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nurs 211

anxiety disorders

def of stress as a person's total response to environmental demands or pressures- flight or fight
fear def the unpleasant cognitive state consisting of psychophysiological responses to a real external threat or danger
def anxiety; physical s/s of this an emotional response to anticipation of danger (stressor),the source may be unknown or unrecognized; tachycardia, hyperventilation, increased vision
what is the psych response fear or anxiety; what is the emotional response fear or anxiety; fear; anxiety
anxiety: it becomes pathologic when anxiety interfers with what effectiveness in living,achievement of goals or satisfaction reasonable emotional comfort
anxiety: in this the body experiences all of the s/s of fear but there is no real ___; danger;
anxiety history of it: it was first identified by what s/s; what were other names of it; physiological; cardiac neurosis, irritable heart, nervous tachycardia, soldier's heart;
anxiety history of it: who introduced the term anxiety neurosis; freud showed that anxiety also affect the ___ wellbeing; when did internal med finally accept it; freud; physiological; after WWII;
anxiety disorders: they are the most common of all what; they result in what; are they more common in men or WM; is there a familial predisposition; what % of kids have this; what socioeconomic groups have this psych illnesses; functional impairment and distress; WM; yes; 43%; low
children and anxiety: married or separated parents of children who have this; w separated;
Levels of anxiety: how many are there; name them 4 ; mild, mod, severe, panic;
Levels of anxiety: mild- is this considered healthy?; what happens physically- to eyes; hearing; smells?; what happens to sense of touch yes; pupils dilate; intensifies; intensifies; highly sensitive
Levels of anxiety: mild- they are highly what; alert;
Levels of anxiety: at what level is learning the best mild
Levels of anxiety: moderate- healthy of unhealthy; what happens to the perceptual fields; what is attention; is focus increased or decreased; what is observed unhealthy; they narrow; on selective; increased; automatism
def automatism repetitive purposeless movements
Levels of anxiety: mod- ex of automatism shaking of hands and feet, twirling of hair, tapping of fingers
Levels of anxiety: severe- what is further reduced; there is difficulty for person to do what; what movements are noted; example; perceptual fields; communicate; gross motor movements; paceing;
Levels of anxiety: severe- when communicating with this patient how should it be done short and simple sentences
Levels of anxiety: panic- what happens to perceptual fields; can they communicate; what is there a loss of there is a total disruption of the fields;no; communication, rational thought, counscious thinkning;
Levels of anxiety: panic- what is priority of care for these ppl provide a safe and secured environment- do not leave them
anxiety: normal reaction- there is a ___ danger or threat to biological integrity or self concept; when does the anxiety dissipate realistic; when the danger or threat is no longer present
anxiety: abnormal reaction- 1) it is out of proportion to what; 2) anxiety interferes with what functioning; the situation creating the anxiety; social, occupational or other areas
anxiety: abnormal reaction- axample of it being out of proportion to the situation; what is an example how anxiety interferes with functioning mrs. K witnessed a car accident 1 mo ago while driving car to work and refuse to drive and spouse needs to drive; mrs. K needs to quit her job due to lack of transportation;
assessment of anxiety: assess what; what is the anxiety rating scale; history, physical assessment of symptoms; Hamilton anxiety rating scale;
Hamilton anxiety rating scale: what does it measure; what type of anxiety does it meaure the severity of anxiety s/s and is still widely used today in clinical and research settings; both psuchic and somatic anxiety
self anxiety assessment: what is score for mild anxiety; what is mod anxiety; what is severe anxiety; 18+; 25+; 30+
goals for anxiety: reduce what; what is reduced intensity; control factors that contribute to what; teach to recognize what; frequency, intensity; move from severe/panic to moderate or coping; anxiety; s/s of it;
goals for anxiety: will implement strategies to prevent what response anxiety reponse;
what are alternative ways to deal with stress DB, games, going outside, crafts
anxiety tx: what type of psychotherapy; what other therapy; alter cognitive what; teach what techniques; individual, group, family; cognitive behavioral therapy; distortions; relaxation techniques'
anxiety tx: what are behavior therapy such as systemic what; what is EMDR; desensitization or implosion; eye movement desensitization and reprocessing for traumatic events;
anxiety tx: what are meds to give for this; name anxiolytics; anxiety; SSRIs, SNRIs, noradrenergic agents, barbiturates, buspirone
what are the types of anxiety disorders panic disorders, generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, phobia
panic disorder: panic attack- def; this is the most severe form of what; what are the s/s a sudden overwhelming feeling of terror or impending doom and has all of the physical manis; emotional anxiety; behavioral, cognitive and physiological s/s;
