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N363: Practice of Nursing IV > Exam 2: Anxiety > Flashcards

Exam 2: Anxiety Flashcards

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1
Q

Anxiety (definition)

A

A sense of psychological distress

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2
Q

Is transient anxiety normal?

A

Yes, a normal response to job interviews, tests, walking into unfamiliar places, and other scenarios

Feeling anxious, frightened, uneasy, or worried are all normal responses to life experiences that are perceived as disruptive, threatening or dangerous

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3
Q

Anxiety provides what?

A

The motivation for achievement, a necessary force for survival

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4
Q

Are anxiety and stress the same thing?

A

No, they are commonly interchangeably used but they are not the same

Stress is not a disorder - it is a normal part of life with no good or bad connotations.

Often what causes anxiety is stress

Stress is more transient but anxiety will persistently persist even without a stressor

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5
Q

What does it mean when stress is described as individualized?

A

It is unique to each person and what one may perceive as stressful may not be perceived that way by others

Anxiety can present differently among people as well

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6
Q

Frequently stressors are cited as causes of anxiety, when the mind interprets events as threatening, the body…

A

Responds with the signs and symptoms of anxiety

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7
Q

Physiologic Response: Fight or Flight Changes

A

HR and BP Increase

Blood flow to muscles increase

RR increases

Perspiration and Blood Clotting Increases

Saliva Production, digestion, immune responses all decrease

energy producing stored glycogen is released

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8
Q

Anxiety as a ____

A

Continuum

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9
Q

What does it mean that anxiety acts as a continuum

A

It affect cognition, psychological, and physical functioning all while being rated as MILD, MODERATE, or SEVERE

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10
Q

Mild anxiety results in…

A

Improved functioning with heightened awareness

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11
Q

As anxiety increases beyond mild…

A

It interferes with all aspects of functioning

Cognitive functioning becomes distorted and the body must endure extended periods of high physical alertness

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12
Q

Anxiety Disorder

A

Group of conditions in which the affected person experiences persistent anxiety that cannot be dismissed

Coping mechanisms are ineffective

Anxiety interferes with ADLs

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13
Q

Persons with Anxiety feel…

A

The core of their personalities are threatened when there is no actual danger

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14
Q

How are anxiety and fear different?

A

Anxiety is an emotional process and fear is a cognitive one

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15
Q

Anxiety effects what 3 main things

A

Sensation

Cognition

Verbal Ability

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16
Q

Effects of Mild Anxiety

A

Heightens sensation, sight, hearing, able to learn and verbalize rationally

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17
Q

Effects of Moderate Anxiety

A

Begins to dull perceptions

Can attend to greater sensory input if directed

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18
Q

Effects of Severe Anxiety

A

Perceptions become increasingly distorted, become scattered, and disorganized

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19
Q

Effects of Panic (What comes after severe anxiety)

A

Perception grossly distorted

Cannot differentiate real from imaginary stimuli

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20
Q

When does anxiety require intervention?

A

When it is of greater than expected intensity based on context

When it prevents fulfillment of professional, personal, or social roles

When it is accompanied by flashbacks, obsessions, or compulsions

When you are unable to attend to daily and social activities

When it lasts longer than expected given the precipitating stress/events

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21
Q

What is the most common of all psychiatric illnesses?

A

Anxiety Disorders

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22
Q

Anxiety Disorders are more common in what groups?

A
  1. Women > Men
  2. Minority children and children from low SES environments at risk
  3. Those with familial predispositions
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23
Q

Adaptive and Maladaptive Coping Mechanisms for Anxiety

A

Withdrawal or retreating from the anxiety provoking situations

Acting out - discharging anxiety through aggression

Psychsomatization

Avoidance - evasive behaviors

Problem solving systematic method for addressing difficult situations

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24
Q

Psychosomatization

A

Physiologic expression of anxiety

25
Q

Anxiety disorder barriers to treatment

A

Lack of knowledge r/t nature and prevalence

Lack of knowledge of the positive response to treatments

Social stigma

Cost - 42 billion each year

Misdiagnosis and untreated

26
Q

2 Important Theories about Anxiety Disorders

A

Neurobiological Theories

Psychological Theories

27
Q

Neurobiological Theories about Anxiety Disorders

A

50% of all affected people have a similarly affected relative

Genetic mutation with the development of COD

Bodys ability to regulate serotonin and GABA are likely to lead to anxiety disorders

Hippocampus - processing threatening stimuli and encoding information into memories

Locus coeruleus - initiates responses to danger could be overactive potential for PTSD

Striatum - area of the brain involved in motor control and thought to be involved with OCD

28
Q

Psychological Theories about Anxiety disorders

A

Low self esteem

Shyness

Timid as a child

Critical or angry parents

Long term abuse

Violence

Poverty

Anxiety resulting from conditioning - developed by linking dangerous or fear inducing events with a neutral event

29
Q

Panic

A

Intense apprehension

Terror without any real threat accompanied with somatic or cognitive symptoms

The next level above anxiety

30
Q

Characteristics of Panic

A

Over response to stressors

Incorrectly perceives circumstances

Can feel depersonalized, derealization

Very debilitating and may feel out of body

31
Q

Characteristics of Panic

A

Over response to stressors

Incorrectly perceives circumstances

Cognitive symptoms = can feel depersonalized, derealization

Somatic symptoms = choking, dizziness, chest pain, sweating, vertigo, fainting, hot and cold flashes, fear of dying, going crazy

32
Q

How long do panic attack last?

