Exam 3 Flashcards
Characteristics of generalized anxiety disorder
The client has exhibited uncontrollable, excessive worry for at least 6 months.
Purpose of rituals in OCD
to reduce stress and anxiety
What are examples of rituals performed by those with OCD
handwashing, ordering, checking, praying, counting
Systemic desensitization
Least to greatest, type of therapy, small exposure within safe limits then will progress to real-life situation.
used to treat different phobias
Social anxiety disorder
an excessive fear of situations in which a person might do something embarrassing to be evaluated negatively by others.
Validation definition
Support and affirm the needs of the client individually and separate from milieu/ other clients.
Active,empathetic listening to the client’s perceptions of their illness, any concerns they may have and promoting autonomy.
How do we show empathy?
by sitting down, and being on their level to understand where they are coming from.
Interventions for anxiety
-provide structured interview to keep client focused
-provide safe environment for client and staff
-provide structured milieu with therapeutic communication and daily activities
-relaxation techniques
-find community resources regarding anxiety
Interventions for severe anxiety
-remain with the client
-paper bag if hyperventilating
-provide safety and comfort
-calm, quiet environment
-do not try to perform patient education
Function of amygdala
fear
Systematic Desensitization for fear
safest option, client is taught relaxation techniques
progressive exposure to the situation or stimuli during a relaxed state.
step by step and be able to handle it when they are out in public.
Sessions for systematic desensitatization can be executed how?
through fantasy
real-life
or in a combination of both.
What is implosion therapy (flooding)
done at one time, floods patient with triggers at one time
What is agoraphobia?
This occurs when the client experiences an extreme fear of certain places where the client feels unsafe and vulnerable.
outdoors, or being on a bridge.
might effect the patient’s employment.
can not easily escape from (such as being in a crowd)
what medications are used for anxiety?
ssris
paroxetine, fluoxetine and sertraline
Panic episodes are___ whereas Generalized panic is ______
time-limited, panic all the time
anticonvulsants (pregabalin-GABA)
derivative useful in treating in anxiety disorders
schedule 5 controlled substance posing a risk for dependence and diversion.
Social anxiety is defined by what?
performance in the community
what medication do we give for social anxiety?
anit-hypertensives
propranolol, atenolol, and clonidine
Most used for test and performance anxiety.
Why do we not use clonidine long term?
dependence
Benzodiazepine client education (ex: diazepam and lorazepam)
-monitor for sleep driving
-should only be take PRN for acute anxiety
-dependence and tolerance can occur
Why do we use benzo
increase gaba and as a prn for panic attacks and severe anxiety.
Obsession vs compulsion
Obsessions: recurrent and stressful intrusive rituals(thoughts)
Compulsions: repetitive, ritualistic behaviors or mental acts intended to reduce the anxiety of obsessive thoughts.
Long term treatment for anxiety
Buspirone.
busiprone education
takes up to two weeks to diminsh symptoms. does not have addictive properties, and not used for PRN
-avoid grapefruit juice, avoid St John’s Wart, avoid erythromycin and ketoconazole
-take with meals
Benzodiazepines complications
blood dyscrasias, if they drink with them they can have respiratory issues
sx of Blood dyscracias from anxiolytics (benzos)
sore throat, fever, malaise, bruising, and bleeding.
Benzo is similar to?
alcohol and can have the same effect.
interventions for Panic attack
do not use busprione, use benzo as prn
Neurotransmitters for anxiety
low serotonin, high norepi, low gaba
Levels of anxiety
mild,moderate, severe, panic
Mild anixety includes,
fight or flight starts
pupils dialate, perceptional field increases, allow for more vision.
Can learn better at this level
emotional characteristics of mild anxiety
may remain superficial, rarely distressful, motivation increased
symptoms of mild anxiety
restlessness, irritability
intervention for ocd
slowly get rid of the ritual, and replace is with therapeutic things and medication
Why do we need to slowly stop their rituals with ocd?
If you take away their ritual, their anxiety will increase and can cause a panic.
moderate anxiety
-reduction in perceptual field
-reduced alertness to environmental events
-learning occurs but not at optimal ability/ decreased attention span
Symptoms of moderate anxiety
increased restlessness, HR, RR, perspiration, gastric discomfort, increased muscular tension, increase speech rate/volume/pitch
Emotional symptoms of moderate anxiety
-discontent, impairment in interpersonal relationships as individual begins to focus on self
severe anxiety
perceptual field greatly diminished, only extraneous details are perceived
may focus on one single detail
may not notice events
effective learning cannot occur
symptoms of severe anxiety
headaches, dizzines,s nausea, trembling, insomnia, palpitations, tachycardia, hyperventilation, urinary frequency, diarrhea
Emotional sx of severe anxiety
feelings of dread, loathing, horror
total focus on self and intense desire to relieve anxiety
Panic anxiety
unable to focus even on one detail
misperceptions of the environment (perceived detail may be elaborated)
sx of panic anxiety
dilated pupils, labored breathing, severe trembling, sleeplessness, palpitations, diaphoresis, pallor, immobility/hyperactivity, incoherence
Emotional characteristics of panic anxiety
impending doom, severe terror
-shouting, screaming, running, clinging to others,
-hallucinations, delusions
-extreme withdrawal into self
do we teach relaxation techniques during panic?
no, need to teach them after they have medication
as anxiety increases, visual field?
decreases drastically. (tunnel vision).
