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mental health
sleep wake, and anxiety disorders
| Term | Definition |
|---|---|
| recommended amount of sleep for infants | 14-17 hours |
| recommended amount of sleep for school aged children | 9-11 hours |
| recommended amount of sleep for adults | 7-9 hours |
| insomnia | a predominant complaint of dissatisfaction with sleep quantity or quality associated with one or more of the following symptoms - difficult initiating sleep, difficulty maintaining sleep, early more awakening without being able to return to sleep |
| pharmacologic management of insomnia | short onset of action and require person to be ready for sleep benzodiazepines- Estazolam, Flurazepam |
| narcolepsy | condition characterized by frequent and uncontrollable periods of deep sleep |
| pharmacologic intervention for narcolepsy | stimulants |
| hypersomnolence | excessive daytime sleepiness that has persisted for more than 3 months, pt does not feel rested after 9+ hours of sleep, frequent naps |
| interventions for hyper-somnolence | increased sleep time at night and stimulants |
| restless leg syndrome | an uncomfortable sensation in the legs accompanied by the urge to move |
| pharmacologic interventions for restless leg syndrome | dopamine receptor agonists such as Ropinrole or Pramipexole |
| sleep apnea | repeated episodes of upper airway collapse and obstruction that results in sleep fragmentation |
| risk factors for sleep apnea | advancing age, being a man, obesity, having a respiratory or cardiac disease |
| circadian rhythm disorders | misalignment between the timing of the normal circadian rhythm and external factors that affects the timing or duration of sleep Delayed sleep phase, advanced sleep phase, irregular-sleep wake, shift work, non-24 hour sleep wake |
| Non-REM sleep arousal disorder | includes sleep walking and sleep terrors |
| nightmare disorder | frequent nightmares during REM sleep Treatment includes lifestyle modifications and/or alternative methods such as hypnosis |
| REM sleep behavior disorder | characterized by physically acting out vivid, often unpleasant dreams with vocal sounds and sudden arm and leg movements during REM sleep |
| patient education for proper sleep hygiene | Good sleep schedule Quiet, dark, calm sleeping environment Limit caffeine and heavy food intake Avoid daytime napping Get good exercise daily |
| medications for treatment of sleep disorders | Benzo- Temazepam (Restoril) Nonbenzo receptor agonists- Eszopiclone (Lunesta), Zolpidem (Ambien) |
| nursing assessment for sleep disorders | Daytime sleep patterns, sleep habits/behaviors, sleep environment, sleep history, stress and its impact on sleep, exercise habits, safety at work/home, driving habits, work performance, social obligations, physical health |
| risk factors for development of anxiety disorders | Genetics- first generation biological relative Neurobiological- those with low levels of GABA suffer from anxiety disorders Psychological factors – anxiety is a learned behavior, includes thought distortions and a result of negative life events |
| mild anxiety | a person is able to perceive, hear, and grasp more information Manifestations may include restlessness, irritability, mild psychomotor agitation (fidgeting, foot tapping) |
| moderate anxiety | a person sees, hears and grasps less information and exhibits selective inattention- ability to think is impaired but learning can occur Manifestations- increased VS, GI problems, tremors and headache |
| severe anxiety | a person cannot focus on details and the level of perception has lowered, unable to learn or problem solve at this level Manifestations- nausea, dizziness, confusion, hyperventilation |
| panic | a person is unable to process and may lose touch with reality Manifestations- extreme behaviors- screaming, shouting, social withdrawal, hallucinations |
| separation anxiety disorder | developmentally inappropriate anxiety over separation from a significant person in their life – clingy and needy behavior |
| specific phobias | persistent fear of a specific thing, activity or situation that causes the affected person to avoid or eliminate those from their lives Examples- fear of heights, fear of water Often occurs due to a negative or traumatic event in their past |
| social anxiety disorder | an anxiety disorder that is characterized by persistent and exaggerated fear of social situations in which embarrassment or negative judgement by others may occur- the situation would be avoided due to the anxiety that surrounds them |
| panic disorder | - characterized by panic attacks Sudden onset of extreme apprehension or fear of impending doom, intense, unpredictable and can last around 10 mins |
| body dysmorphic disorder | obsessive focus on a perceived flas in appearance, often have a history of abuse or neglect |
