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NUR 289 > Chapter 15 Anxiety and Obsessive > Flashcards

Chapter 15 Anxiety and Obsessive Flashcards

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1
Q

Agoraphobia

A

Intense excessive ANXIETY or FEAR about being:

-in places or situations

from which escape might be difficult or embarrassing or

-where help might not be available

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2
Q

Agoraphobia = word derivative

A 
agora = greek for open
phobia = fear
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3
Q

Agoraphobia
what is avoided? AND why?

A
  • *Feared places are AVOIDED.**
  • *To control anxiety.**
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4
Q

Agoraphobia

Examples of what is avoided

A

Being ALONE OUTSIDE
Being ALONE at HOME
Car, bus, or airplane.
BRIDGES
ELEVATORS

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5
Q

ANXIETY

Who has it?

A

Everyone
it is a universal human experience

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6
Q

Anxiety
what type of emotion is it

A

BASIC HUMAN EMOTION

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7
Q

ANXIETY

A

Feeling of apprehension, uneasiness, uncertainty, or dread from a

PERCEIVED or REAL threat. What is their reality?

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8
Q

ANXIETY vs FEAR

A

ANXIETY = vague sense of dread related to unspecified or unknown danger

FEAR= reaction to a SPECIFIC danger.

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9
Q

GAS
what is it?

A

General Adaptation Syndrome - Hans Selye. ARE

Alarm
Resistance
Exhaustion

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10
Q

FIGHT OR FLIGHT
Cannon

A
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11
Q

DSM-5 Anxiety Disorders
Name 5

A
  • *Separation Anxiety Disorder**
  • *Panic w or w/o Agoraphobia**
  • *Specific Phobias**
  • *SAD - Social Anxiety Disorder**
  • *GAD - General Anxiety Disorder**
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12
Q

Anxiety Disorders can be caused by +________+ and _____________-

A

another medical condition - ie hyperthyroidism

substance/medication induced -

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13
Q

COMPULSIONS - Anxiety Disorders related to
abnormal selective over attention obsessions
Name 5

A

COMPULSIONS

Obsessive Compulsive Disorder OCD
Body dysmorphic disorder
Hoarding disorder
Hair pulling (trichotillomania)
Skin picking (excoriation)

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14
Q

COMPULSIONS

A

RITUALISTIC BEHAVIORS individuals feel driven to perform in an attempt to reduce anxiety or prevent and imaged calamity. Only temporary relief so repeated again and again.

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15
Q

Body Dysmorphic Disorder

A

Imagined body defective part which results in obsessional thinking and compulsive behavior

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16
Q

Anxiety Disorders

A

Separation Anxiety

Panic with or without agoraphobia

Specific phobia

Social Anxiety Disorders (SAD)

General Anxiety Disorder (GAD)

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17
Q

Anxiety - Maladaptive coping

A

Smoking

Eating too much

Drinking

Drugs

Sleeping too much

Avoidiing behavior

Denial

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18
Q

Peplau’s 4 levels of anxiety

A

Mild, moderate, severe and panic

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19
Q

What are nursing interventions for anxiety based on?

A

Level of anxiety

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20
Q

anxiety is the initial response to a ________threat

A

psychic - their perception

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21
Q

Mild anxiety - 4 aspects

A

Occurs in everyday living

Perceive reality in sharp focus

Heightened awareness

CAN learn NEW behaviors and take in ALL stimuli

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22
Q

MIld Anxiety - sx

A

slight discomfort

irritability

mild tension-relieving behavior (nail biting)

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23
Q

Mild anxiety - can you teach/learning?

