Anxiety
This can be productive and does not require direct intervention.
Mild anxiety
This anxiety can motivate
Ex: Studying for a test
Psychological response in this level of anxiety causes a narrowing of the perceptual field to immediate task and the client becomes selectively attentive, has trouble connecting thoughts or events independently,
increased use of automatisms (foot tapping, etc.)
What is moderate?
Chapter 14, page 225 Table 14.1
In the DSM-5-TR, personality disorders are clustered around a predominant type of behavioral pattern. What are the clusters called?
What are Cluster A, B, C?
A: odd/eccentric- weird: Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder
B: erratic/dramatic wild: Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder
C. anxious/fearful: worried: Avoidant personality disorder Dependent personality disorder Obsessive personality disorder
A form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object (either by picture or actual object) until it longer produces anxiety.
What is flooding?
The idea is that because the client has faced his worst fear and didn't die, there is little reason to fear it anymore. Highly anxiety producing and should only be conducted by a trained therapist.
Chapter 14, page 237
This class of meds have a high potential for abuse and dependence, and should only be used short-term for anxiety
Name one of them
What are Benzodiazepines?
What is Xanax?
Chapter 14, page 225
This disorder involves extreme mood swings from episodes of mania to episodes of depression
What is Bipolar Disorder?
In the ____________ stage of Selye's general adaptation syndrome, the body has responded negatively to anxiety and stress and is depleted physically and emotionally.
What is exhaustion
This is it. They cannot manage or reason. They are in panic mode
Chapter 14, page 223
Hans Selye, General Adaptation Syndrome
These are involuntary, unconscious mannerisms that a person with anxiety may exhibit.
What are automatisms?
Ex: drumming fingers, twirling hair, tapping foot.
Chapter 8, page 134
What personality disorders listed under Cluster A of "odd or eccentric behaviors"?
What are Paranoid, Schizoid, Schzotypal?
Chapter 18, page 329
A behavioral therapy in which the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases.
What is desensitization?
During each exposure, the complexity and intensity of exposure gradually increases but the client's anxiety decreases.
Chapter 14, page 237
This drug is used for anxiety without the risk of dependence. Side effects include orthostatic hypotension, take with food
What is Buspar?
Chapter 14, Table 14.2
This mood disorder robs person of joy, self-esteem, and energy. It interferes with relationships and occupational productivity. It is the most correlated diagnosis with suicide attempts/success
What is major depression?
What is anxiety?
Hans Selye with general adaptation syndrome discusses the physical symptoms that go along with each stage of anxiety.
Chapter 14, page 223
In this level of anxiety, the client can no longer take in any information or pay attention
What is panic level anxiety
Chapter 14, page 224
Table 14.1
What personality disorders listed under Cluster B, "erratic or dramatic behaviors"?
What are Antisocial, Borderline, Histrionic, Narcissistic?
Chapter 18, page 329
What are the three categories of phobias?
What are agoraphobia: "fear of the market-place" or fear of being outside
Specific phobia to object or a situation- irrational fear of
Social anxiety: anxiety provoked by certain social or performance situations
Chapter 14, page236
This class of med is the treatment of choice for anxiety disorders in older adults.
SSRI's Low and slow
Why not benzo's? A significantly increased risk for hip fractures is associated with long-term use of Benzo's by older persons. (Page 230)
People with this disorder have a labile mood and are manipulative, have high self-esteem, and believe they are capable of anything. They sleep little, are always in frantic motion, invade the boundaries of others, cannot sit still, and start many tasks (goal oriented) etc
What is Bipolar Disorder/manic phase?
What is fear?
Someone chasing you, etc.
Chapter 14, page 222
Name one immediate outcome for a client with anxiety in the hospital when completing a plan of care.
What is "Be free from injury throughout hospital stay."
Chapter 14, page 227, Plan of care for client with anxious behavior.
What personality disorders listed under Cluster C, "anxious & fearful behaviors"?
What are Avoidant, Dependent, Obsessive?
Chapter 18, page 329
The relief of anxiety achieved by performing the specific anxiety-driven behavior (such as staying in the house to avoid the anxiety of leaving the safe place)
Primary gain
Chapter 14, page 232
With these meds, you would tell client to avoid sugary drinks and use sugar free hard candy for dry mouth, increase water intake/increase bulk in diet, may use stool softeners, sunscreen, rise slowly from lying or sitting position, avoid driving or hazardous tasks until used to med, may take the med if forgotten only if 3-4 hours later, may cause weight gain
What are antipsychotics?
Client and family teaching box
What must the nurse monitor in client's who are manic?
What is food/fluid intake, rest & sleep, and behavior with a focus on safety
Why? Always on the go. Give snacks they can eat on the go
Four levels of anxiety that causes both physiological and emotional changes in a person. Theorized by Hildegard Peplua.
What is Mild, Moderate, Severe, Panic?
Table 14.1, page 225
With panic level anxiety client, what nursing action is appropriate? Name some
What is: Remain with client at all times, PRN meds may be appropriate, move to area less stimulated, use short, simple, and clear statements, don't force the client to make choices. Safety.
Chapter 14, page 227-228, Plan of care for anxious clients
Nurses typically encounter client's with antisocial & borderline personality disorders in the hospital setting?
