Unit 23 Anxiety/Adjustment/Trauma Related Disorders Flashcards

1
Q

What are some anxiety disorders?

A
General anxiety disorder
Panic disorder
Phobias
Obsessive compulsive
Post Traumatic Stress Disorder
Adjustment Disorders
Body Dysmorphic Disorder
Trichotillomania (Hair-Pulling Disorder)
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2
Q

What is stress? anxiety? fear?

A

Stress is an external pressure that is brought to bear on the individual.

Anxiety is the subjective emotional response to that stressor.

Fear is a cognitive process whereas anxiety is emotional.

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3
Q

What are the common characteristics of people with Neuroses?

A
  • Aware that they are experiencing distress
  • Aware that their behaviors are maladaptive
  • Unaware of any possible psychological causes of the distress
  • They feel helpless to change their situation
  • They experience no loss of contact with reality
  • Ego-dystonic symptoms* (thoughts and behaviors that are in conflict with the ego/person’s ideal self-image.)
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4
Q

How are neurotransmitters affected in anxiety disorders?

A

Serotonin decreased

Norepinephrine increased

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5
Q

What can anxiety interfere with? Who is more common in and who is at risk for anxiety?

A
  • Anxiety interferes with social, occupational, or other important areas of functioning.
  • More common in women

-Minority children and children from low socioeconomic
environments at risk

-Genetic, developmental, environmental and
psychological play a role in the etiology

-Mild, moderate, severe, and panic levels

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6
Q

What else can produce anxiety?

A

Medical issues that produce those symptoms such as:

  • Cardiac
  • Endocrine
  • Respiratory
  • Neurological

Substance induced anxiety from:

  • Alcohol
  • Amphetamines or cocaine
  • Hallucinogens
  • Caffeine
  • Cannabis
  • Etc.
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7
Q

What is General Anxiety Disorder? What are manifestations of it?

A

Chronic, unrealistic, excessive anxiety and worry that persists at least 6 months.
General anxiety all the time

Motor tension:
Restless, easily fatigued, difficulty
concentrating, irritable, muscle tension

Autonomic hyperactivity:
sweating, palpitations, clammy hands, urinary frequency, ↑ HR

Apprehensiveness:
Worry, insomnia, ↓ concentration

Hyper-vigilance:
Scanning the environment, distractibility

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8
Q

What is Panic Disorder? What do symptoms include?

A

Severe, recurrent panic attacks, with sudden unpredictable onset and intense dread.

At least *4 of the following symptoms:

  • Dyspnea
  • Palpitations
  • Chest discomfort
  • Syncope
  • Dizziness
  • Diaphoresis
  • Hot or cold flashes
  • Trembling
  • Tingling hands or feet
  • Fear of losing control
  • Feelings of unreality going crazy, dying
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9
Q

What is Panic Disorder with Agoraphobia?

A

-Characterized by same symptoms characteristic of
panic disorder

-In addition, fear of
being in places where escape might be difficult (or embarrassing) or in which help might not be available in the event that a panic attack
happens

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10
Q

What is the basic nursing care for individuals with Panic Disorder of General Anxiety Disorder?

A

-Relief of acute panic symptoms.

-Assisting patient to take control of
his/her own life situations and accept those
situations over which he/she has no
control.

-one instruction at a time, (face to face, stay with them)

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11
Q

What are Phobias?

A

Irrational fear of an object or situation, although the person may recognize it as unreasonable.

Examples:

  • Agoraphobia
    (open spaces)
  • Social phobia
  • Specific phobia

-Anxiety is severe if the object, situation, or activity
cannot be avoided.
-Defense mechanism used is “Displacement.”

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12
Q

What is the nursing care for phobias?

A

Intervention aimed at decreasing fear and increasing ability to function in presence of the phobic stimulus.

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13
Q

What is Obsessive Compulsive Disorder? what happens if compulsions are resisted?

A

Preoccupation with persistent intrusive thoughts (obsessions) and repeated performance of rituals
(compulsions).

-Time consuming and impair normal functioning.

-Anxiety occurs if obsessions or compulsions
are resisted.

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14
Q

What are interventions for escalating anxiety?

A

-Stay and offer safety
-Maintain calm, non-threatening approach
-Use simple words and brief messages
-Slow breathing
-Low stimuli
-Helping the client learn to function in the presence of the phobic object without experiencing panic anxiety
-Administer medication
-When level of anxiety reduced, explore reasons
for occurrence
-Teach s&s, ways to interrupt progression

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15
Q

What are treatments for anxiety disorders?

