[Exam 2] Chapter 14: Anxiety and Anxiety Disorders Flashcards
1
Q
What is Anxiety?
A
Vague feeling of dread or apprehension. Response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms
2
Q
What if fear?
A
Feeling afraid of threatened by a clearly identifiable external stimulus that represents a danger to the person
3
Q
Positive things that Anxiety can do?
A
Motivate the person to take action to solve a problem or resolve a crisis
4
Q
What are anxiety disorders?
A
Comprise a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiolgoical responses
5
Q
Clients suffering from anxiety disorder can demonstrate what behaviors?
A
Unusual behaviors such as panic without reason, unwarranted fear of objects or life conditions, or unexplainable or overwhelming worry
6
Q
What is stress?
A
Wear and tear that life causes on the body. Occurs when a person has difficulty dealing with life siutations, problems, and goals
7
Q
What did Hans Selye identify?
A
General Adaption Syndrome, which are the physiological aspects of stress
8
Q
General Adaptation Syndrome: How was this created?
A
Used lab animals to assess biologic changes to physical responses to pain, heat, toxins, and restraint.
9
Q
General Adaptation Syndrome: Three stages of reaction to stress?
A
Alarm Reaction Stage
REsistance Stage
Exhaustion Stage
10
Q
General Adaptation Syndrome: What is the Alarm Reaction stage?
A
Stress stimulates the body to send messages from the hypothalamus to the glands (adrenaline and norepinephrine) and organs (sucha s liver to covert to glucose for food) to prepare for potential defense needs
11
Q
General Adaptation Syndrome: What is the resistance Stage?
A
Digestive system reduces function to shunt blood to areas needed for defense
12
Q
General Adaptation Syndrome: Examples of resistance stage?
A
Lungs take in more air, heart beats faster so that blood in muscles defend the body by flight, fight, or freeze.
13
Q
General Adaptation Syndrome: What happens if body adapts to stress in resistance stage?
A
Body responses relax, and the gland, organ, and systemic responses abate
14
Q
General Adaptation Syndrome: What is the exhaustion stage?
A
Occurs when the person has responded negatively to anxiety, and astress
15
Q
General Adaptation Syndrome: Example of what happens in exhaustion stage?
A
Body stores are depleted or the emotional components are not resolved, resulting in continuall arousal of the physiological responses and little reserve capacity
16
Q
Anxiety as a Response to Stress: Autonomic nervous system responses to fear and anxiety to generate what?
A
Involuntary activites of the body that are involved in self-preservation
17
Q
Anxiety as a Response to Stress: Exampes of autonomic nervous system gearing up body?
A
Adrenal glands release adrenaline (take in more O2, dilate pupils, and increase HR)
Shunting blood form GI
Glycogenolysis to fee glucose for fueld for heart, muscles, and central nervous system
18
Q
Anxiety as a Response to Stress: What uncomfortable changes does anxiety cause?
A
Difficulty with logical thought, increasingly agitated motor activity, and elevated vital signs
19
Q
Anxiety as a Response to Stress: How does person attempt to reduce uncomfortable feelings?
A
Implementing new adaptive behaviors or defense mechanisms
20
Q
Anxiety as a Response to Stress: Adaptive behaviors can be positive and help the person learn what?
A
Imagery techniques to refocus atention on a pleasant scene, practicing sequential relaxation of the body from head to toe and breathing slowly and steadily.
21
Q
Anxiety as a Response to Stress: Negative responses to anxiety may result in maladaptive behaviors such as
A
maladaptive behaviors such as tension headaches, pain syndromes, and stress-related responses
22
Q
Mild Anxiety Psychological Responses?
A
Wide Perceptual Field
Sharpened Senses
Increased motivation
Effective problem-solving
Increased learning ability
23
Q
Mild Anxiety Physiological Responses?
A
Restlessness
Fidgetting
GI Butterflies
Difficulty Sleeping
24
Q
Moderate Anxiety Psychological Responses?
A
Perceputal field narrowed
Selective attentive
Cannot connect thoughts
Increased Automatisms
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Moderate Anxiety Physiological Responses?
Muscle Tension , pounding pulse, headache, dry mouht, high voice pitch, faster rate of sptth
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Severe Anxiety Psychological Response?
Behavior geared toward anxiety relief doesn't work.
Canot complete tasks
Cannot solve problems
Feels awe, dread, or horror
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Severe Anxiety Physiological Response?
