EXAM 1 Flashcards
Id
Sigmund freud
- is unconscious and impulsive. it is the drive of all instincts, reflexes, and needs
- the id cannot tolerate frustration & seeks to discharge tension and return to a more comfortable level of energy
- lacks the ability to problem solve and is illogical
Ego
Sigmund freud
- child beings to interact with others within the 1st few years of life
- unconscious, conscious, preconscious levels of awareness
- differentiate subjective experiences, memory images & objective reality
- The reality principle
superego
- develops between the ages of 3 and 5
- represents the moral component of personality
- resideds in the conscious, preconscious and unconscious levels of awareness
- conscience –all of the should nots internalized from parents and society
- ego ideal– all of the shoulds internalized from parents and society
- guilt can occur when the behavior falls short of ideal
- if the superego is too powerful, then the person can be self-critical and suffer from inferiority
transference
unconscious feelings that the patient has toward a healthcare worker orininally felt in childhood for a significant other
“you remind me exactly of my sister” the transference can be positive (affectionate) or negative (hostile)
countertransference
refers to unconscious feelings that the healthcare worker has torwards the patient
If the patient reminds you of someone you do not like, then they may uncounsciously react as if the patient were that person
maslows hierachy of needs
Physiological needs The most basic needs are the physiological drives—needing food, oxygen, water, sleep, sex, and a constant body temperature. If all needs were deprived, this level would take priority over the rest.
Safety needs: Once physiological needs are met, safety needs emerge. They include security; protection; freedom from fear, anxiety, and chaos; and the need for law, order, and limits.
Belonging and love needs People have a need for intimate relationships, love, affection, and belonging and will seek to overcome feelings of loneliness and alienation. Maslow stresses the importance of having a family and a home and being part of identifiable groups.
Esteem needs People need to have a high self-regard and have it reflected to them from others. If self-esteem needs are met, they feel confident, valued, and valuable. When self-esteem is compromised, they feel inferior, worthless, and helpless.
Self-actualization becoming everything one is capable of
self-transcendence (overcoming limits of the individual self and desire in spiritual contemplation and realization)
Erikson’s stages of development
Trust versus mistrust
* infancy (0–1½ years) Forming attachment to mother, which lays foundations for later trust in others
Autonomy versus shame and doubt
* Early childhood (1½–3 years) Gaining some basic control of self and environment (e.g., toilet training, exploration)
Initiative versus guilt
* Preschool (3–6 years) Becoming purposeful and directive
Industry versus inferiority
* School age (6–12 years) Developing social, physical, and school skills
Identity versus role confusion
* Adolescence (12–20 years) Making transition from childhood to adulthood; developing sense of identity
Intimacy versus isolation
* Early adulthood (20–35 years) Establishing intimate bonds of love and friendship
intimacy vs isolation
* Middle adulthood (35–65 years) Fulfilling life goals that involve family, career, and society; developing concerns that embrace
Integrity versus despair
* Later years (65 years to death) Looking back over one’s life and accepting its meaning
pre-orientation phase
- preparing for assessment
- recognizing your own thoughts and feelings regarding the 1st meeting
orientation phase
first time the nurse and the patient meet & is the phase where the nurse conducts the initial interview
- pt may begin to express thoughts, and feelings, identify problems & discuss realistic goals
i. Establish Rapport by displaying empathy, genuineness, unconditional
positive regard
ii. Specify a contract- either stated or written, place, time, date, and duration of the meetings, also discussing termination of relationship.
