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Kathleen Health & Illness 4 > MIDTERM > Flashcards

MIDTERM Flashcards

1
Q

What is anxiety?

A

A feeling of unease, apprehension, uncertainty, dread deriving from a real or perceived threat. Typically FUTURE ORIENTED.

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2
Q

How prevalent are anxiety disorders?

A

20% of the general population has an anxiety disorder. 3-5% of children/adolescents have it.

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3
Q

What are risk factors for anxiety?

A

Being female, stressful/traumatic events, family hx, childhood adversity, support system, substance use, concurrent psychiatric conditions, personality, TBI’s

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4
Q

What is happening in the brain of someone who has anxiety?

A

In individuals with anxiety the Amigdula is hyperactive

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5
Q

What axis is activated in someone with anxiety? What does this look like?

A

The autonomic NS/HPA axis is activated, this is responsible for our fight or flight response. Therefore vitals are increases, dilated pupils, hyperglycemia, dilated bronchioles, peripheral vasoconstriction.

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6
Q

What are the levels on the anxiety spectrum?

A

Mild -> Moderate -> Severe -> Panic

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7
Q

What is mild anxiety?

A

Normal everyday stress such as taking a test. Problem solving becomes more effective in this state, pt will be restless, irritable, and exhibit tension relieving behaviours such as fidgeting or nail biting.

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8
Q

What is moderate anxiety?

A

In this stage perceptual field narrows, attention is selective, the ability to process in formation begins to be impaired, problem solving is adequate. Heart pounding, high HR & RR, perspiration, Mild GI upset, headache, urinary urgency.

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9
Q

What is severe anxiety?

A

Automatic behaviour such as hand writing, pacing, fidgeting begins, headaches, nausea, dizziness, insomnia, trembling, tachycardia, hyperventilation and sense of dread ensue. These pts are hard to refocus and cannot do so themselves.

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10
Q

What is Panic?

A

Panic is the impending sense of doom, can border on psychosis, hallucinations, disorganization, irrational reasoning, shock like symptoms, may feel they are dying. Typically the result of an unexpected situation or panic disorder. (Ex - losing a child)

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11
Q

What are the nursing interventions for a panic attack?

A

Stay with patient, DO NOT LEAVE ALONE, Assist to a quiet place, speak calmly & clearly. Panic attacks can be sudden but peak around 10-15 minutes.

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12
Q

What is generalized anxiety disorder?

A

GAD is a persistent exaggerate apprehension and tension causing dysfunction. CONSISTENT WORRY .
More common in females

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13
Q

How common is GAD?

A

5% of the population is diagnosed with GAD.

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14
Q

How is GAD diagnosed?

A

GAD is diagnosed with the DSM - V. Characteristics for diagnosis may include: excessive anxiety for more days than not over 6 months, hard to control anxiety & cant self soothe, have 3 or more symptoms if adult, one or more in children, causes impairment of daily life, not explained by another factor such as meds, substances or medical condition.

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15
Q

What symptoms are included in the DSM -V ?

A

Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances.

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16
Q

What symptoms are indicative of poor coping?

A
  • Avoidance
  • Procrastination
  • Poor problem-solving skills
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17
Q

What symptoms are indicative of distorted cognitive process?

A
  • Poor concentration
  • Unrealistic assessment of problems
    -Excessive worry over minor matters
  • Fear grave misfortune
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18
Q

What symptoms are indicative of excessive physiologic arousal?

A

-SOB
-Tachycardia
-Palpations
-Dry mouth
-Sweating
-Nausea
-Diarrhea
-Muscle tension
-Irritability
-Fatigue/Insomnia
-Headache

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19
Q

How does anxiety affect sleep?

A

Pt’s may ruminate over real or imagined mistakes, problems or future difficulties.
Lack of sleep may contribute to worsening of symptoms.

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20
Q

What are treatment options for anxiety?

A

CBT - Cognitive behavioural therapy. Therapist assists in recognition of harmful ways of thinking and analyzing.

