Classes 7 & 8
Describe interventions for patients with anxiety disorder related to a medical condition or substance/medical induced.
1. Nursing care of patients with this disorder must take into consideration the underlying cause of the anxiety. 2. Holistic nursing care is essential to ensure that the patient's physiological and psychosocial needs are met. Nursing actions appropriate for the specific medical condition must be considered. 3. Nursing care of the patient with substance-induced anxiety disorder must take into consideration the nature of the substance and the context in which the symptoms occur—that is, intoxication or withdrawal.
What are the 3 theories that are related to phobias?
1. Psychoanalytic theory 2. Learning theory 3. Cognitive theory
What are the 2 theories related to panic disorder & generalized anxiety disorder (GAD)?
1. Psychodynamic theory 2. Cognitive theory
Describe the interventions to achieve the previous goals for patients with phobias.
1. Reassure patient that he or she is safe. 2. Explore patient's perception of the threat to physical integrity or threat to self-concept. 3. Discuss reality of the situation with patient to recognize aspects that can be changed and those that cannot. 4. Include patient in making decisions related to selection of alternative coping strategies (e.g., client may choose either to avoid the phobic stimulus or to attempt to eliminate the fear associated with it. 5. If patient elects to work on elimination of fear, techniques of desensitization or implosion therapy may be employed. 6. Encourage patient to explore underlying feelings that may be contributing to irrational fears and to face them rather than suppress them.
Describe the interventions to meet the previous goals for panic disorder & generalized anxiety disorder (GAD).
1. Stay with the patient and offer reassurance of safety and security. Do not leave the patient in panic anxiety alone. 2. Maintain a calm, nonthreatening, matter-of-fact approach. 3. Use simple words and brief messages, spoken calmly and clearly, to explain hospital experiences. 4. Hyperventilation may occur during periods of extreme anxiety. Hyperventilation causes the amount of carbon dioxide in the blood to decrease, possibly resulting in lightheadedness, rapid heart rate, shortness of breath, numbness or tingling in the hands or feet, and syncope. If hyperventilation occurs, assist the patient to breathe into a small paper bag held over the mouth and nose. Six to 12 natural breaths should be taken, alternating with short periods of diaphragmatic breathing. 5. Keep immediate surroundings low in stimuli (dim lighting, few people, simple décor). 6. Administer tranquilizing medication, as ordered by physician. Assess for effectiveness and for side effects. 7. When level of anxiety has been reduced, explore possible reasons for occurrence. 8. Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (relaxation techniques, such as deep-breathing exercises and meditation, or physical exercise, such as brisk walks and jogging).
What are 4 types of medications that can treat anxiety disorders?
1. benzodiazepine sedative hypnotic anxiolytics 2. atypical anxiolytic/ non barbiturate anxiolytics (Buspirone) 3. selective serotonin reuptake inhibitors (SSRIs) 4. serotonin norepinephrine reuptake inhibitors (SNRIs)
What are 9 treatment modalities to combat for anxiety disorders?
1. individual psychotherapy 2. support psychotherapy 3. insight-oriented psychotherapy 4. cognitive therapy 5. behavior therapy 6. habit reversal training 7. systematic desensitization and implosion therapy 8. systematic desensitization 9. implosion therapy (flooding)
What are the 4 types of anxiety disorders according to the DSM-5?
1. mild 2. moderate 3. severe 4. panic
A patient with OCD spends many hours each day washing her hands. What is the most likely reason she washes her hands so much? a. To relieve her anxiety b. To reduce the probability of infection c. To gain a feeling of control over her life d. To increase her self-concept
A
The nurse is caring for a client who has generalized anxiety disorder (GAD) and is experiencing severe anxiety. Which of the following statements would be most therapeutic? a. Tell me about how you are feeling right now. b. You should focus on the positive things in your life to decrease your anxiety. c. Take a deep breath and let's discuss the medications your provider is prescribing to decrease your anxiety. d. Why do you believe you are experiencing anxiety?
A
The nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? a. Stay with the client and remain quiet. b. Distract the client with a television show. c. Show the client how to change the behavior. d. Discuss new relaxation techniques.
A
Tina, who is experiencing a panic attack, has just arrived at the emergency department. Which is the priority nursing intervention for this patient? a. Stay with Tina and reassure her of her safety. b. Administer a dose of diazepam. c. Leave Tina alone in a quiet room so that she can calm down. d. Encourage Tina to talk about what triggered the attack.