A

10-30 minutes all the way to continuing up to 1 Hour

33
Q

Panic Disorder

A

Characterized by recurrent panic attacks, 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

Onset unpredictable

34
Q

Agoraphobia

A

Characterized by the same symptoms of panic disorder

In addition, the individual experiences FEAR of being in places or situations from which escape may be difficult or embarrassing or in which help might not be available in the event that a panic attack should occur

35
Q

The limitations of panic disorder and agoraphobia become so severe…

A

It diminishes QOL and leads to depression

36
Q

Generalized Anxiety Disorders (GAD)

A

Characterized by chronic, unrealistic, and excessive worry and anxiety for at least 6 MONTHS!!!

So much discomfort causes interference with ADLs and relationships

Persistent and chronic s/sx of muscle tension, autonomic hyperactivity, apprehension, feeling “on edge,” inability to concentrate, chronic fatigue, impaired sleep patterns, and depression

37
Q

Phobia

A

A persistent irrational fear attached to an object or situation that objectively DOES NOT POSE A DANGER

May be simple and specific to certain situations, events, and objects

Ex: acro (heights), calustro (closed spaces), etc

38
Q

What is an important difference between panic attacks and phobias?

A

Panic attacks can be unpredictable; Phobias are ALWAYS anticipated and never unexpected

39
Q

When phobias are accompanied with panic attacks that is a ….

A

Panic Disorder

40
Q

Social Phobia

A

Compelling fear and desire to avoid situations that involve strangers or scrutiny from others

Fear of speaking in front of others, eating, and using public bathrooms

41
Q

Nursing Diagnoses for Panic Disorders

A

Panic and anxiety r/t real or perceived threat to biological integrity or self concept evidenced by inability to perform ADL’s s/t …

Powerlessness r/t impaired cognition evidenced by inability to complete tasks of bathing s/t…

42
Q

Goals for Treating Anxiety Disorders

A

The patient:

  • is able to recognize signs of escalating anxiety
  • is able to intervene so that anxiety does not reach levels of panic
  • is able to discuss long term plan to prevent panic or anxiety when stressful situations occur
  • practices techniques of relaxation daily
  • engages in physical exercise 3x a week
43
Q

Obsessive Compulsive Disorder

A

Cluster C Personality Disorder - Anxious or Fearful

Significant impairment and distress linked to an obsession and a compulsion to act on in order to reduce anxiety

Not exactly an anxiety disorder as there is no real connection

Can be mild or severe and if not treated can become so uncomfortable it can lead to depression or suicide

44
Q

What sets OCD apart from an anxiety disorder?

A

OCD has compulsion linked to an obsession, and compulsions decrease anxiety related to the obsessions

45
Q

OCD is time consuming, it takes up how much of a persons day?

A

More than 1 hour/day!

46
Q

Obsessions

A

Recurrent, intrusive, persistent ideas, thoughts and impulses - cognitively invasive

Usually clients see them as repugnant and meaningless but remain preoccupied with them

47
Q

Compulsions

A

Ritualistic behaviors that clients are compelled to perform in order to prevent or reduce anxiety

48
Q

Acute Stress Disorder

A

Occurs within the 1st month of exposure to extreme trauma like combat, rape, or physical assault

Symptoms will begin shortly after the incidence with dissociation occurring with detachment, dream state, poor memory and dissociative amnesia of what was encountered

Usually resolves within 2-28 days

49
Q

Post Traumatic Stress Disorder

A

Acute Stress Symptoms continuing greater than 1 month with additional symptoms of generalized anxiety, intrusive thoughts, flashbacks, nightmares, sleep disturbances, and a need to avoid triggers

Can cause low self asteem, loss of positive and trusting attitudes, and sense of being damaged

50
Q

After ___ months, PTSD is considered chronic

A

3 months

51
Q

Acute Stress Disorder usually resolves…

A

in 2-28 days

52
Q

General Clinical S/Sx of all Anxiety Disorders

A

Substance abuse and use

Barbiturate and benzodiazepine dependence

Chronic relationship difficulties

Frequent healthcare services for somatic complaints

Negative outlook

Obsessive or compulsive behaviors

Eating disorders

Sometimes can become healthcare dependent for their somatic complaints and issues

53
Q

Diagnostic Testing for Anxiety Disorders

A

Testing should be done to rule out any underlying illnesses and stressors that could be leading to s/s related to anxiety

Identification should be done as well to differentiate medical illness from anxiety - and once an anxiety disorder is identified the goal is to improve s/s and decrease recurrence

54
Q

Treatments for Anxiety Disorders

A

CBT - recognize thoughts that cause anxiety - gain insight and learn new responses

Relaxation - desensitization, replacing anxiety with relaxation responses

Psychopharmacology - SSRIs, Buspirone, beta Blockers, TCAs

Benzodiazepines

55
Q

What is the issue in using Benzodiazepines for anxiety disorders?

A

They should only be used in the short term and at the lowest dose without discontinuing abruptly as it can cause dependence/withdrawal

56
Q

Nursing Diagnoses for Stress and Anxiety Disorders

A

Anxiety r/t perceived threat or stress (state)

Ineffective coping r/t inadequate individual resources (states)

Ineffective breathing r/t hyperventilation r/t severe anxiety (state)

57
Q

Desired outcomes for treatment of anxiety disorders

A

Patient will report a decrease in aggressive behaviors and a decrease in the intensity of anxiety

Patient will report the effective use of coping strategies to deal with symptoms of anxiety

Patient will demonstrate breathing techniques to control anxiety and hyperventilation

58
Q

Successful management of an anxiety disorder involves…

A

Helping the client ID thoughts and behaviors that lead to anxiety, ID stressors, then finding effective coping strategies that are developed with the client and the nurse through a therapeutic and holistic approach

N363: Practice of Nursing IV (16 decks)

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