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Mental Health
Exam 4; chapters 11, 17, 18 Drugs
| Question | Answer |
|---|---|
| acute and chronic psychoses; selected agents are also used as antiemetics, in the treatment of intractable hiccoughs, used for agitation and aggression, atypical antipsychotic assist with negative symptoms such as apathy, flat affect, and lack of motivat | Indications; antipsychotic drugs |
| control of tics and vocal utterances in Tourette’s disorder | antipsychotic drugs |
| unknown; thought to block postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla; | Action; antipsychotic drugs.. probably older |
| may block action on receptors specific to blocking dopamine, serotonin, and other neurotransmitters | Action; newer antipsychotic drugs |
| Conventional (Traditional); Atypical; New Generation | Antipsychotic drugs |
| Thorazine, Prolixin, Mellaril, Stelazine | phenothiazines; Conventional Antipsychotic Drugs; |
| Navane, Haldol, Loxitane, Moban | Conventional Antipsychotic Drugs; |
| Extrapyramidal side effects (EPSs)Pseudoparkinsonism Dystonia Akathisia Anticholinergic side effects Tardive dyskinesia (TD)Neuroleptic malignant syndrome (NMS)Photosensitivity | Side effects of Conventional Antipsychotic Drugs; |
| Adhering to medication regimen Managing side effects of conventional antipsychotic drugs are? | ThirstConstipationSedation |
| tremor, shuffling gait, drooling, rigidity Symptoms may appear 1-5 days after initiation of antipsychotics | Pseudoparkinsonism-Extrapyramidal Symptoms (EPS)of antipsychotic drugs |
| Symptoms may appear 1-5 days after initiation of antipsychoticsAkinesiaAkathisiaDystoniaOculogyric crisis*AIMS Scale used to evaluate | Extrapyramidal Symptoms (EPS)of antipsychotic drugs |
| Bizarre facial and tongue movements, stiff neck, and difficulty swallowing Clients on long-term (months or years) antipsychotic Rx. @ riskSymptoms potentially irreversible | Tardive dyskinesia |
| Symptoms=severe parkinsonian muscle rigidity, hyperpyrexia- 107F,tachycardia, tachypnea, fluctuations in BP, diaphoresis | Neuroleptic malignant syndrome (NMS) |
| Rapid detoriation of mental status to stupor & coma. | Neuroleptic malignant syndrome (NMS) |
| Rare & Potentially FatalOnset hours or years-progression rapid | 24-72 hours; Neuroleptic malignant syndrome (NMS) |
| Stop neuroleptic med immediately* Monitor vital signs *Extent of muscle rigidity *Intake & output *Level of consciousness *Medical emergency | Nursing Implementation (NMS) |
| Clozaril, Risperdal, Zyprexa, Seroquel, Geodon | Atypical Antipsychotic Drugs |
| Fewer EPSs Weight gain Agranulocytosis which one? | Clozaril, Atypical Antipsychotic Drugs |
| Adhering to medication regimen Reducing sugar and caloric intake | Patient Teaching; Atypical Antipsychotic Drugs |
| Weekly WBC monitoring Discontinue medication and seek care at first sign of infection | Clozaril, Atypical Antipsychotic Drugs |
| aripiprazole (Abilify) | New-Generation Antipsychotic Drugs |
| Headache Anxiety Nausea | Side Effects; New-Generation Antipsychotic Drugs |
| Patient Teaching Adhering to medication regimen | New-Generation Antipsychotic Drugs; aripiprazole (Abilify) |
| Lithium; anticonvulsant medications (carbamazepine (Tegretol), valproic acid (Depakote), lamotrigine (Lamictal), gabapentin (Neurontin) | Mood-Stabilizing Agents |
| prevention and treatment of manic episodes associated with bipolar disorder | Mood-Stabilizing Agents; indications |
| enhances the reuptake of norepinephrine and serotonin in the brain, lowering levels in the body and resulting in decreased hyperactivity. | Action: lithium; Mood-Stabilizing Agents |
| Action of anticonvulsants, ______, , and olanzapine in the treatment of bipolar disorder is not fully understood. | verapamil, (anticonvulasnt)mood stabalizing agents |
| Nausea Diarrhea Anorexia Fine hand tremor Polydipsia Polyuria Fatigue Weight gain Acne | Side Effects (Lithium), mood stabalizing agent |
| Taking with food Having monthly blood levels drawn 12 hours after last dose (maintain therapeutic levels between | 0.5–1.5 mEq/L); (Lithium), mood stabalizing agent |
| Nausea and vomiting Drowsiness; dizziness Blood dyscrasias | Monitor for side effects of anticonvulsants; mood stabalizing agents |
| Prolonged bleeding time; weight gain; liver dysfunction | (with valproic acid); Monitor for side effects of anticonvulsants; mood stabalizing agents |
| Risk of severe rash | (with lamotrigine); Monitor for side effects of anticonvulsants; mood stabalizing agents |
| Decreased efficacy with oral contraceptives | (with topiramate); Monitor for side effects of anticonvulsants; mood stabalizing agents |
| Somnolence, dizziness, asthenia Fever; tachycardia Postural hypotension Dry mouth Constipation Increased appetite; weight gain | Monitor for side effects of olanzapine mood stabalizing agents |
| Indications for: anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation | Antianxiety Agents/Sedative/Hypnotics Benzodiazepines/BuSpar/Antihistamines |
| Action: depression of the CNS; moderate the actions of GABA | Agents/Sedative/Hypnotics Benzodiazepines/BuSpar/Antihistamines |
| SE: Tolerance and dependence Drowsiness Sedation Poor concentration Impaired memory Clouded sensorium | Agents/Sedative/Hypnotics Benzodiazepines/BuSpar/Antihistamines |
| Nursing Implications: Using caution during driving due to slower reflexes and response timeNever discontinuing abruptly as withdrawal can be fatal Avoiding alcohol | Agents/Sedative/Hypnotics Benzodiazepines/BuSpar/Antihistamines |