A
How do you apply the nursing process to phobias (specific to object or situation)? Diagnosis
A diagnosis of specific phobia is made only when the irrational fear restricts the individual's activities and interferes with his or her daily living. The disorder is diagnosed more often in women than in men. Behavior directed toward avoidance of a feared object or situation (phobic disorder)
Annie has hair-pulling disorder. She is receiving treatment at the mental health clinic with HRT. Which of the following elements would be included in this therapy? (Select all that apply.) a. Awareness training b. Competing response training c. Social support d. Hypnotherapy e. Aversive therapy
A, B, C
The nurse is assessing a client who has generalized anxiety disorder (GAD). Which of the following findings should the nurse expect on assessment? (Select all that apply). a. Sleep disturbance b. Excessive worry for six months c. Restlessness d. Delayed reflexes e. Impulsive decision making
A, B, C
Describe anxiety.
Anxiety (a healthy sense of urgency) can be a normal, healthy response to life stressors).
What is anxiety?
Anxiety is a feeling of discomfort, apprehension, or dread related to anticipation of danger, the source of which is often nonspecific or unknown. Anxiety is considered a disorder (or pathology) when fears and anxieties are excessive (in a cultural context) and there are associated behavioral disturbances such as interference with social and occupational functioning.
What is the difference between fear and anxiety?
Anxiety may be distinguished from fear in that the former is an emotional process, whereas fear is a cognitive one. Fear involves the intellectual appraisal of a threatening stimulus; anxiety involves the emotional response to that appraisal.
Jareth has a diagnosis of generalized anxiety disorder. His physician has prescribed buspirone 15 mg daily. Jareth says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse? a. "Xanax is not effective for generalized anxiety disorder." b. "Buspirone must be taken daily in order to be effective." c. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." d. "Your friend really should be taking the Xanax every day."
B
The initial care plan for a patient with OCD who washes her hands obsessively would include which of the following nursing interventions? a. Keep the patient's bathroom locked so she cannot wash her hands all the time. b. Structure the patient's schedule so that she has plenty of time for washing her hands. c. Place the patient in isolation until she promises to stop washing her hands so much. d. Explain the patient's behavior to her because she is probably unaware that it is maladaptive.
B
Describe body dysmorphic disorder.
Body dysmorphic disorder is characterized by the exaggerated belief that the body is deformed or defective in some specific way. The most common complaints involve flaws of the face or head, such as wrinkles or scars, the shape of the nose, excessive facial hair, and facial asymmetry that are slight or not observable by others. Other complaints involve the ears, eyes, mouth, lips, or teeth. Some clients may present with complaints involving other parts of the body, and in some instances a true defect is present. The significance of the defect is unrealistically exaggerated, however, and the person's concern is grossly excessive. These beliefs are differentiated from delusions in that the individual with body dysmorphic disorder is aware that his or her beliefs are exaggerated. In some cases, though, people with body dysmorphic disorder also develop psychotic disorders.
. Sandy, a patient with OCD says to the nurse, "I've been here four days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? a. Give attention to the ritualistic behaviors each time they occur and point out their inappropriateness. b. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. c. Set limits on the amount of time Sandy may engage in the ritualistic behavior. d. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.
C
Joselyn is a new patient at the mental health clinic. She has been diagnosed with Body Dysmorphic Disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joanie? a. Alprazolam (Xanax) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Olanzapine (Zyprexa)
C
The nurse observes a client who has obsessive compulsive disorder (OCD) repeatedly apply, remove, then reapply eye makeup. The nurse identifies that repetitive behavior in the client who has OCD is due to which of the following underlying reasons? a. Narcissistic behavior b. Fear of rejection c. Attempt to reduce anxiety d. Adverse effects of medication
C
Which of the following is the most appropriate therapy for a client with agoraphobia? a. 10 mg Valium qid b. Group therapy with other people with agoraphobia c. Facing her fear in gradual step progression d. Hypnosis
C
Describe the Learning Theory.
Classic conditioning in the case of phobias may be explained as follows: a stressful stimulus produces an "unconditioned" response of fear. When the stressful stimulus is repeatedly paired with a harmless object, eventually the harmless object alone produces a "conditioned" response: fear. This conditioning becomes a phobia when the individual consciously avoids the harmless object to escape fear.
Describe the Cognitive Theory (as it relates to phobias).