| hoarding disorder | a persistent difficulty discarding or parting with possessions because of a perceived need to save them, a stressful life event often precipitates this |
| trichotillomania | – a disorder that involves recurrent, irresistible urges to pull out body hair |
| excoriation disorder | skin picking disorder, negative impact on daily function |
| generalized anxiety disorder | o Characterized by excessive worry that is out of proportion to the true nature of the situation for more than 6 months o The person may avoid events or put things off due to anxiety |
| obsessions | thoughts, impulses, or images that persist and recur |
| compulsions | ritualistic behaviors that an individual feels driven to perform (time-consuming and interfere with life) |
| obsessive-compulsive disorder | o Mental disorder in which somebody feels they have to repeat certain actions or activities to get rid of fears or unpleasant thoughts |
| interventions for mild-moderate levels of anxiety | help pt identify anxiety, use nonverbal language to demonstrate interest, encourage the pt to talk about feelings and concerns, avoid closing off avenues of communication that are important to the pt, encourage problem solving |
| interventions for severe levels of anxiety | maintain a calm manner, always remain with the patient, minimize environmental stimuli, use a low-pitched stimuli, speak slowly, use clear and simple statements, reinforce reality, attend to physical and safety needs |
| Benzodiazepines prescribed for anxiety disorders | alprazolam (Xanax), Chlordiazepoxide (Librium), Clonazepam (Klonopin) |
| side effects of benzos | drowsiness, fatigue, slow reflexes, confusion |
| teaching for benzodiazepines | not for minor stresses, OTC drugs might enhance the action, avoid driving until tolerance develops, do not exceed the prescribed dose, avoid alcohol and CNS depressants, do not stop abruptly |
| buspirone (Buspar) | Non-benzo med for anxiety, non-sedating, no cross-tolerance with alcohol and sedatives, takes 1-6 weeks for full effect (a benzo may be used until full effects are felt), no dependence, withdrawal or tolerance, few drug-drug reactions |
| posttraumatic stress disorder | A disorder in which the person has difficulty recovering after experiencing or witnessing a terrifying event Recurrent dreams or flashbacks, avoidance of stimuli associated with trauma, numbing of responsiveness |
| dissociation | involuntary response that protects the individual from full awareness of the trauma |
| positive symptoms of dissociation | - unwanted additions such as flashbacks and emotional triggers |
| negative symptoms of dissociation | deficits such as lack of sense/control of body parts or a decline in memory |
| depersonalization disorder | the persistent feeling of observing oneself from the outside one’s body or having a sense that one’s surroundings aren’t real the person may feel mechanical, dreamy, or detached from the body |
| dissociative amnesia | inability to recall personal information often occurring after a traumatic event dissociative fugue- sudden, unexpected travel away from home and inability to recall one’s identity and information about one’s past |
| dissociative identity disorder | a disorder characterized by the presence of two or more distinct personality states presence of a principal personality (core) that functions in everyday life and blocks traumatic memories |
| somatic symptom disorder | - extreme focus on physical symptoms, such as pain, or fatigue, that causes emotional distress and problems functioning Physical symptoms in absence of a physiological cause |
| illness anxiety disorder | patient has obsessive thoughts about illness and disease, patient misinterprets physical sensations as evidence of a s serious illness |
| conversion disorder | - symptoms that affect voluntary motor or sensory function suggest a physical condition Stressors are manifested into physical symptoms- it is not faking or doing it on purpose |
| PTSD assessment | length of onset, severity of symptoms and impact on daily functioning, safety in current environment |
| PTSD interventions | patient and family teaching, development of coping skills for anxiety, anger and/or depression, SSRIs are best pharmacological intervention (Zoloft and Paxil are FDA approved) |
| dissociative disorder interventions | teach coping skills and stress triggers, encourage maintenance of routine and expression of feelings, treatment is long-term therapy Impact of events scale! |
| somatic disorder interventions | referral to community support groups, education on coping skills, long term treatment/therapy, avoid doctor shopping, collaborate with family |
| somatic disorder assessment | Collect data about nature, location, onset, characteristics and duration of physical symptoms, determine ability to meet basic needs, determine if the patient is receiving any secondary gains, determine substance use |
Created by:
ellabrewer3
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