| Increased effects with: alcohol, barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, neuromuscular blocking agents, cimetidine, or disulfiram, and with herbal depressants (e.g., kava and valerian) | Agents/Sedative/Hypnotics Benzodiazepines/BuSpar/Antihistamines |
| cigarette smoking and caffeine consumption | Agents/Sedative/Hypnotics Benzodiazepines/BuSpar/Antihistamines |
| Uses: ADHD, residual ADD in adults, and narcolepsy | Stimulant Drugs Methylphenidate (Ritalin, Concerta), Pemoline (Cylert), Dextroamphetamine ( Adderal, Dexedrine) Lisdexamfetamine Dimesylate (Vyvanse) |
| Methylphenidate (Ritalin, Concerta), Pemoline (Cylert), Dextroamphetamine (Adderal, Dexedrine) Lisdexamfetamine Dimesylate (Vyvanse) | Stimulant Drugs |
| Cause release of neurotransmitters | Stimulant Drugs |
| Side Effects Anorexia Weight loss Nausea Irritability Tics Heart palpitations | Stimulant drugs |
| Patient Teaching Avoiding caffeine, sugar, and chocolate Taking after meals Long-term use can cause dependency Medications should be taken in the morning-if given after 1600 could interfere with sleep. | Stimulant drugs |
| Used as an alternative to the CNS stimulants | Central Alpha-Agonists Clonidine (Catapress); Guanfacine (Tenex) |
| May not be listed as indicated for use with children for ADHD (Tenex not FDA approved) | Central Alpha-Agonists Clonidine (Catapress); Guanfacine (Tenex) |
| Seems to work best for the inattentive aspects not so well for distractibility | Central Alpha-Agonists Clonidine (Catapress); Guanfacine (Tenex) |
| Because these medications are used to treat blood pressure, must monitor BP closely in the children receiving. | Central Alpha-Agonists Clonidine (Catapress); Guanfacine (Tenex) |
| Dry mouth Hypotension Weight gain Nausea Drowsiness Nervousness Agitation | SE of Central Alpha-Agonists Clonidine (Catapress); Guanfacine (Tenex) |
| Headache Dizziness Fatigue Dry eyes | SE of Central Alpha-Agonists Clonidine (Catapress); Guanfacine (Tenex) |
| is the first and only non-stimulant medication approved by the US Food and Drug Administration (FDA) for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. is a norepinephrine reuptake inhibitor, a clas | Strattera; Non-stimulant Atomoxetine |
| Decreased appetite Dizziness Nausea/vomiting Dry mouth Problems with urination Decreased sleep Problems with liver function | SE; Strattera; Non-stimulant Atomoxetine |
| Indications: treatment of all forms of parkinsonism and for the relief of drug-induced extrapyramidal reactions | Antiparkinsonian Agents Cogentin/Bendryl |
| Action: work to restore the natural balance of acetylcholine and dopamine in the CNS | Antiparkinsonian Agents Cogentin/Bendryl |
| InteractionsAdditive anticholinergic effects and potentially fatal paralytic ileus with other drugs that possess these properties | Antiparkinsonian Agents Cogentin/Bendryl |
| Concurrent use with haloperidol or phenothiazine may result in decreased effect of the antipsychotic and increased incidence of anticholinergic side effects.Additive CNS effects with CNS depressants | Antiparkinsonian Agents Cogentin/Bendryl |
| Monitor client for side effects: Anticholinergic effects, nausea, GI upset, sedation, dizziness, exacerbation of psychoses, orthostatic hypotension | Antiparkinsonian Agents Cogentin/Bendryl |
| Traditional antipsychotic drugs work by: | Blocking postsynpatic dopamine receptors |
| A patient has been on Lithium (Lithane) 600 mg tid and Haloperidol (Haldol) 2 mg qd for 2 weeks to control mania and now complains to the nurse of diarrhea, vomiting, and blurred vision. The nurse observes a coarse hand tremor. The nurse should first: | Hold the next dose and obtain an order for a stat serum lithium level; above 1.5 will have blurred vision, nausea, vomiting, and diarrhea, tinnitus, ataxia |
| Causes of EPS | antipsychotics, higher potency causes more |
| EPS: greater with high potency meds such as Haldol (up to | 77% with long-term use) |
| EPS: greater with high potency meds such as Prolixin as much as | (18%) |
| EPS: greater with high potency meds such as Stelazine as much as | (12%), |
| EPS: greater with high potency meds such as Compazine as much as | (19%) |
| EPS: less with lower potency drugs: such as (2 of them) | Mellaril (4%), Thorazine (7%) |
| EPS: lowest EPS rates with | clozapine (Clozaril) and quetiapine (Seroquel); |
| with _____ EPS symptoms increase in direct proportion to doses. | Risperdal |
| Onset rapid, from hours to 5 days Risk factors male under 40 years of age high potency medication Prevalence = 10% | Acute Dystonia: EPS |
| Differential diagnosis (rule out) seizures tetanus | Acute Dystonia: EPS |
| Characterized by brief or prolonged muscle contractures, usually of the head, neck and tongue, resulting in abnormal movements | Acute Dystonia: EPS |
| Presentations include:facial grimacingoculogyric crisis (eyes rolling up in headtorticollis (drawing head to one side with chin pointing to other side, stiff neck | Acute Dystonia: EPS |
| Presentations (continued)tongue protrusionlaryngeal or pharyngeal dystonias, hoarse voice choking sensationa medical emergency | Acute Dystonia: EPS |
| Onset-- 2-6 weeks or immediately after dose increase Prevalence = 10% | Parkinsonism: EPS |
| Risk factors female elderly previous history of Parkinsonis mother neurological illness | Parkinsonism: EPS |
| Differential diagnosis (rule out) Parkinson’s disease catatonia negative symptoms of schizophrenia psychomotor retardation tardive dyskinesia | Parkinsonism: EPS |
| Presents As: resting tremor (rhythmic, 3-6 cycles per second; stops with purposeful grasping)rigidity (lead pipe continuous or cogwheel)The abnormal tone is referred to as lead-pipe and cogwheel rigidity | Parkinsonism: EPS |