Cognitive theorists espouse that anxiety is the product of faulty cognitions or anxiety-inducing self-instructions. Two types of faulty thinking have been investigated: negative self-statements and irrational beliefs. Cognitive theorists believe that some individuals engage in negative and irrational thinking that produces anxiety reactions. The individual begins to seek out avoidance behaviors to prevent the anxiety reactions, and phobias result.
Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? a. Ms. T experiences panic anxiety when she encounters snakes. b. Ms. T refuses to fly in an airplane. c. Ms. T will not eat in a public place. d. Ms. T stays in her home for fear of being in a place from which she cannot escape.
D
The nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse make a priority? a. Instill hope for positive outcomes. b. Assist the client to participate in treatment decisions. c. Encourage the client to participate in group therapy sessions. d. Assess the clients risk for self-harm.
D
With implosion therapy, a client with phobic anxiety would be: a. Taught relaxation exercises. b. Subjected to graded intensities of the fear. c. Instructed to stop the therapeutic session as soon as anxiety is experienced. d. Presented with massive exposure to a variety of stimuli associated with the phobic object or situation.
D
How do you apply the nursing process to generalized anxiety disorder (GAD)? Diagnosis
Excessive worry, difficulty concentrating, sleep disturbance Verbal expressions of having no control over life situation; nonparticipation in decision making related to own care of life situation; expressions of doubt regarding role performance
How do you apply the nursing process to agoraphobia? Outcome identification
Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety
How do you apply the nursing process to phobias (specific to object or situation)? Outcome identification
Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety
How do you apply the nursing process to social anxiety disorder (social phobia)? Outcome identification
Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety
Describe the background of generalized anxiety disorder (GAD).
Generalized anxiety disorder (GAD) 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. The anxiety and worry are associated with muscle tension, restlessness, or feeling keyed up or on edge The disorder may begin in childhood or adolescence, but onset is not uncommon after age 20. Depressive symptoms are common, and numerous somatic complaints may also be a part of the clinical picture. GAD tends to be chronic, with frequent stress-related exacerbations and fluctuations in the course of the illness.
How do you apply the nursing process to agoraphobia? Evaluation
In the final step of the nursing process, a reassessment is conducted in order to determine if the nursing actions have been successful in achieving the objectives of care.
How do you apply the nursing process to generalized anxiety disorder (GAD)? Evaluation
In the final step of the nursing process, a reassessment is conducted in order to determine if the nursing actions have been successful in achieving the objectives of care.
How do you apply the nursing process to panic disorder? Evaluation
In the final step of the nursing process, a reassessment is conducted in order to determine if the nursing actions have been successful in achieving the objectives of care.
How do you apply the nursing process to phobias (specific to object or situation)? Evaluation
In the final step of the nursing process, a reassessment is conducted in order to determine if the nursing actions have been successful in achieving the objectives of care.
How do you apply the nursing process to social anxiety disorder (social phobia)? Evaluation
In the final step of the nursing process, a reassessment is conducted in order to determine if the nursing actions have been successful in achieving the objectives of care.
How do you apply the nursing process to generalized anxiety disorder (GAD)? Outcome identification
Is able to recognize signs of escalating anxiety and intervene before reaching panic level? Is able to maintain anxiety at manageable level and make independent decisions about life situation?
How do you apply the nursing process to panic disorder? Outcome identification
Is able to recognize signs of escalating anxiety and intervene before reaching panic level? Is able to maintain anxiety at manageable level and make independent decisions about life situation?
What is the Hamilton Anxiety Rating Scale (HAM-A)?
It is a scale that observes the following: 1. Anxious nood 2. Tension 3. Fears 4. Insomnia 5. Intellectual 6. Depressed mood 7. Somatic (muscular) 8. Somatic (sensory) 9. Cardiovascular symptoms 10. Respiratory symptoms 11. Gastrointestinal symptoms 12. Genitourinary symptoms 13. Autonomic symptoms 14. Behavior at interview 0= not present 1= mild 2= moderate 3= severe 4= very severe Scoring 14-17 = Mild anxiety 18-24 = Moderate anxiety 25-30 = Severe anxiety
How do you apply the nursing process to agoraphobia? Background assessment data
It is possible that the individual may have experienced symptoms in the past and is preoccupied with fears of their recurrence.
