MOD. 3 ATI ch. 11, 21, unit 4 Flashcards
Anxiety: Types of Disorders
Separation Anxiety Disorder Specific phobias Agoraphobia Social anxiety disorder Panic disorder Generalized anxiety disorder (GAD)
Separation Anxiety Disorder
client experiences excessive fear or anxiety when separated from an individual to which the client is emotionally attached.
Specific phobias
experiences an irrational fear of a certain object or situation. (ex. monophobia- phobia of being alone, xoophobia- phobia of animals, acrophobia- phobia of heights).
Agoraphobia
client experiences an extreme fear of certain places
social anxiety disorder
social phobia.
client experiences excessive fear of social or performance situations
panic disorder
client experiences recurrent panic attacks
generalized anxiety disorder (GAD)
client exhibits uncontrollable, excessive worry for at least 6 months.
Obsessive Compulsive Disorder
not actual anxiety disorders but have similar effects
effects: OCD, hoarding disorder, body dysmorphic disorder
Anxiety Risk Factors
gender hyperthyroidism pulmonary embolism adverse effects of meds. substance-induced anxiety
Expected Findings of Anxiety Disorders
separation anxiety disorder specific phobias agoraphobia social phobia panic disorder generalized anxiety disorder OCD
Expected Findings of Anxiety Disorders
separation anxiety disorder specific phobias agoraphobia social phobia panic disorder generalized anxiety disorder OCD
generalized anxiety disorder (GAD) manifestations
restlessness
muscle tension
avoidance of stressful activities or events
increased time and effort required to prepare for stressful activities or events
procrastination in decision making
sleep disturbance
Anxiety screening tools
Hamilton Rating Scale for Anxiety Fear Questionnaire (phobias) Panic Disorder Severity Scale Yale-Brown Obsessive Compulsive Scale Hoarding Scale Self-Report
Anxiety Medications
SSRI antidepressants
SNRI antidepressants
Antianxiety medications- benzodiazepines, buspirone, beta blockers, antihistamines, anticonvulsants
SSRI antidepressants
first line for anxiety and OCD
sertraline or paroxetine
SNRI antidepressants
effective in treatment of anxiety
venlafaxine or duloxetine
Other antianxiety meds.
benzos (diazepam)- indicated for short term
busiprone- taken for long-term use
beta blockers and antihistamines- to decrease anxiety
anticonvulsants- mood stabilizer for a client experiencing anxiety
Anxiety: Therapeutic Procedures
cognitive behavioral therapy
behavioral therapy
Cognitive behavioral therapy
decrease anxiety by changing cognitive distortions.
Uses cognitive reframing to help client identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.
Behavioral Therapy
teach clients ways to decrease anxiety or avoidant behavior and allow an opportunity to practice techniques.
relaxation therapy modeling systematic desensitization flooding response prevention thought stopping
Relaxation training
control pain, tension, and anxiety.
modeling
allows client to see a demonstration of appropriate behavior in a stressful situation. Goal is for client to imitate behavior
systematic desensitization
begins with mastering of relaxation techniques. Then client is exposed to anxiety stimuli so they can use the techniques. Goal is for client to tolerate higher and higher levels of anxiety. Used a lot with phobias
flooding
exposing the client to a great deal of undesirable stimulus in attempt to turn off anxiety response. Used for clients with phobias
Response prevention
preventing client from performing a compulsive behavior with the intent that anxiety will diminish.
thought stopping
teaches client to say “stop” and change thought to a positive thought. Goal is for client to silently use the command.
Medications for Anxiety Disorders
Benzos.
Atypical anxiolytic/ non-barbiturate anxiolytics
Others
Benzos. Sedative Hypnotic Anxiolytics
Lorazepam
Alprazolam
Clonazepam
Diazepam
Atypical Anxiolytic/ non-barbiturate Anxiolytic
Busiprone
Selected Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs): paroxetine, sertraline, fluoxetine, citalopram, escitalopram, fluvoxamine
Serotonin norepinephrine reuptake inhibitors (SNRIs): venlafaxine, duloxetine, desvenlafaxine
Other Anxiolytics used
other antidepressants:
- tricyclic antidepressants (TCAs): amitriptyline, imipramine, clomipramine
- monoamine oxidase inhibitorss (MAOIs): phenelzine
- Antihistamines: hydroxyzine pamoate, hydroxyzine hydrochloride
- Mirtazapine
- Trazodone
Beta blockers: propranolol
Centrally acting alpha- blockers: Prazosin
Anticonvulsants: gabapentin, preabalin
major meds to treat trauma-and-stressor related disorders
Antidepressants: SSRI, SNRI, tricyclic antidepressants, MAOI, noradrenergic and specific serotonergic antidepressant (NaSSA)
beta blockers
centrally acting alpha-blockers
centrally acting 2 agonists
SSRIs for trauma and stressor-related disorders
paroxetine, sertraline, fluoxetine, escitalopram, fluvoxamine
Anxiety (study guide)
normal response to stress. Subjective feeling that includes feelings of apprehension, uneasiness, uncertainty, or dread.
normal= healthy acute= imminent loss of change that threatens one's sense of security chronic= persists
Mild Anxiety
tense experiences that occur in everyday life, increased ability to grasp information, sense of sight and sound are increased. Can be motivating, produce growth, enhance creativity and increase learning.
