MOD. 3 ATI ch. 11, 21, unit 4

Question 1

Anxiety: Types of Disorders

Answer 1

Separation Anxiety Disorder
Specific phobias
Agoraphobia
Social anxiety disorder
Panic disorder
Generalized anxiety disorder (GAD)

Question 2

Separation Anxiety Disorder

Answer 2

client experiences excessive fear or anxiety when separated from an individual to which the client is emotionally attached.

Question 3

Specific phobias

Answer 3

experiences an irrational fear of a certain object or situation. (ex. monophobia- phobia of being alone, xoophobia- phobia of animals, acrophobia- phobia of heights).

Question 4

Agoraphobia

Answer 4

client experiences an extreme fear of certain places

Question 5

social anxiety disorder

Answer 5

social phobia.

client experiences excessive fear of social or performance situations

Question 6

panic disorder

Answer 6

client experiences recurrent panic attacks

Question 7

generalized anxiety disorder (GAD)

Answer 7

client exhibits uncontrollable, excessive worry for at least 6 months.

Question 8

Obsessive Compulsive Disorder

Answer 8

not actual anxiety disorders but have similar effects

effects: OCD, hoarding disorder, body dysmorphic disorder

Question 9

Anxiety Risk Factors

Answer 9

gender
hyperthyroidism
pulmonary embolism
adverse effects of meds.
substance-induced anxiety

Question 10

Expected Findings of Anxiety Disorders

Answer 10

separation anxiety disorder
specific phobias
agoraphobia
social phobia
panic disorder
generalized anxiety disorder
OCD

Question 11

Expected Findings of Anxiety Disorders

Answer 11

separation anxiety disorder
specific phobias
agoraphobia
social phobia
panic disorder
generalized anxiety disorder
OCD

Question 12

generalized anxiety disorder (GAD) manifestations

Answer 12

restlessness

muscle tension

avoidance of stressful activities or events

increased time and effort required to prepare for stressful activities or events

procrastination in decision making

sleep disturbance

Question 13

Anxiety screening tools

Answer 13

Hamilton Rating Scale for Anxiety
Fear Questionnaire (phobias)
Panic Disorder Severity Scale
Yale-Brown Obsessive Compulsive Scale
Hoarding Scale Self-Report

Question 14

Anxiety Medications

Answer 14

SSRI antidepressants
SNRI antidepressants
Antianxiety medications- benzodiazepines, buspirone, beta blockers, antihistamines, anticonvulsants

Question 15

SSRI antidepressants

Answer 15

first line for anxiety and OCD

sertraline or paroxetine

Question 16

SNRI antidepressants

Answer 16

effective in treatment of anxiety

venlafaxine or duloxetine

Question 17

Other antianxiety meds.

Answer 17

benzos (diazepam)- indicated for short term
busiprone- taken for long-term use
beta blockers and antihistamines- to decrease anxiety
anticonvulsants- mood stabilizer for a client experiencing anxiety

Question 18

Anxiety: Therapeutic Procedures

Answer 18

cognitive behavioral therapy

behavioral therapy

Question 19

Cognitive behavioral therapy

Answer 19

decrease anxiety by changing cognitive distortions.
Uses cognitive reframing to help client identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.

Question 20

Behavioral Therapy

Answer 20

teach clients ways to decrease anxiety or avoidant behavior and allow an opportunity to practice techniques.

relaxation therapy
modeling
systematic desensitization
flooding
response prevention thought stopping

Question 21

Relaxation training

Answer 21

control pain, tension, and anxiety.

Question 22

modeling

Answer 22

allows client to see a demonstration of appropriate behavior in a stressful situation. Goal is for client to imitate behavior

Question 23

systematic desensitization

Answer 23

begins with mastering of relaxation techniques. Then client is exposed to anxiety stimuli so they can use the techniques. Goal is for client to tolerate higher and higher levels of anxiety. Used a lot with phobias

Question 24

flooding

Answer 24

exposing the client to a great deal of undesirable stimulus in attempt to turn off anxiety response. Used for clients with phobias

Question 25

Response prevention

Answer 25

preventing client from performing a compulsive behavior with the intent that anxiety will diminish.

Question 26

thought stopping

Answer 26

teaches client to say "stop" and change thought to a positive thought. Goal is for client to silently use the command.

Question 27

Medications for Anxiety Disorders

Answer 27

Benzos. Atypical anxiolytic/ non-barbiturate anxiolytics Others

Question 28

Benzos. Sedative Hypnotic Anxiolytics

Answer 28

Lorazepam Alprazolam Clonazepam Diazepam

Question 29

Atypical Anxiolytic/ non-barbiturate Anxiolytic

Answer 29

Busiprone

Question 30

Selected Antidepressants

Answer 30

Selective Serotonin Reuptake Inhibitors (SSRIs): paroxetine, sertraline, fluoxetine, citalopram, escitalopram, fluvoxamine Serotonin norepinephrine reuptake inhibitors (SNRIs): venlafaxine, duloxetine, desvenlafaxine

Question 31

Other Anxiolytics used

Answer 31

other antidepressants: * tricyclic antidepressants (TCAs): amitriptyline, imipramine, clomipramine * monoamine oxidase inhibitorss (MAOIs): phenelzine * Antihistamines: hydroxyzine pamoate, hydroxyzine hydrochloride * Mirtazapine * Trazodone Beta blockers: propranolol Centrally acting alpha- blockers: Prazosin Anticonvulsants: gabapentin, preabalin