Biofeedback - becoming aware of consciously controlling body functions

Behavioural modelling:
Modelling
Systematic desensitization
Flooding
Response prevention
Thought stopping

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21
Q

What are medication treatment options for anxiety?

A

Beta blockers - slow the somatic nervous system
SRI/SNRI - help boost and stabilize mood
Anxiolytic- Can be a sedative, takes pt out of fight or flight state.

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22
Q

What are the 3 S’s of SSRI Adverse Effects?

A

Stomach upset
Sexual dysfunction
Serotonin Syndrome

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23
Q

What are the side effects of SNRI’s?

A

Use B A D S N R I. To remember
B - body weight decrease
A- Anorexia
D- Decreased BP
S- Suicidal thoughts
N- Nausea/Vomiting
R- Reproductive - sexual dysfunction
I- Insomnia

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24
Q

What are some nursing interventions for anxiety?

A

Decrease stimuli, give brief directions, ask questions to clarify and dispute illogical thinking while remaining supportive, list strengths, reframe situations in a positive light.

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25
Q

When is PTSD diagnosable?

A

4 weeks of stress is ASD or acute stress disorder.
4+ weeks is PTSD
20% of CAF Veterans have an operation stress injury such as PTSD.

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26
Q

What are risk factors for PTSD?

A

Female, under 25 yo, education level, childhood trauma, childhood adversity, adverse life events, psychiatric disorders, genetics, perceived severity of trauma, nature of trauma (more likely to have PTSD if trauma is human perpetrated), HPA axis dysfunction.

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27
Q

What are the diagnostic criteria for PTSD?

A

Exposure or threat, intrusion symptoms, recurrent avoidance, negative changes in cognition and mood, trauma related alterations in arousal and reactivity, duration of symptoms, functional significance (is it effecting their ADL’s), Elimination

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28
Q

What are the main features of PTSD?

A

R- re-experiencing (flashbacks)
A- avoidance of stimuli associated with trauma
I- increased arousal
N-numbing of general responsiveness/negative changes

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29
Q

How does PTSD manifest in children?

A

Less likely to show distress, they may not show it but feel it. Often express memory through play.

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30
Q

What are negative stress coping mechanisms associated with PTSD?

A

Denial - typical of PTSD
Repression - typical of PTSD
Regression - not typical of PTSD
Rationalization - also not typical of PTSD

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31
Q

What are treatment options for PTSD?

A

Exposure therapy, group therapy, SSRI and SNRI medications, Anxiolytics and sleep aids.

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32
Q

What are the risks of PTSD? The three S’s

A

Suicide risk, substance abuse, survivors guilt.

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33
Q

What are somatoform disorders?

A

Disorders in which physical symptoms are present with no physical cause, stems from psychological causes. Typically co-occur with depressive, psychotic, or anxiety disorders.

34
Q

How can somatic symptoms or somatic disorders be diagnosed?

A

Symptoms must persist for more than 6 months in order for diagnosis.

35
Q

What is considered a conversion disorder?

A

One or more symptoms of altered voluntary motor and sensory function inconsistent with their condition.

36
Q

What is illness anxiety disorder?

A

Preoccupation with getting/having a serious medical disorder

37
Q

What is primary gain in conversion disorders?

A

The process of avoiding mental symptoms by causing physical symptoms. Relieves pressure to deal with anxiety directly.

38
Q

What is secondary gain in conversion disorders?

A

Benefits of primary gain with the addition of benefits that come from having symptoms.

39
Q

What are risk factors for somatic symptom disorders?

A

Education, Socioeconomic status, childhood, family history, psychiatric history or conditions, sex (females more prone)

40
Q

What are the most common somatic symptoms?

A

Gastrointestinal issues, pain, sexual dysfunction, persistent anxiety .

41
Q

What are interventions for somatic patients?

A

Limit focus on illness and symptoms (find root cause), promote insight - identify stressors, Introduce positive coping mechanisms to reduce stress.

42
Q

What is mood?

A

Subjective experience, how the patient would describe their mood.

