Exam 2 Flashcards
Anxiety: Assessment
determine whether anxiety is the primary problem (anxiety disorder) or secondary to another source (medical condition or substance), determine level (mild, moderate, severe, panic), assess for potential self harm and suicide, psychosocial assessment (what is going on in your life that is contributing?); Hamilton Rating Scale for anxiety (high scores indicate generalized anxiety or panic disorder.
Anxiety: diagnosis (examples)
Anxiety (moderate, severe, panic)
Ineffective coping
Chronic low self esteem
Self-mutilation
Anxiety: planning
Usually, patients with anxiety do not require admission, therefore planning may involve selecting interventions that can be implemented in a community setting. Whenever possible the patient should be encouraged to participate. Shared planning is especially appropriate for someone with mild or moderate anxiety.
Anxiety: implementation - pharmacological
Pharmacological: antidepressants (SSRIs, SNRIs (cymbalta for generalized anxiety), and MAOIs (reserved due to hypertensive crisis from eating tyramine)), antianxiety (benzodiazepines-quick onset due to dependency & side effect potential; buspirone is an alternative anxiolytics that does not cause dependence but 2-4 weeks are required to titrate), Beta blockers (block nerves that stimulate the heart to beat faster-social anxiety), anticonvulsants (social and generalized), antihistamines (safe alternative to benzos)
Anxiety: implementation-non-pharmacological
Cognitive therapy: negative beliefs cause anxiety (I have to be perfect or my bf will not love me)-restructuring of this thought process.
Behavioral therapy: relaxation training, modeling (to imitates role model), systematic desensitization, flooding (opposite of desensitization), thought stopping.
Cognitive behavioral therapy: combination of the two
Anxiety: evaluation
Is the patient experiencing a reduced level of anxiety?
Does the patient recognize symptoms as anxiety related?
Is the patient able to use newly learned behaviors to manage anxiety?
Does the patient adequately perform self-care activities
Is the patient able to assume usual roles and maintain interpersonal relations?
Anxiety levels: mild to moderate
Still able to solve problems; however, the ability to concentrate decreases as anxiety increases.
Nursing communication techniques should include: open-ended questions, giving broad openings, and exploring and seeking clarification.
Anxiety levels: severe to panic
Unable to solve problems and may have a poor grasp of what is happening in the environment.
Nursing interventions should prioritize the safety of the patient and others and to meet physical needs (fluids, rest, etc)
Agoraphobia
Intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. (E.g. Afraid to travel in a car, afraid to leave the house, think of What About Bob)
Panic disorder
An anxiety disorder where panic attacks are a key frailties. A panic attack is the sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom.
Social anxiety disorder
Also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that be evaluated negatively by others. (Ex. Fear of saying something that sounds foolish in public, looking like a weirdo while eating or drinking in public, etc)
Generalized anxiety disorder
Excessive worry that is out of proportion to the true impact of events or situations. These people anticipate disaster and are: restless, irritable, and experience muscle tension. Decision making is difficult for these people and sleep disturbance is common. (Ex. Include: Inadequacy, health of family members, finances).
Obsessive compulsive disorder
Obsessions: thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind even if attempted.
Compulsions: ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity.
Pathological obsessions or compulsions (sexuality, violence, contamination, illness or death) cause marked distress to individuals who often feel humiliation or shame regarding these behaviors.
Body dysmorphic disorder
An obsessive compulsive disorder that involves preoccupations with an imagined defective body part. (Behavior ex.: mirror checking, camouflaging). These people are commonly seen in psychiatric, cosmetic surgery, and dermatological settings.
False assumptions about the importance of appearance, fear of rejection by others, perfectionism, and conviction of being disfigured lead to overwhelming emotions of disgust, shame and depression.
Depression: Assessment
Assess suicide potential (symptoms: severe hopelessness, overuse of alcohol, recent loss or separation, a history of past and serious suicide attempts, and acute suicidal ideation) - do they have a plan?
Depression can be secondary to other disorders therefore evaluate whether: the patient is psychotic, has taken drugs or alcohol, medical conditions, history of comorbid psychiatric syndrome (anxiety, eating disorder)
Affect
The outward representation of a persons internal state of being. This is an objective finding based on the nurses assessment.
Depression: diagnosis (examples)
*risk for suicide is always considered (high priority) Risk for self-directed violence Social isolation Chronic low self esteem Ineffective coping Self-care deficit
Depression: planning
Geared towards the patient’s phase of depression. Always be cognizant for the potential of suicide and self harm (and harm to others). Safety is priority but personal care, social interaction, activity level, etc need targeting as well.
Depression: implementation
Acute phase: (6-12 weeks) reduction of symptoms and restoration of psychosocial and work function. Continuation phase (4-9months) prevention of relapse through pharmacotherapy, education, and psychotherapy. Maintenance phase (1 year or more) treatment is directed at prevention of further episodes. Medication may be phased out or continued.
Anhedonia
Loss of ability to experience joy or pleasure in living
Depression: evaluation
Ongoing evaluation on the frequency and content of suicidal ideation.
Benzodiazepines
Promote activity of the neurotransmitter GABA. Result is increased frequency of chloride channel opening which inhibits cellular excitation.
Buspirone (BuSpar)
Reduces anxiety without having strong sedative hypnotic properties. It is not a CNS depressant and therefore does not have a great danger of reaction with other CNS depressants such as alcohol.
Clonazepam (Klonopin) is a
Benzodiazepine for panic disorder
Amitriptyline (Elavil) is a
Tricyclic antidepressant (which are like old SSRIs)
