Ch 18 Flashcards
an emotional response to anticipation of danger, the source of which is largely unknown or unrecognized
anxiety
is anxiety a necessary force for survival?
yes
an external pressure that is brought to bear on the individual
stressor
is the subjective emotional response to that stressor
anxiety
Anxiety may be distinguished from fear in that anxiety is…
an emotional process, whereas fear is a cognitive one
who was the first to associate anxiety with neurotic behaviors?
Freud
the most common of all psychiatric illnesses
anxiety disorders
what are panic disorders characterized by
recurrent panic attacks, the onset of which are unpredictable and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort
anxiety may or may not be accompanied by
agoraphobia
symptoms of panic attack
sweating, trembling, shaking SOB, chest pain, discomfort nausea, dizziness, chills, hot flashes numbness, tingling sensations fear of losing control and dying
what are generalized anxiety disorder symptoms
WATCHERS
worry, anxiety, tension, concentration (lack of), hypervigilence, energy, restlessness, sleep (decrease)
what is GAD characterized by
chronic, unrealistic, and excessive anxiety and worry
Ego unable to intervene betweenid and superego
Overuse or ineffective use of ego defense mechanisms results in maladaptive responses to anxiety
psychodynamic theory
Faulty, distorted, or counterproductive thinking patterns result in anxiety that is maintained by mistaken or dysfunctional appraisal of a situation
cognitive theory
Fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms
agoraphobia
examples of agoraphobia
Traveling in public transportation Being in open spaces Being in shops, theaters, or cinemas Standing in line or being in a crowd Being outside of the home alone in other situations
Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others
social anxiety disorder
Fear of specific objects or situations that could conceivably cause harm, but the person’s reaction to them is excessive, unreasonable, and inappropriate
specific phobia
exposure to phobic objects produces what symptoms
panic, including palpitations, sweating, dizziness, and difficulty breathing
Unconscious fears may be expressed in a symbolic manner as phobia
psychoanalytic theory
Fears are conditioned responses and thus are learned by imposing reinforcements for certain behaviors
learning theory
Anxiety is the product of faulty cognitions or anxiety-inducing self-instructions
cognitive theory
Characteristics with which one is born that influence how he or she responds throughout life to specific situations (e.g., innate fears)
temperament
what may set the stage for phobic reactions later in life
early experiences
Medical conditions that may produce anxiety symptoms
Cardiac
Endocrine
Respiratory
Neurological
May be associated with intoxication or withdrawal from any of the following substances.
Alcohol, sedatives, hypnotics, or anxiolytics
Amphetamines or cocaine
Hallucinogens
Caffeine
Cannabis
substance induced anxiety disorder
Recurrent obsessions or compulsions that are severe enough to be time-consuming or to cause marked distress or significant impairment
obsessive compulsive disoder
Recurrent thoughts, impulses, or images experienced as intrusive and stressful, and unable to be expunged by logic or reasoning
obsessions
Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation
compulsions
Characterized by the exaggerated belief that the body is deformed or defective in some specific way
body dysmorphic disorder
common symptoms of body dysmorphic disorder
depression and obsessive-compulsive personality are common
what is hair pulling disorder also called
Trichotillomania
The recurrent pulling out of one’s own hair that results in noticeable hair loss
Preceded by increasing tension and results in sense of release or gratification
trichotillomania
The persistent difficulty discarding possessions regardless of their value.
hoarding disorder
gender ratio for hoarding disorder
more men than women
Clients with OCD have weak, underdeveloped egos.
Aggressive impulses are channeled into thoughts and behaviors that prevent the feelings of aggression from surfacing and producing intense anxiety fraught with guilt.
psychoanalytic theory
Conditioned response to a traumatic event
Passive avoidance
Active avoidance
learning theory
Psychosocial influences related to trichotillomania
Stressful situations
Disturbances in mother-child relationship
Fear of abandonment
Recent object loss
Possible childhood abuse or emotional neglect
Possible decrease in serotonin with what disorders
OCD and body dysmorphic disorder
Nursing diagnoses commonly associated with anxiety
Panic anxiety (panic disorder and GAD) Powerlessness (panic disorder and GAD)
nursing diagnoses commonly associated with OCD
Ineffective coping (OCD) Ineffective role performance (OCD)
nursing diagnoses commonly associated with body dysmorphic disorder
disturbed body image
nursing diagnosis commonly associated with hair pulling disorder
ineffective impulse control
nursing diagnoses commonly associated with phobias
Fear (phobias) Social isolation (agoraphobia)
client outcomes for GAD
Is able to recognize signs of escalating anxiety and intervene before reaching panic level
Is able to maintain anxiety at manageable level and make independent decisions about life situation
client outcomes for phobias
Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety
Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety
client outcomes for OCD
Is able to maintain anxiety at a manageable level without resorting to the use of ritualistic behavior
Demonstrates more adaptive coping strategies for dealing with anxiety than ritualistic behaviors
implementation for anxiety
Maintain calm, nonthreatening approach.
Keep the immediate surroundings low in stimuli.
Teach the client signs of escalating anxiety.
implementation for fear
Include the client in making decisions.
Encourage the client to explore underlying feelings.
implementation for ineffective coping
Initially meet the client’s dependency needs.
Provide a structured schedule of activities.
implementation for disturbed body image
Help client see his or her body image is distorted.
Involve client in activities that reinforce positive sense of self.
Make referrals to support groups.
implementation for ineffective impulse control
Convey a nonjudgmental attitude.
Practice stress management techniques.
Offer support and encouragement.
When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented?
communicate with simple words and brief messages
what are the two types of behavior therapy
Systematic desensitization
Implosion therapy
a treatment for phobias in which the patient is exposed to progressively more anxiety-provoking stimuli and taught relaxation techniques.
systematic desensitization
what meds are the first line given for anxiety
SSRIs (Zoloft and Lexapro)
this is an antihistamine used for anti anxiety
Hydroxyzine (Vistaril)
this is the only FDA approved med for anxiety
takes 4-6 weeks for full effects
Buspirone (Buspar)
these have many side effects and are very addictive (must sign waiver for responsibility)
Benzodiazepines
what are examples of Benzodiazepines
Xanax, Klonopin (Clonazepam)
describe Benzodiazepines
may cause dimentia, depression, hypotension
alcohol + booze = you lose (DIE)
LAST RESORT (short term basis, NOT long term)
required by law to look at record of drug history
what is very important of all anti anxiety drugs
do not end abruptly (will cause seizures)
be careful with BP (rise SLOWLY from lying/sitting position)
can aggravate depression
what are the common side effects of antianxiety drugs
drowsiness, confusion, dependence, depression, orthostatic hypotension, paradoxical excitement, dry mouth, NV, blood dyscrasias
specific medications for panic and GAD
Anxiolytics
Antidepressants
Antihypertensive agents (Propanolol- for nerve wracking experiences like stage fright)
specific medications for phobic disorders
Anxiolytics
Antidepressants
Antihypertensive agents
medication for OCD and body dysmorphic disorder
Antidepressants
medications for hair pulling disorder
Chlorpromazine Amitriptyline Lithium carbonate Selective serotonin reuptake inhibitors and pimozide Olanzapine
What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?
That there is a potential for dependence and tolerance
Xanax is a benzodiazepine and has addictive properties