43
Q

What is affect?

A

The objective observation of mood, what emotions is the patient expressing. How they APPEAR

44
Q

What can cause mood disorders?

A

Social factors, hormonal imbalances, changed levels of neurotransmitters, personality traits, family history or mental health conditions

45
Q

What is bipolar disorder?

A

Dramatic shifts in mood, emotions, and energy. Must have both manic and depressive episodes.

46
Q

What are risk factors for bipolar disorder?

A

Genetics - family history increases risk by 10 TIMES, SSRI’s can cause manic episodes, HPA axis dysfunction, anxiety disorders, substance abuse, common in post partum psychosis.
Stress is a common trigger.
Men tend to be more aggressive
Women tend to commit suicide.

47
Q

What is mania?

A

Inflated self esteem, grandiosity, decreased need for sleep, talkative, flight of ideas, distractibility, high risk activities, hyper productivity is common, feel like they can take on the world.

48
Q

What is hypomania?

A

Hypomania is a more muted display of mania.

49
Q

What is depression as classified by the DSM-V?

A

Depressed mood, diminished interest in activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue/loss of energy, feelings of worthlessness/guilt, decreased concentration or indecisiveness, suicidal ideation or attempt.

50
Q

What is bipolar one?

A

Depression lasting minimum 2 weeks, mania lasting minimum of 1 week. More common in men. Hallucinations, delusions, and psychosis are specific to bipolar 1.

51
Q

What is bipolar 2?

A

Mania is less severe, no psychosis, depression may be profound, hypomania lasts a minimum of 4 days, VERY high suicide risk, most common in women. Less likely to be hospitalized.

52
Q

What is cyclothymia?

A

Less severe hypomania and less severe depression, symptoms last a minimum of 2 years in adults or 1 year in children in order to get a diagnosis.

53
Q

What is a mixed episode?

A

An episode lasting a minimum of one week where the patient meets the criteria for both a depressive and manic episode at the same time. (Sporadic, not common)

54
Q

What is rapid cycling?

A

4 or more episodes of mood changes such as depression or mania within a 12 month period, Switches from high to low. There isnt a lot of stability.

55
Q

What is the assessment for mood and affect?

A

Safety - risk taking
Protection - possibly finding alternate decision maker
Hospitalization- past medical hx, allergies, treatment
Medical status - family involvement, medication education
Co-morbidities - depression, anxiety
Understanding

56
Q

What are some considerations for those with bi-polar during mania?

A

Limiting group contract, ensure less stimuli and more 1:1 help, set firm boundaries that are consistent among staff, dietary considerations must be made as they will not sit long enough to eat - try to give them nutrient rich on the go foods.

57
Q

What are the summary of mania main findings?

A

M-Mood swings
A- Agitation
N- Non stop talking
I-Impulsivity
C- Can’t sit still or concentrate

E- Euphoric
P- Poor judgement
I- Increased sexual interest
S- Substance abuse (misuse)
O- Omnipotent feelings
D- Decreased sleep
E- Endless energy

58
Q

What are the main medications used for individuals with bipolar disorder?

A

Carbamazepine, Valproic Acid and Lithium

59
Q

What does carbamazepine do for BPD and what should we watch for?

A

Anticonvulsant used as a mood stabilizer, may lower WBC’s so monitor for infection, oral contraceptive will be ineffective on this med, monitor for Steven-Johnson syndrome (deadly) -rare-

60
Q

What do we need to monitor when treating BPD with Valproic Acid?

A

Liver toxicity may result in low platelets - watch for bleeding. NOT SAFE FOR PREGNANCY, Best for mixed episodes.

61
Q

What do we need to know about lithium when treating BPD?

A

Lithium is the primary treatment especially for mania, NO NSAIDs as lithium is hard on the kidneys, used long term and must be continued after episodes subside. NARROW THERAPEUTIC RANGE (0.6-1.2 mEq/L)
LOTS OF MONITORING FOR TOXICITY.