N/V , Diarrhea
Trembling
Rigid Stance
Vertigo
Pale
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Panic Anxiety Psychological Response?
Cannot process any stimuli
Distorted perception
Loss of rational thought
doesn't recognize potential danger
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Panic Anxiety Physiological response?
May bolt, or run
Dilated pupils
Increased bp and pulse
Flight, Fight, orFreeze
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Working with Anxious Clients: What does the nurse do first?
Assess the person's anxiety level because that determine what interventions are likely to be effective
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Working with Anxious Clients: With moderate anxiety, nurse must be certain of what?
That client is followingwhat the nurse is saying since client's mind cna wander. SPeak in short, simple sentences
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Working with Anxious Clients: What must nurse do if patients anxiety becomes severe?
Client can no longer pay attention or take in information. Goal must be to lower anxiety. Also stay with them.
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Working with Anxious Clients: What must nurse do during a panic anxiety?
Person safety is the primary concern. They cannot perceive potential harm and have no capcaity for rational thoughts. Keep talking to person in comforting manner. And go to quiet, nonstimulating room.
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Working with Anxious Clients: How long can panic-anxiety last?
Anywhere from 5-30 minutes
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Working with Anxious Clients: Short term anxiety can be treated with what?
Anxiolytic medications
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Working with Anxious Clients: What are some anxiolytic meds?
Benzodiazepines. Have high tendency for abuse and dependence however. Use only for 4-6 weeks
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Working with Anxious Clients: What are benzodiazepines designed for?
To relieve anxiety so that the person can deal more effectively with whatever crisis or siutation is causing stress
38
Working with Anxious Clients: In broad terms, what can we do for these patients?
Self-Awareness of Anxieety Level
Assessment of Persons Anxiety Level
Use short sentences
Lower persons anxiety
Low,calm, soothing voice
Safety during panic level
short-term use of anxiolytics
39
Stress-Related Illness: This is a broad term that covers what?
A spectrum of illnesses that results from or worsen because of chronic, long-term or unresolved stress
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Stress-Related Illness: Chronis stress that is repressed can cause
eating disorders, such as anorexia nervosa and bulimia
41
When are anxiety disorders diagnosed?
Are diagnosed when anxiety no longer functions as signal of danger or a motivation for needed cahnge but becomes chronic and permeates major portions of the person's life
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What are some types of anxiety disorders?
Agoraphobia
Panic Disorder
Specific Phobia
Social Anxiety Disorder
Generalized Anxiety Disorder
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What is anxiety?
Vague feeling of fread or apprehension in response to external or internal stimuli resulting in emotional, physical, cognitive, or behavioral symptoms
44
Stress-Related Illness: How common is anxiety?
Anxiety disorders have the highest prevalence rates of all mental disorders in the United States. 1 in 4 adults are affected. More prevelant in women
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Anxiety and Related Disorders: What is Selective Mutism?
Diagnosed in children when they fail to speak in social situation even though they are able to speak. High level of social anxiety in these situations
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Anxiety and Related Disorders: When is anxiety disorder due to another medical condition diagnosed?
When the prominent symptoms of anxiety are judged to result directly from a physiological condition. May have panic attacks, generalized anxiety, or obsessions
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Anxiety and Related Disorders: What medical conditions can cause anxiety?
Endocrine dysfunction, chronic obstructive pulmonary disease, congestive HF and neurologic conditions
48
Anxiety and Related Disorders: What is substance/medication-induced anxiety disorder?
Is anxiety directly caused by drug abuse, medication, or exposure to a toxin.
49
Anxiety and Related Disorders: Symptoms of substance/medication-induced anxiety?
Prominent anxiety, panic attacks, phobias, obsessionsn, or compulsions
50
Anxiety and Related Disorders: Treating anxiety disorder with meds is only part of the approach. What is the other?
Teach people anxiety management techniques as well to make appropriate referrals for therapy
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Anxiety and Related Disorders: What is Separation Anxiety Disorder?
Excessive anxiety concerning separation from home or from persons, parents, or caregivers to whom the client is attached
52
Etiology & Genetic Theories: What is heritability?
Refers to proportion of disorder that is attributed to genetic factors
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Etiology & Genetic Theories: What does high heritability show?
Greater than 0.6 and indicate that genetic influences dominate
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Etiology & Genetic Theories: What does moderate heritability show?
