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NUR 289 > Chapter 15 Anxiety and Obsessive > Flashcards

Chapter 15 Anxiety and Obsessive Flashcards

1
Q

Agoraphobia

A

Intense excessive ANXIETY or FEAR about being:

-in places or situations

from which escape might be difficult or embarrassing or

-where help might not be available

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2
Q

Agoraphobia = word derivative

A 
agora = greek for open
phobia = fear
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3
Q

Agoraphobia
what is avoided? AND why?

A
  • *Feared places are AVOIDED.**
  • *To control anxiety.**
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4
Q

Agoraphobia

Examples of what is avoided

A

Being ALONE OUTSIDE
Being ALONE at HOME
Car, bus, or airplane.
BRIDGES
ELEVATORS

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5
Q

ANXIETY

Who has it?

A

Everyone
it is a universal human experience

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6
Q

Anxiety
what type of emotion is it

A

BASIC HUMAN EMOTION

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7
Q

ANXIETY

A

Feeling of apprehension, uneasiness, uncertainty, or dread from a

PERCEIVED or REAL threat. What is their reality?

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8
Q

ANXIETY vs FEAR

A

ANXIETY = vague sense of dread related to unspecified or unknown danger

FEAR= reaction to a SPECIFIC danger.

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9
Q

GAS
what is it?

A

General Adaptation Syndrome - Hans Selye. ARE

Alarm
Resistance
Exhaustion

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10
Q

FIGHT OR FLIGHT
Cannon

A
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11
Q

DSM-5 Anxiety Disorders
Name 5

A
  • *Separation Anxiety Disorder**
  • *Panic w or w/o Agoraphobia**
  • *Specific Phobias**
  • *SAD - Social Anxiety Disorder**
  • *GAD - General Anxiety Disorder**
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12
Q

Anxiety Disorders can be caused by +________+ and _____________-

A

another medical condition - ie hyperthyroidism

substance/medication induced -

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13
Q

COMPULSIONS - Anxiety Disorders related to
abnormal selective over attention obsessions
Name 5

A

COMPULSIONS

Obsessive Compulsive Disorder OCD
Body dysmorphic disorder
Hoarding disorder
Hair pulling (trichotillomania)
Skin picking (excoriation)

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14
Q

COMPULSIONS

A

RITUALISTIC BEHAVIORS individuals feel driven to perform in an attempt to reduce anxiety or prevent and imaged calamity. Only temporary relief so repeated again and again.

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15
Q

Body Dysmorphic Disorder

A

Imagined body defective part which results in obsessional thinking and compulsive behavior

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16
Q

Anxiety Disorders

A

Separation Anxiety

Panic with or without agoraphobia

Specific phobia

Social Anxiety Disorders (SAD)

General Anxiety Disorder (GAD)

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17
Q

Anxiety - Maladaptive coping

A

Smoking

Eating too much

Drinking

Drugs

Sleeping too much

Avoidiing behavior

Denial

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18
Q

Peplau’s 4 levels of anxiety

A

Mild, moderate, severe and panic

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19
Q

What are nursing interventions for anxiety based on?

A

Level of anxiety

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20
Q

anxiety is the initial response to a ________threat

A

psychic - their perception

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21
Q

Mild anxiety - 4 aspects

A

Occurs in everyday living

Perceive reality in sharp focus

Heightened awareness

CAN learn NEW behaviors and take in ALL stimuli

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22
Q

MIld Anxiety - sx

A

slight discomfort

irritability

mild tension-relieving behavior (nail biting)

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23
Q

Mild anxiety - can you teach/learning?

A

yes

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24
Q

Moderate Anxiety

A

Decreased perceptual field (immediate task only)

Can learn new behavior but only with assistance

Another person can redirect the person to a task

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25
Q

Moderate Anxiety -Symptoms

A

Tension

pounding heart

Inc HR and RR

sweating

Mild somatic sx GI, H/A, urinary urgency

GAS beginning to be activated

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26
Q

Severe Anxiety

A

Focus on only one detail or many scattered details

Difficulty with noticing environment

Feeling of dread or terror

Cannot be redirected to task

Learning is NOT possible, Not a good time for teaching

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27
Q

Severe Anxiety - symptoms

A

H/A headache

Nausea

Dizziness

insomnia

pounding heart

hyperventilate

sense of impending doom or dread

May go to ER thinking they have a heart attack

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28
Q

Panic Anxiety

A

Most extreme level of anxiety

marked disturbed behavior

may lose touch with reality (delusions, distorted perceptions, hallucinations

does not respond to efforts to calm

physical immobility

muteness - not able to speak

physical behaviors - erratic, uncoordinated, impulsive, pacing, running, shouting, screaming

my bolt/ run aimlessly

expose self to injury and others

safe environment - someone with them.