| Presentations (continued)bradykinesia (mask-like facies, difficulty initiating movement, shuffling gait with propulsion and retropulsion, decreased arm swing while walking, decreased spontaneous movements) | Parkinsonism: EPS |
| Characterized by a subjective feeling of restlessness, or a feeling of “I can’t sit still” or “I’m jumping out of my skin.” | Akathisia: EPS |
| Objective observation of pacing, rocking or rapid alteration of standing and sitting | Akathisia: EPS |
| Onset 1-4 weeks orimmediately after dose increase | Akathisia: EPS |
| Risk factors female middle-aged Prevalence = 10% | Akathisia: EPS |
| Differential diagnosis (rule out)anxiety agitation psychosis acting out | Akathisia: EPS |
| Cogentin 2 mg IM or IV orBenadryl 50 mg IM or IV If no response in 20 minutes repeat; Continue to administer anticholinergics with psychotropic meds | Treatment of EPS; Acute Dystonia |
| dose antipsychotic as low as possibleswitch to low potency medCogentin 0.5-2 mg po bid and/orBenadryl 25-50 mg po bid and/or | Treatment of EPS: Parkinsonism |
| amantadine 100 mg po bid or tidNote: anticholinergics should be stopped after 14 days if asymptomatic because long-term dosing increases risk of abuse and tardive dyskinesia | Treatment of EPS: Parkinsonism |
| If no other EPS (in order of choice)Propanolol 10-30 mg po tidLorazepam 1 mg po tid Cogentin 1 mg po bid | Treatment of EPS: Akathisia |
| If other EPS present (in order of choice)Cogentin 2 mg po bidCogentin with propanolol as above Cogentin with lorazepam as above | Treatment of EPS: Akathisia |
| Do ______ evaluation before antipsychotic meds initiated with EPS. | AIMS |
| Observe pt for symptoms of EPS upon initiation or increase in dose of | antipsychotic meds |
| Report symptoms to MD Administer meds as ordered & document effects of any | anticholinergic or beta-blocker drugs given for EPS |
| Can't see, can't pee, can't sit, can't S#*! | SE of anticholinergic drugs |
| A late-occurring motor side effect that has been associated with use of antipsychotic medications Onset--may occur with 1st dose of neuroleptic drug, but usually not | TARDIVE DYSKINESIA; EPS |
| Much more prevalent with use of older atypical drugs | TARDIVE DYSKINESIA; EPS |
| Studies have shown that the incidence of TD with traditional antipsychotics is _____ per year. | 5-6% |
| Estimated risk for TD in general population with atypical antipsychotics after 20-25 yrs is | >70% |
| a syndrome of persistent involuntary, hyperkinetic, abnormal movements that most frequently occur in the face tongue thrusting chewing motion sside to side or rotary jaw movements | TARDIVE DYSKINESIA; EPS |
| lip smacking rapid eye blinking may also involve choreoathetoid movements in the limbs and trunk | TARDIVE DYSKINESIA; EPS |
| ceaseless occurrence of rapid, highly complex jerky movements that appear to be well coordinated but are performed involuntarily. | choreoathetoid movements: TARDIVE DYSKINESIA; EPS |
| speech, eating, walking and respiratory function may be impaired in the most severe cases | TARDIVE DYSKINESIA; EPS |
| Risk Factors: increased age--6 times higher than non-geriatric pts.early development of EPS higher doses of neuroleptics duration of neuroleptic usepresence of affective disorders alcohol abuse non-Caucausian races | TARDIVE DYSKINESIA; EPS |
| What is switch to atypical antipsychotics for treatment of TD? | S=start atypical agentW=withdraw conventional agent I=involve & educate pt., family,staffT=Titrate atypical drug to effectC=Challenge adverse effectsH=Halt conventional neuroleptics |
| Do _____ or DISCUS evaluation on admission prior to starting antipsychotics for treatment of TD | AIMS; nursing consdierations |
| Repeat before new drug changeRepeat if pt symptomatic of ______ Educate patient & family Report TD to physician Administer medications as ordered | Nursing considerations for TD |
| a potentially fatal symptom complex associated with the use of antipsychotic medications that exhibits hyperpyrexia up to 107*F (can overheat the medulla), tachycardia, tachypnea, BP fluxuations, diaphoresis, stupor.. | Neuroleptic Malignant Syndrome |
| This is not an EPS | Neuroleptic Malignant Syndrome |
| is rare, but the potential for mortality & morbidity is high; some studies suggest a mortality rate of 76%; however most show 10-20% | Neuroleptic Malignant Syndrome |
| duration of uncomplicated NMS averages | 7-10 days |
| exact incidence is unknown; some large studies suggest 0.07-2.2% approximately 1:500-1000 patients treated with antipsychotics will develop | Neuroleptic Malignant Syndrome (NMS) |
| newer as well as older drugs may cause ______associated with dopamine receptor activation | Neuroleptic Malignant Syndrome (NMS) |
| Risk Factors high potency neuroleptics in high doses MAO inhibitors in combination with TCAs, serotonergic agents or meperidine (Demerol)rapid dose increaseage <40male | Neuroleptic Malignant Syndrome (NMS) |
| Prevalence first described in France during early clinical trials of antipsychotics.________ remained obscure until 1980s two-thirds of cases develop within the first week of antipsychotic use | Neuroleptic Malignant Syndrome (NMS) |
| Contributing Factors May Include:dehydration agitation catatonia mood disorders organic brain syndrome withdrawal states rapid dose escalation prior episode increases risk for 1/3 of pts. | Neuroleptic Malignant Syndrome (NMS) |
| Differential Diagnosis (rule out)acute encephalitislethal catatoniastructural brain lesions dehydration & infections thyrotoxicosis pheochromocytoma heat stroke | Neuroleptic Malignant Syndrome (NMS) |
