anxiety
what is anxiety ?
anxiety - apprehension, uneasiness, uncertainty, or dread from real or perceived threats (with fear or for no reason)
explain the assessment portion of the nursing process with anxiety
- sound physical and neuro exam
- determine source (primary vs secondary)
- determine current level
- assess for potential self-harm
- psychosocial assessment (causes they can identify)
- self assessment
explain the difference between obsessions and compulsions
obsessions : thoughts, impulses, or images that persist and recur that wont go away ; individual attempts to ignore, suppress, or neutralize
compulsions : repetitive behaviors or mental acts that they feel driven to perform in response to an obsession ; behaviors are aimed at preventing or reducing anxiety or distress, or preventing dreaded event or situation
what are flooding and exposure/response prevention therapies and what disease are they used for ?
OCD !
exposure and response prevention : 1st line cognitive behavioral intervention, expose pts to triggers, the message is that anxiety does not subside even when the ritual is not completed
flooding : expose the patient to large amounts of triggers to extinguish response
what are the levels of anxiety ? explain them (3, not including panic)
mild : everyday problem solving leverage, grasps more information effectively, s/s= restless, seeking attention, requires approval or reassurance, allows a student to study for effectively
Moderate : selective inattention, clear thinking is hampered, problem solving isnt optimal, SNS symptoms, s/s = have to pee, HA, tension, sweating, unable to sleep, difficulty concentrating, display increased worry, tosses and turns
severe : pereceptual field greatly reduced, difficulty concentrating on enviornment, confused and automatic behavior, somatic symptoms increase, s/s + unresponsive to others, unable to complete simple tasks, intense feeling of dread or doom
explain the nursing diagnosis and outcomes portion of the nursing process with anxiety
anxiety and fear - self monitors intensity, uses reduction techniques
difficulty coping - identifies ineffective/effective patterns, asks for assistance and info, and modifies PRN
impaired socialization and low self esteem- self monitors anxiety and desire for avoidance, uses techniques to reduce anxiety and maintain role performance
what are risk factors for the development of OCD ?
child abuse or trauma, post infectious autoimmune syndrome, 1st degree relatives Hx, comorbidity with anxiety disorders, eating disorders, and/or tic disorders
what are the 2 surgical treatments for OCD
gamma knife : creates lesions to form a disconnect of overactive circuits
deep brain stimulation (DBS) : implanted pulse generator uses low dose current to reduce symptoms of OCD
explain what panic anxiety/panic disorder is
panic anxiety : maredly disturbed behavior (running, yelling, screaming, pacing), unable to process reality, impulsivity
s/s - overwhelmed with terror, reaches points of exhaustion, unable to communicate verbally, detached from reality, may be at risk of self harm
panic attacks : Abrupt surge of intense fear or intense discomfort that reaches a peak within minutes
explain the planning, implementation, and eval of the nursing process with anxiety
planning : dont usually need inpatient tx, planning involves selecting community based interventions, encourage active participation in planning (may not be able with severe)
implementation : different for different levels, counseling, health teaching and promotion, teamwork and safety, promotion of self care
eval : reduced level, able to recognize symptoms, how frequent and intense symptoms are, able to manage, adequate self care, maintain interpersonal relations, able to assume usual roles
what is the DSM-5 Criteria for OCD ?
- obsessions, compulsions, or both
- not due to substance or other condition
- not explained by another psych disorder
- time consuming (in excess of 1 hour/day)
explain what benzodiazepines we discussed
meds (think Ben wakes in the AM) : diazepam (valium), alprazolam (xanax), lorazepam (ativan), oxazepam (serax)
routes : PO, IV, IM, PR
indication : anxiety, seizures, alc whitdrawal, induction of anesthesia, skeletal muscle spasms
AE : drowsy, slurred speech, impaired recall of events, paradoxical reaction, htn, resp. depression, withdrawal symptoms
NC/PE : risk of severe resp. depression and sedation with other depressants, monitor VS (esp. with IV), taper over 1-2 weeks to minimize withdrawal
what are the types of defense mechanisms against anxiety and what is their purpose ?
defense mechanisms maintain self image by blocking feelings, conflicts, memories, and are automatic and protect against anxiety
- adaptive : lowers anxiety for acceptable achievement of goals
- maladaptive : overuse of immature defenses
denial : dismissing the situation as not true or based in reality (adaptive vs maladaptive)
rationalization : using reasoning or logic to avoid / explain the stressor or their actions and avoid their emotions (adaptive vs maladaptive)
what are the treatment modalities for anxiety ? (biological and psychological)
bio - pharmacology (anti depressants, anti anxiety, and others)
integrative medicine
psychological therapies - CBT and behavioral therapy
explain the components of the nursing process when dealing with OCD
assessment : self assess, when did it start, how long do they last, do you find it difficult to control worrying ?
nursing diagnosis : anxiety, impaired skin integrity / body image, risk for self destructive behavior, impaired socialization, fear, difficulty coping, and chronic self esteem
outcomes : reduced anxiety and self destructive behavior, as well as improved skin integrity, body image, socialization, reduce fear, improved coping, and self esteem
interventions : basic include self care activities, monitor skin integrity, health promotion and looking for UTIs. advanced includes flooding and CBT
explain what anxiolytic / non-benzodiazepine are
med : buspirone (buspar)
indication : anxiety disorders
AE : dizziness, nauseas, HA, paradoxical effects
PE/NC : therapeutic effect takes 2-4 weeks, take with food if nausea occurs
what is the clinical picture of GAD and what places patients at risk for anxiety or anxiety related things ?
GAD : excessive worry in response to numerous situations (anxiety lasts for months)
risk factors : family Hx, personality traits, trauma/negative life experiences, cultural factors
what are the different types of treatment offered for patients with OCD ?
biological - SSRIs, Clomipramine (TCA), Venlafaxine (SNRI) , some antipsychotics
surgical treatments - gamma knife and deep brain stimulation
psychological therapy - exposure and response prevention, and flooding