Row 1
Ch. 15
Ch. 15
What are the levels of Anxiety in order?
-- Mild
-- Moderate
-- Severe
-- Panic
Anxiety disorders:
What is separation anxiety?
--Give an example
--Exhibit developmentally inappropriate levels of concern over being away from significant other (ex)
(1) What is GAD?
(2) What is selective mutism? `
(200 points added)!
(1) excessive worry (job, children)
(2) Children (people in general) do not speak (fears of negative response).
Defense mechanisms:
(1) What is identification?
(2) what is introjection?
(3) what is intellectualization?
(300 points added)!
(1) Attempting to be like another person
(2) adopting values/qualities of others into own personality
(3) Looking at a situation only using logic/no emotions
Learning card!!
Assessment (anxiety)
--Complete a physical and neurological examination
-- Determine level of anxiety
-- Assess for potential for self-harm and suicidal ideations (HIGH RISK OF SUCIDE)
-- Perform a psychosocial assessment---ASK "What is going on your life that may be contributing to your anxiety?"
What does mild anxiety entail and what are some symptoms?
Normal, healthy, increases problem solving ability,
--Irritable or restless
Anxiety disorders:
What is Specific phobias?
--Give an example.
-- persistent irrational fear of a specific object, activity, or situation that leads to a desire for avoidance or actual avoidance of the object, activity, or situation.
(example: dogs, water, heights...)
OCD
(1) Name the comorbidities of OCD
(2) Name the treatment options for OCD
(300 points added)!
--Review evaluation PowerPoint :)
(1) Anxiety, depression, eating disorders, bipolar disorder
(2) SSRI's (review these drugs) and Antipsychotics at times.
--Deep brain simulation (surgical tx)--failed at least 3 SSRI trials.
-- Exposure and response prevention (flooding).
Defense mechanisms:
(1) What is Projection?
(2) What is Rationalization?
(3) What is reaction formation?
(200 points added)!
(1) putting feeling, beliefs, or opinions on another person.
(2) Justifying unacceptable behavior, blaming others or making excuses
(3) Developing opposite behavior than what is felt "React---choose inappropriate reaction"
what are some therapy options for anxiety disorders?
-- Behavioral: modeling, systematic desensitization, flooding, thought stopping
-- Cognitive behavioral: cognitive restructuring, psycho-education
What does Moderate anxiety entail and what are some symptoms (don't forget the big one)?
Is this a sympathetic or Parasympathetic response to the body?
-- Poor attention span
-- Increased HR, BP, RR, gastric discomfort, HA, URINARY URGENCY
--Sympathetic nervous system
Anxiety disorder:
What is social anxiety disorder (social phobia)?
--Give an example
--severe anxiety or fear provoked by exposure to a social to a social or a performance situation that could be evaluated negatively by others.
What is substance-abuse anxiety disorder?
-- GAD that is associated with substance use.
(1) what is Repression?
(2) What is suppression?
(100 points added)!
(1) unconscious avoidance of memories or feelings
(2) Conscious avoidance of memories or feelings.
(1) SSRI'S are used as a pharmacotherapy for anxiety disorders.
(2) Non-benzodiazepines are also used, name the drugs and teaching points
--Name the drugs and Teaching points
(400 points added)!
(1) Fluoxetine (Prozac), Sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), escitalopram (Lexapro), citalopram (celexa)
--S/Es: sexual dysfunction, HA, insomnia, S/S's of SI (what do we look for)?
--Teach: Takes 4-6 wks to effect mood and DO NOT STOP ABRUPTLY.
(2) Buspirone (BuSpar), zolpidem (Ambien), ramelton (Rozeram).
--Teach: Takes 2-4 wks. to work on anxiety, AVOID ALCOHOL (hard on the liver), avoid caffeinated beverages, avoid use in pregnant women, take with food, taper off these meds
What does severe anxiety entail and what are some symptoms?
-- Disorganized thinking or behaviors, somatic symptoms increase, impending sense of doom.
-- Trembling
Anxiety disorders:
What is panic disorder?
--Give an example
--"Panic attacks"--sudden onset of extreme apprehension of ear, usually associated with feelings of impending doom.
--"losing there minds" "having a HA"
Defense mechanisms:
What is denial?
--refusing to believe reality
Defense mechanisms:
(1) what is sublimination?
(2) What is undoing?
(3) What is splitting
(200 points added)!
(1) socially acceptable behavior
(2) "making up" for the wrong doing
(3) Viewing people as all "good" and all "bad"
What are your interventions as nurse for a patient with mild-moderate anxiety levels?
(200 points added)!
-- Assist the pt to identify anxiety
-- use therapeutic communication and non-verbal linguae to demonstrate interest, FOCUS ON PTS CONCERNS!
-- Encourage the pt to talk about there feelings and concerns
-- Use clarifying technique's "GIVE ME AN EXAMPLE.."
-- Assist the pt to identify thoughts or feelings before the onset of anxiety
-- ENCOURAGE THE PT TO PROBLEM SOLVE
--Assist with role playing and modeling, provide healthy outlet's
--EXPLORE PAS EFFECTYIVE COPING SKILLS "WHAT HAS WORKED BEORE?"
What does panic anxiety entail and what are some mental and physical symptoms?
-- Markedly dysregulated behavior, lost touch with reality, may experience psychosis, may be pacing, running or shouting
-- Psychosis, Delusions, Hallucinations
Anxiety disorders:
What is agoraphobia?
--Give an example
-- Fear about being in situations where escape may be difficult. Worries about help not being available in places or situations for which escape may be more difficult or embarrassing.
--"open spaces" afraid to leave the house. "being alone outside...in the car...
Defense mechanisms:
what is displacement?
-- lashing out at a non-threatening person
Defense mechanisms:
(1) What is conversion?
(2) what is compensation?
(3) What is regression?
(100 points added)
(1) having physical symptoms with out a physical reason in response to stress
(2) only focusing on desirable/strength qualities in self or others
(3) reverting to child-like behaviors
What are your interventions for pts with severe-panic levels of anxiety?
--MAINTAIN A CALM DEMEANOR AND STAY WITH THE PT (THINK SAFETY)!!
-- Decrease environmental stimulation, may need to move to a quiet space.
--USE CLEAR AND SIMPLE STATMENTS WITH REPETITION, LOW-PTICHED VOICE, SPEAK SLOWLY.
-- REINFORCE REALITY, LISTEN FOR THEMES.
--ENCOURAGE PTS TO EAT AND DRINK---HIGH CALORIE FOOD/DRINKS
-- Attend to physical and safety needs
--SET FIRM LIMITS ON SAFETY ISSUES
-- Provide healthy outlets for energy, assess the need for seclusion or meds if needed.