Test 2 (Case Study QUiz) - Chapter 27 - Anxiety, OCD, and related DO's AND Chapter 13 - crisis Flashcards
_________is apprehension, tension or uneasiness from anticipation of danger . The source is unknown or unrecognized. Emotional response.
anxiety
_________is apprehension, tension or uneasiness from anticipation of danger for which the source is known. Cognitive response.
Fear
What are the four levels of anxiety?
mild, moderate, severe and panic
study descriptions in slide
How can we define normal versus neurotic anxiety?
Having anxiety out of proportion to the threat and causing one to be dysfunctional would be labeled neurotic. Example: Levy’s son almost jumped off the stairs at the water park to avoid a tiny little bee.
_____ is the sudden overwhelming feeling of terror or impending doom. This most severe form of emotional anxiety is usually accompanied y behavioral, cognitive, and physiological S&S considered to be outside the expected range of normalcy.
panic.
Physio s&S = dilated pupils, labored breathing, sweating, pale, can’t speak, irrational thinking, fear of dying, going crazy, terror, doom, dread with loss of control, helpless, anger, agression. Hallucinations/delusions may occur
Joe present to the ER with the following S&S:
restles, increased HR and resp., speech is rapid and loud, What level of anxiety is he experiencing?
moderate
There are three levels in the general stress adaptation syndrome according to Selye:
- Alarm reaction stage
- Stage of resistance
- Stage of exhaustion
Describe each
- Alarm reaction stage - fight or flight runs through the body
- Stage of resistance - uses fight or flight to adapt and deal with the stressor. If successful, you will not move into the third stage.
- Stage of exhaustion - Were unable to adapt in previous stage. Now there is prolonged exposure to the stressor. This can lead to headaches, mental disorders, CAD, etc. We need intervention to prevent permanent damage, exhaustion. Can lead to death.
Ch. 1 page 3-4
When assessing a patient who is exhibiting anxiety, what are key things to ask/look for?
- What is the level (mild, mod….)
- What triggered the anxiety?
- Is the anxiety distorted (neurotic)?
- What are (if any) the coping behaviors?
- It is actually FEAR and not anxiety?
When using nursing Dx of anxiety r/t …. You should always be sure to include what?
Degree of anxiety (mild, mod,…)
What is the ultimate goal for the patient with anxiety?
for the patient to learn coping skills and explore causes for their anxiety
What can we do to help a client in panic?
- Have them breathe into paper bag (too much acidic CO2 out means resp alkalosis. trap that CO2 in a bag and have them breathe it back in to keep O2 and CO2 balanced).
- speak calmly using short and simple sentences.
- Nurse remains calm
- give precise instructions
- remove sensory stimuli
- Let patient know you are there for them, will not leave them and will care for them. DO NOT LEAVE THEM!!!
For a patient in moderate anxiety, we can assist with helping patient identify….
- perception of threat (what MIGHT be the cause of anxiety)
- precipitating factors (what happened before the anxiety set in)
- recent changes?
- current stressor? (job, kids, school, money, etc)
- coping behavior used/explore expectations
- Not identify, but correct cognitive distortions (the mouse is not going to eat you and your house).
T or F: Anxiety will eventually go away on its own.
False. It must be recognized and dealt with.
If anxiety is not recognized and effective coping is not implemented, what could happen?
Avoidance as a way of coping is not coping….
Can lead to:
- anxiety disorders/trauma related
- somatic disorders
- dissociative disorders
What is crisis?
When an individual is in a situation where their usual problem-solving/coping/adaptation methods are not adequate to deal…. causes disequilibrium.
What is the definition of crisis?
A crisis is an emergency that is an immediate threat to your physical, emotional and mental health. Extreme stress.
What are some examples of crises?
Dispositional crisis - External situations - boss is an example
anticipated life transitions - normal life cycle transitions, person feels like they do not have control over it. (Having kids, aging, moving to senior care, etc)
Crisis resulting from traumatic stress - unexpected external stress such as being robbed or raped. Person had absolutely no control.