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29
Q

Panic Attack - first concern

A

Safety

Must remain with them

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30
Q

Anxiety Disorders - 2 main biological factors that affect them

A

brain function - metabolic, substances

genetic influences - get a family history, anyone else have anxiety disorder,

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31
Q

What is most important in determining response to an intervention?

A

The patient’s feelings and perceptions about the situation.

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32
Q

What is most important in determining response to an intervention?

A

The patient’s feelings and perceptions about the situation.

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33
Q

Defense Mechanisms/coping style

A

protect from anxiety

maintain self-image by blocking feelings, conflicts, and memories

repression, denial, displacement, regression, sublimation

short term/initial may help but overuse - maladaptive

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34
Q

Defense Mechanisms - name 5

A

repression, denial, displacement, regression, sublimation

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35
Q

Repression

A

ego keeps disturbing/threatening thoughts from becoming conscious

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36
Q

Denial

A

Blocking external events from awareness.

If situation too much to handle, person refuses to experience it.

37
Q

Displacement

A

Satisfying an impulse with a substitute object when one is faced with stress.

Upset with boss, goes home hits wife.

38
Q

Regression

A

Movementment back in psychological time when faced with stress.

39
Q

Sublimation

A

satisfying an impulse with a substitute object

ie aggression with sport

40
Q

what is most common psychiatric disorder in USA

A

Anxiety

40 million adults

MORE COMMON IN WOMEN

41
Q

Anxiety D/x

what else to assess for?

A

Depression

80%

42
Q

Anxiety comorbidity

A

MDD and Anxiety

MDD and panic

MDD and OCD

MDD and SAD 37%

MDD and PTSD

43
Q

Anxiety and genetics

A

Clusters in families

twin studie panic and ocd

½ people with panic have relative with panic

PTSD and GAD inherited components

44
Q

Freud and anxiety

A

threatened breakthrough of repressed ideas from unconscious to conscious

defense mechanisms (ego) used to keep anxiety manageable

defense mechanisms- non adaptive behavior because rigid and repetitive

45
Q

Intellectualization

A

defense mechanism

46
Q

Repression

A

Accident victim cannot remember the details

47
Q

Identification

A

Younger sister copies older sister

48
Q

Anxiety

Harry Stack Sullivan

Interpersonal theory

A

Linked to emotional distress when early needs unmet or disapproval

contagious from parent to infant

early life anxiety - prototype for later life

49
Q

Anxiety - behaviorist theory

A

anxiety learned response to environmental stimuli - classical conditioning

kid anxious when abusive mom is around,

anxious around all wome

50
Q

anxiety - cognitive theorist

A

anxiety caused by distortions in an individual’s thoughts and perceptions

CBT treatment

51
Q

Assessment for Anxiety

A

ask direct and specific questions

what makes you feels anxious,

when do you feel anxious

what do you avoid

52
Q

Self assessment

A

impact on you

if you work with anxious client, watch not taking on that anxiety

self-awareness and self-care

might feel anxiety, fear, anger, frustration, hopelessness

may withdraw from patient and patient withdraws from you.

53
Q

Cultural Considerations

A

must consider it with dx

shame in the culture

expression influenced by culture - a weakness, self-medicate

54
Q

Generalized Anxiety Disorder (GAD)

A

excessive worry:

inadequacy in interpersonal relationships

job responsibilities

finances

health of family members

55
Q

Social Anxiety Disorder (SAD)/Social Phobia

A

severe anxiety provoked by exposure to a social or performance situation that could be evaluated negatively by others.

Ie fear of public speaking

56
Q

SAD - risk factors

A

childhood mistreatment

adverse childhood experiences

shyness inheritable

double risk genetic transmission if parent has

57
Q

Anxiety - Self-Care

A

Prayer, meditation, exercise, mindfulness, walking, writing, music, deep breathing,

58
Q

Anxiety - Medications

A

SSRI’s BZO’s and non- BZO’s

59
Q

How are they different?