| Treatment of ________early recognition & intervention via staff education is essential to a positive outcomemost of treatment is symptom-based discontinue antipsychotic medication intensive medical & nursing care | Neuroleptic Malignant Syndrome (NMS) |
| Treatment of __________dopamine antagonists (Parlodel), benzodiazepines (Valium)and dantrolene (for smooth muscle relaxation) may be beneficial in severe casesat times ECT has been used | Neuroleptic Malignant Syndrome (NMS) |
| Other Drugs May Cause Like Symptomsinhaled anesthetics succinylcholine withdrawal from dopamine agonists alcohol or sedative withdrawal salicylates atropinic & psychodelic drugs serotonergic agents | Neuroleptic Malignant Syndrome (NMS) |
| Clinical Manifestations: muscle rigidity (may include dysphagia)incontinence altered mental status obtundation (stupor) catatonia | Neuroleptic Malignant Syndrome (NMS) |
| Clinical Manifestations (continued)changes in extrapyramidal function:tremors dysarthria (stiff joints)dysphagia drooling | Neuroleptic Malignant Syndrome (NMS) |
| Clinical Manifestations (continued)autonomic instability resulting in hyperpyrexia (increased temperature)irregular pulse or blood pressure tachycardia diaphoresis | Neuroleptic Malignant Syndrome (NMS) |
| lab findings increased LDH, CPK, AST, ALT & alkaline phosphatasehyperuricemiahyperphosphatemiamyoglobinemia | Neuroleptic Malignant Syndrome (NMS) |
| Clinical Manifestations (continued)lab findings continued:thrombocytosis proteinuria decreased serum Fehypocalcemia | Neuroleptic Malignant Syndrome (NMS) |
| Potential Complications rhabdomyolysis renal, hepatic & respiratory failure cardiac arrest infection aspiration pulmonary embolism and/or DVT uncontrolled psychosis | Neuroleptic Malignant Syndrome (NMS) |
| What are the KEY signs of NMS that we can detect with careful observation of vital signs? | muscle rigidity, increased body temperature & fluctuating BP are key symptoms to watch for |
| notify MD immediately if ______is suspectedadminister medications as orderedgive nursing care based on symptoms | Neuroleptic Malignant Syndrome (NMS) |
| Used for MS and migrains... SE are increased weight of up to 70 lbs., most commonly used for mood stabalization... | Depakote or valproic acid |
| Know your theraputic levels, can tear up liver (get enzymes) | Depakote or valproic acid |
| A severe rash with this drug can cause death | Depakote or valproic acid |
| This durg is a mood stabalizer (bipolar disorders) that is an anticonvulsant, FDA may approve for weight loss, caution interferes with oral contraceptives | Topirmate (Topamax) |
| This drug is an antimanic that has a narrow range between theraputic and toxic levels | Lithium carbonate |
| Similar in chemical structure to Na, competing with Na sites in body. To prevent hyponaturia, client must conume Na diet and 2500 to 3000 ml of fluid a day | Lithium carbonate |
| Blurred vision, ataxia, tinnitus, persistent nausea and vomitin, severe diarrhea are at what levels for lithium toxicity? | 1.5-2.0 |
| Excessive output of dilute urine, increasing tremors, muscular irratibility, psychomotor retardation, mental confusion, giddiness, what serum levels of lithium? | 2.0-3.5 |
| Imapred consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, cardiovascular collapse. What levels of lithium? | above 3.5 |
| What type of antipsychotics have less EPS? | Atypical |
| What drug treats hiccups, anxiety, and psychosis | Vistaril |
| All psychotropic drugs have what effects? | Anticholinergic effects, cant see, cant pee, cant sit, cant s### |
| These antipsychotic drugs increase cholosteral, gycomastic, prolactin, glucose.. Get baseline, labs, and BMI | Atypical antipsychotics |
| 12/13 items, numerical, looking for drooling, fae appearance, blinking... determines meds given for EPS symptoms... we normally give cojenton and benadryl | AIMS scale |
| What is the main side effect of antipsychotics? | EPS |
| What EPS is neck to waist | Akathisia |
| What can be mistaken for a drug overdose | Neuroleptic malignant syndrome (NMS)... this in NOT EPS |
| What EPS is subjective and objective? | Akathisia... they hear voices... I can't sit still... I feel like I am jumping out of my skin |
| People with tardive dyskinesia are | frustrated... symptoms are potentially irreversable |
| What atypical antipsychotic is not given often due to granulcytosis (can wipe out WBC's)? | Clozapine (Clozaril) |
| What drug causes increased appetite leading to weight gain and diabetes | Olanzapine (Zyprexa) |
| What drug is the newest for bipolar but still an antipsychotic? | Aripiprazole (Abilify) |
| Anxiety provides the motivation for achievement, a necessary force for | survival. |
| Anxiety is often used interchangeably with the word _____; however, they are not the same. | stress |
| Stress is an _____ pressure that is brought to bear on an individual | external |
| Anxiety is the _______ emotional response to a stressor | subjective |
| Anxiety may be differentiated from fear in that the former is an emotional process, whereas fear is _____. | cognitive |
| _______ is a feeling of apprehension manifested by feelings of impending doom, dread, and uneasiness that is evoked by some perceived threat to the individual | Anxiety |
| ________/______ anxiety helps an individual to focus attention on immediate details and may even enhance the ability to deal with anxiety-producing behavior | Mild to moderate |
| ________ narrows perceptions, decreases the level of functioning, and may lead to inappropriate behavior, illness or somatic complaints, and immobilization or panic | High anxiety |
| Rapid heartbeatHyperventilationPoor appetiteVertigoPallorChest painRespiratory distressDry mouthDilated pupilsCramps | SYMPTOMS OF ANXIETY |