0.3-0.5 and suggest even greater influence of genetic and nongenetic factors
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Etiology & Genetic Theories: What does low heritabilites show?
Less than 0.3 and means that genetics are negligible
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Etiology & Genetic Theories: What tends to be most common in families?
GAD and OCD
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Etiology & Neurochemical Theories: GABA is believed to be dysfunctional in what disorder?
anxiety disorder
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Etiology & Neurochemical Theories: What does GABA do?
Inhibitory that functions as bodies natural antianxiety agent by reducing cell excitability and decreasing rate of neuron firing
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Etiology & Neurochemical Theories: What is serotonin implicated in?
Psychosis and mood disorders , but has many subtypes
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Etiology & Neurochemical Theories: What does Serotonin Type 1a play a role in?
Anxiety, also affecting aggression and moodzo
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Etiology & Neurochemical Theories: What is serotonin believed to playr ole in?
OCD, panic disorder, and GAD
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Etiology & Neurochemical Theories: Excess norepinephrine suspected in what?
Panic disorder, GAD, and PTSD
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Etiology & Intrapsychic/Psychoanalytic Theories: What did Freud recognize a persons anxiety as?
A persons innate anxiety as the stimulus fo rbehavior
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Etiology & Intrapsychic/Psychoanalytic Theories: What did Freud recognize defense mechanisms to be?
Cognitive distortions that person uses unconsciously to maintain a sense of being in control of siutation and to deal with stress. Person unaware of using them
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Etiology & Intrapsychic/Psychoanalytic Theories: Some people use too much defense mechanisms leading to what?
Inhibiting emotional growth, leading to poor problem-solving skills and creating difficulty with relationships
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Etiology & Interpersonal Theories: Who was important here?
Harry Sullivan
Hildegard
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Etiology & Interpersonal Theories: How did Harry Sullivan view anxiety?
As being generated form problems in interpersonal relationships. Caregivers can pass anxiety to children.
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Etiology & Interpersonal Theories: What problems can communicated anxiety cause according to Sullivan?
Dysfunction, such as failure to achieve age-appropriate developmental tasks
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Etiology & Interpersonal Theories: Why does anxiety arise in adults here according to Sullivan.
From persons desire to conform to the norms and values of their cultural grup
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Etiology & Interpersonal Theories: What did Hildegard Pepulae understand?
that humans exist in interpersonal and physiological realms. Thus nurse can help client achieve health by attending ot both areas.
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Etiology & Interpersonal Theories: PEplau identified what?
Four levels of anxiety and developed nursing interventions and interpersonal comunication techniques
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Etiology & Behvaioral Theories: How is anxiety viewed here?
As being learned through experiences. People can change or unlearn behaviors through new experiences
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Cultural Considerations: How do Asians express anxiety?
Through somatic symptoms such as headaches, backaches, fatigue, dizziness, and stomach problems
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Cultural Considerations: Once intense asian anxiety is koro, which is what?
Mans profound fear that his penis will retract into abdomen and he will then die
75
Cultural Considerations: Accepted form of tx for koro?
Person hold firmly onto penis until fear passes, often with assistance from family members or friends.
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Cultural Considerations: Asian womens fear of koro?
Vulva and nipples will disappear
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Cultural Considerations: What is susto in my culture?
Occurs in high anxiety, sadness, agitation, weight loss, weakness, and heart changes.
Believed to occur because supernatural spirits or bad air from dangerous places invade the body
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Treatment: Treatment for anxiety disorder usually invovles what
medication and therapy
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Treatment: What medications used to treat anxiety?
Anxiolytics and antidepressants
80
Treatment: What has ben useful for treating anxiety?
Cognitive-behavioral therapy
81
Treatment: What does positive reframing mean?
Turning negative message into possitive one.
Instead of thinking that my heart is pounding and im going to die.. I'll think "I can stand this. This is just anxiety"
82
Treatment: What is Decatastrophizing?
Involves the therapists use of question to more realistically appraise the situation.
"Is that likely? Could you survive that?"
83
Treatment: How does the client use thought-stopping and distraction techniques?
spashing the face with cold water or snapping a rubber band worn on the wrist. Snaps then out of negative thoughts
84
Treatment: What is assertiveness training?
Helps the person take more control over life situations. Person negotiates interpersonal situations. Use "I" statements to identify feelings and communicate concerns.
85
Treatment: Example of assertiveness training?
