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.
Implementing therapeutic communication techniques for clients with eating disorders
Abnormal lab values for builima
Hypokalemia, dehydration, hyponatremia, hypochloremia, hypomagnesemia, decreased
Diagnostic findings for bulimia nervosa
impaired liver function, anemia, leukopenia, abnormal thyroid function, ecg changes, decreased bone density
Recognizing complications related to anorexia nervosa
refeeding syndrome, dysrhythmias, severe bradycardia, hypotension, cardiac collapse, delirium, death
Symptoms and nursing interventions for refeeding syndrome
fluid and electrolyte shifts: hypophosphatemia, hypokalemia, hypomagnesemia, hypocalcemia
Role of prazosin in PTSD symptom management
Reduces nightmares and enhances normal dreaming patterns.
Differentiate between acute stress disorder and PTSD
Time frame in which it will last.
Acute: lasts at least 3 days, but no more than a month
PTSD: lasts longer than a month following an event and can last for years.
Recognize cues for PTSD
Re-experiencing the traumatic event, high anxiety or arousal, intrusive recollection or nightmares of the event.
General numbness of responsiveness
Interventions for nightmares/flashbacks
do not wake them up.
Interventions for PTSD
Assign the same staff is possible
Non-threatening matter of fact, but a friendly approach
Respect patient’s wishes regarding discomfort interacting with some individuals. (especially if trauma was rape)
stay with them during flashbacks
Rationale for using anti-anxiety medications for symptoms of PTSD.
Antidepressant and anti-panic effects.
Recognizing Factors Influencing Adjustment Disorders
depressed mood: predominant mood disturbances
anxiety: predominant manifestations
Mixed anxiety
Assessment of a trauma
Numbing feeling.
Complete loss of memory. Not oriented.
experiencing even, amnesia-related events, state of arousal, hyperactivity,
guilt, substance use, anger, and aggression.
When do symptoms of trauma usually start?
3 months after exposure
acute stress and PTSD.
Acute stress- time limiting, 3 days to a month but not more than a month
PTSD: lasts longer than one month.
Trauma-informed care
do not retraumatize your client
Recognize s/s of trauma
Interventions for trauma
monitor their stress.
Rate your anxiety.
Post-trauma syndrome Interventions and diagnosis
consistent staff
friendly non-threatening approach
Encourage communication at the patient’s pace
Validate feelings
Provide private environment
Respect opposite-sex avoidance or interaction
Offer safety and security during nightmares and flashbacks(DO NOT wake them up)
spend time with patients.
Why do we not wake up patients experiencing nightmares and flashbacks?
this is very unsafe, and you will get hurt. Do not touch them.
always find common ground with the person you are interacting with.
How does trauma affect the hippocampus?
Exposure to trauma causes a decreased hippocampus volume
Client education for stress management
Meditation, journaling, breathing exercises, guided imagery, progressive muscle relaxation, and physical exercise.
Recognizing biological responses to stress (pg 4 morgan)
fight or flight, norepi and everything increases. Eyes dilate for a better visual of what going on.
Senses are heightened.
Parastalsis slowed down, and absorption and digestion stopped.
BS increases. Glycolysis happens and glucogenesis. Need more oxygen breathing heavier. Bp higher to get more blood, heart rate up to circulate.
Gaba stops the process. Norepi starts.
Reactions to stress, ADAPTIVE
maintain the integrity of the individual, positive and healthy.
Reactions to stress, MALADAPTIVE
disrupts the integrity of individuals, harmful, and unhealthy.
Client education/ recognition of factors that increase stress
May need a axiolytic to stop the response is GABA does not stop it.
Why do we provide privacy for PTSD clients?
abuse could of occured
Recognizing maladaptive stress responses
Chronic anxiety and panic attacks
Chronic pain, depression, sleep disturbances
Increased risk for MI, stroke
Identify the nursing interventions for a client with PTSD
discuss coping strategies:
anti-anxiety and relaxation techniques
animals!!
Box Breathing
Imagery
establish a support system.
