Test 2 (Case Study QUiz) - Chapter 27 - Anxiety, OCD, and related DO's AND Chapter 13 - crisis

Question 1

_________is apprehension, tension or uneasiness from anticipation of danger . The source is unknown or unrecognized. Emotional response.

Answer 1

anxiety

Question 2

_________is apprehension, tension or uneasiness from anticipation of danger for which the source is known. Cognitive response.

Answer 2

Fear

Question 3

What are the four levels of anxiety?

Answer 3

mild, moderate, severe and panic

study descriptions in slide

Question 4

How can we define normal versus neurotic anxiety?

Answer 4

Having anxiety out of proportion to the threat and causing one to be dysfunctional would be labeled neurotic. Example: Levy’s son almost jumped off the stairs at the water park to avoid a tiny little bee.

Question 5

_____ is the sudden overwhelming feeling of terror or impending doom. This most severe form of emotional anxiety is usually accompanied y behavioral, cognitive, and physiological S&S considered to be outside the expected range of normalcy.

Answer 5

panic.

Physio s&S = dilated pupils, labored breathing, sweating, pale, can’t speak, irrational thinking, fear of dying, going crazy, terror, doom, dread with loss of control, helpless, anger, agression. Hallucinations/delusions may occur

Question 6

Joe present to the ER with the following S&S:

restles, increased HR and resp., speech is rapid and loud, What level of anxiety is he experiencing?

Answer 6

moderate

Question 7

There are three levels in the general stress adaptation syndrome according to Selye:

1. Alarm reaction stage
2. Stage of resistance
3. Stage of exhaustion

Describe each

Answer 7

1. Alarm reaction stage - fight or flight runs through the body
2. Stage of resistance - uses fight or flight to adapt and deal with the stressor. If successful, you will not move into the third stage.
3. Stage of exhaustion - Were unable to adapt in previous stage. Now there is prolonged exposure to the stressor. This can lead to headaches, mental disorders, CAD, etc. We need intervention to prevent permanent damage, exhaustion. Can lead to death.

Ch. 1 page 3-4

Question 8

When assessing a patient who is exhibiting anxiety, what are key things to ask/look for?

Answer 8

1. What is the level (mild, mod….)
2. What triggered the anxiety?
3. Is the anxiety distorted (neurotic)?
4. What are (if any) the coping behaviors?
5. It is actually FEAR and not anxiety?

Question 9

When using nursing Dx of anxiety r/t …. You should always be sure to include what?

Answer 9

Degree of anxiety (mild, mod,…)

Question 10

What is the ultimate goal for the patient with anxiety?

Answer 10

for the patient to learn coping skills and explore causes for their anxiety

Question 11

What can we do to help a client in panic?

Answer 11

1. Have them breathe into paper bag (too much acidic CO2 out means resp alkalosis. trap that CO2 in a bag and have them breathe it back in to keep O2 and CO2 balanced).
2. speak calmly using short and simple sentences.
3. Nurse remains calm
4. give precise instructions
5. remove sensory stimuli
6. Let patient know you are there for them, will not leave them and will care for them. DO NOT LEAVE THEM!!!

Question 12

For a patient in moderate anxiety, we can assist with helping patient identify….

Answer 12

1. perception of threat (what MIGHT be the cause of anxiety)
2. precipitating factors (what happened before the anxiety set in)
3. recent changes?
4. current stressor? (job, kids, school, money, etc)
5. coping behavior used/explore expectations
6. Not identify, but correct cognitive distortions (the mouse is not going to eat you and your house).

Question 13

T or F: Anxiety will eventually go away on its own.

Answer 13

False. It must be recognized and dealt with.

Question 14

If anxiety is not recognized and effective coping is not implemented, what could happen?

Answer 14

Avoidance as a way of coping is not coping….

Can lead to:

1. anxiety disorders/trauma related
2. somatic disorders
3. dissociative disorders

Question 15

What is crisis?

Answer 15

When an individual is in a situation where their usual problem-solving/coping/adaptation methods are not adequate to deal…. causes disequilibrium.

Question 16

What is the definition of crisis?

Answer 16

A crisis is an emergency that is an immediate threat to your physical, emotional and mental health. Extreme stress.

Question 17

What are some examples of crises?

Answer 17

Dispositional crisis - External situations - boss is an example

anticipated life transitions - normal life cycle transitions, person feels like they do not have control over it. (Having kids, aging, moving to senior care, etc)

Crisis resulting from traumatic stress - unexpected external stress such as being robbed or raped. Person had absolutely no control.