How do you apply the nursing process to social anxiety disorder (social phobia)? Diagnosis
Marked fear of anxiety about one or more social situations on which the individual is exposed to possible scrutiny by others. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated. The social situations almost always provoke fear or anxiety. NOTE: In children, the fear of anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations. The social situations are avoided or are endured with intense fear of anxiety. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context. The fear, anxiety, or avoidance is persistent, typically lasting longer than 6 months or more. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupation, or other important areas of functioning. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance or another medical condition. The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder. If another medical condition is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
How do you apply the nursing process to agoraphobia? Diagnosis
Marked fear or anxiety about two (or more) of the following five situations: 1. Using public transportation (e.g., automobiles, buses, trains, ships, planes) 2. Being in open spaces (e.g., parking lots, marketplaces, bridges) 3. Being in enclosed places (e.g., shops, theaters, cinemas) 4. Standing in line or being in a crowd 5. Being outside of the home alone The individual fears these situations because of thoughts that escape might be difficult or help might not be available in the even of panic-like symptoms or other incapacitating or embarrassing symptoms. The agoraphobic situations almost always provoke fear or anxiety. The agoraphobic stations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. If another medical condition is present, the fear, anxiety, or avoidance is clearly excessive. The fear, anxiety, or avoidance is not better explained by the symptoms of another medical disorder.
Describe the Psychoanalytic Theory.
Modern-day psychoanalysts believe that unconscious fears may be expressed in a symbolic manner as phobias. For example, a female child who was sexually abused by an adult male family friend when he was taking her for a ride in his boat grew up with an intense, irrational fear of all water vessels. Psychoanalytic theory postulates that fear of the man was repressed and displaced onto boats. Boats became an unconscious symbol for the feared person but one that the young girl viewed as safer because her fear of boats prevented her from having to confront the real fear.
How do you apply the nursing process to social anxiety disorder (social phobia)? Background assessment data
Onset of symptoms of this disorder often begins in late childhood or early adolescence and runs a chronic, sometimes lifelong, course. It appears to be more common in women than in men. Impairment interferes with social or occupational functioning and causes marked distress. Exposure to the phobic situation usually results in feelings of panic anxiety with sweating, tachycardia, and dyspnea.
How do you apply the nursing process to panic disorder? Diagnosis
Palpitations, trembling, sweating, chest pain, shortness of breath, fear of going crazy, fear of dying Verbal expressions of having no control over life situation; nonparticipation in decision making related to own care of life situation; expressions of doubt regarding role performance
Describe the background of panic disorder.
Panic disorder is characterized by recurrent panic attacks, the onset of which are unpredictable. Panic attacks are manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom (clients often fear they are dying) and accompanied by intense physical discomfort. The physical sensations can be so intense that the individual believes he or she is having a heart attack or other critical illness. The symptoms come on suddenly and unexpectedly; that is, they do not occur immediately before or on exposure to a situation that usually causes anxiety (as in specific phobia). They are not triggered by situations in which the person is the focus of others' attention (as in social anxiety disorder). Attacks usually last minutes, or more rarely, hours. The individual often experiences varying degrees of nervousness and apprehension between attacks. Symptoms of depression are common. The average age of onset of panic disorder is the late 20s. Frequency and severity of the panic attacks vary widely.
What is pertinent education that you should teach patients with anxiety disorders?
Premise is that anxiety develops because of learned, inappropriate ways of thinking about and responding to life experiences. Patients learn more effective ways of responding to these experiences through cognitive reframing
Describe the goals related to phobias.
Short-Term Goal: Patient will discuss the phobic object or situation with the healthcare provider within (time specified). Long-Term Goal: By time of discharge from treatment, patient will be able to function in presence of phobic object or situation without experiencing panic anxiety.
Describe the goals for panic disorder & generalized anxiety disorder (GAD).
Short-Term Goal: The patient will verbalize ways to intervene in escalating anxiety within 1 week. Long-Term Goal: By time of discharge from treatment, the patient will be able to recognize symptoms of onset of anxiety and intervene before reaching panic level.
Describe the background of social anxiety disorder (social phobia).
Social anxiety disorder is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others. The individual has extreme concerns about being exposed to possible scrutiny by others and fears social or performance situations in which embarrassment may occur. In some instances, the fear may be quite defined, such as the fear of speaking or eating in a public place, fear of using a public restroom, or fear of writing in the presence of others. In other cases, the social phobia may involve general social situations, such as making comments or answering questions in a manner that would provoke laughter on the part of others.