Maturation/developmental - related to unresolved conflicts in one’s life. Involves dependency, value conflicts, sexual identity, control, and capacity for emotional intimacy.
Psychopathology - bipolar, schizo, borderline personality, severe neuroses, etc
Psychiatric emergencies - not personally responsible, functioning has been severely impaired and the person has been rendered incompetent or unable to assume personal responsibility. Examples: acute suicidal individuals, drug overdoses, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger and alcohol intoxication.
How can we intervene in a crisis?
- depends on the type of crisis (see the handout CRISIS for examples of interventions for each type)
- Develop plan with client and fam/so’s AND be mutually negotiated with client
- focus on immediate problem (concrete cause)
- based on dependence needs
- must be appropriate for the client level of thinking, feeling and behavior.
- The plan must be consistent with culture, lifestyle
- must have time limit attached and be realistic
Panic disorder, Generalized Anxiety disorder, and phobias are considered _______ disorders.
Anxiety disorders.
_______ disorder is characterized by recurrent attacks of severe anxiety. These attacks are not associated with a stimulus.
panic disorder
It could possibly be associated with a certain situation. For example, you are late for work, stuck in traffic, and your heart is racing… the next time you are trapped in traffic, you have a panic attack even though you are not running late for work.
Chapter 27 - page 532 lists the criteria to be considered a panic attack . Four must be present!
See page 532 bullet pointed list on left side.
T or F: panic attacks can be accompanied by agoraphobia
True
They may develop social phobia because they fear losing control, therefore avoid many social situations.
What is the first priority for intervening during a panic attack?
First priorities are to reduce anxiety level and promote safety.
Stay with the client, take vitals, maintain calm manner
Have client breathe into paper bag if available
Use short sentence
refocus client energy
remove from stimuli
use PRN med as LAST RESORT!
What disorder is characterized by persistent, unrealistic, and excessive anxiety and worry, which have occurred more days than not for at least 6 months AND cannot be attributed to specific organic factors such as caffeine intoxication or hyperthyroidism
General Anxiety Disorder
Client are unable to stop worrying, are unable to relax and often have insomnia and physical complaint
List some things we can do to assist a client with GAD.
Teach/ promote relaxation (baths, music, massage, hobbies, etc). This include progressive relaxation and imagery (like what Legaspi does before exams, “Listen to the sound of my voice, take a deep breath, imagine a happy place, go there…etc), Yoga and Mediation
Encourage exercise (kickboxing! I highly recommend it!!!)
Teach thought stopping
-What Is Thought Stopping?
One effective and quick technique to help you with the intrusive negative thoughts and worry that often accompany panic disorder, anxiety and agoraphobia is called “thought stopping.” The basis of this technique is that you consciously issue the command, “Stop!” when you experience repeated negative, unnecessary or distorted thoughts.
Help the client to structure their day, prioritize
Positive self talk, reframing
Humor
MED IS LAST RESORT!!!
_______ is an irrational fear of a specific object, activity or situation that results in a compelling desire to avoid the dreaded object or situation. Almost invariably provokes an immediate anxiety response or panic attack.
Phobia
T or F: When a person has a phobia, they are not actually afraid of the object, activity or situation.
True. Fear is displaced unconsciously onto an external object that is symbolically related to the conflict
The nurse is working with a client who has a fear of flying. Which defense mechanism is being used?
A. Denial
B. Projection
C. Displacement
C. Displacing their fear of something else onto flying.
Fear of pubic speaking is a ___ phobia
social
Phobia of crowds or open places
agoraphobia
Fear of heights
acrophobia
fear of closed in places
claustrophobia
fear of water
hydrophobia
Fear of dark
nyctophobia
nyct (NYKT) = nite = dark
fear of death
thanatophobia
that’s it aphobia (that’s it once you are dead)
fear of electrical storms
astrophobia (electricty = light streak = astro relates to stars - light)
Fear of talking
glossophobia (this could also be speaking in public but it is fear of moving your glossol muscles)
Fear of blood
hematophobia (hemat - blood)
fear of being alone
monophobia (mono = alone)
Fear of germs
mysophobia (my so = me so = me so grossed out by germs)
fear of fire
Pyrophobia
Fear of animals
zoophobia (zoo has animals…)
There are five different methods that Levy listed as interventions for phobias. One of them is systematic desensitization. What does that mean?
increase the exposure systematically.
