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Nursing 111 & Pharmacology > S/A/C > Flashcards

S/A/C Flashcards

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1
Q

What does Genetic Theory (Biological) say about the etiology of Anxiety disorders?

A

Anxiety may have an inherited component because first-degree relatives of clients with increased anxiety have higher rates of developing anxiety.

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2
Q

What does Heritability refer to?

A

Heritability refers to the proportion of a disorder that can be attributed to genetic factors:

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3
Q

What does Neurochemical Theory (Biological) say about the etiology of Anxiety disorders?

A

Imbalances Neurochemicals GABA, Serotonin and Norepinephrine are believed to play a role in OCD, PTSD, Panic disorder and many others.

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4
Q

What does Psychodynamic Theories
Intrapsychic/Psychoanalytic say about the etiology of Anxiety disorders?

A

Freud saw a person’s innate anxiety as the stimulus for behavior. He described defense mechanisms as the human’s attempt to control awareness of and to reduce anxiety

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5
Q

What does Psychodynamic Theories
Interpersonal Theory say about the etiology of Anxiety disorders?

A

Harry Stack Sullivan viewed anxiety as being generated from problems in interpersonal relationships.

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6
Q

What does Psychodynamic Theories
Behavioral Theorists say about the etiology of Anxiety disorders?

A

Behavioral theorists view anxiety as being learned through experiences.

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7
Q

Which medical conditions are risk factors for anxiety disorders?

A

endocrine dysfunction (Diabeters)
COPD
CHF
Neurologic Conditions

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8
Q

Which populations are most at risk for developing anxiety disorders

A

White women
People under 45
People who are divorced or separated
People who are Low SES

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9
Q

Anxiety that starts for the first time late in life is frequently associated with other conditions such as

A

depression,
dementia,
physical illness
medication toxicity
Phobias
agoraphobia
GAD

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10
Q

the most common late-life anxiety disorders are:

A

Phobias
agoraphobia
GAD

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11
Q

Clinical manifestations of Anxiety

A

Ranges from restlessness Fidgeting GI “butterflies” Difficulty sleeping Hypersensitivity to noise

to Dilated pupils Increased blood pressure and pulse Flight, fight, or freeze

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12
Q

Mild Anxiety

A
  • Wide perceptual field
  • Sharpened senses
  • Increased motivation
  • Effective problem-solving
  • Increased learning ability
  • Irritability
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13
Q

Moderate Anxiety

A
  • Perceptual field narrowed to immediate task
  • Selectively attentive
  • Cannot connect thoughts or events independently
  • Increased use of automatisms
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14
Q

Severe Anxiety

A
  • Perceptual field reduced to one detail or scattered details
  • Cannot complete tasks
  • Cannot solve problems or learn effectively
  • Behavior geared toward anxiety relief and is usually ineffective
  • Doesn’t respond to redirection
  • Feels awe, dread, or horror
  • Cries
  • Ritualistic behavior
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15
Q

Panic level Anxiety

A
  • Perceptual field reduced to focus on self
  • Cannot process any environmental stimuli
  • Distorted perceptions
  • Loss of rational thought
  • Doesn’t recognize potential danger
  • Can’t communicate verbally
  • Possible delusions and hallucination
  • May be suicidal
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16
Q

RN assessments for anxiety

A
  • Physical exam
  • VS
  • Auscultation of heart/lungs
  • Cranial nerve assessment
  • Thyroid studies
  • Blood/Urine studies
  • DX based on history and physical findings
  • Mental Status Exam-
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17
Q

RN interventions for Anxiety

A
  • Remain with the client at all times when levels of anxiety are high (severe or panic).
  • Move the client to a quiet area with minimal or decreased stimuli.
  • Administer prescribed medications.
  • Remain calm in your approach to the client.
  • Use short, simple, and clear open statements.
  • Avoid asking or forcing the client to make choices.
  • Teach the client to use relaxation techniques or help with guided meditation.
  • Help the client see that mild anxiety can be a positive catalyst for change and does not need to be avoided.
  • Encourage the client to identify and pursue relationships, personal interests, hobbies, or recreational activities that may appeal to the client.
  • Encourage the client to identify supportive resources in the community.
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18
Q

Priority medications for treatment of Anxiety

A

Benzodiazepines eg. Alprazalam (xanax)
Nonbenzodiazepins eg Buspirone (BuSpar)
Antihistamines eg Hydroxyzine (atarax)
SSRIs eg Fluoxetine (prozac)

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19
Q

What is the most important goal of Anxiety treatment?

A

Effective management of stress and anxiety is the goal, not elimination. Life brings stress, we have to learn to deal with it.

Or just kill all the men and then stress wouldn’t be a thing?!?

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20
Q

What is the etiology of OCD?

A

Unknown, but onset after age 50 is rare

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21
Q

What are the two components of an OCD diagnosis?