Describe the background of phobias (specific to object or situation).
Specific phobia is identified by fear of specific objects or situations that could conceivably cause harm (e.g., snakes, heights), but the person's reaction to them is excessive, unreasonable, and inappropriate. Specific phobias are often identified when other anxiety disorders have become a focus of clinical attention. Treatment is generally aimed at the primary diagnosis because it usually produces the greatest distress and interferes with functioning more so than does a specific phobia. Phobias may begin at almost any age. Those that begin in childhood often disappear without treatment, but those that begin or persist into adulthood usually require assistance with therapy.
How do you apply the nursing process to generalized anxiety disorder (GAD)? Background assessment data
Symptoms are like those often associated with anxiety in the general population but, unlike the typical experience of anxiety, the symptoms in GAD are intense enough to cause clinically significant impairment in social, occupational, or other important areas of functioning. The individual often avoids activities or events that may result in negative outcomes or spends considerable time and effort preparing for such activities. Anxiety and worry often result in procrastination in behavior or decision making, and the individual repeatedly seeks reassurance from others.
Describe hoarding.
The DSM-5 defines the essential feature of hoarding disorder as "persistent difficulties discarding or parting with possessions, regardless of their actual value." Additionally, the diagnosis may be specified as "with excessive acquisition," which identifies the excessive need for continual acquiring of items (either by buying them or by other means). In previous editions of the DSM, hoarding was considered a symptom of OCD. However, in the DSM-5, it has been reclassified as a diagnostic disorder. Individuals with this disorder collect items until virtually all surfaces within the home are covered. There may be only narrow pathways, winding through stacks of clutter, in which to walk. Some individuals also hoard food and animals, keeping dozens or hundreds of pets, often in unsanitary conditions.
Describe trichotillomania.
The DSM-5 defines trichotillomania (hair-pulling disorder) as the recurrent pulling out of one's hair that results in hair loss. The impulse is preceded by an increasing sense of tension and results in a sense of release or gratification from pulling out the hair. The most common sites for hair pulling are the scalp, eyebrows, and eyelashes but may occur in any area of the body on which hair grows. These areas of hair loss are often found on the opposite side of the body from the dominant hand. Pain is seldom reported to accompany the hair pulling, although tingling and pruritus in the area are not uncommon. Comorbid psychiatric disorders are common with hair-pulling disorder. The most common are mood and other anxiety disorders. The disorder usually begins in childhood and is seven times more prevalent in children (between the ages of 4 and 17) than adults. It may be accompanied by nail biting, head banging, scratching, biting, or other acts of self-mutilation. This phenomenon occurs more often in women than in men. Studies indicate that it affects about 4 percent of the population.
How do you apply the nursing process to panic disorder? Background assessment data
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)(American Psychiatric Association [APA], 2013) states that at least four of the following symptoms must be present to identify the presence of a panic attack: 1. Palpitations, pounding heart, or accelerated heart rate 2. Sweating 3. Trembling or shaking 4. Sensations of shortness of breath or smothering 5. Feelings of choking 6. Chest pain or discomfort 7. Nausea or abdominal distress 8. Feeling dizzy, unsteady, lightheaded, or faint 9. Chills or heat sensations 10. Paresthesias (numbness or tingling sensations) 11. Derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself) 12. Fear of losing control or going crazy 13. Fear of dying
Describe the background of agoraphobia.
The Greek translation of the word agoraphobia is "fear of the marketplace." Agoraphobia is the fear of being in open shops and markets, but more specifically, it is the fear of being vulnerable and unable to get help or escape the setting should panic symptoms occur. Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. It is diagnosed more commonly in women than in men. Impairment can be severe. In extreme cases, the individual is unable to leave his or her home without being accompanied by a friend or relative. If this is not possible, the person may become totally confined to his or her home.
Describe the Cognitive Theory.
The main thesis of the cognitive view is that faulty, distorted, or counterproductive thinking patterns accompany or precede maladaptive behaviors and emotional disorders. A disturbance in this central mechanism of cognition causes a consequent disturbance in feeling and behavior. Because of distorted thinking, anxiety is maintained by erroneous or dysfunctional appraisal of a situation. There is a loss of ability to reason regarding the problem, whether it is physical or interpersonal. The individual feels vulnerable in a given situation, and the distorted thinking results in an irrational appraisal, fostering a negative outcome.
Describe obsessive-compulsive disorder (OCD).