62
Q

What are the lithium side effects? (LITHIUM)

A

L- Leukocytosis (high WBCs)
I- Increased urination
T-Thirst & tremor
H-Hypothyroidism
I-Interactions with medications common
U-Upset stomach (nausea, vomiting, diarrhea)
M- Must get levels checked

63
Q

What are signs of lithium toxicity?

A

Nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine hand tremor.

64
Q

How often do we monitor for lithium levels?

A

Twice weekly until in stable therapeutic range, then every month after therapeutic range. Every 3 months after 6-12 months of stability.

65
Q

What treatments do we use for BPD?

A

Pharmacology: Carbamazepine, Valproic acid, lithium, as well as antipsychotics (1st and 2nd gen) and antidepressants.

Psychotherapy: Unhelpful during mania, after mania has subsided can help handle stress and manic episodes.

Electroconvulsive therapy, support groups, health teaching, health promotion.

66
Q

What is ECT?

A

Electroconvulsive therapy when electrical currents are passed through the brain to trigger seizures that change brain chemistry.

67
Q

What is the statistic of people with BPD to commit suicide?

A

1 in 5 or 20% of people will attempt suicide.

68
Q

What are some high risk times for suicide for BPD?

A

Suicide risk periods include: soon after hospital discharge, immediately after admission, recent diagnosis, rapid cycling course, depressive episodes.

69
Q

What are the steps of suicide safety?

A

Ask - if they have a plan or thoughts of suicide/self harm
Place - Put the client on close supervision
Remove - Ensure no harmful objects are in the environment
Contract- May put a safety contract in place in which the client agrees to inform staff of self-harm thoughts.

70
Q

What is persistent depressive disorder?

A

Depression is the leading cause of disability in the world, higher rates in lower income or unemployed populations, average age of onset is between 15 and 45 years of age, more common in women than men.

71
Q

What is Dysthymia?

A

May be referred to as dysthymia and occurs when depression occurs most of the day on the majority of days. Differs from MDD as it is lower level and lasts at least 2 years.

72
Q

What is categorized as persistent depressive disorder?

A

Depressed mood + two or more symptoms of:
-decreased appetite or overeating
-insomnia or hypersomnia
-low energy
-poor self-esteem
-difficulty thinking
-hopelessness

73
Q

What is Beck’s TRIAD?

A

Negative thoughts about the world, yourself and the future, even if there are positives; they cannot see them.

Negative thoughts about the world -> Negative thoughts about oneself -> Negative thoughts about the future

74
Q

What are common medication options for PDD?

A

SSRI (first choice), SNRI, MAOI, TCA.

75
Q

What are considerations with SSRIs/SNRI’s?

A

-Serotonin syndrome (medical emergency)
-Too much serotonin in the brain causes muscle rigidity, high HR, mental changes, & muscles tightness (rhabdo)

76
Q

What are considerations with MAOIs?

A

Interferes with metabolism of tyramine, ingesting foods, wines, and OTC cold medication with tyramine can cause a hypertensive crisis.

77
Q

What considerations should we have with TCA’s?

A

Toxicity can result in a rapid decline in mental and cardiovascular status, monitor for ECG changes as high risk of arrhythmias.

78
Q

What are nursing considerations for Persistent depressive disorder?

A

-Monitoring for suicidal ideation or attempt, create activities and goals that they can meet, assist with appropriate decision making, ensure medication and treatment compliance, set realistic expectations, provide positive reinforcement, may need suicide protocols.

79
Q

What is the Summary of persistent DD symptoms?

A

2- 2+ years
H-hopelessness
E-Energy low
A- Appetite changes
D- Decision making impaired
S- Sleep impaired
S- Self Esteem low

80
Q

What are the two branches of immunity?

A

Innate immunity and Acquired immunity

81
Q

What is innate immunity?

A

First line of defence that we are born with. Quick and general response, not for fighting specific things.

82
Q

What is Acquired Immunity?

A

Our second line of defence, acquired over time, fights specific antigens. Antigen specific response

Kathleen Health & Illness 4 (1 decks)

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