panic disorder: panic attack- is onset predictable; why do they end up staying in the house; what is the average age of onset; how long may someone have this disorder no; bc they do not want it to happen; late 20s; weeks to years;
panic disorder: panic attack- manis- there is intense what; there are feelings of what; intense ___ discomfort; apprehension, fear or terror; impending doom; physical;
panic disorder: panic disorder- characterized by what; is this a one time thing; at least one of the attacks is followed by a month or more of what; recurrent panic attacks; no; persistent concner about having additional panic attacks, worry about the implications of the attach or its consequences, a sig changein behavior rt the attacks
DX of a panick attack: an attack is a period of intense __; does it develop abruptly or slowly; when is the peak; how many od the s/s does it need to have fear or discomfort; abruptly; 10 min; 4
DX of a panick attack: what are the s/s palpations, accelerated HR, sweating, trembling or shaking, sensation of SOB, feeling of choking, chest pain, nasea, dizzy unsteady lightheaded or faint, derealization, depersonalization, fear of going crazy/dying, chills
def derealization feeling of unreality
def depersonalization feelings of being detached from oneself
DX of a panick attack: how long can attacks last; s/s of what other disorders are common min to hours; depression
emergency care of a panic attack: stay with whom; reassure about what; how to give directions; assist pt to what type of environment; explore what; admin PRN what the pt; that we will not leave them; clear and simple; one with minimal stimulation; triggers; anxiolytics
panic disorder with agoraphobia: they have the symptoms of what; plus there is a fear of what; a panic disorder; being in places or situations;
panic disorder with agoraphobia: what types of places do they fear; this fear restricts what; one in which the escape is difficult; travel;
panic disorder with agoraphobia: they may be unable to leave house unless what; common situations; unless they are with others; being outside the home along, being in a crowd, standing in line, on a bridge, traveling in bus train or car;
panic disorder with agoraphobia: what is the defence mechanism of this; def displacement displacement; redirecting of the thoughts feelings and impulses directed at one person or object but taken out upon another person or object;
defense mechanisms: def regression; def repression retreating to an earlier level of development and the comfort measures associated with that level; involuntary blocking unpleasant feelings and experiences from one's awareness;
defense mechanisms: def suppression; def denial blocking of unpleasant feelings and eperiences from one's awareness; refuse to achnowledge the existence of a real situation or the feelings associated with it
defense mechanisms: what one is main coping mech. for anxiety clients; what one is voluntary repression; suppression
generalized anxiety disorder: there is chronic unrealistic what; how long to s/s last; s/s not attributed to specific what; excessive anxiety and worry; >6 mo; organic factors (caffeine, hyperthyroidism)
generalized anxiety disorder: what is DMS criteria; what are the s/s that last for at least 6 mo; s/s cause clinically sign. distress or impairment in social, occupational or other important areas of functioning; restless or feeling keyed yp or on edge, being easily fatigued, difficulty concentrating or mind going blank, muscle tension, sleep disturba
generalized anxiety disorder: when is the onset; what other s/s are common; what type of complaints are common; is it acute or chronic; there is fluctuations in what childhood, adolescence, not uncommon after age 20; depressive; somatic; chronic; the course of the illness
generalized anxiety disorder: name nursing dx; what are biologic interventions; what type of therapy anxiety, ineffective individual coping; identify potential causative factors and severity, sleep and hygiene; cognitive behavioral therapy
generalized anxiety disorder: therapy: what is the cognitive behavioral therapy focus; it is ___ focused; it is ___ directed; how is it an active intervention on examining the relationship between thoughts feelings and behaviors; problem; goal; there is outside homework
predisposing factors to panic and generalized anxiety: psychodynamic theory- this is the inability for the go to intervene when what occurs; what is the conflict between conflict; the id and the superego;
predisposing factors to panic and generalized anxiety: cognitive theory- this is what type of thinking; this thinking precede the what faulty, disorted or counterproductive thinking; maladaptive behaviors and emotionals disorders
predisposing factors to panic and generalized anxiety: what are genetic factors twins and relatives
predisposing factors to panic and generalized anxiety: what are neuroanatomical factors pathological involvement in the temporal lobes and hippocampus
predisposing factors to panic and generalized anxiety: what arethe biochemical factors abnormal elevations of blood lactate with panic disorder
predisposing factors to panic and generalized anxiety: what neurochemical is involved with these norepinephrine