Anixety and learning
when in panic can not learn. The less severe the anxiety, the better they will be able to learn.
Priority nursing intervention for patients with panic anxiety
stay with them and do not touch them.
allow them to use a paper bag If they are hyperventilating so they do not pass out.
Goals for clients with anxiety
safety, how to maintain anxiety, function adaptively
recognize escalating anxiety and intervene
Can benzos be used long-term?
they can not, they will lead to dependence.
can have withdrawal with Benzos
Life-threatening withdrawal.
Recognizing cues for binge eating disorders
-Altered perception of the issue
-feeling uncomfortably full
-Coping strategy for stress
-Terrified of gaining weight and constantly dieting
-guilt or depression due to binge eating
-feeling uncomfortably full
-Collecting recipes, hoarding food
-concerns about eating in public
Satiety and binge eating disorder
delayed gastric emptying, enlarged stomach capacity, decreased secretion of cholecystokinin
-body no longer says “I’m full”
De-escalation for anixety
calm, open hands, limit settings, express concern, reduce stimulation, loud noise. attempt these before using medications.
Recognize cues for anorexia nervosa
refusal to eat
Gross distortion of body image
preoccupation with food
LANUGO
Amenorrhea
laxative abuse
vomiting
Malnourishment
perceive themselves as fat
Recognizing cues for bulimia nervosa
hx of previous AN
intake of high caloric foods in very short time then purging them out
OCCURS IN SECRET
worse decision-making ability
decreased bone density
general and specific functioning decrease
lifetime SA
dietary restriction
frequent use of laxatives
What kind of foods are typically binged with bulimia nervosa
high caloric, sweet, soft, smooth texture
types of bulimia nervosa
purging type: client uses self-induced vomiting, laxatives, diuretics, enemas
Nonpurging type: excessive exercise, laxative misuse, diuretics, enemas
Differentiate between the three eating disorders?
BMI:
anorexia = very low, bulimia= normal, binge eating = high
Eating Habits:
anorexia= restricting mostly, binge eating and purging (still maintain very low BMI) , bulimia= strict binging and compensation, BED= binge eating but no purging
Age:
anorexia= adolescence to young adulthood, bulimia= late adolescence to early adulthood, BED= all ages but mostly aged 46-55
What is the client education for Fluoxetine use?
-first-line treatment
-beneficial in treating comorbid depression (which results from malnutrition and starvation)
-Fluoxetine can decrease the cravings for carbs
-1-3 weeks for response and 2 months to take effect
-avoid hazardous activities at first (such as driving for first 3 days.. from kahoot)
-notify provider of sexual dysfunction
Medications used for eating disorders
fluoxetine (first line)
Topiramate and Lisdexamfetamine -reduce incidents of both binge eating and weight loss (lisdexamfetamine is a diet pill and stimulant)
What is the client education for treatment of anorexia nervosa?
What is the role of the hypothalamus in appetite regulation?
regulates appetite hunger and thirst (controls being hungry and being sated)
Nursing interventions for a client with anorexia nervosa
-highly structured milieu
-encourage positive self-esteem and self-image
-establish goals
-provide small, frequent meals
-high fiber diet and low in sodium
-reward client for positive behaviors
Cue analysis of oral cavity findings for purging
tooth erosion, enlarged parotid glands, mouth ulcers
Recognizing cues with BMI and each eating disorder
below 15 (hospitalized anorexia nervosa) , below 17 (anorexia), 18.5-30 (bulimia) , > 30 (binge eating disorder)
Recognizing cues for physical assessment for a client with bulimia nervosa
enlarged parotid gland, russels sign, tooth erosion, mouth ulcers, diarrhea, decreased HR,BP,and body temp, normal or increased body weight
Symptoms of a hospitalized patient with anorexia nervosa
less than 30 % expected weight, dehydration, severe electrolyte imbalances, cardiac arrhythmias, bradycardia, hypothermia, hypotension, suicidal ideation
Nursing interventions for eating disorders
-same as anorexia ?
Nursing intervention for obtaining a clients weight
take before breakfast, do not let them look at the scale.