Exam 2 Study Material Flashcards
(117 cards)
1
Q
Anxiety Definition
A
vague feeling of dread or apprehension
- response to internal or external stimuli
- can be behavioral, cognitive, emotional physical symptoms
2
Q
Why can anxiety be positive?
A
motivation can take action to fix the stressor
3
Q
Peplau degrees of anxiety
A
Mild Moderate Severe Panic Flashcard from exam 1 on this
4
Q
Nursing interventions for mild, moderate, severe and panic stages of anxiety
A
Mild - educate about coping and problem solving
Moderate - keeping pt. attention, short easy to understand sentences, redirection
Severe - remain with pt., calm voice, walk with pt.
Panic - safety is priority, decrease stimuli, reassume pt. its just anxiety
5
Q
Describe panic disorder
A
Very common - 1/4 adults have it. Genetic or GABA is too low or norepinephrine too high
Panic attacks - 15-30 minute rapid, intense, escalating anxiety with 4 or more (palpation, sweating, tremors, SOB, sense of suffocation, CP, nausea, stomach distress, dizziness, paresthesias, chills, hot flashes)
6
Q
What does someone experience to be diagnosed with anxiety
A
Recurrent, unpredictable panic attacks followed by at least 1mo of persistent worry about more attacks or significant behavior change related to them
7
Q
Phobia definition
A
Persistent, irrational fear attached to object or situation that objectively does not pose a significant danger
8
Q
Agoraphobia
A
Anxiety regarding being in places or situations from which escape would be difficult, or help may not be available
Individuals with agorophobia become excessively dependent on spouse or relative, and may become housebound
Chemical dependency and depression common
9
Q
Social anxiety disorder (social phobia)
A
Fear of social or performance situations in which embarrassment may occur
Fear of being exposed to the scrutiny of others
Examples: fear of public speaking, fear of eating in public
10
Q
What is a specific phobia?
A
Excessive or unreasonable fear of specific object or situation
Examples: Fear of flying; fear of heights (acrophobia); fear of closed spaces (claustrophobia); fear of blood; fear of snakes, etc.
Behavioralists suggest that fears may be learned behaviors
- often occur in childhood and adolescents
- these fears can be learned behaviors (i.e., learned from guardian)
11
Q
Treatment for phobias
A
- Behavioral Therapy
a. teaching about anxiety, helping pt identify anxiety responses
b. teaching relaxation techniques, helping pt visualize phobic situation
c. Systematic desensitization (therapist ID what phobia is… will have pt list in order situations of the phobia from least to most anxiety producing)
d. Flooding – rapid desensitization (lock in room until no longer anxious)
b. Medications
Xanax, Buspar, Imipramine, Paxil, Zoloft
12
Q
Buspar
A
long acting anti-anxiety, not as many sfx as benzos, 4-6 weeks for fx
13
Q
paxil and zoloft
A
SSRI, long treatment
14
Q
Generalized anxiety disorder
A
Excessive anxiety and worry about a number of events or activities
Impatience, irritability, hyper-arousal
Difficulty concentrating and sleeping
15
Q
General anxiety disorder diagnosis
A
feel anxious for at least half of the day everyday for 6+ more months
16
Q
Separation anxiety disorder
A
Involves excessive fear/anxiety concerning separation from home or attachment figures
– typically school age children
17
Q
OCD
A
anxiety driven disorder but NOT anxiety disorder
Previously classified as an anxiety disorder
Disorders characterized by repetitive thoughts
and/or behaviors – OCD spectrum
repetitive, self soothing behaviors, reward seeking seeking, and body …. etc.
