Stress/Coping/Anxiety/Crisis/OCD/PTSD/Phobias

A client who is pacing and wringing his hands states, "I just need to walk" when questioned by the nurse about what he is feeling. Which response by the nurse is most therapeutic?

"Are you feeling anxious?"

(Select all that apply) Education for clients with PTSD should include which of the following?

-Avoid drinking alcohol -Eat well-balanced, nutritious meals -Find and join a support group in the community -Get regular exercise, such as walking

Nursing interventions for Dissociate & PTSD

-Establish trust & support -Promote safety -Help client cope w stress & emotions -Help promote clients self esteem

(Select all that apply) The nurse who is assessing a client with posttraumatic stress disorder would expect the client to report which of the following?

-Inability to relax -Increased alcohol consumption -Insomnia even when very fatigued -Suspicion of strangers

Nursing dx for Dissociate / PTSD related to trauma or abuse

-Risk for Self-Mutilation -Risk for Suicide -Ineffective Coping -Posttrauma Response Chronic -Low Self-Esteem Powerlessness

Medications used for PTSD

-SSRI antidepressants -SNRI venlafaxine -SGA risperidone Evidence is lacking for benzodiazepines, but they are widely used in practice

Interventions for a client with panic disorder would include

-encouraging the client to verbalize feelings -reminding the client to practice relaxation when anxiety level is low -teaching the client reframing techniques -teaching relaxation exercises to the client

three major elements of PTSD

-reexperiencing the trauma through dreams or recurrent and intrusive thoughts -showing emotional numbing such as feeling detached from others -being on guard, irritable, or experiencing hyperarousal

Things that always change in crisis

-sleeping -eating -working

Nursing interventions for panic attacks

-soothing calm voice, quiet place, brief directions, patient safety* most important, reassurance relaxation techniques, remain w client cognitive restructuring techniques deep breathing

Expected outcomes for Dissociate & PTSD

1.The client will be physically safe. 2.The client will distinguish between ideas of self-harm and taking action on those ideas. 3.The client will demonstrate healthy, effective ways of dealing with stress. 4.The client will express emotions nondestructively. 5.The client will establish a social support system in the community.

PTSD the symptoms occur_______ or more after the trauma

3 months

It incorporates exposure therapy as well as the empty-chair technique, in which the participant says whatever he or she needs to say to anyone—alive or dead. This is similar to techniques used in Gestalt therapy.

Adaptive therapy

Propranolol

Alpha-adrenergic agonist Anxiety, panic disorder, GAD

Hydroxyzine

Antihistamine anxiety

Tx for phobic disorder

Behavioral therapy relaxation techniques setting goals positive reframing assertiveness training systematic (serial) desensitization-slow flooding - rapid

Chlorazepate

Benzo anti-anxiety

Diazepam

Benzodiazepines anxiolytic medications (short term use)

Lorazepam

Benzodiazepines anxiolytic medications (short term use)

Oxazepam

Benzodiazepines anxiolytic medications (short term use) Anxiety

Clonazepam

Benzodiazepines anxiolytic medications (short term use) Anxiety, panic disorder

Alprazolam

Benzodiazepines anxiolytic medications (short term use) Anxiety, panic disorder, social phobia, agoraphobia

Chlordiazepoxide

Benzodiazepines anxiolytic medications (short term use)Anxiety

Clonidine

Beta blocker anti-anxiety/panic disorder

During panic-level anxiety (panic attack) what is the primary concern?

Clients safety

The therapy course involves structured sessions that focus on examining beliefs that are erroneous or interfere with daily life, such as guilt and self-blame, for example, "It was my fault, I should have fought harder" or "I should have died with my fellow Marines";

Cognitive processing therapy

Secondary prevention

Early dx & treatment - crisis workers in the community -intervening in problems early -brief tx

Behavior therapy for OCD

Exposure involves assisting the client to deliberately confront the situations and stimuli that he or she usually avoids. Response prevention focuses on delaying or avoiding performance of rituals

a treatment approach designed to combat the avoidance behavior that occurs with PTSD, help the client face troubling thoughts and feelings, and regain a measure of control over his or her thoughts and feelings.

Exposure therapy

Antidepressant used to treat somatic disorder (3)

Fluoxetine Paroxetine Sertraline

Helping the Client Cope with Stress and Emotions for PTSD/Dissociate

Grounding technique Asking what the pt is hearing/seeing/touching/feeling

Emotion-focused coping strategies are designed to accomplish which of the following outcomes?

Helping the client manage the intensity of symptoms

When performing a physical examination on an anxious client, a nurse should expect to find which effect produced by the parasympathetic nervous system?

Hyperactive bowel sounds

illness anxiety disorder =

Hypochondriasis

The nurse is caring for a client with a conversion disorder. Which of the following assessments will the nurse expect to see?

Indifference about the physical symptom

Buspirone

NONBenzodiazepines anxiolytic medications (short term use) Anxiety, social phobia, GAD

Meprobamate

NONBenzodiazepines anxiolytic medications (short term use) anxiety

Phase 3 crisis

Normal coping mechanisms fail increasingly anxious

Do very poorly when they must come into contact with something that they fear

OCD

Dissociation

Protective coping mechanism - can occur both during & after the event

Sertraline

SSRI antidepressant Panic disorder, social phobia, GAD

Fluoxetine

SSRI antidepressant Panic disorder/ gad

Paroxetine

SSRI antidepressant Social phobia, GAD

First line OCD meds

SSRI antidepressants: fluvoxamine & sertraline

Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiologic dependence?

