NURS 323 Week 5 UNIT 2 --> Chapter 10, 11, 20 (OCD and Anxiety Disorders)
Codependent relationship
A relationship in which one person compromises her/his own needs and wants in order to care for another person who may be experiencing emotional, physical, or financial difficulties
Sleep Aids that are NON benzos
Ambien Lunesta Rozerem Benadryl
Flushing, coughing, dyspnea, N/V are all side effects of this treatment
Antabuse
Vistaril (hydroxyzine)
Anti-Anxiety/Anti-Histamine Treats Anxiety, Tension, skin rashes and itching
BuSpar (busprione)
Antianxiety agent - NOT PRN (scheduled > 2-3 weeks to be effective) - No addictive - used for pt's w/previous addiction - Avoid alcohol/grapefruit juice
Vistaril/Atarax (Hydroxyzine)
Antihistamine - sedative - not addictive - EPS s/sx
Atenolol (Tenormin)
Beta blocker - relieves physical symptoms of anxiety as in performance anxiety
Propranolol (Inderal)
Beta blocker - relieves physical symptoms of anxiety as in performance anxiety
What medication is commonly used to treat alcohol withdrawal?
BuSpar (busprione)
Suppression
Consciously and intentionally pushing unpleasant feelings out of one's mind
Vistaril/Atarax should be given HOW if injected?
DEEP IM if injection
You should avoid alcohol grapefruit juice with BuSpar. True/False
FALSE
You should focus on stopping fear when dealing with phobia treatment. True/False
FALSE
What is the major difference between fear and anxiety?
Fear has dread focused on SPECIFIC object or event, whereas anxiety it is nonspecific or unrecognized
The nurse reviews the assessment data of a client admitted to the hospital with a diagnosis of anxiety. The nurse should assign priority to which assessment finding? 1. Affect bland, withdrawn 2. Temperature 98.4°F (36.8°C); respirations 18 breaths/min 3. Tearful, self-isolated 4. Fist clenched, pounding table, fearful
Fist clenched, pounding table, fearful
The second part of the fight-or-flight response is caused by what cortex
HPA (hypothalamus pituitary adrenal)
Holmes/Rahe Scale 300+
High-very high risk
Herbs that can help wit hanxiety
Kava Melatonin Valerian
Holmes/RaheScale 150-299 indicates
Moderate-High chance
Anafranil (Climipramine)
OCD specific medication
What is self-control therapy?
Provides negative reinforcement when teh stimulus is produced
Paroxetine (Paxil)
SSRI antidepressant - treats OCD and GAD
What medications are used as first line treatment for OCD?
SSRI's first line or SNRI's
Conversion/Somatization defense
SUBCONSCIOUS converts anxiety into physical symptoms
Phobias usually begin before 30 years of age. True/False
TRUE
You should support use of defense mechanisms for someone in crisis. True/False
TRUE - this will help maintain self-esteem okay AS LONG AS THEY ARE NOT HARMING THEMSELVES OR OTHERS
What is Allen's Test?
Test for patency of ulnar artery prior to placing a radial arterial line or performing an ABG; examiner occludes both ulnar and radial arteries w/ fingers as patient makes fist; patient opens fist while examiner releases ulnar artery occlusion to assess blood flow to hand
Reaction formation
UNCONSCIOUS person expresses toward another person or situation feeling, attitudes, behaviors that are the opposite of what would normally be expected
Holmes/Rahe Scale 11-150 indicates
You have only a low to moderate chance of becoming ill in the near future
What is systematic desensitization?
a treatment for phobias in which the patient is exposed to progressively more anxiety-provoking stimuli and taught relaxation techniques.