Snake is the example:
- visualize snake
- cartoon snake
- rubber snake
- snake in aquarium
- snake out of aquarium
- have client touch snake
- have client hold snake
There are five different methods that Levy listed as interventions for phobias. One of them is Reciprocal inhibition. What does that mean?
The example is cake and a snake.
I pair cake and a snake for the client. The cake makes them feel good, and counters the negative feelings about the snake.
There are five different methods that Levy listed as interventions for phobias. One of them is cognitive restructuring. What does that mean?
reframe/relabel a frightening object/situation
“Most snakes aren’t poisonous.”
“Most planes don’t crash.”
What is it called when you excessively expose the client to the feared object until the anxiety can no longer exist (due to exhaustion)
flooding/implosion
T or F: Beta blockers are the go to method for solving phobias.
False, they are your last resort! Always choose meds as last resort.
_____ are recurrent and persistent thoughts, impulses, or images experienced as intrusive and stressful. Recognized as being excessive and unreasonable.
obsessions
recurrent thoughts
Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation. The person feels driven to perform such actions in response to an obsession… even though they are recognized as excessive or unreasonable.
compulsions
compelled to act
common compulsions are hand-washing, ordering, checking, praying, counting and repeating words silently
OCD can have either compulsions or obsessions or both.
Why do OCD clients perform rituals?
they reduce anxiety and create a sense of safety (regressive in nature)
What are some examples of obsession symptoms?
contamination, sexual, aggressive, hoarding, saving, religious, symmetry, exactness and somatic
What are some examples of compulsion symptoms?
cleaning, checking, repeating, counting, ordering, hoarding, mental, reassurance seeeking.
Should you rush a client through their ritual to keep their appointment on time?
no, provide time to do the ritual within negotiated time (on contract)
do not interrupt the ritual. (It’s 8am, group is at 9. Remember our contract. Client now has an hour to do morning ritual).
Since stress increases need for rituals, decrease stress
Provide structure and routine
Cognitive Behavioral contract (come see me before you wash your hands 95 times).
SSRI’s - LAST RESORT!
This disorder is characterized by the exaggerated belief that the body is deformed or defective in some specific way. Most common complaint involves imagined flaws. In some instance a true defect is present, but the concern is exaggerated and grossly excessive
Body dysmorphic DO
belief extreme, but not delusional. The patient is AWARE that their concern is exaggerated.
these people may be socially isolated due to being self conscious
Hair loss caused by hair pulling. This D/O begins with increasing of tension and a sense o release or gratification from pulling out the hair.
trichotillomania
usually begins in childhood
can be ANY hair on the body
Persistent difficulty discarding or parting with possessions, regardless of actual value (could be newspapers….)
hoarding
May be labeled with excessive acquisition which is the needs to continually acquire items.
They need to cover every surface in the house with junk.
What are some associates symptoms of hoarding?
- perfectionism
- indecisiveness
- anxiety
- depression
- distractability
- difficult planning and organizing tasks.
Because it is hard to convince client there is a problem, treatment for hoarding has mixed results. Suggested treatment is..
- Psychoeducation first
2. CBT + Med (SSRI)
We should use which group of antidepressants for OCD and anxiety DO’s?
SSRIs
OCD can also be treated with clomipramine (Anafranil)
For long term anxiety effects, try Buspar.
Benzos are good for acute anxiety/panic attacks (clonazepam - Klonopin, alprazolam - Xanax for panic, GAD, social phobia)
