anxiety,somatoform,dissociative d/o
Terms
undefined, object
copy deck
- anxiety is a threat to biological self and a threat to self-concept: Define normal anxiety?
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-realistic threat
-Proportionate response
-no dysfunctional behavior - Define Neurotic anxiety?
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-unrealistic threat
-out of proportionate to threat
-response continues without further stimuli
-impaired functioning - helps to deal constructively with stress, able to focus:
- Mild
- alert but perceptual field is narrowed, limited ability to focus:
- moderate
- feels overwhelmed, can not focus on bigger picture, scattered:
- severe
- irrational thinking, fear of dying, going crazy, terror, doom, dread with loss of control:
- Panic
- Name the physical symptoms of a.n.s.mediated when anxiety is present?
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-dyr mouth
-sweaty palms
-muscle tension
-tachycardia-palpitation
-hyperventilation
-sob
-urinary frequency
-nausea - Name the emotional symptoms(limbic system) during an anxiety episode:
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-apprehension
-irritability/agitation
-crying,angry(labile)
-frustrated
-easily distracted
-overly concerned
-forgetful
-demanding
-nervous
-immobilized - name the cognitive symptoms (cerebral cortex) when anxiety is present?
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-perceptual field narrows
-selective inattention
-problem solving ineffective
-unable to follow directions
-ability to recall impaired
-preoccupied with trivia
-scattered focus
-(decreased logical thinking) - What to assess for in a patient with anxiety?
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1.level of anxiety
2.what caused it
3.cognitive distortion?
4.usual coping behaviors? - Name nursing diagnosis related to anxiety?
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1.fear r/t known object
2.anxiety(degree)r/t threat to self concept,biological self,stressor
3.ineffective coping r/t feeling overwhelmed, lack of knowledge, lack of resources, moderate to severe anxiety
4. powerlessness r/t perceived inability to cope - what is the initial goal (short term) for a patient with anxiety?
- -reduce anxiety to moderate level and then to mild level
- What is the ultimate goal (long term) for a patient with anxiety?
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-teach coping skills and problem solving skills
-explore possible causes of anxiety - interventions for severe-panic anxiety?
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1.guide pt:deep bx exercises
2.speak in calm voice
3.use short simple sentences
4.give precise directions
5.decrease sensory stimuli
6."i am here to care for you"
7."you are safe here"
8.stay with the pt in a panic - Intervention for moderate anxiety?
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Identify:
1.perception of threat
2.precipating factors
3.recent changes
4.current stressor
5.coping behavior used
6.correct cognitive distortion - manifest itself in visible signs and symptoms such as panic attacks,phobias, compulsive behavior?
- anxiety d/o
- converted into physical symptoms that may effect the organs innervatd by the ANS or be converted to the peripheral N.S via the sense organs?
- somatoform d/o
- anxiety is split off from source and contained?
- dissociative disorders
- recurrent attacks of severe anxiety lasting a few moments to an hour. attacks not associated with a stimulus, but instead seem to occur suddenly and sponstaneously. may be assoc. with certain situations?
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Panic d/o
-fear losing control
-avoid situations that induce fear
-may dvlp social phobia - Intervention for client experiencing panic d/o?
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1. reduce anxiety/promote safety
2.stay with client
3.v/s
4.calm manner
5.bx into paper bag
6.short,simple sentences
7.firm directive voice
8.refocus clients energy
9.PRN meds - Pervasive,persistent anxiety of at least 6 months duration. chronic feelings of nervousness/apprehension for no reason, no phobias exp or panic attacks. unable to stop worrying, cant relax, insomnia, physical complaints
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GAD: generalized anxiety d/o
tx with buspar - Intervention for client with GAD:
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1.teach activities to promote relaxation(warm bath,music,distraction,msg)
2.encourage exercise
3.instruct in thought stoppn
4.help clients structure day
5.use 5 step action plan(peplau) - irrational fear of a specific object, activity, situation, result in avoidance of the object/situation?
- Phobic disorder
- Interventions for client experiencing phobic d/o?
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1.systemic desensitization
(begin c least threatening)
2.Reciprocal inhibition:refrain,(anxiety/fear paired with another opposite feeling)ex.ice cream/spider
3.cogntv restrctng:(relabel a frightng object/situat)ex.spider have no teeth
4.flooding(ex. 10 spiders thrown to pt at once) - occurs when a person has been exposed to , experienced/witnessed a traumatic event? what is the goal?