PTSD, GAD, Panic, Phobia, OCD, PTSD

A
60
Q

Separation Anxiety Disorder

A

normal part of development 8-18 months

usually dx prior to 18 years old

causes:death, change in schools, sexual trauma

developmentally inappropriate level of concern from being away

61
Q

Adult Separation Anxiety

A

Begin as a child or adult

problems with romantic relationships, usually unmarried

harm avoidance, worry, shyness, uncertainty, lack of self-direction

significant discomfort

does not respond well to most psychotherapy or CBT

62
Q

SAD

A

Social Anxiety Disorder is not

Seasonal Affect Disorder

63
Q

Panic Disorder

A

Extreme of Disorder

Main characteristics

palpitations

trembling shaking

pounding heart

somatic fear of unknown illness

sweating

chest pain

abdominal distress, weak, numbness, detached, fear of death, fear of going crazy

64
Q

agoraphobia

A

may feel that it could happen again

something will happen, they feel they will be out of control, not able to escape

65
Q

Specific phobias

A

irrational fear of an object, activity, or situation

that leads to avoidance

treatment - is exposure

SSRI

66
Q

OCD

A

cyclic

obsession, anxiety, compulsion, relife, then obsession again

67
Q

OCD - timing

A

allow time for them reasonable

68
Q

OCD - obsessive-compulsive disorder

A

Obsession -thoughts, impulses, or images that recur and cannot be dismissed from the mind. Concerns about : cleanliness, hoarding, worry about contamination, harm to people

Compulsions: ritualistic behaviors individual driven to perform to reduce anxiety, time consuming, rigid rules, can interfere with adl’s, relationships

sexuality questioned, violence, contamination, illness, death

69
Q

GAD

A

Lasts for more than 6 months

excessive anxiety or worry, difficulty making decisions, fear of making mistage

70
Q

GAD

A

Not as intense as panic

excessive worry restless, sleep disturbance, spend large amounts of time preparing, lateness, absence, overall isolation

71
Q

PTSD

A

characterized by persistent re-experiencing of highly. traumatic event that involved actual or threatened death or serious injury which the individual responded with intense fear, helplessness or horror.

Actual or perceived threat

veterans, car accidents

72
Q

Flashbacks

A

dissociative experience event relived

73
Q

PTSD symptoms

A
74
Q

Acute Stress Disorder

A

acute onset

with 1 month

resolves in 4 weeks

75
Q

substance-induced anxiety disorder

A

panic attacks

obsessions compulsions

76
Q

Medically induced anxiety

A

symptoms are directly related to the medical condition

direct - hyperthyroid anxiety

blood sugar low

77
Q

Treatment for Anxiety - drugs

A

SSRI TCA (more side effects )

GAD - BZ, buspirone (2 weeks) TCA if also depressed

Phobias -BZO, beta blockers, SSRI

Panic, SSRI, BZO. TCA. MAO

OCD, - SSRI, MAO

PTSD- antidepressants - clonidine

BZO highly addictive - avoid if SUD Short period of time

BUSPIRONE - not prn - 2weeks non addictive BZO

BZO - work fast 20-30 minutes, addictive

no acute withdrawal

78
Q

Kava Kava

A

Liver enzymes

interactions

79
Q

St. John’s Wort

A

Seratonin syndrome

too much seratonin with an SSRI

80
Q

Milieau Therapy

A

Everything in the environment when hospitalized

81
Q

SSRI

A

Citalopram - celexa. Escitalopram - lexapro

Fluoxetine - prozac. Paroxetine - paxil

Fluvoxamine - Luvox

Sertraline - Zoloft

Suicidality - conenr

82
Q

SSNRI

A

Duloxetine - cybalta

Venlafaxine - effexor

need to take every day steady serum state

83
Q

SSRI

common side effects

A

Insomnia, sedations

appetite change up or down

Nausea

Dry mouth

headache

sexual dysfunction

84
Q

TCA

A

Cardiac, EKG done Ck Urinary retention,

dry mouth blurred vision

constipation fluids, roughage, exercise

dizziniss OHT

85
Q

TCA’s - common

A

Amitriptyline elavil

Clomipramine anafranil

desipramine norpramin

86
Q

Benzodiazepines BZO

A

dependency

quick onset

withdrawal

short periods only not for SUD

87
Q

BZO

A

xanax, librium, klonopin, ativan (lorazapam)

diazepam Valium

stat PRN

sedation, ataxia,

88
Q

Buspirone

A

Buspar

2 weeks

NUR 289 (13 decks)

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