SI is very high in this population
Role of the thalamus in stress response
temporarily blocks minor sensations so that an individual can concentrate on one important event when necessary
Dissociative disorders
occur when anxiety becomes overwhelming
personality becomes disorganized
disruption in psychobiological functions
“out of body experience”
more than one traumatic event that occurs
Recognizing cues for dissociative amnesia
Dissociative amnesia
Inability to recall important information, usually of a traumatic or stressful nature that is too extensive to be explained
Not a direct effect of substance use or a neurological condition
Interventions for dissociative amnesia
Recognizing cues for Conversion disorder with psychological stressor
extreme anxiety, or lack of emotion
impairment in clients life
Blindness, paralysis, seizures, gait disorders, hearing loss
Pseudocyesis.
stroke and conversion disorder look the same but what do we do first?
rule out organic pathology
conversion disorder
voluntary function
can wake up because of stress, can’t see, walk, speak, see, and lose functions of the body. all related to stress and anxiety.
Interventions for somatic symptom disorder
assess for suicidal ideations
limit the amount of time talking about somatic manifestations
Recognizing cues for somatic symptom disorder
remissions and exacerbations of somatic manifestations
client overmedication with analgesics and antianxiety medications
probable alcohol or other substance use
excessive preoccupation with somatic manifestations
Interventions for Factitious disorder
Pretending to be ill to receive emotional care and support, or putting it on someone else.
Interventions for Conversion disorder
Ensure safety, encourage verbalization of feelings.
Educate client on stress management techniques.
Recognizing cues for depersonalization
reports of feeling detached from one’s own body or feeling that one’s personal environment is unreal.
What is depolarization
disturbance in the perception of oneself.
Recognizing cues for derealization
Objects in the environment are perceived as altered in size and shape. People in the environment may seem automated or mechanical
Recognizing cues for dissociative identify disorder
“gaps” in memory
amnesia
fugue states
depersonalization and derealization
Recognizing cues for localized amnesia
unable to recall all incidents associated with a stressful period. Can be broader than just a single event.
“inability to remember months or years of child abuse”
Recognizing cues for a client with dissociative fugue
traumatic event that triggers this. Can last for weeks to months.
Can not remember things about themselves after moving locations
Recognizing cues for illness anxiety disorder
Obsessive thoughts and fear about illness
Research their suspected illness (LMAO)
overly aware of body sensation
seek medical help numerously
Recognizing cues for the defense mechanism repression
a trauma victim is unable to remember anything about the traumatic event
What two things are damaging stressors that cause distress?
anxiety and hunger
What is Dissociative fugue?
A type of dissociative amnesia in which the client travels to a new area and is unable to remember one’s own identity and at least some of one’s own past.
What is Adjustment disorder?
A stressor triggers a reaction causing changes in mood or dysfunction in performing usual activities.
impairment in social and occupational functions
Maladaptive response to stressor/s
Occurs within 3 mo of stress for no longer than 6mo
sx greater than expected reaction.
Cues for Adjustment disorders?
A pattern of lifelong difficulty accepting a change.
Learned pattern of difficulty with social skills or coping strategies when a stressor occurs and can trigger a stress response out of proportion.
What is the difference between purging and nonpurging?
Purging: client uses self-induced vomitting, laxatives, diuretics, and or enemas to lose or maintain weight
Nonpurging: compensation for binge eating through other means (excessive excersie and the misuse of other means).
What is refeeding syndrome?
potential fatal complication that can occur when fluids, electrolytes, and carbs are introduced to a severely malnourished client
Symptoms of Refeeding syndrome?
Cardiac Dysrhythmias, cardiac collapse, delirium, death
Labs for refeeding syndrome
hypokalemia, hypocalcemia, hypomagnesemia, hypophosphours?
Nursing interventions if Refeeding syndrome occurs
place client on cardiac monitoring
monitor vs frequently
report changes in patients status to provider
What is conversion disorder?
Results when a client exhibits neurologic manifestations in the absence of a neurological diagnosis. Clients will transmit emotional or psychological stressors into physical manifestations
what assessment details would indicate a client might have a binge eating disorder?
bmi 38
hga1c 6.5
Which assessment findings might indicate a diagnosis of anorexia nervosa
amenorrhea, lanugo ( fine hair in babies ), bmi 15
Which of the following findings might indicate a diagnosis of bulimia nervosa
russels, dental erosion, parotid enlargement
a nurse is educating a client on fluoxetine for tx of an eating disorder, what is included?
do not drive for the first few days after starting this medication
-takes 5-10 weeks to become effective
-ssri
-appetite and sleep is effected by SSRI,
which of the following interventions is appropriate for a client with anorexia nervosa
assess skin turgor and integrity
sit with client during meals
assess for enlarged parotid glands
Begin parenteral fluids and electrolytes
assess heart rate and blood pressure
How long do we sit with clients with anorexia nervosa?