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PTSD(post traumatic stress d.o)
goal: desensitize the memories of the traumatic event(talk about it) - Obsessions/compulsions and rituals are performed to reduce anxiety and feel safe?
- OCD: AXIS I
- interventins for clients with OCD:
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1.permissive attitude
2.provide time to do ritual/negotiated limits
3.provide structure/routine
4.cog.beh.therapy(stop think, come to me)
5.tx with SSRI - symtoms not under voluntary control, pain is real>aka:hysteria, hysterical reaction, briquets syndrome, begins <age 30,
- Somatoform d/o
- clients report impaired physical function d/o r/t expression of psychological conflict/
- conversion d/o
- What two mechanisms does a person get from having conversion d/o?
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Primary gain:keep conflict out of conscious awareness.
ex. women becomes blind to avoid witnessing a traumatic event.
2. secondary gain: avoid distress/uncomfortable activity,but receiving help from others
(can impede normal life activities) - experiencing pain in the absence of physiologic findings,but may present psychological factors. client goes from MD to MD to find a cure, becomes central issue of ones life?
- pain d/o
- preoccupied with the fear of having a serious illness, not present on physical eval. belief persist for 6mts,despite reassurance,impairs social/occupational functioning?
- hypochondriasis
- preoccupied with imagined defect in physical appearance, not dilusional. Avoidance is used to cope =social isolation,ex. man bald leaves home at night.?
- body dysmorphic disorder
- expected outcome for clients with somatoform d/o?
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1.demonstrate ability to cope with anxiety through the use of new stress management:bx exercises
2.verbalize feelings instead of expressing them symbolically through physical sx.
3.express increase degree of comfort reg.each phys.sx. - Name planning /implementation interventions for client with somatoform d.o?
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1.Rec/understnd the life problem client is facing
2." self perception of inability to cope
3.help id more effective ways to cope - what is a common denominator of dissociative d/o?
- defense mechanism: client strips an idea, object, or situation of its emotional significance ans affective component.
- What characteristic do all dissociative d/o share?
- related mental events is beyond the clients power of recall but can return spontaneously to conscious awareness.
- presence of two or more personalities within one individual. each personalilty takes full control of the persons behavior.
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Disssociative identity d/o
aka: multiple personality
ex. anna claims that zoe, an evil personality that reside within her is responsible.... - wanders, far from home/days at a time. client completely forgets their past life and associations. unaware of having forgotten anything.
- dissocitive fugue
- aware of loss of memory for events that occurred during a period that may range from a few hours to a whole lifetime.
- dissociative amnesia
- one or more episodes of feeling detached from one's self so that the usual sense of personal reality is temporaritly lost or changed
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depersonalization d/o
ex. "i don't feel real any more. It's like i can watch my life as if it's a tv show. Im afraid im going crazy" - Bilogical factors that may be causing dissociative d/o?
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-brain tumors/epilepsy
-alcohol,
-scopolamine
-barbiturates
-BDZ
-hallucinogens - Psychosocial theories r/t to dissociative d/o?
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Pierre janet: splitting
freud: repression/dynamic unconscious:unacceptable ideas/emotions pushed away from awareness -
1.Major areas of focus for client with dissociative d/o?
2.name nsg. dx? -
1. identity, memory, consciousness
2.disturbed sensory perception/thought process
-ineffective role performance
-ineffective coping - When planning care for a client with DID, trust is big issue , name the building blocks of therapy?
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-trust:to express needs
-safety:support
-acceptance:accept dx - which class of medication makes the NT (NE)(5HT)more avialable to the synaptic receptors in the CNS?
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1.TCA: post pone degradation of Ne and 5HT
2.MAOIs: interfere with enzymes responsible for actual breakdown of NT molecules
3. - Drug classification to treat a variety of problems from high levels of anxiety and panic to insomnia?
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Meprobamate:used in 1960s risk for over dose(not safe)
BDZ/NON-BDZ:rapid,effective,safe tx(SE: sedating) -
1.meds to tx OCD and anxiety d/o?
2.to tx social phobia ad GAD?
3. Tx for acute anxiety/panic attacks?
4. what does MAO inhibit? -
1.all ssris, TCA clomipramine (anafranil) OCD
2.venlafaxine (effexor) XR,xanax
3.BDZs:clonazepam(klonopin) and alprazolam (Xanax XR)for Panic d/o, GAD,social phobia
4. NE and 5HT reuptake inhibitor - maladaptive behaviors used to restore inner equilibrium when overwhelmed or unable to cope with stressful life events?