18
Q
Obsession vs. compulsion
A
Obsession—a recurrent, persistent thought, idea, impulse or image that is experienced as intrusive and inappropriate and that causes anxiety or distress
Compulsion—repetitive, ritualistic behavior the person feels compelled to perform
19
Q
OCD incidence
A
Can start in childhood, especially males
In females more commonly starts in 20’s
Symptoms wax and wane over lifetime
Early onset seem to have more severe symptoms, more comorbid diagnoses and family history of OCD
20
Q
ODC related disorder: Excoriation disorder (dermatillomania)
A
Skin picking, self-soothing behavior
21
Q
OCD: Trichotillomania
A
Chronic, repetitive hair pulling – self-soothing behavior
hair anywhere on body
22
Q
OCD: body dysmorphic disorder (BDD)
A
Preoccupation with imagined or slight defect in physical appearance
Blames all of lifes problems on defect, ruminates
23
Q
OCD: Hoarding disorder
A
Had previously been a symptom of OCD, now own diagnosis
Excessive acquisition of animals or useless things
“Reward” behavior
24
Q
OCD treatment
A
- Cognitive and behavioral therapy
a. Learns to tolerate thoughts/anxiety and recognize it will go away without consequences that are imagined
b. Exposure and response prevention
Medications
- SSRI (Luvox, Zoloft)– First line
- Effexor (SNRI)
- Risperdal, Seroquel, Zyprexa – treatment resistant (2nd generation antipychotics; not 1st option)
25
Describe exposure and response prevention
Exposure – assisting pt in purposefully confronting situations/stimuli they usually avoid
Response prevention – focuses on delaying or avoiding performance of rituals
26
PTSD
Disturbing pattern of behavior by pt who has experienced, witnessed or been confronted by a traumatic event
4 subcategories --> intrusive memories, avoidance, negative changes in thinking/mood, changes in physical and emotional reactions
27
Describe the 4 subcategories of PTSD symptoms
Intrusive memories - dreams, recurrent thoughts
Avoidance - no thinking/talking about event, avoiding places/people that are reminders of event)
Negative changes in thinking/mood – hopelessness, memory problems, not able to maintain close relationships, lack of interest in activities, unable to feel positive emotions
Changes in physical and emotional reactions – easily startled/frightened, drinking too much, driving too fast, insomnia, trouble concentrating, irritability, outbursts
28
Describe the s/s PTSD
Symptoms can occur 3 months or more after trauma occurs
Is typically chronic, complete recovery within 3 months occurs in
about 50% of pts
Symptoms can fluctuate and may become worse during stressful times
Pts often develop other psych disorders (depression, anxiety, substance abuse)
Can occur at any age
29
Acute stress disorder
Exposure to a traumatic event causes numbing, detachment, and amnesia about the event for at least 3 days but not more than 1 month following the event
Can be a precursor to PTSD
Cognitive behavioral therapy and anxiety management can prevent PTSD from occurring
30
Nursing interventions with anxiety disorders
Relaxation, imagery and systematic desensitization techniques
• Talk Therapy, EMDR
• Medication administration, teaching, and monitoring for signs of dependence and abuse with antianxiety medications
• Commonly prescribed anxiolytic medications
31
Psychosomatic
Connection between mind and body
| -Mind can cause body to create physical symptoms or worsen physical illness
32
Somatic symptoms
Physical symptoms suggesting medical disease
No pathological or physiological cause
Psychological factors are cause for symptoms
fatigue, insomnia, aches and pain, hypertension, SOB
33
Why do we think somatic illnesses occur (etiology theories)
Psychosocial
Internalization – keeps stress, emotions, anxiety inside
instead of expressing them
Expressed internalized feelings into physical symptoms
Biological
Sensory input amplifies normal body sensations and exaggerates them into physical symptoms
Somatic disorders are more common in women than men
34
Incidence of somatic disorders
Often start experiencing symptoms in adolescence
Usually not diagnosed until early adulthood
Conversion disorder usually between 10-35 years
Pain disorder and illness anxiety can occur at any age
All somatic symptom illnesses are chronic or recurrent
Pts usually do not seek psychiatric help until all
resources are exhausted for medical diagnosis
35
Somatic symptom disorder diagnosis
Presence of 1 or more somatic symptoms that are
distressing or result in disruption of daily life
Excessive thoughts, feelings, or behaviors related to the somatic symptoms
36
Illness anxiety disorder
Formerly called hypochondriasis or hypochondriac
Preoccupation with having or acquiring a serious
illness
Somatic symptoms usually not present—but if present
are only mild in intensity
High level of anxiety regarding health
Either repeatedly checks body for signs/symptoms—or
exhibits maladaptive avoidance of doctor
appointments
37
Conversion disorder
Unexplained, usually sudden deficits in sensory/motor function
- Blindness
- Paralysis
Suggest neurologic disorder but are associated with psychological
factors
May be an attitude of la belle indifference – lack of concern or distress about the deficit
38
Body dysmorphic disorder
Exaggerated belief that the body is deformed or
defective in some specific way
