?
With meals
What is the prototype medication for selective serotonin reuptake inhibitors (SSRIs)?
Paroxetine
Name three other SSRIs besides paroxetine.
- Sertraline
- Citalopram
- Escitalopram
- Fluoxetine
- Fluvoxamine
What is the primary mechanism of action for SSRIs?
Inhibit serotonin reuptake
Do SSRIs block the uptake of dopamine or norepinephrine?
No
What effect can paroxetine have on the CNS?
Causes stimulation, which can lead to insomnia
How long does it take for SSRIs to reach therapeutic medication levels?
Up to 4 weeks
What are the therapeutic uses of SSRI antidepressants?
SSRI antidepressants are the first-line treatment for panic disorders and trauma- and stressor-related disorders.
What conditions is SSRI Paroxetine used to treat?
Paroxetine is used to treat Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive-Compulsive Disorder (OCD), Social Anxiety Disorder, Post-Traumatic Stress Disorder (PTSD), Depressive Disorders, Adjustment Disorders, and associated manifestations of dissociative disorders.
What are early adverse effects of SSRIs?
Early adverse effects include nausea, diaphoresis, tremor, fatigue, and drowsiness.
What client education should be provided regarding early adverse effects for SSRIs
Clients should report adverse effects to the provider, take the medication as prescribed, expect these effects to subside, and avoid driving if these effects occur.
What are later adverse effects of SSRIs after 5 to 6 weeks of therapy?
Later adverse effects include sexual dysfunction, weight gain, and headache.
What client education should be provided regarding sexual dysfunction when taking SSRIs?
Clients should report problems with sexual function, which can be managed with dose reduction, medication holiday, or changing medications.
What should be monitored regarding weight changes in clients on SSRIs?
Monitor the client’s weight, as there may be weight loss early in therapy followed by weight gain with long-term treatment.
What client education should be provided regarding weight changes when taking SSRIs?
Clients should follow a well-balanced diet and exercise regularly.
What nursing actions should be taken for clients with a history of gastrointestinal bleeding when taking SSRIs?
Use SSRIs cautiously in clients with a history of gastrointestinal bleed or ulcers, and those taking other medications that affect blood coagulation.
What client education should be provided regarding gastrointestinal bleeding?
Clients should report indications of bleeding, such as dark stools or emesis that appears like coffee grounds.
What is hyponatremia and who is more likely to experience it when taking SSRIs?
Hyponatremia is more likely in older adult clients taking diuretics.
What nursing actions should be taken regarding hyponatremia when taking SSRIs?
Obtain baseline blood sodium and monitor levels periodically throughout treatment.
What are the manifestations of serotonin syndrome?
Manifestations include confusion, agitation, poor concentration, hostility, disorientation, hallucinations, seizures, tachycardia, labile blood pressure, diaphoresis, fever, incoordination, nausea, vomiting, diarrhea, abdominal pain, and coma.
What client education should be provided regarding serotonin syndrome?
Clients should observe for manifestations and withhold the medication if any occur, notifying the provider.
What is bruxism when taking SSRIs?
Bruxism is grinding and clenching of teeth, usually during sleep.
What nursing actions should be taken for bruxism when taking SSRIs?
Report bruxism to the provider, who may switch the client to another class of medication or treat bruxism with low-dose buspirone.
What client education should be provided regarding bruxism when taking SSRIs?
Clients should use a mouth guard during sleep.
What is withdrawal syndrome in taking SSRIs?
Withdrawal syndrome includes nausea, sensory disturbances, anxiety, tremor, malaise, and unease.
What client education should be provided regarding withdrawal syndrome in taking SSRIs?
After a long period of use, clients should taper the medication slowly according to a prescribed dosing schedule to avoid withdrawal effects and avoid abrupt discontinuation.
What does the ‘S’ in SHIVERS stand for in relation to Serotonin Syndrome?
Shivering
What does the ‘H’ in SHIVERS represent?
Hyperreflexia/ Myoclonus
What does the ‘I’ in SHIVERS indicate?
Increased Body Temperature
What does the ‘V’ in SHIVERS refer to?
Vital Sign Instability (Increased RR/HR, Variable BP)
What does the ‘E’ in SHIVERS stand for?
Encephalopathy (altered LOC)
What does the ‘R’ in SHIVERS represent?
Restlessness
What does the ‘S’ in SHIVERS indicate?