Question 32

major meds to treat trauma-and-stressor related disorders

Answer 32

Antidepressants: SSRI, SNRI, tricyclic antidepressants, MAOI, noradrenergic and specific serotonergic antidepressant (NaSSA) beta blockers centrally acting alpha-blockers centrally acting 2 agonists

Question 33

SSRIs for trauma and stressor-related disorders

Answer 33

paroxetine, sertraline, fluoxetine, escitalopram, fluvoxamine

Question 34

Anxiety (study guide)

Answer 34

normal response to stress. Subjective feeling that includes feelings of apprehension, uneasiness, uncertainty, or dread. ``` normal= healthy acute= imminent loss of change that threatens one's sense of security chronic= persists ```

Question 35

Mild Anxiety

Answer 35

tense experiences that occur in everyday life, increased ability to grasp information, sense of sight and sound are increased. Can be motivating, produce growth, enhance creativity and increase learning. Physical symptoms- restlessness, irritability or mild tension

Question 36

Moderate Anxiety

Answer 36

focus is on immediate concerns. Narrowed perceptual field, sense of sight and sound diminish as selective inattentiveness occurs. Learning and problem solving still occur. Physical= increased heart rate, perspiration, gastric discomfort, headache, urinary urgency, and or mild tremors.

Question 37

Severe Anxiety

Answer 37

feeling something BAD is about to happen. Significant narrowing of perceptual fields, focus is on minute or scattered details, all behavior is aimed at relieving anxiety. Learning and problem solving are not possible Physical= caused by stimulation of SNS; headache, nausea, dizziness, sleep disturbance, increased tremors, pounding HR, hyperventilation. individual needs direction to focus

Question 38

Panic Anxiety

Answer 38

dread and tremor and sense of impending doom. Disorganization, difficulty perceiving perception occurs,. Is unable to communicate or function effectively. If prolonged it can lead to exhaustion and death. Physical= increased motor activity; pacing, shouting, screaming, or withdrawal, impulsive or erratic behavior

Question 39

Interventions for Mild to Moderate Anxiety

Answer 39

- help client identify source of anxiety - encourage client to talk about feelings and concerns - help client identify thoughts and feelings that occurred before the onset of anxiety - encourage problem solving - encourage gross motor exercise

Question 40

Interventions for Severe to Panic Anxiety

Answer 40

- reduce anxiety quickly: use calm manner - ALWAYS REMAIN WITH CLIENT - minimize environmental stimuli, provide clear statements, use low pitched voice - Attend to physical needs - provide gross motor activity - administer meds. as prescribed - ensure safety

Question 41

Assessment of GAD

Answer 41

restlessness and inability to relax episodes of trembling and shakiness, chronic muscular tension, dizziness, inability to concentrate chronic fatigue and sleep problems inability to recognize the connections between anxiety and physical symptoms client focused on physical discomfort

Question 42

Agoraphobia

Answer 42

fear of open spaces

Question 43

Interventions for OCD and related disorders

Answer 43

- ensure basic needs are met - identify situations that precipitate compulsive behavior - encourage client to verbalize concerns and feelings - Be empathetic toward the client and aware of their needs to perform compulsive behavior - DO NOT interrupt compulsive behavior UNLESS they're unsafe - allow client to perform compulsive behavior but... - SET LIMITS - set schedule that distracts them - establish written contract that assists client to decrease frequency - recognize and reinforce positive non-ritualistic behaviors

Question 44

PTSD

Answer 44

after traumatic event, individual is prone to re-experience the event.

Question 45

PTSD: | Diagnosis

Answer 45

diagnosis- symptoms last at least 1 month and can occur months to years after the traumatizing events

Question 46

PTSD: | Assessment

Answer 46

- avoidance or numbness - irritability or outbursts of anger - detachment - depression that may involve suicidal thoughts - anxiety - sleep disturbances and nightmares - flashbacks - hypervigilance - exaggerated startle response - guilt about surviving event - poor concentration and avoidance of activities

Question 47

PTSD: | Interventions

Answer 47

* non-judgmental * ensure feelings and behaviors are normal reactions * help recognize association between feelings and behaviors and trauma * encourage feeling expression * provide individual therapy that addresses loss of control or anger issues * monitor for suicidal risk * teach stress management technique * encourage support group * facilitate progressive review of the trauma ( FLOODING ) * encourage relationship establishments * include family * hypnotherapy/ systematic desensitization may be recommended *** cancer patients may develop PTS - can occur anytime during or after treatment. Symptoms similar to PTSD but not as severe

Question 48

Suicidal: | assessment

Answer 48

``` # assess if client is thinking of suicide # SAD PERSONS scale # comments or signals can be overt (direct) or covert (indirect): ex. overt= "there is just no reason to go on living" covert= "everything is looking pretty grim to me" # assess client's suicide plan # how lethal is the plan? # can client describe plan exactly # does client have access to intended method? # has the mood changed? sad to happy can indicate intention to commit suicide ``` Physical assessment findings= lacerations, scratches, scars

Question 49

Suicide: | Nursing Care

Answer 49

Primary intervention- focus on suicide prevention through the use of community education and screenings to identify individuals at risk. Secondary interventions- focus on prevention for a client who is having an acute suicidal crisis. Suicide precautions are included at this level. Tertiary interventions- providing support and assistance to survivors of a client who completed suicide.