iii. Explaining Confidentiality- who will be given the information shared with the nurse, the information might be shared with clinical supervisor, physician, staff, or other nursing students in conference
working phase
Gathering further data
* Identifying problem-solving skills and self-esteem
* Providing education about the disorder
* Promoting symptom management
* Providing medication education
* Evaluating progress
termination phase
- final integral phase of the nurse-patient relationship
- discuss termination during the 1st meeting and again during the working state
- can occur during discharge
- Summarizing the goals and objectives achieved
- Reviewing patient education and providing handouts
- Discussing ways for the patient to incorporate new coping strategies
- Reviewing situations that occurred during the nurse-patient relationship
- Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship
western worldviews
roman, greek, judeo-christian, the enlightenment; decartes
* the “real” has form and essence; reality tends to be stable
* cartesian dualism: body and mind spirit
* self is the staring point of idenity
* time is linear
* wisfom: preparation for the future
* disease has a cause that creates the effect: disease can be observed and measured
Eastern worldviews
- chinese and indian philosphers: buddha, confucius, laotse
- The “real” is a force or energy; reality is always changing
- mind-body-spirit unity
- family is the starting point of idenity
- time is circular, flexible
- wisdom; acceptance of what is
- disease is caused by lack of balance and energy forces (yin-yang, hot-cold) imbalance between daily routine, diet, and constituational type
- one is born into an unchangeable fate
indigenous worldview
- deep relationship with nature
- the “real” is multidimensional; reality transcends time and space
- mind, body, and spirit are united; there may not be words to indicate them as distinct entities
- community is the starting point of idenity; a person is only an enity in relation to others; there may be no concept of person or personal ownership
- time is focused on the present
- wisdom; knowledge of nature
- disease is caused by a lack of personal, interpersonal, environment, or spiritual harmony; thoughts and words can shape reality; evil spirits exist
stigma of mental illness
- stigma presents significant barriers that delay or prevent individuals from seeking treatment
- some associate mental illness with weakness or dangerousness
- in some cultural groups, the stigma of mental illness may be more prevalent or severe
- In cultural groups that emphasize the interdependence and harmony of the family, mental illness may be perceived as a failure of the family
- Stigma and shame can lead to reluctance to seek help, so members of these cultural groups may delay or prevent entry into the mental healthcare system.
worldview
A system of thinking about how the world workds and how people should act, especially in relation to one another
stigma
negative attitudes toward mental illness and its treatments in which they engage
serotonin syndrome
onset abrupt
course rapidly resolving
neuromuscular findings mycoclonus and tremors
reflexes increased
pupils mydriasis
classic traits of the four levels of anxiety
perception
mild=focused
moderate= selective inattention
severe= distortive, scattered, detail focused
painic= lack of processing, depersonalization, derealization
problem-solving
mild= effective, appropriate action
moderate= effective but not at an optimal level
severe= ineffective due to confusion
panic= ineffective due to irrational reasoning
characteristics
mild= restlessness, irritability, fideting, nail biting
moderate= increased HR and RR, GI distress, voice tremors, pacing
severe= rapid speech, hyperventilation, sense of doom
panic= hallucination, impulsivity, unintelligible, communication, withdrawl
seperation anxiety
- seperation from home or attachment figures, developmentally inappropriate
- lasts greater than 4 weeks in children/ adolescents, 6 months in adults
EXAMPLE– fear over accidents, clingling or shawdowing, traveling independently
specific phobias
- crippling fear or anxiety over a particular object or situation with active avoidance
- most individuals have more than one phobia
EXAMPLES
Arachnophobia- spiders
ophidiophobia- snakes
acrophobia- heights
agoraphobia- open or enclosed spaces
cynophobia- dogs
social anxiety
- fear or anxiety over exposure to possible scrunity by others with an attempt to avoid socai situations
- typically lasts greater than 6 mo
Examples
public speaking, performing arts, eating in front of others
panic disorders
- recurrent, unexpected panic attacks (abrupt onset of fear with feelings of impending doom)
- panic attacks can last for several minutes, followed by one month of persistant worry about future panic attacks
generalized anxiety disorder
- excessive worry over multiple events, lasting greater than 6 months
- females are at a greater risk
- must display a minimum of 3 following symptoms; restlessness, easy to fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances
- cannot be explained by other physiological or psychological disorder, or substance use
obsessive-compulsive disorder
- obsessions-anxiety and stress caused by persistent thoughts, urges, or images with attempts to ignore or suppress by performing another thought or action