| Itching/hivesFlushingNauseaTremorsInsomniaDifficulty swallowingSighingDiarrheaWeaknessSweating | SYMPTOMS OF ANXIETY |
| Increased mental activity, bronchiolor dilation, increased R rate, increased glucose with increased fatty acids, increased blood flow to skeletal muscles, dilated pupils, increased HR with increased CO, increased arterial BP | Fight or flight response from anxiety |
| Palpitations, racing heart, increased blood pressure, fainting, decreased blood pressure | Cardiovascular system, cilinical manifestations of anxiety |
| Rapid, shallow breathing, pressure in chest, shortness of breath, gasping, lump in throat | Respiratory system; cilinical manifestations of anxiety |
| Loss of appetite or increased appetite, abdominal discomfort or feeling of fullness, nausea, heartburn, diarrhea | Gastrointestinal system; cilinical manifestations of anxiety |
| Hyperreflexia, insomnia, tremors, pacing, clumsiness, restlessness, flushing, sweating, muscle tension | Neuromuscular system; cilinical manifestations of anxiety |
| Decreased attention, inability to concentrate, forgetfulness, impaired judgment, thought blocking, fear of injury or death | Cognitive; cilinical manifestations of anxiety |
| Rapid speech, muscle tension, fine hand tremors, restlessness, pacing, hyperventilation | Behavioral; cilinical manifestations of anxiety |
| Irritability, impatience, nervousness, fear, uneasiness | Affective; cilinical manifestations of anxiety |
| Anxiety disorders most common type of all psychiatric illnesses | Epidemiological statistics of anxiety disorders |
| More common in ______ than men; Also occurs in childrenMore prevalent in girls than in boysChildren in lower socioeconomic environments at greatest risk | women; Epidemiological statistics of anxiety disorders |
| Sudden onsetPhysical symptoms of anxietyDread/doom/fear of death | Panic Attacks |
| Occur with:Panic disorderSocial phobiaSimple phobiaPosttraumatic stress disorder (PTSD) | Panic Attacks |
| Recent unexpected panic attacksIntense apprehension, fear, or terrorAt least four symptoms of a panic attack must be presentSymptoms of depression are common | Panic Disorder |
| Anxiety about being where escape is difficultSituations avoided/endured with anxietyNot due to effects of a medical condition/substance | Panic Disorder with Agoraphobia |
| Common agoraphobic situations include being outside the home, being in crowds, being in planes, trains, or cars | outside the home, being in crowds, being in planes, trains, or cars |
| Characterized by chronic, unrealistic, and excessive anxiety and worrySymptoms have existed for 6 months or longer and can not be attributed to a specific organic factor | Generalized Anxiety Disorder (GAD) |
| Excessive anxiety and worryOccurring more days than notAt least 6 months duration | Generalized Anxiety Disorder |
| Presence of three of the following: restlessness, edginess, fatigue, poor concentration, irritability, muscle tension, sleep disturbance | Generalized Anxiety Disorder |
| Anxiety and worry that interfere with normal social and occupational functioning | Generalized Anxiety Disorder |
| – inability of the ego to intervene when conflict is present between id and superego | Psychodynamic theory; GAD: Etiological Implications for Panic and GAD |
| cognitive views are faulty | Cognitive theory: Etiological Implications for Panic and GAD |
| Medical conditions of GAD | Caffeine: Etiological Implications for Panic and GAD |
| Genetics – twin studies Neuroantomical – limbic system/thalamus/hypothalamusBiochemical – blood lactateNeurochemical – (GABA); mentions norepinephrine for panic disorder | Etiological Implications for Panic and GAD |
| Agoraphobia without history of panic disorder Social phobia Specific phobia | Phobias |
| Animal Natural environmental Blood-injection-injury Situational Other | Specific phobias; Animal Zoophobia; study page 398 |
| Marked, persistent fear of one or more social or performance situationsOften exposes individual to scrutiny because behavior may be embarrassing Avoided or endured with anxietyTreated with individual therapy and serotonin selective reuptake inhibitors (SS | Social Phobia |
| Marked, persistent fearExcessive and unreasonableCued by presence/anticipation of specific object/situationAvoided or endured with anxietyDistressed about having the phobia | Specific (simple) Phobia |
| – unwanted, intrusive thoughts that cause anxiety or distress | Obsessions |
| – unwanted repetitive patterns or mental acts that are intended to reduce anxiety | Compulsions |
| Cannot be suppressed/ignoredRecognized as unwanted/unreasonable Interferes with normal functioning | Obsessive Compulsive Disorder |
| Etiology: trauma to basal ganglia/cortical connectionsTreatment: SSRIs | Obsessive Compulsive Disorder |
| have weak, underdeveloped egos.Aggressive impulses are channeled into thoughts and behaviors that prevent the feelings of aggression from surfacing and producing intense anxiety fraught with guilt | Psychoanalytical theoryObsessive-Compulsive Disorder Etiological Implications |
| Conditioned response to a traumatic eventPassive avoidance – staying away from the sourceActive avoidance – engage in behaviors that provide relief from the anxiety | Learning theoryObsessive-Compulsive Disorder (OCD) |
| Neurobiological disturbances may play a role. | Biological aspectsObsessive-Compulsive Disorder (OCD) |
| Abnormalities in various regions of the brain have been implicated in the neurobiology of | Neuroanatomy Obsessive-Compulsive Disorder (OCD) |
| Neurotransmitter serotonin may be implicated influentially in the etiology of | BiochemicalObsessive-Compulsive Disorder (OCD) |
