anxiety Flashcards
(46 cards)
1
Q
anxiety disorders
A
panic disorders phobias obsessive compulsive disorder generalized anxiety disorder PTSD acute stress disorder substance induced anxiety disorder somatic disorders anxiety due to medical conditions functional neurologic disorders/conversions disorders
2
Q
acute stress resp
A
- flight or fright response
- acute stress response first coined in 1920’s
- body responses; sympathetic stimulates adrenals, triggers catecholamines, which include adrenaline and noradrenaline
- increases HR, BP, R
- body returns to pre-arousal state in 20-60 min
- triggers can be both real or imaginary
3
Q
chronic stress response
A
- human response to prolonged stress over which a person perceives he/she has no control
- involves endocrine system, corticosteroids
- if continues can cause damage to physical and mental health
4
Q
stress vs anxiety
A
- stress is a response to a threat in a situation
- stress comes from the pressures we feel in life, as we are pushed by work or any other task that puts undue pressure on our minds and body. Adrenaline is released, extended stay of the hormone causes anxiety, depression, a rise in the blood pressure and other negative changes
- anxiety is a reaction to the stress
- anxiety is stress that continues after that stressor is gone
- anxiety is a feeling of apprehension or fear. it is almost always accompanied by feelings of impending doom. the source of this uneasiness is not always known or recognized, which can add to the distress you feel
5
Q
anxiety responses
A
- physical
- affective
- cognitive
- behavioural
6
Q
manifestations of anxiety
A
physiological - cardiovascular - respiratory - gastrointestinal - neuromuscular - urinary tract - skin behavioural - restless - rapid speech - inhibition - hypervigilance - lack of co-ordination cognitive - impaired attention - blocking of thoughts - loss of objectivity - flashbacks - preoccupation affective/emotional - edginess - impatience - terror - guilt - helplessness - social - increasing isolation
7
Q
Peplau, 1963 levels of anxiety
A
- anticipated
- mild
- moderate
- severe
- panic
8
Q
Peplau anticipated and mild anxiety
A
- associated with the tensions of daily living, person alert, perceptual field increased
- motivates learning, growth, creativity
- S/S; restlessness, irritability, impatience, relieving behaviour such as finger tapping, fidgeting
9
Q
Peplau moderate anxiety
A
- person focuses on immediate concerns, narrowing of perceptual field
- person hears, sees, grasps less
- S/S: voice tremours, difficulty concentrating, pacing, increase VS, urinary frequency, headache
10
Q
Peplau severe anxiety
A
- significant reduction in perceptual field
- person focuses on specific detail and not anything else
- all activity directed to relieving anxiety, much direction needed to focus on another area, requires supervision
- focuses on self, environment blocked out, sense of dread
- S/S: inability to process info and make decisions, purposeless activity
11
Q
Peplau panic anxiety
A
- associated with sense of terror
- person unable to do things even with direction
- disorganized personality, loss of rational thought
- distorted perception, emotionally paralyzed
- unable to communicate and function
- S/S: sense of terror, dilated pupils, pallor, speaks unintelligibly or is mute, severe tremours, hallucinations, extreme withdrawal or out of control aggitation
12
Q
anxiety and perception
A
perceptual field increases with mild anxiety, becomes increasingly constricted as anxiety increases and completely disrupted at panic levels
13
Q
facilitate therapeutic relationships w/ each anxiety level
A
- mild: as usual
- moderate: ask focused questions to allow client to voice concerns, to ventilate, remain calm, provide direction, provide outlet for tension
- severe: maintain a calm disposition, remain with person give direction and assure safety, reduce environmental stimuli, use calm low pitched voice, short clear direction
- panic: remain with client, offer support and keep talking to the person even though they may not be able to respond, provide safety, solitude, kindness. if person extremely agitated provide for physical safety, seclusion
14
Q
constructive means to cope w/ anxiety
A
- finding comfort in our social network
- talking it out
- intense expression of feeling
- relying on self discipline, breathe
- avoidance and withdrawal
- working it off
- reframing the situation, question thought pattern
- engaging in self healing practices (mind body practices)
- prayerfulness, mindfulness
- using symbolic substitutes
15
Q
common defense mechanisms
A
dissociation: disruption in the function of consciousness
repression: unconscious blocking from awareness that which is threatening or painful
displacement: discharging pent up feelings, usually of hostility, on objects less dangerous than those that initially aroused the emotion
rationalization: justifying ones failures with socially acceptable reasons instead of the real reasons
reaction formation: transforming anxiety producing thoughts into their opposites in consciousness
regression: returning to more primitive levels of behaviour
denial: refusing to admit that something unpleasant is happening or that a taboo emotion is being experienced
16
Q
anxiety theories
A
genetic - 50% panic disorders - 40% GAD - 20% phobias - OCD strong family link biochemical - amygdala/hippocampus - sensitivity to CO2 neurotransmitters involved in experience of anxiety: GABA, serotonin, dopamine, epinephrine, and more psychodynamic interpersonal - family dynamics behavioural traumatic event medical conditions - migraines, sleep apnea, mitral valve prolapse, IBS, chronic fatigue syndrome, PMS - pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS)
17
Q