A

An Obssession
and
A Compulsion (ritual)

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22
Q

What is an obsession?

A

-recurrent, persistent unwanted thoughts, images or
impulses that cause anxiety and interfere with interpersonal, social or occupational functions

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23
Q

What is a compulsion

A

ritualistic or repetitive behaviors that the person
uses to attempt to neutralize their anxiety

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24
Q

Populations most at risk for developing OCD (same as anxiety)

A

White women
People under 45
People who are divorced or separated
People who are Low SES

25
Q

Clinical Manifestations of OCD

A

*Ambivalence regarding decisions or choices

*Disturbances in normal functioning due to obsessive thoughts or compulsive behaviors (loss of job, loss of/or alienation of family members, etc.)

*Inability to tolerate deviations from standards

*Rumination

*Low self-esteem

*Feelings of worthlessness

*Lack of insight

*Difficulty or slowness completing daily living activities because of ritualistic behavior

26
Q

When would a patient recieve a clinical diagnosis of OCD

A

OCD is diagnosed when Obsessions and Compulsions consume the person or he or she is compelled to act out the behaviors to a point at which they interfere with personal, social, and occupational functions.
Obsessions and compulsions are a source of distress and shame to the person, who may go to great lengths to keep them secret.

27
Q

What are some common compulsions for OCD patients?

A

Common compulsions include the following:
*Checking rituals
*Counting rituals
*Washing and scrubbing until the skin is raw
*Praying or chanting
*Touching, rubbing, or tapping
*Ordering arranging and rearranging
*Exhibiting rigid performance (getting dressed in an unvarying pattern)
*Having aggressive urges (for instance, to throw one’s child against a wall)

28
Q

What are the gerontologic considerations of OCD?

A

Onset of OCD after age 50 is rare so
* Recent acquired OCD behavior, PCP should check for organic cause
including, infections, degenerative disorders, brain injury
* Treatment is directed at the underlying cause

29
Q

RN assessments for OCD

A
  1. Yale-Brown Obsessive-Compulsive Scale
  2. History (when did rituals begin)
  3. General appearance and Motor behavior
  4. Mood and affect
  5. Thought process and content
  6. Judgement and insight
  7. Self-concep
  8. Effect of OCD on roles and relationship
30
Q

RN interventions for OCD

A

*Offer encouragement, support, and compassion.
*Be clear with the client that you believe he or she can change.
*Encourage the client to talk about feelings, obsessions, and rituals in detail.
*Gradually decrease time for the client to carry out ritualistic behaviors.
*Assist the client in using exposure and response prevention behavioral techniques.
*Encourage the client to use techniques to manage and tolerate anxiety responses.
*Assist the client in completing daily routine and activities within agreed-upon time limits.
*Encourage the client to develop and follow a written schedule with specified times and activities.
Teach about OCD.
*Review the importance of talking openly about obsessions, compulsions, and anxiety.
*Emphasize medication compliance as an important part of treatment.
*Discuss necessary behavioral techniques for managing anxiety and decreasing prominence of obsessions.

31
Q

What are we teaching families of OCD patients?

A

*Avoid giving advice such as, “Just think of something else.”

*Avoid trying to fix the problem; that never works.

*Be patient with your family member’s discomfort.

*Monitor your own anxiety level, and take a break from the situation if you need to.

32
Q

What is the best practice treatment for OCD?

A

Cognitive behavioural Therapy (CBT)

33
Q

Priority medications for OCD

A

First line is SSRIs - Sertraline (zoloft) and Fluvoxamine (Luvox)

Treatment resistant OCD may respond to second-generation antipsychotics such as risperidone (Risperdal), quetiapine (Seroquel), or olanzapine (Zyprexa)

34
Q

What is the Pathophysiology of Panic disorder?

A

Most severe form emotional anxiety-usually accompanied by behavioral,cognitive and physiological signs and symptoms which are considered being outside the expected range of normalcy

35
Q

What is the definition of a panic attack?

A

15 to 30 minutes of rapid, intense, escalating anxiety with four or more of:

palpitations,
sweating,
tremors,
shortness
breath,
sense of suffocation,
chest pain,
nausea,
abdominal distress,
dizziness,
paresthesias,
chills,
hot flashes.

