Anxiety Flashcards
Apply information about the exemplars: BPD, Panic Disorders, and OCD
What are some potential factors and causes of personality disorders?
- Genetics
- neurobiology
- Trauma history
- Intrapersonal factors
- Sociocultural factors
What are some risk factors for personality disorders?
- Genetics
- Unstable home life
- parental loss via death or divorce
- Verbal, physical, and sexual abuse or neglect
- diagnosis of other disorders (childhood conduct disorder)
- Low socioeconomic status
What are some symptoms of BPD?
- Impulsivity, unstable emotions, depression, and self-harm
- Splitting
- low self-esteem
- dissociation
- tendency t take offense easily
- fear of abandonment
- manipulating
What are some clinical therapies?
- Schema-focused therapy
- Dialectical behavior therapy
- CBT
- antidepressants, antianxiety, antipsychotics, and mood stabilizers
- Group therapy
- alternative therapy
What is Dialectal Behavioral Therapy?
Striking a balance between 2 extremes; the therapies displays understanding and validates the pt’s behaviors and feelings while at the same time imposing limits and making the pt responsible for changing unhealthy patterns
What is schema-focused therapy?
- combines aspects of CBT with other forms of psychotherapy to change a pt’s self-perception
- Aims to help pt’s view themselves differently so they can create new and more effective ways of interacting with their environment and others
How would a nurse promote basic safety precautions with a patient that has a personality disorder?
- Ensure that the pt’s environment is free from items that may be used to harm self or others
- Provide close supervision and monitoring
- Encourage pt to seek assistance from members of the healthcare team when they need to process their feelings, including when they perceive that their stress levels are rising
- Encourage pts to participate actively in therapy and groups
How would a nurse provide safety in the community setting for someone with a personality disorder?
- teach about meds and possible suicidal ideation with SSRIs
- Pts with NSSI= Contact providers if they experience increases in severity or occurrence
- Pts need to be in a nonviolent, financially stable, and emotionally stable safe environment
How would a nurse promote a therapeutic relationship with someone who has a personality disorder?
- Avoid stigmatizing the pt because of an illness. They do not have a defective personality, they have a neurological imbalance
- Balance flexibility with firmness
- Focus on the strengths of the individual and his family system
How would a nurse establish boundaries with someone with a personality disorder?
- teach the client about physical, social, emotional, and sexual boundaries
- Talk about how the client adopts others’ thoughts and feelings as own
- Teach them they have a choice of how to react to a comment
- Help client establish, maintain own boundaries
How does impulsiveness increase the risk for injury?
- person does not think of the consequences, only the action.
- they do not think things through before doing them meaning they do not consider safety.
- there are no warning signs
- seeking a thrill
- cannot rationalize consequences
A suicidal client is diagnosed with a borderline personality disorder. Which short-term outcome is most beneficial for the client?
- The client will be free from self-injurious behavior
- The client will express feelings without inflicting self-injury by discharge
- The client will socialize with peers in the milieu by day 3
- the client will acknowledge his or her role in altered interpersonal relationships
The correct answer is: The client will express feelings without inflicting self-injury by discharge
The client’s being able to express feelings without inflicting self inf-injury by discharge is an outcome that reinforces the priority for client safety, is measurable, and has a time frame.
Although it is important for the client to be safe and free from self-injurious behaviors, this outcome does not have a time frame and is incorrectly written.
Although it is important for the client to be able to socialize with peers in the milieu, is not the priority outcome and is incorrect.
The ultimate outcome for a client diagnosed with a borderline personality disorder is to understand better how specific personal behaviors affect interpersonal skills. Because this outcome does not have a time frame and does not reinforce the priority of safety, it is incorrect.
After being treated in the ED for self-inflicted lacerations to wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority?
- Administer tranquilizing drugs
- Observe client frequently
- Encourage the client to verbalize hostile feelings
- Explore alternative ways of handling frustration
The correct answer is: Observe client frequently
The priority nursing intervention is to observe the client’s behavior frequently. The nurse should do this through routine activities and interactions to avoid appearing watchful and suspicious. Close observation is required so that immediate interventions can be implemented as needed.
Giving the client tranquilizing medications may have a calming effect and reduce aggressive behavior, but it does not address the client’s priority safety issues. Tranquilizing medications are considered a chemical restraint and would be used only when all other, less restrictive measures have been attempted.
Encouraging the client to verbalize hostile feelings may help the client to come to terms with unresolved issues, but it does not address the client’s priority safety need.
It is important to explore alternative ways of handling frustration, such as physical activities Although this may relieve pent-up frustration, it does not address the client’s priority safety need.
What are some medications that can be used for BPD?
- Olanzapine
- Quetiapine
- Topiramate
- Risperidone
- Fluoxetine
- Buspirone
A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication(s) would the nurse expect to administer? Select all that apply
- Lithium Carbonate
- Carbamazepine
- Fluoxetine
- Paroxetine
- Divalproex sodium
The correct answers are: Lithium carbonate, Carbamazepine, and Divalproex sodium
The goal of treatment in the acute phase is symptom reduction and stabilization. Therefore, mood stabilizers, such as lithium carbonate, carbamazepine, and divalproex sodium, are the mainstays of pharmacotherapy.
Antidepressants, such as fluoxetine or paroxetine, are not recommended in bipolar depression because of the risk of switching to mania.
What are the risk factors for anxiety disorders?
- Childhood adversity
- family incidence
- Social factors
- Serious or chronic illness
- Multiple stressors
- More frequent in young girls
- could be in older adults because of cognitive impairment, one or more chronic physical impairments, and significant emotional loss
What are the clinical manifestations of mild anxiety?
- increase in sensory perception and arousal
- Increase in alertness
- sleeplessness
- Increase in motivation
- Restlessness and irritability
What are the clinical therapies for mild anxiety?
- coping mechanisms
- improved sleep hygiene
- relaxation techniques
- Behavior therapy
- Massage
- Aromatherapy
What are the clinical manifestations of moderate anxiety?
- Narrowing of perceptual field and attention span
- reduction in alertness and awareness of surroundings
- Feeling of discomfort and irritability with others
- Self-absorption
- Increased restlessness
- Increase in respiration, heart rate, and muscle tension
- Increase in perspiration
- Rapid speech, louder tone, and higher pitch
What are the clinical therapies for moderate anxiety?
- Cognitive and behavior therapy to identify triggers
- relaxation techniques
- Integrative therapies such as yoga, acupuncture, massage
- Low-dose antianxiety meds if symptoms do not improve with other therapies or if the meds exacerbate chronic conditions
What are the clinical manifestations of severe anxiety?
- Perceptual field greatly reduced
- Difficulty following directions
- Feelings of dread, horror
- Need to relieve anxiety
- Headache
- Dizziness
- Nausea, trembling, insomnia
- Palpitations, tachycardia, hyperventilating, diarrhea
What are the clinical therapies for severe anxiety?
- Cognitive and behavior therapy to learn to identify triggers and to learn better coping techniques
- Antianxiety meds (may include benzodiazepines)
- Relaxation techniques
- Integrative therapies such as yoga, acupuncture, massage
- Hospitalization may be required initially to manage severe anxiety until improved coping mechanisms are developed