| Traumatic event preceding symptomsIndividual response: fear, horror, helplessnessClient often re-experiences eventDisturbing recollectionsFeeling/acting as though event is reoccurringPhysiologic distress during reoccurrencePhysiologic reactivity to simila | Posttraumatic Stress Disorder |
| Avoidance of stimuli associated with the traumaNumbing of general responsivenessEstrangement, detachmentRestricted affectSymptoms of increased arousalSleep disturbedIrritability Poor concentrationExaggerated startle response | Posttraumatic Stress Disorder |
| Traumatic experienceIndividualRecovery environment | Psychosocial theory; Posttraumatic Stress Disorder |
| Learning theoryCognitive theoryBiological aspects play a part in | Posttraumatic Stress Disorder Etiological Implications |
| Hyperthyroidism, pheochromocytoma, hypoglycemia | Endocrine: Anxiety Disorder Due to A General Medical Condition |
| CHF, pulmonary embolism, arrhythmia | Cardiovascular: Anxiety Disorder Due to A General Medical Condition |
| COPD, pneumonia, hyperventilation | Respiratory: Anxiety Disorder Due to A General Medical Condition |
| Vitamin B12 deficiency, porhyria | Metabolic: Anxiety Disorder Due to A General Medical Condition |
| Neoplasm, vestibular dysfunction, encephalitis | Neurological: Anxiety Disorder Due to A General Medical Condition |
| Benzodiazepines (Ativan, Xanax)Review side effects and nursing considerations | Treatment Modalities of anxiety disorders |
| SSRIsFluoxetine, fluvoxamine | OCD; Treatment Modalities of anxiety disorders |
| SSRI's Paroxetine | (GAD, OCD, PTSD, social phobia, panic disorder) |
| SSRI's Sertraline | (OCD, panic disorder, PTSD |
| Venlafaxine | (GAD) |
| Clomipramine | (body dysmorphic disorder) |
| Buspar and AntihypertensivesPropranolol Clonidine | Treatments for anxiety disorders |
| Etiological: family hx of hay fever or eczema, hx of allergies, smoking, pollutants, hx of excessive dependency, fears, emotional liability, increased anxiety | Asthma |
| Rx bronchodilators and corticosteroids, psychotherapy focused on attitudes, emotions, and progress with seperation individuation process | Asthma |
| Etiological influences: hx of family with it of the breast, stomach, colon, kidney, uterus, lung; hx enviornment carcinogens, smoking, asbestos, asphalt, viruses, immunosuppressive agents, diethylstilbestrol, oral contraceptives | Cancer |
| Psychosocial: Type C "nice guys disease", they repress negative emotions, passivity, apologetic, overly cooperative, suppresses anger, calm, feels depressed, low self-esteem and worth, puts others before their own needs, martyr, unrealistic standards, res | Cancer |
| Depression has been linked to an increase in | cancer |
| Rx: radiation, chemo, pallative when no cure, psychotherapy to express feelings | Cancer |
| More prevalent in men than women the elderly and low socioeconomic groups | Coronary heart disease (CHD) |
| Etiological: hx family of it, high serum lipoprotein, hypertension, DM | Coronary heart disease (CHD) |
| Etiological: nx enviornment, smoking, obesity, sedentary life, | Coronary heart disease (CHD) |
| Etiological: hx pshychosocial, Type A, competitive drive, chronic sense of time, concentrates on career, aggressive, no time for hobbies, leisure time is a waste, seldom satified with accomplishments, extroverted but concealing deep-seated insecurity abou | Coronary heart disease (CHD) |
| They don't feel a sense of urgency, and preform just as well as others, can function under pressure when needed but are not consumed by it, don't feel need to be competitive, self-worth arises from goals met, recognize strengths and weaknesses, leisure ti | Type B personality |
| Type B have negative emotions, inability to express feelings, social inhibition, what disease are they related to? | Coronary heart disease (CHD) |
| Rx: Vasodilators (nitro), increase coronary tissue perfusion B-blockers (proranolol), angina and HTN Ca channel blockers (verapamil), and statins to lower serum lipid levels | Coronary heart disease (CHD) |
| Progressive relaxation, autohypnosis, meditation, biofeedback, and group therapy , interpersonal council, behavior modification therapy | Type A with CHD |
| Occurs more 4X more in men then women | Peptic Ulcer |
| Etiological influences: H. pylori, | Peptic Ulcers |
| Etiological, environment: smokers, asprin, alcohol, steroids, NSAIDS causing damage to the mucosal barrier | Peptic Ulcers |
| Etiologal: psychosocial, increased gastric secretion and motility in presence of hostility, guilt, frustration, unhealthy attachment to others, dependent but feel they have few people they can depend on, excessive worriers, have more times of crises, anxi | Peptic Ulcers |
| Rx: antacids, histamine (cimetidine), proton pump inhibitors (omeprazole), avoid spicy foods, caffeine, aspirin, NSAIDS, psychotherapy with meds. | Peptic ulcers |
| Cause of CVA and cardiac disease and renal failure, often asymptomatic | HTN |
| Etiological: Hx family had it, physiological imbalance of vasoconstrictors (angiotension), and vasodilators (prostaglandins), increased sympathetic nervous system = increased vasoconstriction | HTN |
| Etiological: environmental, obesity, smoking contributes to essential | HTN |
| Etiological: psychosocial, suppressed anger, childhood rearing that forbae expression of angry feelings, keep anger bottled up or become hostile | HTN |
| Rx: lifestyle changes, decreased sodium, caffeine, alcohol, saturated fats, increased physical activity, diuretics, B blocker, Ca blocker, ACE inhibitors, meditation, yoga, hynosis, biofeedback, psychotherapy to express honest feelings esp. anger | HTN |