A
  • Individual psychotherapy
  • Cognitive therapy
  • Behavior therapy
  • Desensitization therapy and Implosion therapy (Phobia)
  • Relaxation
  • Physical Exercise
  • Nutrition ;↓ caffeine, take additional vitamins B and C
  • Group therapy
  • Psychopharmacology- Anxiolytics, antidepressants
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16
Q

Describe the action of anti-anxiety agents used in Anxiety Disorders.

A
  • Depress levels of the CNS
  • Potentiates the inhibitory effects of GABA

Exception: Buspirone
-Buspirone does NOT depress the CNS
-It’s thought to effect serotonin, dopamine, and other
neurotransmitter receptors

17
Q

What are the anti-anxiety (Anxiolytic) medications used?

A

[Benzodiazepines:]
all the “zepam” Rx’s

[-buspirone (BuSpar)]

[Antihistamines:]
hydroxyzine (Vistaril)
diphenhydramine (Benadryl)

[B-Blockers]
Propranolol (Inderal)

18
Q

What are side effects of antianxiety(Anxiolytic) agents?

A
  • Drowsiness, confusion, lethargy
  • Enhances effects of other CNS depressants
  • Orthostatic hypotension
  • Paradoxical excitement
  • Dry mouth; nausea and vomiting
  • Blood dyscrasias (body part suffers abnormal blood supply)

-10 to 14 day delayed onset of action (with
buspirone)

-Tolerance; physical and psychological dependence
(does not apply to buspirone)

19
Q

What are the medications for the specific disorders OCD and PTSD?

A

OCD:
-Antidepressants (Luvox-SSRI)

PTSD:
Antidepressants - Tricyclics, SSRI’s,Trazadone
Anxiolytics - Xanax, Buspirone
Antihypertensives - Propranolol
Anticonvulsant - Tegretal, Depakote, Lithium

20
Q

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?

A

That there is a potential for dependence and

tolerance.

21
Q

What are nursing interventions for OCD?

A
  • Helping the client learn new, more adaptive coping strategies without resorting to obsessive-compulsive behaviors
  • Helping the client gain independence and greater control over life situations
22
Q

What are nursing interventions for PTSD aimed at?

A
  • Integration of the trauma into his or her persona
  • Renewing significant relationships
  • Establishing meaningful goals for the future
  • Progressing through the grief process
  • Developing a sense of optimism and hope for the future
23
Q

What is Body Dysmorphic Disorder?

A
  • Characterized by the exaggerated belief that the body is deformed or defective in some specific way
  • If true defect is present, the person’s concern is unrealistically exaggerated and grossly excessive
  • Symptoms of depression and obsessive-compulsive personality are common
24
Q

What is Hair-Pulling Disorder (Trichotillomania)?

A
  • The recurrent pulling out of one’s own hair that results in noticeable hair loss
  • Preceded by increasing tension and results in sense of release or gratification
  • More common in women
25
Q

What are psychosocial influences related to trichotillomania?

A

Stressful situations

Disturbances in mother-child relationship

Fear of abandonment

Recent object loss

Possible childhood abuse or emotional neglect

26
Q

What is Posttraumatic Stress Disorder?

A

A reaction to an extreme trauma, likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes.

  • Symptoms may begin within the first 3 months after the trauma, or there may be a delay of several months or even years
  • More common in women
27
Q

What are the characteristics of Posttraumatic Stress Disorder?

A
  • Re-experiencing the traumatic event
  • A sustained high level of anxiety or arousal
  • A general numbing of responsiveness
  • Intrusive recollections or nightmares
  • Amnesia to certain aspects of the trauma
  • Depression; survivor’s guilt
  • Substance abuse
  • Anger and aggression
  • Relationship problems
28
Q

What is Acute Stress Disorder?

A
  • Similar to PTSD in terms of precipitating traumatic events and symptomatology
  • Symptoms are time limited: up to 1 month following the trauma
  • If the symptoms last longer than 1 month, the diagnosis would be PTSD
29
Q

What is Adjustment Disorder?

A

-Maladaptive reaction to an identifiable stressor or stressors, results in significant emotional or behavioral symptoms

-Symptoms occur within 3 months of the
stressor and last no longer than 6 months

30
Q

Which of the following medications is
considered to be a first-line medication of
choice in the treatment of PTSD?

A

SSRI paroxetine