The manifestations of obsessive-compulsive disorder (OCD) include the presence of obsessions or compulsions, or both, the severity of which is significant enough to cause distress or impairment in social, occupational, or other important areas of functioning. The individual recognizes that the behavior is excessive or unreasonable but, because of the feeling of relief from discomfort that it promotes, is compelled to continue the act. Common compulsions include hand washing, ordering, checking, praying, counting, and repeating words silently. The disorder is equally common among men and women. It may begin in childhood but more often begins in adolescence or early adulthood. The course is usually chronic and may be complicated by depression or substance abuse. OCD is identified more frequently in single people than in married people, but this finding probably reflects the difficulty that individuals with this disorder have with maintaining interpersonal relationships
How do you apply the nursing process to phobias (specific to object or situation)? Background assessment data
The phobic person may be no more (or less) anxious than anyone else until exposed to the phobic object or situation. Exposure to the phobic stimulus produces overwhelming symptoms of panic, including palpitations, sweating, dizziness, and difficulty breathing. These symptoms may occur in response to the individual's merely thinking about the phobic stimulus. Invariably, the person recognizes that his or her fear is excessive or unreasonable but is powerless to change, even though the individual may occasionally endure the phobic stimulus when experiencing intense anxiety.
Describe the Psychodynamic Theory.
The psychodynamic view focuses on the inability of the ego to intervene when conflict occurs between the id and the superego, producing anxiety. For various reasons (unsatisfactory parent-child relationship, conditional love, or provisional gratification), ego development is delayed. When developmental defects in ego functions compromise the capacity to modulate anxiety, the individual resorts to unconscious mechanisms to resolve the conflict. Use of defense mechanisms rather than coping and management skills results in maladaptive responses to anxiety.
Describe the background of anxiety disorder related to a medical condition of substance/medication induced.
The symptoms associated with these disorders are judged to be the direct physiological consequence of another medical condition or due to the direct physiological effects of substance intoxication or withdrawal or exposure to a medication. A number of medical conditions have been associated with the development of anxiety symptoms. Some of these include cardiac conditions, such as myocardial infarction, congestive heart failure, and mitral valve prolapse; endocrine conditions, such as hypoglycemia, hypo- or hyperthyroidism, and pheochromocytoma; respiratory conditions, such as chronic obstructive pulmonary disease and hyperventilation; and neurological conditions, such as complex partial seizures, neoplasms, and encephalitis. The diagnosis of substance-induced anxiety disorder is made only if the anxiety symptoms are in excess of those usually associated with the intoxication or withdrawal syndrome and warrant independent clinical attention. Evidence of intoxication or withdrawal must be available from history, physical examination, or laboratory findings to substantiate the diagnosis. Substance-induced anxiety disorder may be associated with use of the following substances: alcohol, amphetamines, cocaine, hallucinogen, sedatives, hypnotics, anxiolytics, caffeine, cannabis, or other substances.
When do anxiety disorders begin?
When anxiety begins to impair normal functioning.
What is implosion therapy (flooding)?
a therapeutic process in which the client, for prolonged must imagine situations or participate in real-life situations that he or she finds extremely frightening
What is habit reversal training?
attempt to extinguish the unwanted behavior by identifying the undesirable behavior and substituting a more adaptive coping strategy
What is behavior therapy?
behavior modification may include a system of positive and negative reinforcements in an effort to modify behavior
What is individual psychotherapy?
can be used logical and rational explanations to increase the client's understanding about various situations that create anxiety
What is systematic desensitization?
gradually exposing the client to the phobic stimulus. involves two elements: training in relaxation techniques & progressive exposure to a hierarchy of fear stimuli while in the relaxed state
What is support psychotherapy?
is designed to help clients identify their personal strengths and explore adaptive coping mechanisms
As nurse generalists, it is important to understand anxiety disorders and the various ways they can show up in general practice within our clients. SOME anxiety is "healthy" and when it becomes ----, it needs to be addressed and helped.
maladaptive
What is systematic desensitization and implosion therapy together?
treats clients with phobic disorders and to modify the stereotyped behavior of client with OCD
What is insight-oriented psychotherapy?
which is designed to help clients identify, explore, and resolve internal psychological conflicts that are contributing to anxiety
What is cognitive therapy?
·how individuals respond in stressful situations to their subjective cognitive appraisal of the event strives to assist the individual to reduce anxiety response by altering cognitive distortions based on education.