predisposing factors to panic and generalized anxiety: what medical conditions predispose; MI, valvular disfunction, seizures, hypoglycemia, pheochromocytomas
predisposing factors to panic and generalized anxiety: def pheochromocytoma rare tumor of adrenal gland tissue results in the release of too much epinephrine and norepi that control HR, metabolism and BP
predisposing factors to panic and generalized anxiety: what substance issues can cause this intoxication or withdrawalof cocaine, marij, opioid
OCD: DSM- this is recurrent ___ or ____; they are severe enough to be ___ consuming; they cause marked ____ or ___; does client recognize behavior as excessive or unreasonable; obsessions or compulsions; time; distress or sign impairment; yes- but they cont the act
OCD: most common compulsions; washing and cleaning, counting, checking, requesting or demanding assurance, repeating actions, ordering
OCD: more men or women; occurs more in single or married persons; when does it usually begin; acute or chronic; what other issues do persons suffer from equally common in both; single; in adolescence or early adulthood; chronic; depression or substance abuse;
OCD: obsession- def; thoughts or behaviors intrusive and inappropriate recurrent and persistent thoughts impuses or images that are intrusive and inappropriate and cause marked anxiety or distress; thoughts
OCD: obsession- the thoughts are or are not simply excessive worries about real life; does the person attempt to ignore or suppress the thoughts; the person recognizes that the thoughts are a product of what are not; yes; their own mind
OCD: compulsions- are they thoughts or behaviors; def; the behaviors or mental acts are aimed at preventing/reducing what; behaviors; repetitive behaviors that the person is driven to perform; distress, some event, or situation;
OCD: the person recognizes what; they cause great what; and they interferewith what that the obsessions or compulsions are excessive or unreasonable; discomfort; the person's academic work or social life and relationships
predisposing factors to OCD: psychoanalytic theory- persons with OCD have weak or strong egos; why is there a weak ego weak egos; due to unsatisfactory parent-child relationship, conditional love or provisional gratification
predisposing factors to OCD: learning theories- this is a conditional response to what; the event produces what; the OCD behaviors provide what traumatic events; anxiety and discomfort; relief
predisposing factors to OCD: biological- neuroanatomy- there is abnormal metabolic rates where in the brain in the basal ganglia and orbital frontal cortex;
predisposing factors to OCD: biochemical- what neurochemical influences OCD behaviors serotonin;
predisposing factors to OCD: transactional model ofstress/adaption- OCD is influenced by multiple what factors
OCD: nursing dx- why is there a risk for injury; what are interventions; aeb repeated scrubing of hands under hot water; decrease stimuli-people, noise,demands;
OCD: nursing diagnosis- why is behavior allowed initially; why is behavior done; bc the ritual tasks aid in decreasing anxiety; to get thought out of mind
OCD: nursing diagnosis- develop trust and esteem to decrease what; find a safer what; what is the last resort; need for compulsion; compulsion; neuro-psychosurgery
OCD: nursing management and psychological assessment- assess type and severity of what; assess the degree as to which OCD interferes with what; do what type of rating scale; what safety assessment should be done; obsessions and compulsions; with patient's daily functioning; anxiety; suicide assessment;
PTSD: development of th s/s follow exposure to an extreme ____ stressor; the stressor involves a personal threat to what; ex of personal threat; traumatic; physical integrity or the integrity of others; unexpected or violent death, serious harm, threat of death or injury of a family member or close associate
PTSD: s/s are not r/t common experiences like; this events that are severe are distressing to whom if it were to happen in their life; uncomplicated bereavement, marital conflict, or chronic illness; anyone;
PTSD: examples of distressing events military combat, experiencing a violent personal assault, being kidnapped, or taken hostage, being tortured, incarcerated as a prisoner of war, disasters, surviving a severe car crash, or life threatening dx
PTSD: they re-experience what; when experiencing the traumatic event there is a high level of what; the traumatic event in nightmares or flashbacks; anxiety or arousal or general numbing of responsiveness;
PTSD: the flashbacks are the experienced in what 2 ways usually; they may not remember what; may suffer with feelings of guilt if what nightmares, flashbacks; certain aspects of the trauma; if they are a survivor
PTSD: how long must the s/s be present b4 pt is dx; the s/s must cause a significant interference with what; what is onset; s/s may begin within how many months of the event one months; social, occupational and other areas of functioning; any age; 3 months or be delayed for years
PTSD: what are the most common mental health dx for vets from Iraq or Afghanistan; the younger the vet the most likely they are to have what; is there an accurate reporting of PTSD PTSD, substance abuse, depression; a mental health disorder; no tremendous underreporting