Sweating (Diaphoresis)
True or False: Sweating is a symptom of Serotonin Syndrome.
True
Fill in the blank: Increased Body Temperature is one of the symptoms in _______.
Serotonin Syndrome
What is the Pregnancy Risk Category for paroxetine?
D
Paroxetine poses significant risks during pregnancy.
Which medications are contraindicated in clients taking SSRIs?
MAOIs and TCAs
These combinations can lead to serious side effects.
What should clients avoid while taking SSRIs?
Alcohol
Alcohol can exacerbate side effects of SSRIs.
In which conditions should SSRIs be used cautiously?
- Liver dysfunction
- Renal dysfunction
- Seizure disorders
- History of gastrointestinal bleeding
- Bipolar disorder
Caution is advised due to the potential for adverse effects.
What can concurrent use of TCAs, MAOIs, or St. John’s wort cause?
Serotonin syndrome
This condition can be life-threatening.
How long before starting an SSRI should MAOIs be discontinued?
14 days
This helps to prevent serotonin syndrome.
How long should fluoxetine be discontinued before starting an MAOI?
5 weeks
This timing is crucial for safety.
What should be monitored when SSRIs are taken with warfarin?
Prothrombin time (PT) and INR levels
Increased warfarin levels can lead to bleeding risks.
What are the indications of bleeding to monitor for?
- Bruising
- Hematuria
Notify the provider if these occur.
How should SSRIs be taken to minimize sleep disturbances?
In the morning
This timing can help regulate sleep patterns.
What is the expected pharmacological action of serotonin norepinephrine reuptake inhibitors (SNRIs)?
Inhibit the uptake of serotonin and norepinephrine; minimal inhibition of dopamine
This mechanism is key to their therapeutic effects.
List the therapeutic uses of SNRIs.
- Major depression
- Panic disorders
- Generalized anxiety disorder
These are common mental health conditions treated with SNRIs.
What are common complications associated with SNRIs?
- Headache
- Nausea
- Agitation
- Anxiety
- Dry mouth
- Sleep disturbances
These side effects can affect patient compliance.
What should be monitored in older adult clients taking SNRIs?
Blood sodium levels
Hyponatremia is a risk in this population.
What nursing action should be taken for clients experiencing anorexia from SNRIs?
Monitor the client’s weight
Weight loss can be a significant concern.
What should be monitored for in clients taking SNRIs regarding blood pressure?
Increases in blood pressure
Hypertension is a potential side effect.
What actions should be taken for clients experiencing sexual dysfunction from SNRIs?
Report problems with sexual function
Management may include dose reduction or changing medications.
What is the Pregnancy Risk Category for SNRIs?
C
This indicates that risks cannot be ruled out.
In which situations are SNRIs contraindicated?
- Clients taking MAOIs
- Clients with hepatic disease
- Clients consuming large amounts of alcohol
These conditions can lead to serious adverse effects.
What should clients avoid while taking SNRIs?
Abrupt cessation of the medication and alcohol
Sudden discontinuation can lead to withdrawal symptoms.
What are some actual names of medications used to treat anxiety disorders?
MAOIs, tricyclic antidepressants, SNRIs, antihistamines, anticonvulsants, beta blockers
Examples of antihistamines include hydroxyzine and Diphenhydramine.
What are the potential side effects of MAOIs?
Food and drug interactions, orthostatic hypotension, weight gain, sexual dysfunction, hypertensive crisis
MAOIs are considered last-line drugs.
When are tricyclic antidepressants (TCAs) typically used?
After a patient has failed with at least one SSRI
TCAs are usually not well tolerated and can cause sedation, orthostatic hypotension, and anticholinergic effects.
What serious risk is associated with an overdose of tricyclic antidepressants?
Fatal dysrhythmias
What do SNRIs block in the brain?
Reabsorption (reuptake) of serotonin and norepinephrine
This is different from SSRIs, which only block serotonin.
How do the side effects of SNRIs compare to those of SSRIs?
SNRIs sometimes have more side effects than SSRIs
Which off-label medications can be used to treat anxiety?
Antihistamines such as hydroxyzine or Diphenhydramine
What role can anticonvulsants play in treating anxiety disorders?
They can help by calming hyperactivity in the brain
What is the benefit of using beta blockers for anxiety?
They can reduce physical symptoms caused by autonomic hyperactivity
Examples of physical symptoms include tremors, sweating, tachycardia, and palpitations.