Individuals may consult plastic surgeons or
dermatologists and may undergo unnecessary surgery
Excessive anxiety with the imagined defect cause
social and occupational impairment
39
Malingering disorder
Intentional production of false or grossly exaggerated symptoms
Motivated by external incentives such as avoiding work, criminal prosecution, getting financial compensation or drugs
40
Factitious disorder, imposed on self (Munchausen)
Intentionally produces symptoms just for attention
May even inflict injury on self for attention
41
Somatic sypmtom interventions
Accept the physical complaint is real to the client
Convey empathy
Reaffirm the diagnostic test results reveal no
pathology
Help the client verbalize fears and anxieties related to the thoughts of physical complaint/illness
Assist client in identifying appropriate coping
mechanisms
Assess client’s perception of his or her body image
Help patient recognize the misperception
42
Somatic disorder treatment
```
Controlling symptoms
Depression/anxiety may also be present
May use antidepressant medications
Prozac, Paxil, Zoloft most commonly used
Cognitive behavioral therapy
```
43
Go look at "Anxiety effects handout" in week 3 content
okay good
44
intoxication
use of a substance that causes abnormal behavior
45
Withdrawal syndrome
a negative mental and physical reaction happens when the use of the substance stops or significantly decreased
46
Detoxification
process of withdrawaling safely from substance
47
Substance abuse
using substance in a way that is not consistent with medical/social norm dispit its negative consequences
48
Substance dependence
being addicted to substance
49
Tolerance break
when someone just needs small amounts of alc to become intoxicated
50
Who has the highest rates for successful recovery
ppl who dont use substances at all going forward and motivated to change and actively work to prevent relaspe
51
Spontaneious remission
quits drinking on own without outside help
| might engage in other activities like church or pyhsical activity
52
Etiology of addiction: biologic factors
Genetic vulnerability
| Neurochemical influences
53
Etiology of addiction: psychosocial factors
family dynamics, coping styles
54
Etiology of addiction: social and environmental factors
Cultural factors, social attitudes, peer behaviors Laws, cost, availability
55
Cultural considerations with alcohol for muslims, jewish, native american, japan, russia
Muslims - typically do not drink
Jew - wine big part of religion
Native American - some tribes use peyote
Japan - alc. not regarded as drug
Russia - high rates of alc. abuse, suicide, and cig for male population
56
Alcohol - effects of intoxication
Slurred speech, unsteady gait, lack of coordination, and impaired attention, memory, judgment
Aggressive behavior or display of inappropriate sexual behavior; blackout
57
Alcohol overdose
vomiting, unconsciousness, respiratory depression
(medical attention, turn to side, dont put stuff in mouth, gastric laboge (?); get physiologically stable before you worry about any other treatment )
58
Long term effects of alcohol: Cardiomyopathy
weakened and thinned cardiac muscle; impairs hearts ability to pump blood correctly
59
Long term effects of alcohol: Wernicke encephalopathy
caused by thiamine deficiency (key vitamin); severe mental status changes
hard time tracking items with eyes, poor coordination, shuffling gait
60
Long term effects of alcohol: Korsakoff psychosis
might be paired with above Wernicke encephalopathy; late complication of persistent Wernicke encephalopathy OR can happen after repeated episodes of alc. withdrawal; memory is severly impacted (short term); disoriented to time, emotional changes
61
Long term effects of alcohol: pancreatitis
inflammation of pancreas; abd pain / back pain, bloat, fatty stool; tachycardia
62
Long term effects of alc.: Eosphagitis
inflammation of esophagus, pain, chest pain
63
Long-Term Effects of Alcohol: hepatitis
inflammation of liver; jaundice, n/v, abd. tender, low grade fever, tired, malnourished
64
Long-Term Effects of Alcohol: cirrhosis
fibrosis of liver, chronic liver damage, irreversible
65
Long-Term Effects of Alcohol: ascites
accompanies cirrhosis; fluid collects in abd; look preg.; increases likely hood of death in following year
treat w abd. tap to remove fluid but they fill back up quick
66
CAGE questionnaire
Instrument for detecting an alcohol use disorder
Have you ever felt you should CUT down your alcohol intake?
Have you ever felt ANNOYED by criticism of your drinking?
Have you ever felt GUILTY about your drinking?
Have you ever taken a drink first thing in the morning (EYE-OPENER) to steady your nerves?
(Answering “yes” to two of the four questions in the CAGE increases the likelihood of an alcohol use disorder to at least 90%)
67
CIWA
based on score, tells us how much benzo we give our pt to ensure they withdrawal safely
68
Onset of alc WD
Onset within 4 to 12 hours after cessation or marked reduction of alcohol intake; usually peaks on the second day and complete in about 5 day
69
S/S alc. WD
coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety (because CNS so used to being depressed so now its lighting up and going crazy)
70
Severe or untreated alc. s/s may lead to what?
transient hallucinations, seizures, or delirium (DTs).