A

yes

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24
Q

Moderate Anxiety

A

Decreased perceptual field (immediate task only)

Can learn new behavior but only with assistance

Another person can redirect the person to a task

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25
Moderate Anxiety -Symptoms
Tension pounding heart Inc HR and RR sweating Mild somatic sx GI, H/A, urinary urgency GAS beginning to be activated
26
Severe Anxiety
Focus on only one detail or many scattered details Difficulty with noticing environment Feeling of dread or terror Cannot be redirected to task Learning is NOT possible, Not a good time for teaching
27
Severe Anxiety - symptoms
H/A headache Nausea Dizziness insomnia pounding heart hyperventilate sense of impending doom or dread May go to ER thinking they have a heart attack
28
Panic Anxiety
Most extreme level of anxiety marked disturbed behavior may lose touch with reality (delusions, distorted perceptions, hallucinations does not respond to efforts to calm physical immobility muteness - not able to speak physical behaviors - erratic, uncoordinated, impulsive, pacing, running, shouting, screaming my bolt/ run aimlessly expose self to injury and others safe environment - someone with them.
29
Panic Attack - first concern
Safety Must remain with them
30
Anxiety Disorders - 2 main biological factors that affect them
brain function - metabolic, substances genetic influences - get a family history, anyone else have anxiety disorder,
31
What is most important in determining response to an intervention?
The patient's feelings and perceptions about the situation.
32
What is most important in determining response to an intervention?
The patient's feelings and perceptions about the situation.
33
Defense Mechanisms/coping style
protect from anxiety maintain self-image by blocking feelings, conflicts, and memories repression, denial, displacement, regression, sublimation short term/initial may help but overuse - maladaptive
34
Defense Mechanisms - name 5
repression, denial, displacement, regression, sublimation
35
Repression
ego keeps disturbing/threatening thoughts from becoming conscious
36
Denial
Blocking external events from awareness. If situation too much to handle, person refuses to experience it.
37
Displacement
Satisfying an impulse with a substitute object when one is faced with stress. Upset with boss, goes home hits wife.
38
Regression
Movementment back in psychological time when faced with stress.
39
Sublimation
satisfying an impulse with a substitute object ie aggression with sport
40
what is most common psychiatric disorder in USA
Anxiety 40 million adults MORE COMMON IN WOMEN
41
Anxiety D/x what else to assess for?
Depression 80%
42
Anxiety comorbidity
MDD and Anxiety MDD and panic MDD and OCD MDD and SAD 37% MDD and PTSD
43
Anxiety and genetics
Clusters in families twin studie panic and ocd ½ people with panic have relative with panic PTSD and GAD inherited components
44
Freud and anxiety
threatened breakthrough of repressed ideas from unconscious to conscious defense mechanisms (ego) used to keep anxiety manageable defense mechanisms- non adaptive behavior because rigid and repetitive
45
Intellectualization
defense mechanism
46
Repression
Accident victim cannot remember the details
47
Identification
Younger sister copies older sister
48
Anxiety Harry Stack Sullivan Interpersonal theory
Linked to emotional distress when early needs unmet or disapproval contagious from parent to infant early life anxiety - prototype for later life
49
Anxiety - behaviorist theory
anxiety learned response to environmental stimuli - classical conditioning kid anxious when abusive mom is around, anxious around all wome
50
anxiety - cognitive theorist
anxiety caused by distortions in an individual's thoughts and perceptions CBT treatment
51
Assessment for Anxiety
ask direct and specific questions what makes you feels anxious, when do you feel anxious what do you avoid
52
Self assessment
impact on you if you work with anxious client, watch not taking on that anxiety self-awareness and self-care might feel anxiety, fear, anger, frustration, hopelessness may withdraw from patient and patient withdraws from you.
53
Cultural Considerations
must consider it with dx shame in the culture expression influenced by culture - a weakness, self-medicate
54
Generalized Anxiety Disorder (GAD)
excessive worry: inadequacy in interpersonal relationships job responsibilities finances health of family members