PTSD: what are the 2 common things that must be present in order to be dx with this 1) the person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or threat to physical integrity of self or others 2) the person's response involved intense fear, helplessness, or horror
PTSD: the traumatic event is persistently re_____; what else is in criteria re-experienced; traumatic event is persistently re-experienced in one or more ways, persistent avoidance of stimuli associated with the trauma, persistent s/s of increased arousal
PTSD: predisposing factors- what is traumatic neurosis; the PTSD development is r/t what; ego's inability to master the degree of disorganization brought by the traumatic experience; the traumatic experience, the individual, and the recovery environment
PTSD: client/family teaching what is anxiety, what might it be r/t, what is OCD, what is PTSD, s/s of anxiety disorders, support services, crisis hotline, support groups, individual psychotherapy
PTSD: client/family teaching- what to teach about med management; teach ways to interrupt escalating what; teach and practice what possible side effects, length if time to take effect, what to expect from the meds; anxiety; relaxation techniques
somatoform disorder: def; this causes significant distress or impairment in what areas of functioning; psychological needs expressed in the form of physical symptoms; social occupational;
somatoform disorder: is there a cause to physical s/s; this is associated with repressed what; ex; no; anxiety; physical pain with no medical finding;
somatoform disorder: care providers are hesitant to determine that the pain is what; no patient wants to be told what psychological in nature; that the pain is in your head
somatoform disorder: pt is unable to get relief from what; they begin to distrust whom their s/s; other healthcare professionals bc of their experience they often do not follow through with any recommedations that are made
somatoform disorder: what two disorders must be ruled out first b4 ppl are dx wit this facititious disorders, malingering
factitious disorder: def; are they aware that they are doing this fake produce, or exaggerate their s/s for some type of internal gain such as sympathy; no
malingering: def; intentionally fake or greatly exaggerate their s/s for some type of external gain such as insurance benefits or to avoid going to jail for a crime they committed
somatoform disorders: hypochondriasis- somatization disorder- formally called what; they have a long hx of going to the doctor why formally called hysteria or briquet's syndrome; for unexplainable s/s;
somatoform disorders: hypochondriasis- somatization disorder- the s/s begin when in life; the s/s need to include various pain issues in how many sites; what are the sites someone may have pain b4 30 yo; 4 sites; GI (Diarrhea and n/v), sexual s/s (low libido), and s/s that would suggest a neuro prob (paralysis, seizures, blindness, deafness)
somatoform disorders: hypochondriasis- somatization disorder- what other issues manifest bc of this suicidal threats and attempts not uncommon
somatoform disorders: hypochondriasis- Conversion Disorder- this is a loss or change in what; this results from what; what are issues that happen with their senses; what are s/s that happen with their motor functions body functions; psychological conflict; blindness, deafness; difficulties swallowing,weakness is specific areas
somatoform disorders: hypochondriasis- Conversion Disorder- what is believed to be associated with the development of the disorder; as nurse we need to avoid the focus on what; is this involuntary or voluntary; this is an involuntary attempt to solve wha conflict or other types of stress; physical limitations; involuntary; their conflict
somatoform disorders: Pain disorder- what is the primary complaint with this disorder; is there a physical explanation for the pain; what are believed to play a role in triggering, maintaining or exacerbating the pain or make it more intense pain; no; underlying psych issues
somatoform disorders: hypochondriasis- what are these ppl often called; they are preoccupied with the belief or fear that they have a serious what; their belief or fear is triggered by their own misinterpretation of what; give example hypochondriacs; medical condition; their physical s/s; they have occasional HA and fear they have a brain tumor
somatoform disorders: hypochondriasis- when they see many doctors they are convinced of what; what can prompt alarm that proper care is not received; reading about a illness or a friend with an illness
somatoform disorders: body dysmorphic disorder- they are extremely preoccupied with what; ex one or more imagined or actual minor physical flaws; someone with a small scar on her hand always wears gloves or keeps her hand hidden from others
somatoform disorders: NOS- this meets the criteria for a ____ disorder; but doesn't meet the criteria for what somatoform disorder; one of the other somatoform disorder
somatoform disorders: tx- what is performed as a priority; why is physical exam performed; if no physical findings to explain s/s what is completed; physical exam; to rule out organic pathology; psychological exam completed;