Physical symptoms- restlessness, irritability or mild tension
Moderate Anxiety
focus is on immediate concerns.
Narrowed perceptual field, sense of sight and sound diminish as selective inattentiveness occurs.
Learning and problem solving still occur.
Physical= increased heart rate, perspiration, gastric discomfort, headache, urinary urgency, and or mild tremors.
Severe Anxiety
feeling something BAD is about to happen. Significant narrowing of perceptual fields, focus is on minute or scattered details, all behavior is aimed at relieving anxiety.
Learning and problem solving are not possible
Physical= caused by stimulation of SNS; headache, nausea, dizziness, sleep disturbance, increased tremors, pounding HR, hyperventilation.
individual needs direction to focus
Panic Anxiety
dread and tremor and sense of impending doom.
Disorganization, difficulty perceiving perception occurs,. Is unable to communicate or function effectively.
If prolonged it can lead to exhaustion and death.
Physical= increased motor activity; pacing, shouting, screaming, or withdrawal, impulsive or erratic behavior
Interventions for Mild to Moderate Anxiety
- help client identify source of anxiety
- encourage client to talk about feelings and concerns
- help client identify thoughts and feelings that occurred before the onset of anxiety
- encourage problem solving
- encourage gross motor exercise
Interventions for Severe to Panic Anxiety
- reduce anxiety quickly: use calm manner
- ALWAYS REMAIN WITH CLIENT
- minimize environmental stimuli, provide clear statements, use low pitched voice
- Attend to physical needs
- provide gross motor activity
- administer meds. as prescribed
- ensure safety
Assessment of GAD
restlessness and inability to relax
episodes of trembling and shakiness, chronic muscular tension, dizziness, inability to concentrate
chronic fatigue and sleep problems
inability to recognize the connections between anxiety and physical symptoms
client focused on physical discomfort
Agoraphobia
fear of open spaces
Interventions for OCD and related disorders
- ensure basic needs are met
- identify situations that precipitate compulsive behavior
- encourage client to verbalize concerns and feelings
- Be empathetic toward the client and aware of their needs to perform compulsive behavior
- DO NOT interrupt compulsive behavior UNLESS they’re unsafe
- allow client to perform compulsive behavior but…
- SET LIMITS
- set schedule that distracts them
- establish written contract that assists client to decrease frequency
- recognize and reinforce positive non-ritualistic behaviors
PTSD
after traumatic event, individual is prone to re-experience the event.
PTSD:
Diagnosis
diagnosis- symptoms last at least 1 month and can occur months to years after the traumatizing events
PTSD:
Assessment
- avoidance or numbness
- irritability or outbursts of anger
- detachment
- depression that may involve suicidal thoughts
- anxiety
- sleep disturbances and nightmares
- flashbacks
- hypervigilance
- exaggerated startle response
- guilt about surviving event
- poor concentration and avoidance of activities
PTSD:
Interventions
- non-judgmental
- ensure feelings and behaviors are normal reactions
- help recognize association between feelings and behaviors and trauma
- encourage feeling expression
- provide individual therapy that addresses loss of control or anger issues
- monitor for suicidal risk
- teach stress management technique
- encourage support group
- facilitate progressive review of the trauma ( FLOODING )
- encourage relationship establishments
- include family
- hypnotherapy/ systematic desensitization may be recommended
*** cancer patients may develop PTS - can occur anytime during or after treatment. Symptoms similar to PTSD but not as severe
Suicidal:
assessment
# assess if client is thinking of suicide # SAD PERSONS scale # comments or signals can be overt (direct) or covert (indirect): ex. overt= "there is just no reason to go on living" covert= "everything is looking pretty grim to me" # assess client's suicide plan # how lethal is the plan? # can client describe plan exactly # does client have access to intended method? # has the mood changed? sad to happy can indicate intention to commit suicide
Physical assessment findings= lacerations, scratches, scars
Suicide:
Nursing Care
Primary intervention- focus on suicide prevention through the use of community education and screenings to identify individuals at risk.
Secondary interventions- focus on prevention for a client who is having an acute suicidal crisis. Suicide precautions are included at this level.
Tertiary interventions- providing support and assistance to survivors of a client who completed suicide.