Adjustment disorders
abnormal/excessive reaction to an identifiable life stressor, reaction more severe than normal
Define agoraphobia
acute anxiety in crowds or going out in public places - actively avoids the situations becuase of no escape, no help, fear of embarrassment unless they have companion or endure with great anxiety/stress
When do panic disorders usually onset?
adolescence and mid 30's
Passive aggression
aggression towards another manifested through passivity (purposeful inefficiency, procrastination, etc)
Revia (naltrexone) is used for what treatment
alcohol and opiate addiction treatment
What is commonly experienced by client during Phase 2 of crisis?
anxiety level grows to level of extreme discomfort - trial and error to solve problems begins
Select Mutism
children do not initiate speech or reciprocally respond when spoken to by others in situations where communication is expected
Disinhibited social engagement disorder
condition where child actively approaches and interacts with unfamiliar adults
Rationalization
defense mechanism that offers self-justifying explanations in place of the real, more threatening, unconscious reasons for one's actions
N/V, tremors, sweating, seizures are all symptoms of what disorder
delirium tremens
Symptom phase
describe their cognitive, physical, emotional, or behavioral experiences of the incident
Maturational crisis
developmental stages
Situational crisis
external, unexpected, sudden EX: getting in a car accident, experiencing flood/earthquake, victim of a crime
What is trichotillomania
hair pulling disorder
Reactive attachment disorder
in children, a pattern of inhibited, withdrawn behavior toward adult caregivers
What is commonly experienced by client during Phase 1 of crisis?
increased level of anxiety caused by external stimuli
What is commonly experienced by client during Phase 3 of crisis?
increased level of panic due to grief and loss - relief behaviors - flight/withdrawal
What is paradoxical intention?
instructing the client to do what the client fears and, if possible, to exaggerate the outcome of this exposure to the point of humor
Repression
keeping distressing thoughts and feelings buried in the unconscious
Lasix (furosemide) use may lead to what toxicity
lithium toxicity
The cerebellum is the organ primarily responsible for what?
maintaining equilibrium
Excess anxiety as defined by the DSM-5
more days than not for 6 months or more
Busprione (BuSpar)
non benzo antianxiety- little sedation no risk for abuse, takes 3 weeks to work avoid ETOH and grapefruit juice
Teaching phase
normality of the symptmos they experience and future symptoms to anticipate
eustress
positive stress - makes us strive to reach our goals, etc
HOw does a tricyclic antidepressant help to relieve depression?
prevents destruction of norepinephrine
CT and MRI scans do what?
provide skull imaging
PROJECTION
psychoanalytic defense mechanism by which people disguise their own threatening impulses by attributing them to others
Displacement
psychoanalytic defense mechanism that shifts sexual or aggressive impulses toward a more acceptable or less threatening object or person, as when redirecting anger toward a safer outlet
Adventitious crisis
rare unexpected happenings not apart of everyday life EX: flood, fire, earthquake, airplane crashes, riots, wars
Define compulsion
recurrent behavior
Isolation defense mechanism
separation of unacceptable feeling, idea, or impulse from one's thought process
What is VDRL (RPR)?
serum screening test for syphilis
Thought phase
sharing of idease and thoughts between clients
When speaking to a patient in crisis, how should you speak to them?
speak in short, concise sentences
reaction phase
talk about painful events associated with the crisis incident
Identification
the process by which, according to Freud, children incorporate their parents' values into their developing superegos
What is the main cause of Wernicke-Korsakoff syndrome?
thiamine deficiency
Define obsession
thoughts, impulses, or images that persist and recur so that they cannot be dismissed frmo the mind
If a patient is taking Thorazine (chlorpromazine), remind them to do what?
to use sun screen when outside
Secondary traumatic stress
trauma that health care providers experience when witnessing and caring for others suffering trauma
Define altruism
unselfish regard for the welfare of others
Splitting defense mechanism
view of characteristics of others or self alternates between polar extremes, all good or all bad
Intellectualization Defense Mechanism
- An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis.
Introjection: Defense Mechanism
- Integrating the beliefs and values of another individual into ones own ego structure. EX: Children integrate their parents value system into the process of conscience formation.
sublimation (defense mechanism)
- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD.
Undoing: Defense Mechanism
- Symbolically negating or canceling out an experience that one finds intolerable. EX: Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her flowers.
What are common medications used for OCD?
- benzodiazepines - antidepressants - SSRI's - SNRI's - TCA's - MAOI's - Buspirone
According to the Joint Commission, when is an occurrence considered a sentinel event?