somatoform disorders: tx- why is cognitive behavioral therapy used; what other therapies; why are meds used to focuses on helping ppl identify and change errors in their thinking; group; to alleviate s/s of anxiety or depression but is usually not an effective form of tx
dissociative disorders: freud viewed dissociation as a type of ___; why did he view it as repression; repression; an active defense mechanism to remove threatening or unacceptable contents from conscious awareness
dissociative disorders: when anxiety becomes overwhelming what becomes disorganized; personality;
dissociative disorders: fives symptoms of it: there is difficulty recalling ____ or aka; there is a sense of detachment or disconnect from ____; this disconnect is aka; personal info or amnesia; one's self; depersonalization
dissociative disorders: they person feels like a stranger to whom; there is a asense of disconnect from who else; the disconnect from one's surrounding is aka; oneself; familiar ppl or one's surrounding; derealization;
dissociative disorders: there is confusion about what; there is a sense of acting like a different ____ one's identity; person
dissociative disorders: dissociative amnesia- inability to recall what; where in hospital is this encountered; caused by what; examples of severe trauma; important info; in ER; a single stressful event; automobile accident where they forget details might include one's actions immediately b4 an auto accident in which the person with the disorder was involved
dissociative disorders: dissociative amnesia- seen when else in hx; during wartime, witnessing a violent crime or encountering a natural disaster may also trigger dissociateive amnesia
dissociative disorders: dissociative Fugue- characterized by a sudden onset resulting from what; this involves the creation of a new partial or complete what; this new identity is created to replace what; a single severe traumatic event; identity; the personal details that are lost in response to the trauma
dissociative disorders: dissociative Fugue- are these ppl alert and oriented; although alert and oriented that are unconnected to what; what is a common serious sign; is it usually a single episode or more then one; are there recurring episodes; yes; former identity; sudden unplanned wandering from home or work; single; no;
dissociative disorders: dissociative Fugue- what is recovery like spontaneous and rapid
dissociative disorders: depersonalization disorder- feelings that one is going through the motions of ___; feels that one boy is what; what is perceived as unattached; does it happen often or one time; what does it lead to life; disconnected or unreal; mind or body; often; distress or dysfunction
dissociative disorders: depersonalization disorder- does it happen with any kind of substance abuse no
dissociative disorders: dissociative identity disorder- aka; occurs in what type of ppl; follows severe what multiple personality disorder; varied backgrounds, educational levels, and from all walks of life; trauma including persistent psychological physical or sexual abuse during childhood
dissociative disorders: dissociative identity disorder- how many distinct personalities exist within one individual; the different personalities can control what in person 2 or more; their behavior and thoughts
dissociative disorders: dissociative identity disorder- there are ____ swings; they experience amnesia for what; mood swings; personal information, including some of the identities and activities of alternate personalities;
dissociative disorders: dissociative identity disorder- some experience memory problems similar to what; they self medicate with what; they have a physical exam to rule out ___; they may have been previously dx with what ADD; drugs or alcohol; cause from substance abuse; bipolar disorder, major depression, add, anxiety, psychotic or substance abuse disorder
dissociative disorders: depersonalization disorder- characterized by a temporary chane in what; feels detachment from what; they feel like they observe self from what; what other disorders does this occur in; quality of self-awareness; environment; outside of body; schizo, depression, anxiety or organic mental disorders;
dissociative disorders: depersonalization disorder- objects in environment are perceived how; to be sx how many episodes of this do they need to have; the depersonalization needs for cause signification what as altered in size or shape; recurring; distress or impairment
dissociative disorders: predisposing factors- can genetics cause this; more common in relatives of pple with ___; how can neurobiological issues cause this; what did freud believe was the cause genetics; disorder; temporal lobe epilepsy, severe migraine HA; this occurred with repressed distressing mental contents from conscious awareness
dissociative disorders: predisposing factors- repression of mental content is a coping mechanism to protect the client from what; how does psychological trauma cause this; is a ___ stragety to cope with horrifying sexual, physical or psych abuse emotional pain; it overwhelms the person's ability to cope; survival strategy
nursing care with somatization disorders: why is there a nursing dx of fear; r/t death of someone else from disease;
nursing care with somatization disorders:
Created by: jmkettel