Maturation/developmental - related to unresolved conflicts in one’s life. Involves dependency, value conflicts, sexual identity, control, and capacity for emotional intimacy.

Psychopathology - bipolar, schizo, borderline personality, severe neuroses, etc

Psychiatric emergencies - not personally responsible, functioning has been severely impaired and the person has been rendered incompetent or unable to assume personal responsibility. Examples: acute suicidal individuals, drug overdoses, reactions to hallucinogenic drugs, acute psychoses, uncontrollable anger and alcohol intoxication.

Question 18

How can we intervene in a crisis?

Answer 18

1. depends on the type of crisis (see the handout CRISIS for examples of interventions for each type)
2. Develop plan with client and fam/so’s AND be mutually negotiated with client
3. focus on immediate problem (concrete cause)
4. based on dependence needs
5. must be appropriate for the client level of thinking, feeling and behavior.
6. The plan must be consistent with culture, lifestyle
7. must have time limit attached and be realistic

Question 19

Panic disorder, Generalized Anxiety disorder, and phobias are considered _______ disorders.

Answer 19

Anxiety disorders.

Question 20

_______ disorder is characterized by recurrent attacks of severe anxiety. These attacks are not associated with a stimulus.

Answer 20

panic disorder

It could possibly be associated with a certain situation. For example, you are late for work, stuck in traffic, and your heart is racing… the next time you are trapped in traffic, you have a panic attack even though you are not running late for work.

Question 21

Chapter 27 - page 532 lists the criteria to be considered a panic attack . Four must be present!

Answer 21

See page 532 bullet pointed list on left side.

Question 22

T or F: panic attacks can be accompanied by agoraphobia

Answer 22

True

They may develop social phobia because they fear losing control, therefore avoid many social situations.

Question 23

What is the first priority for intervening during a panic attack?

Answer 23

First priorities are to reduce anxiety level and promote safety.

Stay with the client, take vitals, maintain calm manner

Have client breathe into paper bag if available

Use short sentence

refocus client energy

remove from stimuli

use PRN med as LAST RESORT!

Question 24

What disorder is characterized by persistent, unrealistic, and excessive anxiety and worry, which have occurred more days than not for at least 6 months AND cannot be attributed to specific organic factors such as caffeine intoxication or hyperthyroidism

Answer 24

General Anxiety Disorder

Client are unable to stop worrying, are unable to relax and often have insomnia and physical complaint

Question 25

List some things we can do to assist a client with GAD.

Answer 25

Teach/ promote relaxation (baths, music, massage, hobbies, etc). This include progressive relaxation and imagery (like what Legaspi does before exams, "Listen to the sound of my voice, take a deep breath, imagine a happy place, go there...etc), Yoga and Mediation Encourage exercise (kickboxing! I highly recommend it!!!) Teach thought stopping -What Is Thought Stopping? One effective and quick technique to help you with the intrusive negative thoughts and worry that often accompany panic disorder, anxiety and agoraphobia is called “thought stopping.” The basis of this technique is that you consciously issue the command, “Stop!” when you experience repeated negative, unnecessary or distorted thoughts. Help the client to structure their day, prioritize Positive self talk, reframing Humor MED IS LAST RESORT!!!

Question 26

_______ is an irrational fear of a specific object, activity or situation that results in a compelling desire to avoid the dreaded object or situation. Almost invariably provokes an immediate anxiety response or panic attack.

Answer 26

Phobia

Question 27

T or F: When a person has a phobia, they are not actually afraid of the object, activity or situation.

Answer 27

True. Fear is displaced unconsciously onto an external object that is symbolically related to the conflict

Question 28

The nurse is working with a client who has a fear of flying. Which defense mechanism is being used? A. Denial B. Projection C. Displacement

Answer 28

C. Displacing their fear of something else onto flying.

Question 29

Fear of pubic speaking is a ___ phobia

Answer 29

social

Question 30

Phobia of crowds or open places

Answer 30

agoraphobia

Question 31

Fear of heights

Answer 31

acrophobia

Question 32

fear of closed in places

Answer 32

claustrophobia

Question 33

fear of water

Answer 33

hydrophobia

Question 34

Fear of dark

Answer 34

nyctophobia nyct (NYKT) = nite = dark

Question 35

fear of death

Answer 35

thanatophobia that's it aphobia (that's it once you are dead)

Question 36

fear of electrical storms

Answer 36

astrophobia (electricty = light streak = astro relates to stars - light)

Question 37

Fear of talking

Answer 37

glossophobia (this could also be speaking in public but it is fear of moving your glossol muscles)

Question 38

Fear of blood

Answer 38

hematophobia (hemat - blood)

Question 39

fear of being alone

Answer 39

monophobia (mono = alone)

Question 40

Fear of germs

Answer 40

mysophobia (my so = me so = me so grossed out by germs)

Question 41

fear of fire

Answer 41

Pyrophobia

Question 42

Fear of animals

Answer 42

zoophobia (zoo has animals...)