True
Chapter 18, page 329
The attention received from others as a result of the behavior, such as not leaving the house
Secondary gain
example- family do the grocery shopping and errands for the person who won't leave the house.
Chapter 14, page 232
This med competes for salt receptors in the human body (because it is already present in the body, like copper is.) affecting salt, but it affects calcium, potassium, and magnesium ions as well as glucose metabolism. It can cross blood-brain barrier and is distributed through sweat and breast milk. Blood levels must be checked for therapeutic or toxic range. Toxic level is 1.5mEq/L and above.
Lithium
2 ways to become toxic- too much lithium is going in or not enough lithium is being excreted by the kidneys.
You would encourage adequate water intake and the usual amount of table salt. If there is too little water or losing fluids through sweating, vomiting, or diarrhea- this can increase the toxicity of Lithium. You would report any diarrhea, vomiting, flu like symptoms, or any condition that leads to dehydration.
What are single adults, divorced men, adolescents, older adults, the very poor or wealthy, urban dwellers, migrants, students, whites, people with mood disorders, substance abusers, people with medical or personality disorders, and people with psychosis all at risk for?
Suicide
Chapter 17, page 324
Cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress.
What are defense mechanisms?
Chapter 14, page 229
This behavioral therapy goal is to change negative messages into positive
What is positive reframing?
Ex: when having panic attack, client thinks "my heart is pounding, I'm going to die." Therapist teaches client to change the message, such as "This is anxiety, I can handle this, I'm not going to die."
Chapter 14, page 230
Other clusters or behavior related to maladaptive personality traits include the following?
Depressive behavior & Passive-aggressive behavior
Chapter 18, page 329-330
Not doing something because it causes uncomfortable feelings, even just remembering how it made you feel, can cause anxiety, so the person exhibits __________ behavior
What is avoidance behavior?
With agoraphobia avoid going out because a panic attack "May' occur.
Chapter 14, page 232
These antidepressants are used for depression and have fewer side effects than other antidepressants
SSRI's
What are some some clues someone may be planning their suicide?
What is making threats of suicde
giving away prized possessions, putting life in order, making vague goodbyes.
Someone who has been severely depressed and suddenly appears joyful and happy, should be monitored and placed on suicide precautions. This could mean they have made up their mind to end their life.
This therapy consists of the therapist asking questions such as "What is the worst thing that can happen? Is it likely? Could you survive it?" The client will use thought-stopping and distraction techniques to jolt themself from focusing on negative thoughts.
What is decatastrophizing?
Chapter 14, page 230
This technique teaches the client to use "I" statements. Assists the person to take more control of their life and relationships. It helps to negotiate interpersonal situations and foster self-assurance.
What is assertiveness training?
"I feel angry when you talk to me like that."
Chapter 14, page 230
Personality disorders occur in _____%-______% of the general population?
Of all psychiatric inpatients, ____% have personality disorder.
Those with a primary diagnosis of a major mental illness, ________ %to _______%have a coexisting personality disorder.
In outpatient settings, ___% to ____% have personality disorders
What is 10-20%? Incident is even higher in those in lower socioeconomic groups or unstable/disadvantaged populations -like people in prison or dealing with substance abuse.
What is 15%?
What is 40-45%?
What is 30%-50%?
Chapter 18, page 330
When assessing a client with anxiety, the nurse's questions should be
a.)avoided until anxiety is gone
b.) open-ended
c.) postponed until the client volunteers information
d.) specified and direct
d.) Specific and direct
Why? These patients are having some trouble concentration and with focus. Specific and direct questions require less cognitive effort and won't overwhelm the already overwhelmed.
These 2 different classes of antidepressants have longer lag periods before they become therapeutic.
What are Tricyclic's and MAOi's?
What type of role does a nurse take with a suicidal client?
What is an Authoritative role?
The safety of the client is of the utmost importance. That is the priority to keep them alive. It takes precedence over what a client may want. Ex: wants to be alone in room to think. This is not allowed on suicide precautions
Chapter 17, page 320
Clients with depression, Bipolar disorder, schizophrenia, substance abuse , PTSD, and borderline disorder are at increased risk of what?
Suicide
This med is an anticonvulsant that is used as a mood stabilizer. There is a risk with this med and agranulocytosis and levels must be drawn.
What is carbamazepine (Tegretol)
Clozapine carries the same risk but is an atypical (or second-generation antipsychotic
Personality disorders have been highly correlated with...
Criminal behavior, alcoholism, and drug abuse
Chapter 18, page 330
True or false?
Depressed clients who begin taking an antidepressant may have a continued or increased risk of suicide in the first few weeks of therapy.
True
The antidepressant may give them more energy, even though they are still depressed, and help them to carry out their plan or it takes some time for med to work, and this may cause frustration that they aren't feeling better. Monitoring for suicidal ideation is important once antidepressant is started.
Chapter 17, page 319
Hypertensive crisis may be caused by this medication
MAOi's
Risk of Hypertensive crisis if taken with tyramine containing foods.
What is the leading cause of death among children, adolescents, and young adults?
Suicide
Predictors of suicide attempts include depressive disorder, being bullied, unsafe home or school environment, and emotional trauma. ETOH use is also a significant predictor of suicide attempts among young adults.
Chapter 17, page 321