| Pain in one side of the head, originates from muscles of the face, neck and head... bv dilate, pain on exertion of pressure on nerves that live around congested bv. | Migraine |
| Occur at 16-30 years, between 16 and 30, more in women, often around menstrual cycle | Migraine |
| Etiological: hx several generations, some may skip but can be traced, | Migraine |
| Etiological: environmental, cafffeine, chocolate, aged cheese, vinegar, organ meats, alcoholic beverages, sour cream yogurt, aspartame, citrus, banannas, raisns, avocados, onions, smoked, monosodium glutamate, nitrites, BP lowering drugs | Migraine |
| Etiological: psychosocial, perfectionistic, overly conscientious, inflexible, compulsive, neat, hard workers, intelligent, high expectations on self, repressed or suppressed anger.. Clone of type A | Migraine... have migraine personality |
| Emotional stress triggers it, in response to the secondary gains one recieves assuming the sick role by providing an escape from the stressful situation | Migraine |
| Some only develop them after the stressful situation has passed called "let down"... this occurs on weekend or holidays when person relaxes | Migraine |
| Rx: prevention propranolol, amitriptyline, fluoxetine, verapamil, divalproex sodium... once begun injections of narcotics like meperidine, codine allowing sleep until attack subsides | Migraine |
| Rx: serotonin receptor agonists like sumariptan (-iptan), inhalents. Psychotherapy to help modify some of the characteristics of this "" personality. Biofeedback, regular muscle exercise, relaxation, behavior therapy, diet | Migraine |
| Systemic disease, inflammation or lesions of major organs of the body 3x greater in women. There are periods of remission and exacerbation | Rheumatiod Arthritis (RA) |
| Etiological hx serum protein of ____ factor frequent in relatives, autoimmune | rheumatiod arthritis (RA) |
| Etiological: psychosocial, self-sacrificing, conforming, self-conscous, inhibited, inability to express anger, tramautic events (loss of spouce, seperation) | rheumatiod arthritis (RA) |
| Rx: NSAIDs, antirheumatic agents (gold, penicillamine), corticosteroids (prednisone), antineoplastic agents (methotrexate), surgery | rheumatiod arthritis (RA) |
| Rx; psychotherapy, many deny illness at first then adaptive process kicks in and pt shows resignation, episodic anger, sadness, and anxiety, blame self for disease and depression.. Treated | rheumatiod arthritis (RA) |
| Blood diarrhea common onset 15-35 more male caucasians and high jewish | Ulcerative colitis |
| Etiological: hx genetic, anticolon antibodies, serum and mucosal autoantibodies against intestinal epithelial cells | Ulcerative colitis |
| Etioligical psychosocial have predominance of OCD traits.. neat orderly punctual difficulty expressing anger.. onset displayed with stressful life events w/ altered immune status | Ulcerative colitis |
| Rx: avoid irritating foods, sulfasalazine, severe corticosteroids, antidirrheals antispasmodics for sx, surgery, help recognize stressors adaptive coping help with feelings of security | Ulcerative colitis |
| Convert anxiety into physical symptomsPhysical symptoms without organic diseaseReflect complex interactions between mind and bodyMay cause serious impairments in social and occupational functioning | Somatoform Disorders |
| PsychoanalyticBiologicBehavioralCognitiveGenetic | Etiology of Somatoform Disorders |
| Somatization disorderPain disorderConversion disorderHypochondriasisBody dysmorphic disorder | Types of Somatoform Disorders |
| Frequently seeking and obtaining medical treatment for multiple, clinically significant somatic complaints | Somatization Disorder |
| Diagnosis requires: Involvement of multiple organ systemsEarly onset and chronic course without development of physical signs or structural abnormalities No clinical laboratory abnormalities commonly associated with general medical conditions | Somatization Disorder |
| Pain in one or more anatomic sites with significant impairment in one or more areas of functioningPsychologic factors may play an important role in the onset, severity, exacerbation, or maintenance of the pain | Pain Disorder |
| Exhibits one or more symptoms that affect voluntary motor or sensory functionCauses significant distress in social, occupational, or other areas of functioningCommon forms include blindness, paralysis, seizures, deafness, or abnormal motor movements | Conversion Disorder |
| Fears having (or the idea of having) a serious medical problemMisinterpretation of symptoms persist despite medical evaluationPreoccupation with illnessCauses significant distress in everyday function | Hypochondriasis |
| Preoccupation with an imagined defect in appearanceSlight anomaly has an excessive responseCauses significant distress in everyday functioning | Body Dysmorphic Disorder |
| Intentionally produces physical or psychologic signs to assume the sick roleBehavior satisfies need for secondary gains | Factitious Disorder |
| One or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature | Dissociative amnesia Types of Dissociative Disorders |
| Sudden, unexpected travel away from home or one’s customary place of work, with an inability to recall one’s past | Dissociative fugue Types of Dissociative Disorders |
| Demonstrates two or more distinct identities or personality statesAt least two of these personality states recurrently take control of the person’s behavior | Dissociative identity disorder Types of Dissociative Disorders |
| Persistent or recurrent episodes of feelings of detachment or estrangement from one’s self | Depersonalization disorder Types of Dissociative Disorders |