30 minutes, we do not want to let them sit In front of food for too long
if the patient has a purging disorder why do we sit with them for an hour after they eat?
the food will be digested in an hour then they will not be able to purge the food.
why should we do an oral assessment on a client with suspected purging episodes?
to check for dental erosion
daily weights are ordered on a client with an eating disorder, how do we proceed?
weigh on the same scale every day,
-do not let them see the scale (turn them backward).
-weight in the morning before meals
-dry weight (after peeing)
client experiences refeeding syndrome, what are the risk factors?
cardiovascular collapse, cardiac arrhythmias, and altered mental status.
what lab findings would you expect in a client abusing laxatives?
hypokalemia
How long do symptoms need to be there for anxiety?
6 months
Phobias
trigger the amygdala, and want to avoid whatever it is that they are scared of.
Specific to an object.
what neurotransmitters are implicated in anxiety disorders?
norepi, serotonin, gaba
what structure heightens fear in the individual?
amygdala
Hippocampus
memory
Is there a link between the hippocampus and the amygdala?
yes because memories can relate to fear. If we have a memory it can cause a feeling of fear. The next time you do the activity you will not have as much fear about the situation
What level of anxiety improves awareness and alertness?
Mild
client unable to focus, concentrate or comprehend simple commands, what level is this?
panic
Moderate
concentration is narrowed
the patient is in panic level anxiety, what interventions are appropriate?
Stay with the client, admin lorazepam, obtain a paper bag, and decrease environmental stimuli.
patient taps the table 6 times what is the term for this ritual?
compulsion
progression of anxiety producing imagery, while creating a state of relaxation? (least to greatest)
systematic desensitization
client reports restlessness, feeling “keyed up” and sleep disturbances for the last seven months, what is this?
GAD
the client can not ride the bus because of fear of panic and fear from escaping what is this
agoraphobia
patient prescribed benzos for relief of acute anxiety, what should we teach them?
monitor for sleep-driving
why can we not use buspirone for acute level panic attacks?
this takes time to work and be effective. Takes days to reach effectiveness.
coping strategies for adjustment disorder
awareness of factors causing the stress
Breathing, meditation
Communication or “talk the problem out”
Problem-solving or objective decision-making
pets, music
Complicated grieving
so many losses in a row, you can not go through the stages properly.
Explore problem-solving
Let them experience their anger
Explain the stages of grieving
Crying is cool because it is an emotional release
risk-prone health behavior
talk about lifestyle before changes in health status
discuss changes or loss, express anger
Express fear surrounding lifestyle alterations
Assist with ADL
identify community resources
if a client is suicidal or homicidal we should
referr them to someone?
Cognitive Behavior therapy
regain hope and optimisum about safety.
Prolonged exposure therapy
specific to trauma and stress within the safe limit, (systematic de-sensitation).
Education: breathe retaining for relaxation, imagined exposures, then real life.
e.mdr
Express a negative believe, what do you want to believe?
replace negative believes
rate the validity of self-statement
Identify a picture best representing the memory
What antidepressants are used as first line treatment?
SSRI: first line treatment
Amitriptiline: tricyclic antidepressant (SI)
Phenelzine: MAOI good outcomes for PTSD
Anxiolytics
alprazolam is anti panic, antidepressant effects
What medication is used for short term control of aggression ad agitation?
anti-psychs
what medication disrupts fear associated with trauma off label?
ketamine (tranquilizer)
What medication increases levels of endogenous cannabinoids?
Endocannabinoids
What medication reduces nightmares in PTSD?
prazosin
What medication decreases recall of traumatic memories?
Glucocorticoids
Somatic patients usually go where?
Usually end up in PCP and seek for a second opinion. They hardly go to the psychiatrist for their symptoms.
Organic Pathology
There is no organic cause
Does somatic symptom have to have how many symptoms present to be diagnosed as somatic symptom, instead of illness anxiety disorder?
one
Learning theory
primary gain:avoid stress obligations, postpone unwelcome challenges or excused from troublesome duties
directly effects you
Secondary: sick person becomes a prominent focus of attention because of illness. (get attention)
Tertiary: relieves conflict within the family as concern is shifted to the ill person and away from the real issue.
conflict shifted because of the sick individual.
Nursing interventions
Accept physical complaint is real to client
-comfort and safety.
Compulsions versus obsession
compulsion: repetitive ritualistic behaviors or mental acts an individual feels driven to preform to reduce anxiety
Obsession: intrusive thoughts that are recurrent and stressful.