What is a common emotional outcome of effective treatment?
Feelings of less anxiety
This indicates a reduction in anxiety symptoms as a result of treatment.
What is a key indicator of treatment success related to mood?
Description of improved mood
Improved mood reflects the psychological benefits of effective treatment.
What social outcome can signify effective treatment?
Ability to participate socially or occupationally
This shows improvement in social interactions and workplace involvement.
What cognitive improvement is associated with successful treatment?
Improved ability to cope
This refers to enhanced coping strategies in stressful situations.
What cognitive function might improve with effective treatment?
Improved memory retrieval
This indicates better recall of information as a result of treatment.
What daily living skill can improve with successful treatment?
Ability to perform activities of daily living
This reflects the restoration of functional independence.
What sleep-related outcome is a sign of effective treatment?
Maintaining normal sleep pattern
This indicates stabilization of sleep quality and duration.
What overall well-being indicator can show treatment effectiveness?
Report increased well-being
This encompasses physical, mental, and emotional health improvements.
What is Agoraphobia?
Fear of being outside
Agoraphobia often leads to avoidance of situations where escape might be difficult.
Define Anxiety.
A vague feeling of dread or apprehension
Anxiety can manifest in various forms, including physical symptoms.
What are Anxiety disorders?
A group of conditions that share a key feature of excessive anxiety
These disorders can significantly impact daily functioning.
What is Assertiveness training?
Techniques using statements to identify feelings and communicate needs and concerns to others
Assertiveness training helps individuals express themselves effectively.
Define Avoidance behavior.
Behavior designed to avoid unpleasant consequences
This behavior can reinforce anxiety and fear.
What is Decatastrophizing?
A technique that involves learning to assess situations realistically
This technique helps reduce irrational fears.
What is Detense mechanism?
Cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation
These mechanisms can prevent individuals from facing reality.
Define Fear.
Feeling afraid or threatened by a clearly identifiable, external stimulus
Fear can trigger the fight-or-flight response.
What is Flooding?
Rapid desensitization in which a behavioral therapist confronts the client with the phobic object
Flooding aims to reduce fear response through prolonged exposure.
What is Mild Anxiety?
A sensation that something is different and warrants special attention
Mild anxiety can be a motivating force.
Define Moderate anxiety.
The disturbing feeling that something is definitely wrong
Moderate anxiety can interfere with daily activities.
What is Panic Anxiety?
Intense anxiety, may be a response to a life threatening situation.
Panic anxiety can manifest in various forms, often leading to panic attacks.
Define Panic Attacks.
Between 15 and 30 minutes of rapid, intense, escalating anxiety.
Panic attacks are characterized by sudden onset and can include physical symptoms such as heart palpitations.
What is Panic disorder?
Composed of discrete episodes of panic attacks.
Panic disorder is diagnosed when the panic attacks are recurrent and lead to significant changes in behavior.
Define Phobia.
An illogical, intense, and persistent fear of a specific object or social situation.
Phobias can lead to avoidance behaviors that significantly impact a person’s life.
What is Positive reframing?
Turning negative messages into positive ones.
This technique is often used in cognitive-behavioral therapy to help individuals change their thought patterns.
What is Primary gain?
The relief of anxiety achieved by performing the specific anxiety-driven behavior.
Primary gain often refers to the internal benefits a person experiences from their symptoms.
Define Secondary gain.
The external benefits received from others because one is sick.
Secondary gain can include attention, sympathy, or financial benefits from being perceived as ill.
What is Selective mutism?
Diagnosed in children when they fail to speak in social situations even though they are able to speak.
Selective mutism is often linked to severe anxiety in social settings.
What characterizes Severe anxiety?
An increased level of anxiety when more primitive survival skills take over.
Severe anxiety can lead to physical and emotional symptoms that may require intervention.
Define Stress.
The wear and tear that life causes on the body.
Chronic stress can lead to various health problems, including anxiety disorders.
What is anxiety?
A vague feeling of dread or apprehension.
Anxiety can manifest in various forms and is often a response to stress.
What are the symptoms of anxiety?
Behavioral, emotional, cognitive, and physical symptoms.
These symptoms can vary widely among individuals.
Is anxiety always negative?
No, anxiety can be positive and normal; however, elevated or persistent anxiety can cause concerns.
Positive anxiety can motivate individuals to take action.
What can elevated or persistent anxiety disrupt?