| Is there a medical diagnosis?What does the patient think is causing the anxiety?What happens immediately before the anxiety attack? | Steps of the Nursing Process Nursing Assessment (for all anxiety disorders) |
| How often have the symptoms occurred before?What did the patient do to treat or help alleviate the symptoms in the past? | Steps of the Nursing Process Nursing Assessment (for all anxiety disorders) |
| Is there a relationship between anxiety and: | Diet, activity level and exercise, medical problems, alterations in living habits, side effects of medications, side effects of withdrawal from addictive substances? |
| What is happening in terms of recent life-change events within the family? | NURSING ASSESSMENT |
| Are there family issue that need to be shared to reduce the patient’s anxiety?Are there actual changes in the patient’s mental status? | NURSING ASSESSMENT |
| What are the thoughts that are disturbing to the patient?To what degree is there a support system of close friends, family, and co-workers?How can the support system be utilized to decrease the patient’s anxiety?What part of the anxiety reaction troubles | NURSING ASSESSMENT |
| Nursing Diagnosis | AnxietyIneffective copingPost-trauma syndromeStress overloadRisk-prone health behaviorFearGrieving |
| the anxious patient should be based on a thorough nursing assessment taking into consideration the nature and intensity of the patient’s symptoms. | Planning for |
| anxiety should be multi-modal, ranging from the therapeutic use of the nurse’s voice, to the nurse teaching the patient emergency anxiety-management breathing techniques, to long-term psychotherapy | Treatment of |
| anxiety requires knowledge, skill, empathetic warmth, and perseverance | Treatment of |
| Let the patient know that you are aware of his anxiety and that you take it seriously Be available to the patient, checking in with him often if this seems to ease anxiety | NURSING ACTIONS |
| Maintain a calm manner, using short declarative sentences and utilizing a soft but firm voice (which can imply to the patient that you will provide the external controls needed) | NURSING ACTIONS |
| If possible, move a highly anxious patient to a smaller physical environment to minimize external stimuli | NURSING ACTIONS |
| Assist the patient to recognize what anxious behaviors are by reflecting to the patient aspects of his behavior that are familiar (e.g., sitting in a posture similar to the patient’s, pacing your movements to about the same rate as the patient’s, etc) | NURSING ACTIONS |
| Eventually, make changes in your voice that make it:Lower in pitchSofterSlowerThese changes in the nurse’s voice are often contagious to the patient who may begin to respond in like manner | NURSING ACTIONS |
| The nurse helps her patient best when she encourages expression of thoughts and feelings about illness, dependency, and other concerns rather than inappropriately reassuring the patient when anxiety exists | NURSING ACTIONS |
| Allow full expression as appropriate; however, this should not take on the character of an endless recital, since that may reinforcing to the anxiety | NURSING ACTIONS |
| Assist patient in identifying threats or stresses in his personal environment that might be removed | NURSING ACTIONS |
| Since perceptions are narrowed when anxiety is increased, realize that the patient may have difficulty making decisions, problem-solving, attending, or remembering | NURSING ACTIONS |
| Teach the patient to monitor thoughts that come before anxious feelings | NURSING ACTIONS |
| Teach the patient to make positive self-statementsTeach the patient to question the rationality of his anxiety | NURSING ACTIONS |
| Teach the patient to use breathing and relaxation techniques for moderate anxietyTeach the patient to do thought stopping | NURSING ACTIONS |
| Teach patient to use imagery and affirmations, to imagine himself being successful in an anxiety-provoking situation | NURSING ACTIONS |
| Realize that anxiety is a feeling of loss of control. Any nursing interventions that can help the patient gain actual control over aspects of the situation, himself, or his health, emotions, thoughts, and future will help to alleviate the anxiety and/or | NURSING ACTIONS |
| Report anxiety when present, using words Rate the level of anxiety (on a 0-10 scale) and report this level | EXPECTED OUTCOMES; The patient will be able to: |
| Determine the major predisposing circumstances or situations that seem to engender anxiety Identify usual thought patterns precipitating anxiety and determine if they are: Rational or irrational Worries or useful for problem-solving | EXPECTED OUTCOMES; The patient will be able to: |
| On his own, select and effectively utilize anxiety-management techniquesControl “not-useful” thinkingControl “not-useful” behaviors that produce anxiety | EXPECTED OUTCOMES |
| Decrease somatic complaintsExpress hostility and anger appropriatelyAlter diet, exercise, living habits, or medications to reduce anxiety | EXPECTED OUTCOMES |
| Utilize support systems appropriatelyExhibit useful and appropriate ways to get needs met | EXPECTED OUTCOMES |
| The DSM-IV defines obsessions and compulsions as criteria for obsessive-compulsive disorder (OCD). | A recurrent, persistent behavior persistently performed in a particular manner |
| The distinguishing feature between dissociative amnesia and dissociative fugue is that: | Fugue involves flight and memory loss of past events |
| A patient who is having a panic attack is hyperventilating and not responding to your nursing interventions. Your concern if this continues is: | Respiratory alkalosis |
Created by:
Cinderelle