"I feel angry when you turn your back while im talking"
86
Treatment & Elder Considerations: Anxiety that starts for the first time later in life is associated with another condition such as
depression, dementia, physical illness, or medication toxicity
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Treatment & Elder Considerations: Most common late life disorders?
Phobias, Agoraphobia and GAD
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Treatment & Elder Considerations: Most people with late onset agoraphobia attribute start of disorder to what?
Abrupt onset on a physical illness or a response to a traumatic event such as fall or mugging
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Treatment & Elder Considerations: Late onset GAD associated with what?
depression
90
Treatment & Elder Considerations: Ruminative thoughts are common in late depression can take the form of what?
Obsessions, such as contamination fears, pathologic doubt, or fear of harming others
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Treatment & Elder Considerations: Treatment of choice for anxiety disorders is what?
SSRIs. Doses start lower than normal. Too high can exacerbate anxiety
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Treatment & Comunity Based Care: Formal treatment for those with anxiety occurs where?
offices of physicians, psychaitric clinical specialists, psychologists and other mental health counselors
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Mental Health Promotion: Tips for managing stress?
Keep positive attitude
Accept some events can't be controlled
Learn to relax
Exercise regularly
Get enough rest and sleep
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Mental Health Promotion: For people with anxiety disorders, it is important to emphasize what?
That the goal is effective management of stress and anxiety, not the total elimination of anxiety.
95
Panic DisordeR: What is this?
Composed of discrete episodes of panic attacks, which are 15-30 min episodes of rapid, intense , escalating anxiety in which person experiences fear and physiological discomfort
96
During a panic attack, person has intense anxiety and experiences four or more of the following symptoms
Palpitations, Sweating, Tremors, SOB, Sense of Suffocation, Chest Pain, Nausea, Abdominal Distress, Dizziness, Paresthesias, Chills or Hot flashes
97
Panic Disorder: This is diagnosed when?
Person has recurrent , unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks
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Panic Disorder Clinical Course: A panic with panic disorder experiences these without what?
Stimulus
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Panic Disorder Clinical Course: What is avoidance behavior?
When the memory of the panic attack, coupled with fear of having more leads to this
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Panic Disorder Clinical Course: What is agoraphobia?
Fear of marketplace or being outside and the person becomes homebound and stays in a limted area near home
101
Panic Disorder Clinical Course: What is primary gain?
Relief of anxiety achieved by performing the specific anxiety-driven behavior, such as staying in the house to avoid the anxiety of leaving a safe space
102
Panic Disorder Clinical Course: What is secondary gain?
Attention received from others as a result of these behaviors. May receive attention from family members who assume all responsibility of family life outside the home
103
Panic Disorder Treatment: This is treated how?
With CBTs, deep breathing and relaxation, and medications
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Panic Disorder Treatment: What medications treat this?
Benzodiazepines, SSRI, Antidepressants, Tricyclic antidepressants and hypertensives such as clonidine (catapres) and propranolol(inderal)
105
Panic Disorder History: During history, client cannot idetnify what?
Any trigger for these events
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Panic Disorder General Appearance: What may be apperant if client anxious?
Speech may increase in rate, ptich, and volume
Automatisms may be apparent. Automatisms are geared toward anxiety relief and increase in intensity with anxiety level
107
Panic Disorder and Mood and Affect: Assessment of mood and affect may reveal what?
That client is anxious , worried, tense, depressed, serious, or sad.
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Panic Disorder and Moodo and Affect: During panic attack, client may describe feelings of
being disconnected from him or herself and sesing that things are not real
109
Panic Disorder and Thought Process: How may client feel during this?
May think they're dying, losing control, or going insane. May even consider suicide. Thoughts are disorganized.
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Panic Disorder and Sensorium: How will they appear here?
Will become confufsed and disoriented. Canot take environmental cues and respond appropriately
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Panic Disorder and Judgement: How is this during panic attacks?
Suspended. Effort is made to escape and may run out of building onto oncoming traffic.
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Panic Disorder and Self-Concept: What statements do patients make here?
"I can't believe I'm so weak and out of control" or "I used to be a happy, well0adjusted person"'. Will evaluate themselves negatively
113
Panic Disorder and Roles and Relationships: What cn change here?
Changes with social, occupational, or family life. Person typically avoids people, places, and events assocaited with previous panic attacks
114
Panic Disorder and Physiological and Self-Care Concerns: Client reports what problems?
sleeping and eating.