Hamilton Anxiety Rating Scale (HAM-A)
A
- scale 0 to 4 (not present or very severe)
- 14 items
- anxious mood
- tension
- fears
- insomnia
- intellectual
- depressed mood
- somatic (muscular)
- somatic (sensory)
- cardiovascular symptoms
- respiratory symptoms
- gastrointestinal symptoms
- genitourinary symptoms
- autonomic symptoms
- behaviour at interview
18
Q
generalized anxiety disorder (GAD)
A
- difficult to determine the exam boundary between GAD and normal worries
- worry that is excessive, persistent, and pervasive for more days than not for a period of 6 months
- “generalized” if it focuses on a variety of life events and activities
- the amount of time spent on worrying, the degree of control over ones worry, the impact on personal, social, and occupational functioning are key components of the assessment
- diagnosis of exclusion
19
Q
GAD nursing interventions
A
- combine relaxation, awareness of stressors, excersize, cognitive behavioural therapy with goal of bringing worry process under person’s control
- ask questions to dispute illogical thinking
- sleep hygiene is important (establishing a routine). diminishing stimulants in the evening is recommended
20
Q
GAD nursing interventions pharmacological
A
- benzodiazepines was once the first line treatment. because of the chronic nature of GAD and the risks of addiction with long term use of benzodiazepines, it is no longer the first line treatment
- SSRIs and SSNRIs are the pharmacological treatment of choice
- gabapentin
21
Q
obsessive compulsive disorder
A
- obsessions
- – unwanted, intrusive, and persistent thoughts, impulses, or images that cause anxiety and distress
- compulsions
- – behaviours that are performed repetitive, in a ritualistic fashion, with the goal of preventing or relieving anxiety and distress caused by obsessions
- psychiatric disorder characterized by severe obsessions and compulsions that significantly interfere normal daily living
- obsession’s can consume a person’s judgement to the degree that most of his or her day is spent performing actions in an attempt to minimize severe anxiety
22
Q
OCD nursing care
A
- it is very important that all staff members be consistent in their expectations and acceptance of the patient’s behaviours to keep the person with OCD from becoming frustrated or confused regarding expectations during treatment
- know that individuals do not consider their compulsions pleasurable. often they recognize them as odd and may initially try to resist them. resistance eventually fails, they feel ineffective, exacerbating their mental health concerns
- work with the person experiencing OCD - harm reduction principles: maintaining skin integrity- (remove harsh soaps, try to influence frequency of hand washing, use tepid water)
23
Q
OCD biological nursing interventions
A
- should be assessed for dermatologic lesions caused by excessive hand washing and excessive cleaning, osteoarthritic joint damage secondary to cleaning rituals may be observed
- type and severity of obsessions should be assessed
24
Q
OCD psychological nursing interventions
A
- response prevention: presented with situations or objects that are known to induce anxiety and asked to refrain from performing ritualistic behaviours
- thought stopping: interrupt obsessional thinking by saying “stop”
- relaxation techniques: used to improve sleep patterns (often patients suffer from insomnia because of anxiety)
- cognitive restructuring: examine distorted, automatic thoughts. the goal is to realize the incongruence between thoughts and reality
25
OCD social nursing interventions
- consider sociocultural factors and patients ability to relate to others
- in the hospital, unit routines are carefully and clearly explained to decrease patients fear of unknown
- recognize significance of rituals
- assist patient in arranging schedule
26
OCD treatments: therapy
- CBT involving exposure and ritual prevention
| - deep brain stimulation
27
OCD treatments: pharmacological
- venlafaxine (SNRI) and clomipramine (TCA) have been compared
- - both seem to be effective; venlafaxine may have fewer unwanted side effects
- - side effect monitoring may be a problem for those preoccupied with somatic concerns (may become the focus of obsession)
28
PTSD/Operational stress disorder
- affects 8% of pop
- however, the prevalence of PTSD is higher depending on the type of trauma, ranging from about 20% after motor vehicle crash to mote than 80% after prisoner of war incident
- PTSD doesn't only develop after a personal experience but may also include witnessing a traumatic event, an event that causes death or threatened physical activity
- individuals with PTSD experience
- - re-experiecing
- - avoidance
- - numbing
- - heightened arousal
29
factors that contribute to PTSD
- trauma
- fatigue
- grief
- moral injury
30
PTSD treatment
- several past and present focused psychosocial treatments
- -- past focused treatments emphasized repeated exposure to memories and emotions of the event in order to diminish their impact
- -- present focused teach coping skills to improve functioning
- medications: SSRI, TCA, antipsychotics, mood stabilizers, service animals
31
acute stress disorder
- share the same symptom cluster as PTSD
- - differs in duration (symptoms emerge 2 to 4 days after exposure, last up to a month)
- - differs also by including dissociative symptoms (ex. depersonalization, dissociative amnesia, etc)
- controversy continues over whether acute stress disorder should be considered PTSD and if dissociation is necessary for diagnosis
32
panic disorder
- discrete episodes of intense anxiety that begin abruptly and reach a peak within minutes
symptoms: palpations, sweating, trembling, SOB, chest pain, sensation of choking, nausea, cognitive; depersonalization, derealization, fear of going crazy or dying