36
Q

Panic disorder is diagnosed when

A

the person has recurrent, unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks or their meaning or a significant behavioral change related to them

37
Q

50% of people with Panic disorder also have

A

Agoraphobia

38
Q

Panic disorder is most common in people who have not

A

Graduated from college or been married

39
Q

RN assessments for Panic disorder

A
  1. Hamilton rating scale for anxiety
  2. History (when did panic attacks begin)
  3. General appearance and Motor behavior
  4. Sensorium and intellectual processes
  5. Thought process and content
  6. Judgement and insight
  7. Self-concept
  8. Effect of disorder on roles and relationship
  9. Physiological and self care concerns
40
Q

RN interventions for Panic disorder

A

Provide a safe environment and ensure the client’s privacy during a panic attack.
*Remain with the client during a panic attack.
*Help the client focus on deep breathing.
*Talk to the client in a calm, reassuring voice.
*Teach the client to use relaxation techniques.
*Help the client use cognitive restructuring techniques.
*Engage the client to explore how to decrease stressors and anxiety-provoking situations.
Review breathing control and relaxation techniques.
*Discuss positive coping strategies.
*Encourage regular exercise.
*Emphasize the importance of maintaining prescribed medication regimen and regular follow-up.
*Describe time management techniques such as creating “to do” lists with realistic estimated deadlines for each activity, crossing off completed items for a sense of accomplishment, and saying “no.”
*Stress the importance of maintaining contact with community and participating in supportive organizations.

41
Q

What is the Treatment for Panic Disorder?

A

CBTs, deep breathing and relaxation

medications:
benzodiazepines
SSRI antidepressants
tricyclic antidepressants
antihypertensives-clonidine (Catapres) and propranolol (Inderal).

42
Q

What is the definition of Delirium?

A

Delirium is a state of temporary but acute mental confusion, a
common, life-threatening syndrome resulting from an identifiable source

43
Q

What are some examples of acute sources of Delirium?

A

hypoglycemia, cerebral disease or drug
intoxication/withdrawal, dehydration, infection, trauma, hypoxia, urinary retention

44
Q

What are the risk factors for Delirium?

A
  • Elderly, particularly because of polypharmacy
  • Substance abuse/withdrawal
  • Anasthesia
  • Medications
  • Insomnia/lack of sleep
  • Hearing impairment
45
Q

What are the Clinical Manifestations of Delirium

A
  • Sudden onset
  • Poor judgment
  • Cognitive impairment
  • Impaired memory
  • Lack of or limited insight
  • Loss of personal control
  • Inability to perceive harm
  • Illusions
  • Hallucinations
  • Mood swings
46
Q

RN Assessments for Delirium

A
  • PMH and recent medical history (what changed)
  • A person who has sudden cognition impairment, disorientation, clouded sensorium is more likely to be delirium
  • Current medication list (anything recently started/ drug to drug interactions etc)
  • Onther cognitive disorders
  • Onset and duration of symptoms
  • Hydration status
47
Q

Nursing interventions for Delirium

A
  • 1:1 supervision for safety
  • Monitoring medications
  • Reducing stimulation in environment
  • Assess ADLs and be aware of needs
  • REassurance and reorientation
  • Avoid restraints
  • Treat underlting illness if present
  • Neuro exam
  • Vitals
  • Establish and encourage better sleep reoutine
  • Nutrition and hydration
48
Q

Pharmacological treatment of delirium?

A

benzodiazepines, lorazepam (Ativan) can be used for
delirium caused by substance withdrawal
Antipsychotics - Haloperidal may be used to decrease agitation, risk of harm to self and aid sleep

Pharmacological is a last resort

49
Q

Priority Labs/ Diagnostics for Delirium

A
  • CBC, serum electrolytes, BUN, creatinine, Tox. Screen & ETOH,
    urinalysis, thyroid functions, glucose.
  • If suspect trauma- x-rays, CT, MRI to r/o head trauma.
  • If fever, lumbar puncture to r/o meningitis/encephalitis, EKG
50
Q

Safety/Goals for Delirium

A

Patient will remain oriented
Patient will be safe from self harm
Patient will be involved in ADLs
Patient will maintain skin integrity
Patient will maintain adequate ROM
Patient will maintain adequate nutrition

51
Q

Erikssons first stage of Development age 0-18months

A

Trust vs. mistrust

Trust (or mistrust) that basic needs, such as nourishment and affection, will be met

52
Q

Erikssons second stage of Development age 18months-3 years

A

Autonomy vs. shame/doubt

Develop a sense of independence in many tasks

53
Q

Erikssons third stage of Development age 3-6 years

A

Initiative vs. guilt

Take initiative on some activities—may develop guilt when unsuccessful or boundaries overstepped

54
Q

Erikssons fourth stage of Development age 7-12 years

A

Industry vs. inferiority

Develop self-confidence in abilities when competent or sense of inferiority when not

55
Q

Erikssons fifth stage of Development age
12-18 years

A

Identity vs. confusion

Experiment with and develop identity and roles

56
Q

Erikssons sixth stage of Development age
19-29 years

A

Intimacy vs. isolation

Establish intimacy and relationships with others

57
Q

Erikssons seventh stage of Development age 30-64 years

A

Generativity vs. stagnation

Contribute to society and be part of a family

58
Q

Erikssons eighth stage of Development age 65+ years

A

Integrity vs. despair

Assess and make sense of life and meaning of contributions

Nursing 111 & Pharmacology (12 decks)

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