71
Delerium tremens
severe form of alc. WD; begin within 48-96 hr after last week but can occur up to 7-10 days; tremors, irritable, AMS, deep sleep lasting days, confusion, hallucinations, sensitive to light sound and touch, seizures
72
intoxication symptoms of sedatives, hyponotics, and anxxiolytics
slurred speech, lack of coordination, unsteady gait, labile mood, stupor
73
What does barituate OD look like
possibly lethal; coma, respiratory arrest, cardiac failure, death
74
When does WD occur for Sedatives, Hypnotics, and Anxiolytics
dependent on half-life of drug
| - symptoms opposite of drug's acute effect
75
CNS stimulant - intoxification and OD s/s
High or euphoric feeling, hyperactivity, hypervigilance, anger; elevated blood pressure, chest pain, confusion
• Seizures, coma with overdose
76
CNS stimulant WD
Onset within hours to several days
• Primary symptom is marked dysphoria.
• “Crashing”
• Not treated pharmacologically
not life-threatening; can be uncomfortable
77
Cannabis intoxification s/s
Lowered inhibitions, relaxation, euphoria, increased appetite
Symptoms of intoxication include impaired motor control, impaired judgment
Delirium, cannabis-induced psychotic disorder
No overdose or clinically significant WD syndrome
78
Opioid intoxication s/s
Desensitization to pain, euphoria, well- being
• Intoxication: apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech, and impaired attention and memory
79
Opioid OD s/s
coma, respiratory depression, pupil constriction, unconsciousness, death
• Naloxone
80
What could someone use to taper off opioids
methadone
81
Opioid WD s/s
Nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, and insomnia
Symptoms cause significant distress
Short-acting drugs (e.g., heroin): onset in 6 to 24 hours; peaking in 2 to 3 days and gradually subsiding in 5 to 7 days
Longer acting drugs (e.g., methadone): onset in 2 to 4 days, subsiding in 2 week
82
Substance abuse treatment
Ind., group, counseling treatment settings
Pharm. treatment to ensure safe WD and prevent relapse
Treatment models
12-step program of Alcoholics
Anonymous (AA; see Box 19.3)
83
Medications for substance use disorder
a. Disulfiram (antabuse)
b. Naltrexone (ReVia)
c. Thiamine (multivitamins)
d. Methadone
e. Benzodiazapine
84
Dual Diagnosis
Substance abuse and another psychiatric illness
Estimated 50% of people with a substance abuse disorder also have mental health diagnoses
Dual diagnosis with schizophrenia, schizoaffective disorder, or bipolar present greatest challenge
The use of substances can increase psychotic behavior
Integrated treatment programs more successful
85
Dual Diagnosis treatment
Successful treatment, relapse prevention strategies (see Nursing Care Plan)
Healthy, nurturing, supportive living environments
Help with fundamental life changes
Connections with other recovering people
Treatment of comorbid conditions
86
Substance abuse: assessment
```
History
General appearance and motor behavior
Mood and affect
Thought process and content
Sensorium and intellectual processes
Judgment and insight
Self-concept
Roles and relationships
Physiological considerations
Type of substance used/abused
Amount and frequency of substance use
Any withdrawals/previous attempts at quitting
Overdoses?
Co-dependence
```
87
Substance abuse - data analysis/nursing diagnosis
```
Outcome identification
Abstain from alcohol and drug
use
Express feelings openly and directly
Accept responsibility for own behavior
Practice nonchemical coping alternatives
Establish an effective aftercare plan
```
88
Substance abuse interventions
addressing family issues
| promoting coping skills
89
Substance abuse: nurse's response
- Be aware of feelings related to alcoholism and drug abuse
• Keep in mind all substance dependent persons suffer from negative self concept
• Avoid reinforcing the negative self concept through non therapeutic treatment
90
Substance abuse in HC professionals, general warning signs:
* Poor work performance/frequent absenteeism
* Increase in wasting drugs, incorrect narcotic counts, higher record of signing out drugs
* Patient’s complaints of inadequate pain control
* Poor concentration, difficulty meeting deadlines, poor memory or recall
* Problems with relationships
* Irritability, isolative, exaggerated excuses for behavior
* Unkempt appearance
91
Schizophrenia
Syndrome/disease process with different varieties and symptoms
• Causes distorted and bizarre thoughts, perceptions, emotions, movements, behavior
92
Schizophrenia - categories of symptoms
Positive (hard)
• Examples: delusions, hallucinations
Negative (soft)
• Examples: flat affect, lack of volition, inattention
93
Go look at slide 3/31 to see more positive vs hard symptoms of schizoprenia
ok goof
94
Schizophrenia - when is it diagnosed?