- client outcome is death - there is permanent harm to a client - severe temporary harm occurs to a client - there is a suicid of a client receiving care in teh facility
What are s/s of opioid intoxication
- decreased rr - constricted pupils - decreased body temp - decreased BP
Panic anxiety characteristics
- dread - terror - loss of control - disorganization - personality disintegration
Moderate anxiety characteristics
- focus on immediate, narrowed perceptual field - selective inattention
Severe anxiety characteristics
- focus on specific detail - greatly reduced perceptual field
What is commonly experienced by the client during phase 4 of crisis?
- high personality disorganization - depression - confusion - suicidal thoughts - panic
Which neurotransmitters are decreased with depression?
- norepinephrine - dopamine - serotonin
What are major symptoms of GAD (Generalized anxiety disorder)
- restlessness - fatigue - difficulty concentrating - irritability - muscle tension - sleep disturbance
Panic attack in panic disorder typically last how long?
1-2 minutes
A client has OCD. Which of the following statements made by the client to the nurse would be the best indicator of improvement? 1. "I have more control over my thoughts and behaviors." 2. "I know that my thoughts and behaviors are not normal." 3. "I only do my ritual to reward myself when I have been good." 4. "My friends don't know about my disorder."
1. "I have more control over my thoughts and behaviors."
Select the best example of altruism. 1. An individual with a long-standing fear of animals volunteers at a community animal shelter. 2. An individual who received a liver transplant volunteers at a local organ procurement agency. 3. After recovering from a gunshot wound, a police officer attends a local support group. 4. After recovering from open heart surgery, an individual plays tennis three times a week.
1. An individual with a long-standing fear of animals volunteers at a community animal shelter.
The nurse reviews the laboratory findings for a client's urine drug screen that is positive for cocaine. Which client behavior should be expected during cocaine withdrawal? 1. Psychomotor agitation 2. Distorted perceptions and hallucinations 3. Detachment from reality and drowsiness 4. Restlessness and hyperactivity
1. Psyhomotor agitation
A client in a crisis state is having difficulty asking for help from significant others. The nurse explains to caregivers that it is important to role model asking for help because in addition to being anxious and overwhelmed, clients in crisis often exhibit which trait? 1. Uncertainty about how to communicate personal needs. 2. Resistant to verbal suggestions about how problems can be approached. 3. Hesitant to depend on others for assistance with problem resolution. 4. Guarded and protective about talking about anxiety and other feelings.
1. Uncertainty about how to communicate personal needs.
What are the three substances that are consumed by swallowing?
1. alcohol 2. opium 3. marijuana
A nurse analyzes reports from four adult patients of frightening events they encountered. Which patient's report most clearly indicates that the resulting fear was mentally healthy? 1. "I was trapped on an elevator that stopped between floors when the power went out." 2. "I was at home when a storm with heavy thunder and lightning lasted over an hour." 3. "I was at the mall when a gunman began firing an assault weapon." 4. "I saw a large spider crawling along my kitchen wall."
2.
The nurse is caring for a client with PTSD. Which statement by the client would indicate the most improvement? 1. "I am responsible for what happened to me." 2. "I enjoy being back at work with my friends." 3. "I like to stay awake at night." 4. "I can't relax. I stay alert all the time."
2. "I enjoy being back at work with my friends."
A client is admitted with a recent history of severe anxiety following a home invasion and robbery. During the initial assessment interview, which statement by the client should indicate to the nurse the possible diagnosis of posttraumatic stress disorder? Select all that apply. 1. "I'm afraid of spiders." 2. "I keep reliving the robbery." 3. "I see his face everywhere I go." 4. "I don't want anything to eat now." 5. "I might have died over a few dollars in my pocket." 6. "I have to wash my hands over and over again many times."
2. "I keep reliving the robbery." 3. "I see his face everywhere I go." 5. "I might have died over a few dollars in my pocket."
A middle-aged client tells the clinic nurse, "I'm again starting to feel overwhelmed and anxious with all my responsibilities. I don't know what to do." Which is the best response for the nurse to make? 1. "I know, but it is important to take time for yourself." 2. "What has worked for you in the past?" 3. "Describe in more detail your feelings about being overwhelmed." 4. "Why don't you give up some of your commitments?"
2. "What has worked for you in the past?"
