Card Set Information
What is generalized anxiety disorder (GAD)?
A pattern of excessive worry that starts interfering with social or occupational functioning.
80% chance of passing to child if parent has it. Only 60% with depression.
What are some SnSs of GAD?
Chronic low level anxiety
Often physical complaints
Chronic worry without objective stressors
Medication: reduces rumination and worry
Calms person to get to their words
4 or more of the following
: (Develops fast & peaks within 10 minutes)
Pounding heart or rapid heart rate
Trembling or shaking
Shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Unsteady, lightheaded or faint
Derealization (feelings of unreality)
Depersonalization (being detached from oneself
Fear of dying
Numbness or tingling
What Rx is used for Panic Disorders?
For SSRIs, reduce 25%/month until discontinued.
What is a Phobia?
Excessive and unreasonable fear for a specific object or situation
Provokes an anxiety response (in children is expressed by crying, tantrums, freezing or clinging)
Person knows the fear is excessive or unreasonable
Phobic situations(s) avoided or endured
Interference with social/occupational functioning or ADL’s
Displacement and regression
Corrected by exposure therapy.
Nursing interventions for phobias?
Anxiety management interventions
Cognitive behavioral strategies
Medications not as effective for phobias.
What are social phobias?
Social situation provokes anxiety which may be as severe as a panic attack
Recognizes the fear is excessive or unreasonable
Social or performance situations are avoided or endured (with intense anxiety or distress)
Interferes with social/occupational functioning or ADL’s
What are some nursing interventions for a social phobia?
Cognitive behavioral interventions
Propranolol (Inderal) (Stage fright)
: Repetitive behaviors
--Mental acts (praying, counting, repeating words silently)
The person feels driven to perform
The behaviors or mental acts:
--Prevent or reduce distress
--Prevent some dreaded event or situation
--Not connected in a realistic way with what they neutralize
Time consuming (More than 1 hour a day). Purpose of the ritual is the alleviate the anxiety. Does it work?
Goal is to limit the ritual compulsive action. Will probably not be successful in eliminating it entirely. Medication may or may not be effective.
What are the two main defense mechanisms for OCDs?
Nursing interventions for OCD?
Cognitive behavioral strategies involving exposure & ritual prevention
What are some Rx to Tx OCD?
Luvox (Fluvoxamine) SSRI
Paxil (Paroxetine) SSRI
Anafranil (Clomipramine) Tricyclic
Zoloft (Serraline) SSRI
Prozac (Floxetine) SSRI
What is PTSD?
Impairment of social/occupational functioning or difficulties with ADLs due to Exposure to a traumatic event
Actual or threatened death or serious injury to self or others.
Had intense fear
PTSD traumatic events experiences in 2 or more of the following:
Thoughts or perceptions (in children, they may re-enact the trauma in repetitive play)
Distressing dreams- nightmares
Acting or feeling as if the traumatic event were recurring
Intense psychological distress
PTSD experiencing numbing/avoiding of 3 or more of the following:
Places or people
That lead to memories of trauma
Inability to recall aspects of the trauma
Diminished interest or participation in significant activities
Feelings of detachment or estrangement from others
Restricted affect (unable to have loving feelings)
Sense of foreshortened future (does not expect to have a career, marriage, children, or a normal life span)
PTSD symptoms of increased arousal of 2 or more of the following:
Difficulty falling or staying asleep
The above are evidenced by:
High risk behaviors
Avoids crowds and open places
Exaggerated startle response
Theoretical framework for PTSD?
Nursing Interventions for PTSD?
Critical incident debriefing
Discuss risk taking behavior
Counseling & therapy
--EMDR (eye movement desensitization reprogramming)
--EFT (emotional freedom technique).
Sleep hygiene Ch 16 Stuart (p. 253)
Teach coping skills
(SSRI, Tricyclics and MAOI)
--Propranolol (Inderal), Fluoxitine (Prozac)
--Trazodone for sleep
What are Somataform Disorders?
Body Dysmorphic Disorder
No physical cause or actual disorder, but will feel pain.
SnSs of somatization disorders
History of many physical complaints
Begins before age 30
Results in seeking treatment
Social/occupational impairment or interference in ADLs.
Somatization defense mechanism
Describe complaints in colorful, exaggerated terms, lacking in factual information
Seek treatment from several physicians at once
May lead to complicated and hazardous treatment combinations
Anxiety and depression common. (Reason seen in a mental health setting)
May have impulsive behavior
May have suicide threats and attempts and marital discord
Lives often chaotic and complicated.
[Source: APA DSM IV-TR]
Nursing interventions for somatization disorders
Help know when experiencing anxiety as needed
Help deal constructively with the anxiety
Set limits on somatic complaints
Address secondary gain
Cognitive behavioral strategies & Group therapy
Administer Antidepressants for comorbid depression
Affects the voluntary motor or sensory functions (suggest a neurological or general medical condition and is not)
preceded by conflicts or other stressors.
not intentionally produced or feigned.
not fully explained after appropriate investigation.
Interference in social/occupational functioning or ADLs.
Nursing interventions for conversion disorders
Help label and deal with feelings
Learn new coping strategies
Intervene in unhealthy defense mechanisms
Discuss precipitants to anxiety
Have a healing ceremony. People with conversion disorders are highly suggestible
What are some nursing interventions for hypochondriasis
Set limits on somatic complaints
Reward interaction that is not focused on symptoms
Withdrawal attention when making physical complaints
Cognitive behavioral strategies
Help them get a life.
Preoccupation with fears of having a serious disease
Preoccupation persists despite appropriate medical evaluation and reassurance
Causes significant interference with social/occupational functioning or interferes with ADLs
What are Malingering vs. Munchhousen
: Faking an illness
Malingering by proxy: Faking illness for someone else
: making self sick
Munchhausen by proxy-making someone else sick
What are some interventions for Malingering/munchhousen
Diagnostics and confrontation, possible legal implications.
What are body dysmorphic disorders?
Preoccupation with imagined defect in appearance.
Excessive concern if slight physical anomaly
Preoccupation causes impairment in social/occupational functioning or ADLs.
What are nursing interventions for body dysmorphic disorders?
Work on body image
Cognitive behavioral and restructuring techniques
What are dissociative disorders?
What is Dissociative amnesia?
Inability to recall important personal information
Traumatic or stressful nature
Too extensive to be ordinary forgetfulness.
Can occur with other disorders
What is dissociative fugue?
Unexpected travel away from home or work place
Inability to recall one's past
Confusion about personal identity
Assumption of a new identity
What is dissociative personality disorder?
Presence of 2 or more distinct identities or personalities (each with its own pattern of perceiving, relating to and thinking about the environment and self)
At least 2 personalities take control of the person’s behavior
Inability to recall important personal information--too extensive to be explained by forgetfulness
Defense mechanism: Dissociation
Nursing interventions for dissociative disorders?
Talk to them through the main alter
Cognitive behavioral strategies and restructuring
Bodywork for body memories. Be sensitive to psychosocial Hx, especially when doing invasive stuff like caths on pt who has been sexually abused.
Count backwards into a safe place
Takes extensive work with a therapist