Anxiety Disorder
What kind of anxiety response is flight or flight considered?
physiological arousal
A panic attack is unexpected and usually peaks around 10 minutes, gradually returning to normal. A panic attack has many s/sx, name as many as you can.
*according to ford, you must have 4 or more... not sure why*
palpitations, pounding heart, increased heart rate, sweating, trembling/shaking, SOB/feels like smothering, feeling of choking, chest pain/discomfort, nausea/abdominal discomfort, dizziness/unsteady/lightheaded/faint, chills/hot flashes, paresthesia, derealization/depersonalization, fear of losing control/going crazy, fear of dying
Define social phobia (social anxiety disorder) and give an example
excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others
public speaking (#1 fear)
eating in front of others
using public bathrooms
meeting new people
In behavioral therapy, there's an technique called implosion therapy, define what it means
relaxation not taught and rapidly exposed to most feared object/situation; no session breaks; requires a lot of time
most patients do not like it and some can't do it
There are many stress/anxiety management techniques you as a nurse can teach your patient, give an example of distraction, positive self-talk, and relaxation techniques.
distraction: interrupt escalating anxiety, physical activity, start a conversation, simple repetitive activities (counting backwards or objects)
positive self-talk: "this will pass", "i can handle this"
relaxation: breathing control, progressive relaxation (tense muscle group then relax, repeat until calm)
What kind of anxiety response is the one with rational decision making and threat analysis considered?
cognitive response
What is agoraphobia?
fear of being in places or situations from which escape might be difficult or in which help might not be available in event of panic-like symptoms or other incapacitating or embarrassing symptoms.
Define obsession and compulsion separately. define hoarding disorder
obsession: intrusive irrational thoughts that are recurrent and stressful, and cannot be ignored
compulsion: repetitive, ritualistic behaviors that or mental acts that carried out as a way to reduce anxiety
- handwashing, ordering, checking, praying, counting, repeating words, etc.
hoarding: difficulty parting with possessions, no matter the value
The plan of care for a patient suffering from an anxiety disorder is to....
recognize signs of escalating anxiety and intervene before reaching panic level (panic and GAD)
After all the interventions and patient teachings, what questions can you ask to evaluate the effectiveness?
was the patient kept safe from harm?
can they recognize signs and symptoms of escalating anxiety and interrupt them before it reaches panic level?
can they function in the presence of the phobic object or situation without experiencing a panic attack?
What kind of anxiety response is the one where you deal with and resolve the threat considered?
coping strategies
Agoraphobia may develop as a way to cope with panic attacks and may lead to becoming home bound. A patient must have at least 2 examples for diagnosis. list as many examples as you can.
traveling in public transport, being in open spaces, being in shops, theaters, or cinemas, standing in line or being in a crowd, being outside of the home alone in other situations
Side effects of antianxiety medications (benzodiazepines and buspirone)
whats the onset delay of buspirone?
whats the reversal drug for benzodiazepines?
caffeine and smoking can _______ the effects
drowsiness, confusion, lethargy
tolerance, physical and psychological dependence (does not apply to buspirone)
potentiates effects of other CNS depressants
orthostatic hypotension, dizziness
paradoxical excitement
dry mouth, n/v
blood dyscrasias (abnormal changes in CBC)
onset delay: 10-14 delay
reversal: flumazenil
decrease the effects
A patient with a phobia has a goal establish with the care team that the patient can...
function adequately in the presence of the phobic object or situation without experiencing a panic attack
generalized anxiety disorder (GAD)
Phobias in general are marked and persistent irrational fear that is excessive or unreasonable. The person realizes that the response is excessive but cannot help it. They are cued by the presence or anticipation of a specific object or situation that ____ ___ ____ __________ ______.
does not pose significant danger
There are several treatment modalities including individual psychotherapy, cognitive therapy, and behavioral therapy. Define each
individual: therapist led sessions to help patient understand their anxiety
cognitive: learn to reduce anxiety by altering the way they think; more patient directed
behavioral: change or learn new behaviors through positive/negative reinforcement
A patient is having a panic attack, what are some interventions to perform as the nurse?
reassure and keep safe, use a calm approach and environment, relief of acute panic symptoms, later - teach how to recognize triggers and signs
Panic is a sudden uncontrollable fear or anxiety. Panic can be singlular, like a panic attack, or a reoccurring, like a panic disorder. Define and differentiate between a panic attack and panic disorder.
panic attack: sudden, intense apprehension, fear, or terror, often associated with feelings of impending doom accompanied by intense physical discomfort
panic disorder: recurrent panic attacks that cause the person to change behavior to avoid an attack
- starts as teen or in 30's; life long disorder
- may lead to development of unrealistic fears of situations, objects, or activities and they try to avoid them
there are 5 types of specific phobias, name all 5.
animal/insect (spider, snake, dog)
nature/environment (storm, height, water)
blood-injection-injury (needle, procedure)
situational (elevator, bridge,flying, enclosed spaces)
other (choking, vomiting, contracting illness)
In behavioral therapy, there's an technique called systematic desensitization, define what it means
relaxation techniques taught, then slowly exposed more and more to feared object/situation, as they use the relaxation technique
A patient with fear will need the nurse to first explore their ________ and gain an ___________. Then the nurse can help the patient take _____ and/or _____ what they cannot.
perspective
understanding
control
accept