Selective serotonin reuptake inhibitors

Dissociative Amnesia

The client cannot remember important personal information (usually of a traumatic or stressful nature). This category includes a fugue experience where the client suddenly moves to a new geographic location with no memory of past events, and often the assumption of a new identity.

Dissociative Identity Disorder

The client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. This is accompanied by the inability to recall important personal information.

Which of the following is true about clients with illness anxiety disorder?

They may interpret normal body sensations as signs of disease

Imipramine

Tricyclic antidepressant Anxiety, panic disorder, agoraphobia

la belle indifference

a seeming lack of concern or distress; a key feature of conversion disorder

The nurse understands that secondary gain for the client with a somatic symptom illness can include

acceptable absence from work. freedom from daily chores. increased attention from family. provision of care by others

Which medications have been found to help reduce or eliminate panic attacks?

antidepressants

A client is diagnosed with agoraphobia without panic disorder. Which type of therapy would most the nurse expect to see included in the plan of care?

behavior therapy

Panic disorder medications

benzodiazepines SSRI antidepressants tricyclic antidepressants antihypertensives-clonidine & propranolol

somatization disorder

characterized as the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them childhood abuse of some sort 90% are women Always 4 parts of the body

Panic disorder is treated with

cognitive-behavioral techniques, deep breathing and relaxation

a turning point when a person is confronted by a situation in which usual problem solving no longer works

crisis intervention theory

acute stress disorder

diagnosis is appropriate when symptoms appear within the first month after the trauma and do not persist longer than 4 weeks

Depersonalization

feelings of being disconnected from himself or herself; the client feels detached from his or her behavior

A client with panic disorder is taking alprazolam 1 mg PO three times daily. The nurse understands that this medication is effective in blocking the symptoms of panic because of its specific action on which neurotransmitter?

gamma-aminobutyrate

Dissociative disorders therapy -

group or individual - focuses on reassociation, or putting the consciousness back together & meds for depression/anxiety OR both if symptoms are present

What treatment can help to stop the progression of acute stress disorder to PTSD?

group or individual therapy

Pain Disorder

has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance

Dissociative disorders

have the essential feature of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception. This often interferes with the person's relationships, ability to function in daily life, and ability to cope with the realities of the abusive or traumatic event.

Primary prevention

identifies people that are likely to get a problem & these people are supported to not ever get the problem

Phobia

illogical, intense, and persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning. Phobias usually do not result from past negative experiences.

Nursing interventions with an anxious client change as the anxiety level increases. At a low level of anxiety, what is the primary focus of intervention

learning & problem solving

Tertiary prevention

long term hospitalization

Optimal treatment for OCD

medication & behavioral therapy

Phase 4 crisis

person uses internal & external resources & tries problem solving methods

Phase 1 crisis

precipitating event (loss of a job/personal failure)

Hypochondriasis

preoccupation with the fear that one has a serious disease or will get a serious disease

such as relief of anxiety, conflict, or distress example of a ________ gain

primary

Defense mechanisms for somatic disorders

repression & denial

Treatment-resistant OCD may respond to second-generation antipsychotics such as

risperidone quetiapine olanzapine

To reverse the effect of a benzo. you would use

romazicon - benzo receptor blocker

Being brought tea, receiving a back rub). The person soon learns that he or she "needs to be sick" to have his or her emotional needs met. example of a _________ gain

secondary

Hypochondria is a ___________ gain

secondary

which is anxiety provoked by certain social or performance situations Examples include making a speech, attending a social engagement alone, interacting with the opposite sex or with strangers, and making complaints. The fear is rooted in low self-esteem and concern about others' judgments. The person fears looking socially inept, appearing anxious, or doing something embarrassing such as burping or spilling food.

social phobia

When assessing a client with anxiety, the nurse's questions should be

specific & direct

which is an irrational fear of an object or a situation For example, fear of getting lost while driving if not able to make all right (and no left) turns to get to one's destination.

specific phobia

Decreased urine output, constipation, and muscle tension would result from ___________ nervous system stimulation

sympathetic

Panic disorder is a ________ response with a _____________ failure & they live in high state of anxiety afraid it'll happen again

sympathetic parasympathetic

Dissociative Fugue

the client suddenly moves to a new geographic location with no memory of past events, and often the assumption of a new identity

Phase 2 crisis

the event is perceived as a threat & increases anxiety

Secondary gain

the internal or personal benefits received from others because one is sick, such as attention from family members, comfort measures, and being excused from usual responsibilities or tasks

Primary gain

the relief of anxiety achieved by performing the specific anxiety-driven behavior; such as staying in the house to avoid the anxiety of leaving a safe place

Goals of therapy for dissociative disorder

to improve quality of life, improved functional abilities, and reduced symptoms

conversion disorder

usually sudden deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly (e.g., blindness, paralysis) -war draft & right arm paralysis

GAD

worries excessively and feels highly anxious at least 50% of the time for 6 months or more has three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations *Use Cog. restructuring