55
Social Anxiety Disorder (SAD)/Social Phobia
severe anxiety provoked by exposure to a social or performance situation that could be evaluated negatively by others. Ie fear of public speaking
56
SAD - risk factors
childhood mistreatment adverse childhood experiences shyness inheritable double risk genetic transmission if parent has
57
Anxiety - Self-Care
Prayer, meditation, exercise, mindfulness, walking, writing, music, deep breathing,
58
Anxiety - Medications
SSRI's BZO's and non- BZO's
59
How are they different? PTSD, GAD, Panic, Phobia, OCD, PTSD
60
Separation Anxiety Disorder
normal part of development 8-18 months usually dx prior to 18 years old causes:death, change in schools, sexual trauma developmentally inappropriate level of concern from being away
61
Adult Separation Anxiety
Begin as a child or adult problems with romantic relationships, usually unmarried harm avoidance, worry, shyness, uncertainty, lack of self-direction significant discomfort does not respond well to most psychotherapy or CBT
62
SAD
Social Anxiety Disorder is not Seasonal Affect Disorder
63
Panic Disorder
Extreme of Disorder Main characteristics palpitations trembling shaking pounding heart somatic fear of unknown illness sweating chest pain abdominal distress, weak, numbness, detached, fear of death, fear of going crazy
64
agoraphobia
may feel that it could happen again something will happen, they feel they will be out of control, not able to escape
65
Specific phobias
irrational fear of an object, activity, or situation that leads to avoidance treatment - is exposure SSRI
66
OCD
cyclic obsession, anxiety, compulsion, relife, then obsession again
67
OCD - timing
allow time for them reasonable
68
OCD - obsessive-compulsive disorder
**Obsession** -_thoughts,_ impulses, or images that recur and cannot be dismissed from the mind. Concerns about : cleanliness, hoarding, worry about contamination, harm to people **Compulsions**: ritualistic _behaviors_ individual driven to perform to reduce anxiety, time consuming, rigid rules, can interfere with adl's, relationships sexuality questioned, violence, contamination, illness, death
69
GAD
Lasts for more than 6 months excessive anxiety or worry, difficulty making decisions, fear of making mistage
70
GAD
Not as intense as panic excessive worry restless, sleep disturbance, spend large amounts of time preparing, lateness, absence, overall isolation
71
PTSD
characterized by persistent re-experiencing of highly. traumatic event that involved actual or threatened death or serious injury which the individual responded with intense fear, helplessness or horror. Actual or perceived threat veterans, car accidents
72
Flashbacks
dissociative experience event relived
73
PTSD symptoms
74
Acute Stress Disorder
acute onset with 1 month resolves in 4 weeks
75
substance-induced anxiety disorder
panic attacks obsessions compulsions
76
Medically induced anxiety
symptoms are directly related to the medical condition direct - hyperthyroid anxiety blood sugar low
77
Treatment for Anxiety - drugs
SSRI TCA (more side effects ) GAD - BZ, buspirone (2 weeks) TCA if also depressed Phobias -BZO, beta blockers, SSRI Panic, SSRI, BZO. TCA. MAO OCD, - SSRI, MAO PTSD- antidepressants - clonidine BZO highly addictive - avoid if SUD Short period of time BUSPIRONE - not prn - 2weeks non addictive BZO BZO - work fast 20-30 minutes, addictive no acute withdrawal
78
Kava Kava
Liver enzymes interactions
79
St. John's Wort
Seratonin syndrome too much seratonin with an SSRI
80
Milieau Therapy
Everything in the environment when hospitalized
81
SSRI
Citalopram - celexa. Escitalopram - lexapro Fluoxetine - prozac. Paroxetine - paxil Fluvoxamine - Luvox Sertraline - Zoloft Suicidality - conenr
82
SSNRI
Duloxetine - cybalta Venlafaxine - effexor need to take every day steady serum state
83
SSRI common side effects
Insomnia, sedations appetite change up or down Nausea Dry mouth headache sexual dysfunction
84
TCA
Cardiac, EKG done Ck Urinary retention, dry mouth blurred vision constipation fluids, roughage, exercise dizziniss OHT
85
TCA's - common
Amitriptyline elavil Clomipramine anafranil desipramine norpramin
86
Benzodiazepines BZO
dependency quick onset withdrawal short periods only not for SUD
87
BZO
xanax, librium, klonopin, ativan (lorazapam) diazepam Valium stat PRN sedation, ataxia,
88
Buspirone
Buspar 2 weeks

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