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Generalized Responses
Restlessness Irritability Fainting Palpitations Diaphoresis Urination N&V Libido
Physiologic Responses
Hyperreflexia Impatience Chest Pressure Headache Muscle tension Gluconeogenesis Dry Mouth Sexual Dysfunction
Mild (+)
Cognitive Responses
Moderate (++)
Severe (+++)
Panic (++++)
Closed perceptual field Contact with reality Impaired thinking/function Unable to process stimuli
Mild (+)
Behavioral Responses
Alert & Confident Speech & Coping Skills
Moderate (++)
Competitive activity Body position frequently Frequent topic s Defense mechanisms Focus on immediate events
Severe (+++)
Overload Neurosis
Panic (++++)
Total loss of control Cling to source of safety Helplessness Psychosis May strike physically or withdraw Completely disorganized
Anxiety Disorders
A group of symptoms & impaired reality testing.
Panic Disorder
Sudden onset Multiple attacks Intense & escalating apprehension Poor judgment, confused & disoriented Feelings of impending doom Fears losing control or going insane Lasts 15-30 minutes or (rarely) hours
Panic Disorder
Intense Physical discomfort
Palpitations Dyspnea
Chest pain HR Choking/Smothering SOB Hyperventilation RR Dizziness Diaphoresis Chills/Hot flashes Tremors & Shaking GI distress Nausea Diarrhea Fear of dying and/or going crazy Depersonalization
Nursing Interventions
Stay with Pt and remain calm
Assess own level of anxiety
Ensure safety and reassure Pt Pt take slow, deep breaths Quiet environment
Focus on a single object in the room
Symptoms
Autonomic Hyperactivity
Jumpiness, tremors, muscle tension HR RR
Obsessive-Compulsive Disorder
Recurrent obsessions & compulsions Time consuming Gradual conditioned response RT traumatic event Obsessions Unwanted intrusive, persistent images or impulses Recurrent thoughts of violence, contamination, doubt or
need for specific order.
Compulsions
Defense Mechanism
Undoing Displacement
Phobias
Persistent or irrational fear of specific object, activity or situation that causes avoidance.
Exposure to stimulus = immediate anxiety response. Blushing, Vomiting, Humiliation, Tremors, HR BP RR Agoraphobia Fear of being alone in public place. No escape Social Phobia Fear of appearing embarrassed or evaluated negatively by others. Simple Phobia (Specific object or situation) Acrophobia = Fear of heights Claustrophobia = Fear of closed in places Mysophobia = Fear of dirt, germs
Nursing Interventions 1st accept Pts fear as real Relaxation techniques Behavior Modification Desensitization
Symptoms Re-experiencing event (Flashback) Avoidance of thoughts, emotions or conversations Sustained Anxiety Angry Outbursts Hypervigilence Nightmares Sleep Disturbances Survivor Guilt Depression Substance Abuse Psychic Numbing Feel detached from others
PTSD
Nursing Interventions
Environmental Stimuli Reorient to reality Reassure Pt is safe Encourage verbalization of event and feelings Facilitate grief process Adaptive coping techniques Anxiolytic meds during flashback
Somatoform Disorders
Women> men
Somatization
Anxiety transformed into physical illness No labs, diagnostic tests support DX Chronic course without structural s
Conversion DisorderHysteria
Loss or alteration in physical functioning
Voluntary motor/sensory
Symptom
Defense Mechanism
Repression Conversion
Secondary Gain
Sympathy, support, attention avoid activities & responsibilities
Nursing Interventions
Focus on anxiety, NOT symptoms Encourage verbalization
Identify conflicts stress & relaxation
Misinterpretation of symptoms
Symptoms
C/O Multiple symptoms & Persist > 6 months Dr. Shopping Demand diagnostic testing & invasive procedures Review objective data, symptoms & interpretation Set limits on whining Self-worth and resolve internal anger
Nursing Interventions
Dissociative Disorders
Psychogenic Amnesia
information.
Sudden inability to recall important extensive personal Sudden unexpected travel away from home or usual
workplace Begin new job, relationships (Unaware of true life) Assumes new identity Escapes from overwhelming stress or rejection
Psychogenic Fugue
Dissociative Disorders
Depersonalization Disorder
Change in quality of self-awareness Feelings of unreality, s in body image. Detachment
Sense of observing oneself (from outside of body) Not in touch with body No somatic sensations
Journals
Self-Help Skills
CognitiveBehavioral Therapy
Positive Reframing
Takes 7-10 days for steady effect Elderly have hepatic & renal function
risk for toxic effect
Anxiolytics Meds
Benzodiazepines
Alprazolam (Xanax) Lorazepam (Ativan) Chlordiazepoxide (Librium) * Diazepam (Valium) Clonazepam (Klonopin) * Clorazepate (Tranxene)
Risk for physical dependence & tolerance Lipophilic & cross blood-brain barrier
Side effects
Anxiolytics Meds
Azaspirodecanediones
Buspirone (Buspar) 5-HT receptor antagonist Takes 2-4 weeks to be effective potential for abuse SE: Dizziness Sedation
N & HA
Propanediols
Meprobamate (Equanil/Miltown) Thalamus & Limbic system response
Sedating Antihistamines
Hydroxyzine (Vistaril/Atarax) CNS depressant effect
Anxiolytics Meds
Selective Serotonin Reuptake Inhibitors (SSRIs)
Citalopram (Celexa) Escitalopram (Lexapro)
Fluoxetine (Prozac/ Serafem Puvules-weekly) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft)
Only prevents 5-HT reuptake = 5-HT available regulation of emotions, wakefulness Use for OCD, GAD, Phobias No other neurotransmitters affected E & NE
Side effects: Anxiety Agitation Nausea Sexual Dysfunction Akathisia (Use Propanolol) Insomnia
Orthostatic Hypotension
Blood Dyscrasias Abrupt Withdrawal Syndrome Flumazenil (Romazicon) Benzodiazepam antagonist
Reverse CNS effects
Defense Mechanisms
Denial
Regression
Displacement (3 way)
Reaction-Formation
expressed by developing opposite thoughts/behaviors Unwanted pregnancy New mom overprotective of baby
Defense Mechanisms
Projection (2 way)
Unacceptable feelings/impulses are attributed to another
person Im needy but claim my husband is demanding
Repression
Involuntary blocking of unpleasant feelings and experiences No memory of sexual abuse as a child
Suppression
Conscious voluntary denial of unpleasant feelings and
experiences Put away NCP & focus on studying for exam
Identification
Rationalization Attempting to form logical reasons to justify unacceptable feelings Not getting accepted to Harvard I didnt want to leave home Sublimation Substituting constructive/socially acceptable activity for
inappropriate impulses. Aggressive person becomes hockey player
Defense Mechanisms