Behavior, emotional, cognitive, and physical concerns.
Disruption in these areas can impact daily functioning.
What does anxiety often indicate for many people?
That they are not dealing with stress effectively.
Recognizing this can be a step towards better stress management.
What are anxiety disorders?
A group of conditions that share features of excessive anxiety.
These disorders can significantly impact an individual’s quality of life.
What are some assessment data points for a client with anxious behavior?
- Decreased attention span
- Restlessness, irritability
- Poor impulse control
- Feelings of discomfort, apprehension, or helplessness
- Hyperactivity, pacing
- Wringing hands
- Perceptual field deficits
- Decreased ability to communicate verbally
These indicators help in understanding the severity and nature of the client’s anxiety.
What is the immediate expected outcome for a client with anxiety?
- Be free from injury throughout hospitalization
- Discuss feelings of dread, anxiety, and so forth within 24 to 48 hours
- Respond to relaxation techniques with staff assistance and demonstrate a decreased anxiety level within 2 to 3 days
These outcomes are critical for ensuring the client’s safety and beginning the therapeutic process.
What is the stabilization expected outcome for a client with anxiety?
- Demonstrate the ability to perform relaxation techniques
- Reduce own anxiety level without staff assistance
This indicates a progression towards independence in managing anxiety.
What is the community expected outcome for a client with anxiety?
- Be free from anxiety attacks
- Manage the anxiety response to stress effectively
Long-term outcomes focus on the client’s ability to function in everyday life without debilitating anxiety.
Fill in the blank: A client with anxious behavior may exhibit _______.
[hyperactivity, pacing, wringing hands]
What is the etiology of anxiety?
Etiology refers to the study of the causes or origins of anxiety.
What are the biological theories of anxiety?
Biological theories include genetic, neurochemical, and psychodynamic factors.
What genetic component is associated with anxiety?
There may be an inherited component with first degree relatives.
What neurochemical dysregulation is linked to anxiety?
- GABA dysregulation
- Serotonin dysregulation
- Excess norepinephrine
What role does GABA play in anxiety regulation?
GABA functions as a natural antianxiety agent by reducing cell excitability.
What is the significance of serotonin in anxiety?
Serotonin dysregulation is known to cause anxiety.
Which neurotransmitter excess is suspected in panic disorder, GAD, and PTSD?
Excess norepinephrine.
What do intrapsychic/psychoanalytic theories suggest about anxiety?
Freud described innate anxiety as a stimulus for behavior and identified defense mechanisms to control anxiety.
Who contributed to the interpersonal theory of anxiety?
Harry Stack Sullivan and Hildegard Peplau.
According to interpersonal theory, what causes anxiety?
Anxiety arises from problems or concerns in interpersonal relationships.
What does behavioral theory state about anxiety?
Anxiety is learned through experiences.
What are somatic symptoms in the context of anxiety?
Somatic symptoms refer to physical manifestations of anxiety.
True or False: Supernatural spirits and bad air are considered modern explanations for anxiety.
False.
Fill in the blank: Anxiety is learned through _______.
[experiences]
For the etiology of anxiety, what are the 2 biological theories ; 3 psychodynamic theories ; cultural considerations?
Biologic theories - genetic and neurochemical ;
Psychodynamic theories - intrapsychic / psychoanalytic theories, interpersonal theory, behavioral theory;
Cultural considerations - somatic symptoms, supernatural spirits, bad air
What is a risk factor for anxiety related to gender?
Female
Females are statistically more likely to experience anxiety disorders.
What kind of link is associated with anxiety disorders?
Genetic and neurobiological link
Genetic predispositions and neurobiological factors may contribute to the development of anxiety.
Name a medical condition that can be a risk factor for anxiety.
Hyperthyroidism, pulmonary embolism
These medical conditions can exacerbate or trigger anxiety symptoms.
What can cause adverse effects leading to anxiety?
Many medications
Certain medications may have side effects that include heightened anxiety.
What type of experiences can be a risk factor for anxiety?
Trauma or negative life experiences
Past trauma or significant stressors can lead to increased anxiety.
What are some lifestyle choices that can impact anxiety levels?
Poor diet, poor exercise, and substance use
A healthy lifestyle can help mitigate anxiety symptoms.
Fill in the blank: _______ can induce anxiety through current use or withdrawal.
Substance
Various substances, including drugs and alcohol, can lead to anxiety when used or withdrawn.
Table 14.1