- Self-destructive behavior
- willful act of ending one's life.(most have seen a medical professinal during the month prior)?
- Suicide
- Clients who are suicidal keep their illness a silence because?
- -stigma and ignorance about mental illness, along with depression
- name conscious self destructive behaviors?
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1.nail biting
2.hair pulling
3.burns
4.scratching/cutting one's wrist
5.smoking
6.reckless driving
7.substance abuse4 - cutting,burning with cigarettes/stove, pulling hair, biting fingernails. Used to deal with anxiety and stress. Likely to be r/t abuse neglect as a child?
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self mutilation
often seen with BORDERLINE PERSONALITY DISORDER - theories or self destructive behaviors?
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1.cope with crisis
2.denial of mental pain and therefore no need to cope with depression
3.impulsive
4.raise low self esteem by denying helplessness
5.self punishing to relieve unconscious guilt - What are some of the reasons clients commit suicide criminal acts?
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1.escape pain
2.avoid being a burden
3.resolve family conflict
4.resolve individual situation
5.avoid punishment of social or personal unacceptable behavior
6.need to control own destiny - name the traits of a suicidal patient?
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1.dichotomous thinking
2.ambivalence
3.communication
4.schneidman theory - belief there is only an either/or choice. death is the only escape. constriction of thought(magical solution)
- dichotomous thinking
- two conflicting desires (life and death)ex. lethal over dose with possibility of rescue?
- ambivalence
- difficulty with expression of needs or feelings. often suicide is directed at a significant person.
- communicatin
- between two people, significant other and suicidal person who is motivated by rejection, abandonment, revenge or pity (attept to alter the relationship) ?
- schneidman theory:
- what NT may be low in suicidal patients?
- SEROTONIN
- how to assess a suicidal client?
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1.are you feeling suicidal?
2.What is your plan?the more specific the more dangerous
3.any past attempts/how? - Times to question or assess a suicidal client?
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1.change in mental status
2.after upsetting event
3.after making certain stmnts
4.giving possessions away or making a will/insurance polcy
5.cancel social engagements
6.decrease in sleep,hopelessness,loss in interest/friends
7.SUDDEN RECOVERY FROM DEPRESSION
8.crying for no reason,plan their funeral - Who are more likely to commit suicide?
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1.men more successful, women have several attempts
2.male over age 50/depression
3.ambivalent about death - When is highest risk for suicide?
- recovering and depression lifts(increase loc and plan)
- what to assess for in suicidal pt?
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substance abuse hx
threat of serious loss
somatic complaints
fam hx
social hx
beck inventory
sigiecaps - assessment of unit safety please list?
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1.free of contraband
2.lock hazardous area
3.breakaway bars in showers/closets
4.safe craft items
5.pt acuity/staff ratios
6.fam/visitory/student contraband monitored
7. AWOL risks - List nsg dx for suicidal client?
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1.risk for self directed violence
2.self esteem disturbance
3.hopelessness
4.social isolation - outcome criteria for the self-destructive client?
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1.acknowledge self-harm thoughts
2.admit to use of self-harm behavior if it occurs
3.be able to identify perosnal triggers
4.learn to properly identify and tolerate uncomfortable feelings
5.choose alternatives that are not harmful
6.admit to the use of self harm behavior if it occurs
7.attempt to id stressors
8.cooperate with interventions - interventions for to prevent suicide?
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1.insure safety
2.encourage discussion of feelings
3.structure daily acitivities
4.calm,reasuring,non judgemental attitude
5.positive reinforcement
6.identify strenghts
7.take all threats seriously
8.remove all contraband
9.search room if DTS/DTO
10.no self harm contract
11.1:1 ,15 min chks,
12.problem solve with pt
13.do not make unrealistic promises
14.visitor/teleph list
15.prioritize pt stressors
16.teach assertion
17.instill hope:goal setting
18.decrease dependency
19.sit with non verbal pt
20.allow pt to cry
21.id support systems
22.tca,maois,ssri,
23.teach indiv/fam.crisis plan - electrical current passed through the brain producing a grand mal seizure. for depression,acute mania, psychosis.
- ECT
- Important things to know about ECT?
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short term memory loss
no involuntary ECT,need court order
prep same as surgical pt.