- strong association with depression and substance abuse
- genetics
33
link between panic attacks, agoraphobia, and other phobias
- panic attacks can lead to the development of phobias or persistent, unrealistic fear of situations, objects or activities
- people with phobias will go to great lengths to avoid the feared objects or situations to deter panic attacks
34
nursing assessment of a person experiencing panic
- determining patterns of panic attack, symptoms, and responses
- -- may be difficult to identify specific triggers because they are no longer present and the individual lives in fear of another attack
- -- mental status: restlessness, irritability, watchful or worried facial expression, decreased attention span, difficulty problem solving, apprehensive, or helpless
- suicidal assessment
- cognitive thought patterns: assess for catastrophic misinterpretation
35
panic disorder treatment
- breathing control
- relaxation techniques
- nutritional planning
- encourage physical activity
- sleep hygiene
36
panic disorder nursing interventions
- distraction: snapping rubber elastic on wrist, initiating conversation, counting down from 100
- positive self talk: i will get through this, use of hand held cards
- psychotherapies
- -- cognitive behavioural therapy is considered to be the first line treatment in panic disorders. goal is to manage anxiety and correct anxiety provoking thoughts
- -- panic control treatment
- -- exposure
- -- systematic desensitization
37
panic disorders: nursing interventions SSRI
- SSRI treatment: usually the first line treatment of panic disorders
- -- full clinical response is usually seen by 4 to 6 weeks
- -- they may cause feelings of overstimulation when initiated, but slow titration can help to alleviate this feeling. morning dosing decreases interference with sleep
- -- at higher dose, some patients find the medication sedating
- -- weight gain has been reported as well as withdrawal syndrome in individuals who stop treatment abruptly
38
panic disorders nursing interventions Benzodiazepine
- used during periods of extreme stress and for immediate symptoms release
- - initiate benzodiazepines until antidepressants begin working
- - short acting, associated with rebound anxiety (alprazolam, lorazepam)
- - avoid if patient has sleep apnea because this type of medication may decrease the rate and depth of respirations
- - withdrawal symptoms are likely to occur after high dose, long term therapy. Do not cease abruptly
- - side effects include headache, confusion, dizziness, disorientation, sedation, and visual disturbances
- - teaching points: avoid alcohol and discuss sedative effects
39
emergency nursing care - panic attacks
- stay with patient
- reassure him/her that you will not leave
- give clear direction
- walk or pace with the patient in an environment with minimal stimulation
- administer PRN anxiolytic medications
- allow the patient to vent his/her feelings after and attack has resolved in order to help them clarify their feelings
40
social phobias
- social phobias (social anxiety disorder) involve persistent fear of social or performance situations in which embarrassment occurs
- exposure to the social or performance situation nearly always provokes immediate anxiety or triggers a panic attack
- individuals with social phobias also fear that others will judge them and will go to great lengths to avoid feared situations
- there are two subtypes of this disorder:
- -- generalized social phobias: most social situations
- -- specific social phobias: one or two social situations
41
phobias
- persistent fear of a specific object or situation
- social phobia (social anxiety disorder) profound fear of public speaking
- specific phobias (10% lifetime incidence)
- treatment
- -- exposure based procedures; particularly in vivo exposure
42
substance induced anxiety
- anxiety symptoms (generalized anxiety, panic attacks, obsessive compulsive, phobia symptoms) cause by a psychoactive substance
- categorized based on prominent feature and whether it began during intoxication or withdrawal
- must be distinguished from delirium - needs clinical history and physical examination to discern
- tx: anxiety symptoms induced by substance usually subside once substance is stopped; OC symptoms do not subside
- medications might include: antianxiety, antidepressants, behavioural therapy
43
somatization disorder
- tendency to experience and communicate psychological distress (anxiety) in the form of somatic symptoms
- 80% W and 20% M
- tx: rule out other causes typically for chest pain, headache, fatigue, dizziness, back pain, SOB, insomnia, abdominal pain, numbness
- -- note: when health care provider unable to provide clear diagnosis, person feels discounted, misunderstood, devalued, stigmatized; likewise health care providers become frustrated with these clients, leading to poor health outcomes
44
conversion disorder/functional neurological disorder
- person experiencing conversion/functional neurological disorder reports impaired physical function that is related to the expression of a psychological conflict
- 2x more W than M
- some demonstrate emotional distress while others "la belle indifference"
- assess primary and secondary gain
45
hypochondriasis/illness anxiety disorder
- misinterpretation of physical sensations
- preoccupied with fear of serious illness
- W=M
- TX: stress management, build trust, distraction, medication anti psychotics, antidepressants
46
somatoform vs factitious disorder
- somatoform disorders should not be confused with factitious disorders in which a person consciously produce physical or psychological symptoms
- man-lingering; deliberately faking symptoms in order to benefit
- Munchausen syndrome