When the nurse is working with a client in crisis, which nursing action is most important? 1. Obtaining a complete assessment of the client's past history. 2. Remaining focused on the client's immediate problem. 3. Determining the relationship of the early life experiences and the crisis state. 4. Develop an action plan for the client.
2. Remaining focused on the client's immediate problem
During an assessment the client tells the nurse, "I can't stop worrying about my makeup. I can't go anywhere or do anything unless my makeup is fresh and perfect. I wash my face and put on makeup at least once and sometimes twice an hour." The nurse's priority should be to adjust the client's plan of care so that which of the following will happen? 1. The client will be required to spend daytime hours out of own room. 2. The client will be given advance notice of approaching time for all group therapy sessions. 3. The client will be asked to keep a journal of feelings experiences if unable to groom self at will. 4. The client will be allowed to use own makeup and grooming products.
2. The client will be given advance notice of approaching time for all group therapy sessions.
The nurse would formulate which goal as most appropriate for a client who has been diagnosed with GAD?1. The client will describe dissociative experiences. 2. The client will display the ability to cope with mild anxiety. 3. The client will relive the traumatic event. 4. The client will verbalize a sense of control over ritualistic behavior.
2. The client will display the ability to cope with mild anxiety
The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event? 1. Witnessing a murder 2. The death of a loved one 3. A fire that destroyed the client's home 4. A recent rape episode experienced by the client
2. The death of a loved one
A young adult client frequently engages in high-risk behaviors, including driving at high speed, drinking excessively, and engaging in high-risk sexual behavior. The nurse assessing this client should recognize that there is a high probability that which of the following is occurring? 1. Unhealthy grieving is occurring. 2. Unconscious thoughts of suicide are present. 3. Arrested maturation is impairing judgment. 4. Antisocial personality traits are causing disregard for life.
2. Unconscious thoughts of suicide are present
The nurse, assessing a client reporting fever, diarrhea, and nausea, notes the dilation of the pupils and heightened reflexes. These assessment finding support which medical diagnosis? 1. Opioid Intoxication 2. Opioid withdrawal 3. alcohol withdrawal 4. stimulant withdrawal
2. opioid withdrawal
Acute stress disorder
3 days to 1 month (diagnosis time frame)
A client seeks help in a crisis clinic secondary to having several family members involved in a serious automobile accident. The client speaks in a loud, disorganized manner with frequent changes of subject. Which nursing approach is most likely to be effective? 1. Encourage the client to identify family members involved in the accident. 2. Assist the client in locating the chapel or another quiet area. 3. Help the client identify the problem and possible ways to manage it. 4. Arrange for a one-time anxiolytic medication for the client.
3. Help the client identify the problem and possible ways to manage it.
A client with GAD states, "I know the best thing for me to do is just to try to forget my worries." How should the nurse evaluate this statement? 1. The client is developing insight. 2. The client's coping skills are improving. 3. The client needs to be encouraged to verbalize feelings. 4. The nurse-client relationship should be terminated.
3. The client needs to be encouraged to verbalize feelings.
The nurse is conducting an initial assessment of a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, which is the most appropriate question? 1. "With whom do you live?" 2. "Who is available to help you?" 3. "What leads you to seek help now?" 4. "What do you usually do to feel better?"
3. What leads you to seek help now?
In order to be diagnosed with panic disorder, how many symptoms must be present?
4 or more symptoms
How much time does it usually take a crisis to self-resolve?
4-6 weeks
Crisis typically resolves in when?
4-6 weeks (Situational/maturational)
Which statement indicates the existence of a codependent relation between a client diagnosed with substance abuse and their life partner? 1. "They are the love of my life but it's so hard living together." 2. "Everyone knows about the addiction and it is so very embarrassing." 3. "All our savings have been spent on rehab treatment." 4. "I'm always so angry about how the addiction controls our lives."
4. "I'm always so angry about how the addiction controls our lives."
The nurse is creating a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor? 1. A crisis state indicates that the client has a mental illness. 2. A crisis state indicates that the client has an emotional illness. 3. Presenting symptoms in a crisis situation are similar for all clients experiencing a crisis. 4. A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.
4. A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.
It is believed that as many as ______% of diseases are stress-related
90%