- compulsion- repetitive actions an individual needs to perform in response to the obsession; goal to eliminate the anxiety associated with the obsession
- four areas- checking, contamination/ mental contamination, hoarding, rumination, intrusive thoughts
body dismorphic disorder
- peroccupation with one or more perceived flaw or defect in physical appearance that is not obserable to others
- performs repetitive behaviors or mental comparisons in response to the appearance concern, average 3-8 hours every day
- does not meet diagnostic criteria for an eating disorder
hoarding disorder
- difficulty getting rid of items regardless of actual value
- accumulation of items that clutter living areas and impede safety, social functioning
- not related to another physical or psychological disorder
hair pulling/ skin picking disorder
- Trichotillomania- recurrent pulling of hair that may lead to permanent loss, despite attempts to cease acivity
- Excoriation- recurrent picking at skin that results in lesions (commonly in the face and arms), despite attempts to cease activity
- both disorders impede social functioning, and not related to another physical or psychological disorder
Tricyclics
- 1st generation
- indigestion
- HA
- dry mouth
- drowsiness
- elevated HR
SSRIs
- 2nd generation
- sweating
- indigestion and nausea
- HA
- dry mouth
- drowsiness
- sexual side effects
SNRIs
- tremors
- nausea
- HA
- dry mouth
- blurred vision
- increased blood pressure
- sexual side effects
- nervousness
- dizziness
MAOIs
- insomnia
- muslce aches
- low blood pressure
- dry mouth
- sexual side effects
- nervousness
- dizziness
- avoid decongestants & certain foods
new combinations of antidepressants
- appetite changes
- indigestion and constipation
- HA
- dry mouth
- insomnia
- sweating
- nervousness
- sexual side effects
- vomitting
benzodiazepines
- GABA agonist
- used as antianxiety, hypnotic (sleep-inducing), anticonvulsant, amnestic (loss of memory), and muscle relaxant properties
- sedation is a potential side-effect
- is a controlled substance with the pontial of misuse
- caution with the use of machinery
- monitor for side effects including sedation, ataxia, and decreased cognitive function.
- fall/ fracture risk in the elderly
- ataxia (impaired coordination)
antianxiety medications MOA
increase the effectiveness of the neurotransmitter GABA
Assessment for anxiety
- patients are experts when it comes to their own illnesses
- assessment should be patient centered to be helpful or meaningful
- ask about what has helped in the past
- identify expectations for the patients personal participation in care and for the family’s or significant others participation in care.
- assess for cultural, ethnic, and social backgrounds that may affect the care that you and the patient plan
- objectively you can use scales to help measure anxiety related symptoms
- phobias are measured on the fear questionnaire
- panic symptoms are measured on the panic disorder severity scale
Assessment guidelines for anxiety
- Ensure that a physical and neurological examination is conducted to help determine whether the anxiety is primary or secondary to another psychiatric disorder, medical condition, or substance use.
- Determine the patient’s current level of anxiety (mild, moderate, severe, or panic).
- Assess for the potential for self-harm and suicidal ideation. People suffering from high levels of intractable anxiety may become desperate and attempt suicide.
- Perform a psychosocial assessment. Always ask the person, “What is going on in your life that may be contributing to your anxiety?” The patient may identify a problem (stressful marriage, recent loss, stressful job, or school situation) that could be addressed by counseling.
Mild level of anxiety
- heightened perceptual field
- focus is flexible and is aware of the anxiety
- Able to work effectively toward a goal and examine alternatives
Physical or other characteristics
* Slight discomfort
* Attention-seeking behavior
* Restlessness
* Easily startled
* Irritability or impatience
* Mild tension-relieving behavior (foot or finger tapping, lip chewing, fidgeting)
severe to panic levels of anxiety
- greatly reduced and distored perceptual field
- focuses on details or one specific detail// attention is scattered
- problem solving seems impossible & unable to see connections between events or details
Physical or other characteristics
* Feelings of dread
* Confusion
* Purposeless activity
* Sense of impending doom
* More intense somatic complaints (chest discomfort,
* dizziness, nausea, sleeplessness)
* Diaphoresis (sweating)
* Withdrawal
* Loud and rapid speech
* Threats and demands
Antidepressants
- SSRIs are considered 1st line of defense in most anxiety disorders
- paroxetine (Paxil), fluoxetine (Prozac), escitalopram (Lexapro), and sertraline (Zoloft).
- some can increase anxiety initally (fluoxetine & sertraline)
- paroxetine tends to have a more calming effect than the others
- Antidepressants have the secondary benefit of treating comorbid depressive disorders
- Venladaxine (Effexor) and duloxetine (cymbalta) are SRNIs that help treat anxiety
antianxiety drugs
- Antianxiety drugs are often used to treat the somatic and psychological symptoms of anxiety disorders.
