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 Affect bland, withdrawn 2.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%