late adolescents or early adulthood
95
Schizophrenia - peak incidence of onset
15-25 for men
| 25-35 for women
96
Schizophrenia etiology
Biologic theories
a. genetic factors
b. neuroanatomic and neurochemial factors
c. research focusing on infections in pregnant women as possible origin (after influence epidemics, respiratory ailments)
97
Schizophrenia onset
abrupt or insidious, most with slow, gradual development of signs and symptoms
diagnosis is usually with more actively positive symptoms of psychosis
98
Schizophrenia: immediate term course
in the years immediately following onset of psychotic symptoms 2 patterns emerge
1. Ongoing psychosis, never fully recovering
2. Episodes of psychotic symptoms alternating with episodes of relatively complete recovery
99
Schizophrenia: Long-term course
intensity of psychosis diminishes with age; disease becomes less disruptive; clients may live independently later in life; many have difficulty functioning in the community.
100
Related disorders to schizophrenia
* Schizophreniform disorder • Catatonia
* Delusional disorder
* Brief psychotic disorder
* Shared psychotic disorder
* Schizotypal personality disorder
101
Schizophrenia treatment: conventional antipsychotics
Targeting positive signs (delusions, hallucinations, disturbed
thinking)
• No observable effect on negative signs
102
Schizophrenia treatment: second generation antipsychotics (example and MOA)
Dopamine, serotonin antagonists
Deminish positive symptoms
Lessen negative symptoms - lack of motivation, social withdrawal, anhedonia
103
Schizophrenia psychopharmacology --> • Six antipsychotics available in long-acting injection form:
6 antipsychotics available in long-acting form
• Fluphenazine in decanoate and enanthate preparations 1st gen • Haloperidol in decanoate 1st gen
• Risperidone 2nd gen
• Paliperidone 2nd gen
• Olanzapine 2nd gen
• Aripiprazole 3nd gen
May take several weeks of oral therapy to reach stable dosing level before transition to depot injections
104
Schizophrenia psychopharmacology side effects (neurologic)
1. Extrapyramidal side effects
a. acute dystonic reactions
b. Akathisia
c. Parkinsonism
2. Tardive dyskinesia
3. Sz.
4. Neuroleptic malignant syndrome
105
Acute dystonic reactions
involuntary muscle contractions, repetitive movements (extrapyramidal sfx)
106
Akathisia
muscle quivering, restlessness
107
Parkinsonism
tremor, slow movement
108
Tardive dyskinesia
repetitive, involuntary movements (grimacing, eye
| blinking)
109
Schizophrenia - nonneurological sfx
* Weight gain, sedation, photosensitivity
* Anticholinergic symptoms
* Orthostatic hypotension
110
Schizophrenia - psychosocial treatment
* Individualandgrouptherapy
* Medication management, use of community supports • Socialskillstraining
* Familyeducationandtherapy
111
Schizophrenia and Nursing Process Application: assessment
history
general appearence, motor behavior, and speech
mood and affect
thought process and content
delusions
sensorium and intellectual processes: hallucination, depersonalization
112
Schizophrenia and Nursing Process Application: Data analysis / nursing diagnosis
* Risk for other-directed violence • Risk for suicide
* Disturbed thought processes
* Disturbed sensory perception
* Disturbed personal identity
* Impaired verbal communication
113
Schizophrenia and Nursing Process Application: outcome ID (acute psychosis, treatment)
* Focus on safety of client and others
* Contact with reality
* Interact with others in environment
* Express thoughts and feelings in a safe, socially acceptable manner
* Adhere to interventions
114
Schizophrenia and Nursing Process Application: interventions
* Safety of client and others
* Therapeutic relationship
* Therapeutic communication
* Interventions for delusional thoughts
* Interventions for hallucinations
* Coping with socially inappropriate behavior
* Client and family education
* Signs and symptoms of relapse (see Box 16.5) • Self-care, nutrition
* Social skills
* Medication management
115
Schizophrenia: cultural considerations
* Ideas considered delusional in one culture possibly commonly accepted by other cultures ex: witchcraft
* Auditory or visual hallucinations as normal part of religious experiences in some cultures ex: hearing Gods voice
* Ethnic differences in response to psychotropic medications
116
Schizophrenia: Community based care
* Housing with family or independently
* Assertive community treatment programs • Behavioral home health care
* Community support programs
* Case management services
117
Schizophrenia: self-awareness issues
* Recognize client’s suspicious or paranoid behavior is part of the illness, not a personal affront.
* Nurse may be frightened; acknowledge those feelings and take measures to ensure safety.
* Don’t take client’s success or failure personally.
* Focus on the amount of time client is out of hospital.
* Visualize the client as he or she gets better.