- Buspirone is an alternative to benzo, that do not cause dependence. it can take 2-4 weeks to reach its full effect & can be used long-term. This drug is not recommended for individuals with impaired hepatic or renal function.
- can cause dizziness, insomnia, HA, nervousness, lightheadedness, insomnia
maladaptive defense against anxiety
- Maladaptive use of defense mechanisms occurs when one or several are used to excess, particularly immature defenses.
adaptive use of denfense mechanisms
Adaptive use of defense mechanisms helps people to lower their levels of anxiety and to achieve their goals in acceptable ways
defense mechanisms
Alturism
* large unconscious motivation to feel caring and concern for others and act for the well-being of others
compensation
* is used to counterbalance perceived deficiencies by emphasizing strength
conversion
* unconscious transformation of anxiety into a physical symptom with no organic cause.
denial
* involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence.
displacement
* the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation
dissociation
* the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation.
identification
* attributing to oneself the characteristics of another person or group. This may be done consciously or unconsciously.
intellectualization
* a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing.
projection
* refers to the unconscious rejection of emotionally unacceptable features and attributing them to others.
rationalization
* consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.
reaction
* formation is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior.
regression
* reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been exhibited previously
repression
* unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness.
splitting
* inability to integrate the positive and negative qualities of oneself or others into a cohesive image.
sublimation
* an unconscious process of transforming negative impulses into less damaging and even productive impulses.
suppression
* the conscious decision to delay addressing a disturbing situation or feeling.
undoing
* when a person makes up for a regrettable act or communication.
moderate level of anxiety
- narrowed perceptual field, graps less of what is going on
- focuses on the source of the anxiety// less able to pay attention
- able to solve problems but not at an optimal level
physical or other characteristics
* Change in voice pitch
* voice tremors
* Poor concentration
* Shakiness
* Somatic complaints (urinary frequency, headache, backache, insomnia)
* increased respiration, pulse, and muscle tension
* More tension-relieving behavior (pacing, banging hands on table)
panic level of anxiety
- unable to attend to the environment
- focus is lost; may feel unreal (depersonalization) or that the world is unreal (derealization)
- Completely unable to process what is happening
Disorganized or irrational reasoning
physical or other characteristics
* Experience of terror
* Immobility, severe hyperactivity, or flight
* Unintelligible communication or inability to speak
* Amplified or muffled sounds
* Somatic complaints increase (numbness or tingling,
* shortness of breath, dizziness, chest pain, nausea, trembling, chills, overheating, palpitations)
* Severe withdrawal
* Hallucinations or delusions
* Likely out of touch with reality
Interventions for mild to moderate levels of anxiety
- Help the patient identify anxiety. “Are you comfortable right now?”
- Anticipate anxiety-provoking situations.
- Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head).
- Encourage the patient to talk about feelings and concerns.
- Avoid closing off avenues of communication that are important to the patient. Focus on the patient’s concerns.
- Ask questions to clarify what is being said. “I’m not sure what you mean. Give me an example.”
- Help the patient to identify thoughts or feelings before the onset of anxiety. “What were you thinking right before you started to feel anxious?”
- Encourage problem solving with the patient.
- Help the patient to develop alternative solutions to a problem through role-play or modeling behaviors.
- Explore behaviors that have worked to relieve the patient’s anxiety in the past.
- Provide outlets for working off excess energy (e.g., walking, playing ping-pong, dancing, exercising)
interventions for severe to panic levels of anxiety
- maintain a calm manner
- always remain with the person experiencing an acute, severe, or panic level of anxiety
- minimize environmental stimuli. move to a quieter setting and stay with the patient
- use clear and simple statements and repetition
- use low-pitched voice; speak slowly
- reinforce realirt if distortions occur (seeing or hearing things that are not there)
- listen for themes in communication
- attend to physical and safety needs when neccessary
- offer high caloric fluids if moving or pacing a lot
- assess need to medication or seclusion after other interventions have been unsuccessful
Health teaching and health promotion for anxiety
- Use counseling, milieu therapy, promotion of self-care activities, pharmacotherapy, biological, and health teaching interventions.
- Guide patients through slowing exercises along with progressive muscle relaxation.
- Identify community resources that can offer the patient specialized treatment proven to be highly effective for people with a variety of anxiety disorders.
- Identify community support groups for people with specific anxiety disorders and their families.