Question 43

There are five different methods that Levy listed as interventions for phobias. One of them is systematic desensitization. What does that mean?

Answer 43

increase the exposure systematically. Snake is the example: 1. visualize snake 2. cartoon snake 3. rubber snake 4. snake in aquarium 5. snake out of aquarium 6. have client touch snake 7. have client hold snake

Question 44

There are five different methods that Levy listed as interventions for phobias. One of them is Reciprocal inhibition. What does that mean?

Answer 44

The example is cake and a snake. I pair cake and a snake for the client. The cake makes them feel good, and counters the negative feelings about the snake.

Question 45

There are five different methods that Levy listed as interventions for phobias. One of them is cognitive restructuring. What does that mean?

Answer 45

reframe/relabel a frightening object/situation "Most snakes aren't poisonous." "Most planes don't crash."

Question 46

What is it called when you excessively expose the client to the feared object until the anxiety can no longer exist (due to exhaustion)

Answer 46

flooding/implosion

Question 47

T or F: Beta blockers are the go to method for solving phobias.

Answer 47

False, they are your last resort! Always choose meds as last resort.

Question 48

_____ are recurrent and persistent thoughts, impulses, or images experienced as intrusive and stressful. Recognized as being excessive and unreasonable.

Answer 48

obsessions recurrent thoughts

Question 49

Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation. The person feels driven to perform such actions in response to an obsession... even though they are recognized as excessive or unreasonable.

Answer 49

compulsions compelled to act common compulsions are hand-washing, ordering, checking, praying, counting and repeating words silently OCD can have either compulsions or obsessions or both.

Question 50

Why do OCD clients perform rituals?

Answer 50

they reduce anxiety and create a sense of safety (regressive in nature)

Question 51

What are some examples of obsession symptoms?

Answer 51

contamination, sexual, aggressive, hoarding, saving, religious, symmetry, exactness and somatic

Question 52

What are some examples of compulsion symptoms?

Answer 52

cleaning, checking, repeating, counting, ordering, hoarding, mental, reassurance seeeking.

Question 53

Should you rush a client through their ritual to keep their appointment on time?

Answer 53

no, provide time to do the ritual within negotiated time (on contract) do not interrupt the ritual. (It's 8am, group is at 9. Remember our contract. Client now has an hour to do morning ritual). Since stress increases need for rituals, decrease stress Provide structure and routine Cognitive Behavioral contract (come see me before you wash your hands 95 times). SSRI's - LAST RESORT!

Question 54

This disorder is characterized by the exaggerated belief that the body is deformed or defective in some specific way. Most common complaint involves imagined flaws. In some instance a true defect is present, but the concern is exaggerated and grossly excessive

Answer 54

Body dysmorphic DO belief extreme, but not delusional. The patient is AWARE that their concern is exaggerated. these people may be socially isolated due to being self conscious

Question 55

Hair loss caused by hair pulling. This D/O begins with increasing of tension and a sense o release or gratification from pulling out the hair.

Answer 55

trichotillomania usually begins in childhood can be ANY hair on the body

Question 56

Persistent difficulty discarding or parting with possessions, regardless of actual value (could be newspapers....)

Answer 56

hoarding May be labeled with excessive acquisition which is the needs to continually acquire items. They need to cover every surface in the house with junk.

Question 57

What are some associates symptoms of hoarding?

Answer 57

1. perfectionism 2. indecisiveness 3. anxiety 4. depression 5. distractability 6. difficult planning and organizing tasks.

Question 58

Because it is hard to convince client there is a problem, treatment for hoarding has mixed results. Suggested treatment is..

Answer 58

1. Psychoeducation first | 2. CBT + Med (SSRI)

Question 59

We should use which group of antidepressants for OCD and anxiety DO's?

Answer 59

SSRIs OCD can also be treated with clomipramine (Anafranil) For long term anxiety effects, try Buspar. Benzos are good for acute anxiety/panic attacks (clonazepam - Klonopin, alprazolam - Xanax for panic, GAD, social phobia)