Anxiety disorder + OCD Flashcards
- differentiate between stress, anxiety, and anxiety disorders - describe definition, types, signs & symptoms of Anxiety Disorders and OCD. -identify available treatments - plan nursing interventions for individuals with anxiety disorders and OCD
The nurse observes a client who is becoming increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high-pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as
a. mild.
b. moderate.
c. severe.
d. panic.
c
When assessing a client with anxiety, the nurse’s questions should be
a. avoided until the anxiety is gone.
b. open-ended.
c. postponed until the client volunteers information.
d. specific and direct.
d
The best goal for a client learning a relaxation technique is that the
client will
a. confront the source of anxiety directly.
b. experience anxiety without feeling overwhelmed.
c. report no episodes of anxiety.
d. suppress anxious feelings.
b
Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiological dependence?
a. Benzodiazepines
b. Tricyclics
c. Monoamine oxidase inhibitors
d. SSRIs
d
Which would be the best intervention for a client having a panic attack?
a. Involve the client in a physical activity.
b. Offer a distraction such as music.
c. Remain with the client.
d. Teach the client a relaxation technique.
c
A client with GAD states, “I have learned that the best thing I can do is to forget my worries.” How would the nurse evaluate this statement?
a. The client is developing insight.
b. The client’s coping skills have improved.
c. The client needs encouragement to verbalize feelings.
d. The client’s treatment has been successful.
c
A client with anxiety is beginning treatment with lorazepam (Ativan). It is most important for the nurse to assess the client’s
a. motivation for treatment.
b. family and social support.
c. use of coping mechanisms.
d. use of alcohol.
d
Select all that apply.
Interventions for a client with panic disorder would include
a. encouraging the client to verbalize feelings.
b. helping the client avoid panic-producing situations.
c. reminding the client to practice relaxation when anxiety level is
low.
d. teaching the client reframing techniques.
e. teaching relaxation exercises to the client.
f. telling the client to ignore any anxious feelings.
a, c, d, e
When working with a client with moderate anxiety, the nurse would expect to see
a. inability to complete tasks.
b. failure to respond to redirection.
c. increased automatisms or gestures.
d. narrowed perceptual field.
e. selective attention.
f. inability to connect thoughts independently.
c, d, e, f
differentiate between stress, anxiety, and anxiety disorders.
Stress
* Perceived _ and _ situations affecting equilibrium.
Anxiety
* A vague feeling of _ or _. A
response to _/stress with emotional, cognition, and physical symptoms
Anxiety Disorder
* Groups of mental problems with
excessive Anxiety, _ _ _.
Stress
* Perceived undesirable and difficult situations affecting equilibrium.
Anxiety
* A vague feeling of dread or worry. A
response to stimuli/stress with
emotional, cognition, and physical symptoms
Anxiety Disorder
* Groups of mental problems with
excessive Anxiety, affecting normal
functioning.
describe signs & symptoms of Anxiety Disorders.
Mild, moderate, severe or panic. Observed from Perceptual & Cognitive Ability, Ability to learn and symptoms
Mild, moderate, severe or panic. Observed from Perceptual & Cognitive Ability, Ability to learn and symptoms
Mild
- Heightened
perceptual
field
- Alert
- Can identify a source of anxiety
- Able to effectively work toward a goal and
examine alternatives
- Slight discomfort
- attention-seeking Behaviour.
-Restlessness
-Irritability
-Mild tension-relieving Behaviour. (e.g. biting
nails)
Moderate
-narrow perceptual field
- Selective Inattention
- Able to solve problems but not at optimal ability
-voice tremors
-Can’t focus
-Shakiness
-Repetitive questioning
-Somatic complaints
-Increased heart rate, RR, pulse rate, muscle tension
-Pacing, banging hands on table
Severe
- Perceptual field greatly reduced
- Focus on specific detail
- Completely
absorbed with self
- May not be able to attend events even when pointed out by the other
- Unable to see
connections between events or details.
- Distorted perceptions
-Loud & rapid speech
-Feeling of dread
-Confusion
-Purposeless activity
-Sense of impending doom
-Hyperventilation
-Tachycardia
-Withdrawal
-Threats & demand
Panic
- Unable to focus on the
environment
- Experience the utmost
state of terror and emotional paralysis
- In panic, may have hallucination or
delusion
- Unable to learn and solve problems
- disorganized or irrational reasoning
- Immobility or severe hyperactivity
- Inability to communicate
- severe shakiness
-Sleeplessness
-Severe withdrawal
describe definition, types of anxiety disorders.
i. Generalised Anxiety Disorder
ii. Social Anxiety
iii. Panic Disorder w/ wo agoraphobia: Four or more symptoms:
palpitations, chest pain, shortness of breath,
choking, nausea, abdominal distress, sweating,
trembling, dizzy, derealisation, depersonalisation,
fear of losing control, of going crazy or of dying
iv. Simple Phobia
v. Obsessive Compulsive Disorder: Obsession: Recurrent and intrusive thoughts, feelings, idea, and sensation.
Compulsion: A conscious recurrent behaviour such as
cleaning, counting, checking, or avoiding.
vi. Adjustment Disorder
identify available treatments
OCD:
1.Pharmacotherapy
Tricyclics (TCAs)
- Clomipramine (Oral)
Selective Serotonin Reuptake Inhibitor (SSRI)
- Fluoxamine (Luvox)
- Fluoxatine (Prozac)
- Paroxetine (Paxil)
-Sertraline (Zoloft)
-Citalopram
Tricyclics/SSRI with Buspirone (if anxious)
with Clonazepam
Tricyclics/SSRI with antipsychotics (if
delusional)
2.Psychotherapy
*Research shows that “behaviour therapy” was an effective treatment for OCD
*Therapeutic Techniques
- Exposure in vivo
- Exposure in fantasy
- Response prevention (Delaying performance & ritual)
*Patient Education
- Managing anxiety during exposure sessions
- Group Therapy
- Cognitive Reconstructuring
- Record Keeping
plan nursing interventions for individuals with anxiety disorders and OCD
Mild and moderate:
Goals; Gain recognition and insight into anxiety
and learning new and adaptive coping behaviours.
- Psychoeducation: knowledge of anxiety, coping resources, and maladaptive responses.
- Recognition of anxiety: help the pt recognise
feelings of anxiety & associated behaviors.
- Encourage pt to talk about his/her feelings.
- Insight into the anxiety: help the pt describe situations that immediately precede anxiety.
“what were you thinking before you started to
feel anxious”
Show interest to the patients (e.g. leaning
toward, maintain eye contact, stay with pt)
Focus on the pt’s concerns.
Use clarifying techniques “ I am not sure what
you mean. Give me an example”
Teach coping strategies.
Assist in develop alternative solutions to a problem through role play or modeling
behaviors.
Explore behaviors that worked to relieve anxiety in the past.
Promote relaxation response
Severe and panic:
- Maintain a calm manner.
- Always stay with the patients.
- Minimize environmental stimuli.
- Use clear, simple statement, repetition.
- Use a low-pitched voice. Speak slowly.
- “Presenting reality” if perception distorted.
- Provide physical and safety need if necessary
(e.g. food, fluid, pain relief, need for family
contact).
- Administer medication as prescribed (e.g.,
anxiolytics)