115
Panic Disorder and Promoting Safety and Comfort: Nurses first concern during panic attack is
provivde a safe environment and ensure client's safety
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Panic Disorder and Promoting Safety and Comfort: What environmetn should they be placed in
quiet place to reduce anxiety and provide privacy
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Panic Disorder and Promoting Safety and Comfort: What could be said to calm down patient?
"John, look around. It's safe and I'm here with you. Nothing is going to happen. . Take a deep breath."
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Panic Disorder and Promoting Safety and Comfort: What can help reduce anxiety from nruse?/
Reassurances and calm demeanor
119
Panic Disorder and Using Therapeutic Communication: Communication when client has severe anxiety?
Should be simple and calm because they can't pay attention to lengthy messages and may pace to release energy
120
Panic Disorder and Using Therapeutic Communication: What should nurse say when anxiety begins to diminish?
"It seems your anxiety is subsiding. Is that correct?" Client then shares emotional responses
121
Panic Disorder and Managing Anxiety: How can a nurse help?
Teach the client relaxation techniques to use what he or she is experiencing stress or nxiety
122
Panic Disorder and Managing Anxiety: Examples of relaxation techniques?
Deep Breathing
Guided imagery and progressive relaxation.
Cognitive restructuring techniques
123
Panic Disorder and Providing Family Education: Is it important for nurse to educate client and family members on what?
About physiology of anxiety and the merits of suing combined psychotherapy and drug management.
124
Panic Disorder and Providing Family Education: Nurse should help the client understand what?
Drugs do not 'cure' the disorder but are methods to help control and manage it
125
Phobias: What are phobias?
Illogical, intense, and persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning.
126
Phobias: How do those with phobias react with anxiety?
Have anticipatory anxiety even when thinking about possibly encountering the dreaded phobic object
127
Phobias: What arre the different types?
Agoraphobia
Specific Phobia
Social Anxiety or Phobia
128
Phobias: When is a diagnosis of phobic disorder made?
When the phobic behavior significantly interferes with the person's life by creating marked distress or difficulty in interpersonal or occupational functioning
129
Phobias: What is a natural environmental phobia?
Fear of storms, water, heights, or other natural phenomena
130
Phobias: What are blood-injection phobias?
Fear of seeing one's own or others blood, traumatic injury, or invasive medical procedure
131
Phobias: What are siutational phobias?
fear of being in a specific siutation such as on a bridge or in a tunnel, elevator, small room, hospital, or airplane
132
Phobias: What is animal phobia?
fear of animals or insects
133
Phobias: Other types of specific phobias?
Fear of getting lost while driving is not able to make all right turns to get to one destination
134
Phobias: What happens with a social phobia?
Person becomes severely anxious to the point of panic or incapacitation when confronting siutations involving people
135
Phobias: Specific phobias occur when?
Childhood or adolescence
136
Phobias and Treatment: What works best here?
Behavioral therapy
137
Phobias and Treatment: What occurs in behavioral therapy?
Focus on teaching what anxiety is ,helping client identify anxiety responses, teaching relaxation techniques, setting goals, discussing methods to achieve goals
138
Phobias and Treatment: Example of behavioral therapy often used to treat phobias?
Systemic (serial) desensitization
139
Phobias and Treatment: What happens in systemic desensitization?
Therapist progresively exposes the client to threatening object in a safe setting until the client's anxiety decreases
140
Phobias and Treatment: Another example used is flooding. What is this?
Rapid desensitization. Confront the client with the phobic object until the client no longer produces anxiety. Goal is to get rid of anxiety in 1-2 sessions.
141
Generalized Anxiety Disorder: How does person react here?
Worries excessively and feels highly anxious at least 50% of the time for 6 months or more
142
Generalized Anxiety Disorder: Defining characteristics of this?
Unable to control focus and has three or more of following symptoms:
uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations
143
Generalized Anxiety Disorder: More people with this disorder are seen by whi?
Family physicians
144
Generalized Anxiety Disorder: Most effective treatments for this?
Buspirone (Buspar) and SSRI or Serotonin-Norepinephrine Reuptake Inhibitor Antidepresssants
145
CBTs used to treat cliens with anxiety disorder include what?
positive reframing, decatastrophizing, thought-stopping, and distraction
146
Being Self-Aware about what helps improve personal and professional relationships
one's anxiety and responses
