Term
| What is experienced when stressed out? |
|
Definition
Trouble with:
-Sleeping
-Eating
-Headache/Backpain
-Lose interest in fave activiites
-Feel tense and irritable
-Powerlessness |
|
|
Term
| What causes the fight/flight response? |
|
Definition
| Sympathetic Nervous System |
|
|
Term
| What causes the rest and digest response? |
|
Definition
| Parasympthetic nervous system |
|
|
Term
| What are the steps to the stress signaling system? |
|
Definition
8.)Alertness Heightened
7.)Circulating adrenaline = ↑ heart rate, ↑ blood pressure, ↑ respirations, ↑ blood flow
6.)Pituitary gland releases ACTH
5.)Epinephrine (Adrenalin)
is released
4.)SNS signals adrenal glands
3.)Hypothalamus stimulates autonomic nervous system
2.)Brain signals hypothalamus
1.)The body prepares for a situation that threatens survival! |
|
|
Term
| What is the sympathetic nervous system responsible for? |
|
Definition
Pituitary gland releases adrenocorticotropic hormone (ACTH),
and adrenal cortex secretes cortisol. |
|
|
Term
| What hormones are secreted? |
|
Definition
Adrenal medulla secretes stress hormones (e.g., epinephrine).
Stress hormones travel via bloodstream to organs (e.g., heart, intestines). |
|
|
Term
| What is the stress response? |
|
Definition
Smooth muscles or glands activate
(e.g., pupils dilate).
Fight or Flight |
|
|
Term
| Describe, physiologically, the role of the hypothalamus-pituitary-adrenal (HPA) gland in chronic stress.? |
|
Definition
1.) Epinepherine
2.) Hypothalamus - stimulates the hPA axis
3.) Corticotropic releasing hormone travels to the pituitary gland
4.) ACh travels to the adrenal gland
5.) Cortisol is released |
|
|
Term
|
Definition
| Yes. When stress is prolonged, chemicals produced by the stress response (cortisol, adrenaline, and other catecholamines) can have damaging effects on the body |
|
|
Term
| What are the physiological and emotional results of prolonged stress? |
|
Definition
Colds
and influenzas
Asthma
Stomach ulcers
Eczema and other skin disorders
Heart disease
Cancer
Depression
Posttraumatic
stress
disorder |
|
|
Term
| What are stress reduction techniques? |
|
Definition
Eliciting the relaxation response
Physical activity
Social supports (e.g., close family ties, acquaintances, spouses, friends) |
|
|
Term
| What is PTSD? Are there any physiological differences? |
|
Definition
Posttraumatic Stress Disorder (PTSD)
Usually occurs after a traumatic event outside the range of usual human experience.
HPA system is abnormal. |
|
|
Term
| What is comorbid with PTSD? |
|
Definition
| Major depression frequently occurs. |
|
|
Term
| What are examples of traumatic events/ |
|
Definition
Childhood physical abuse, torture or kidnapping; military combat; sexual assault; natural disasters; human disasters
Crime-related events: terror attacks, assault, mugging, rape, incest, taken hostage
Diagnosis of a life-threatening illness |
|
|
Term
| What is the common element of PTSD? |
|
Definition
extraordinary
helplessness or powerlessness |
|
|
Term
| What are the symptoms of PTSD? |
|
Definition
Flashbacks
Avoidance of stimuli associated with trauma
Experience of persistent numbing of responses
Persistent symptoms of increased arousal |
|
|
Term
|
Definition
Cognitive behavioral therapy (CBT)- Modify negative thoughts that lead to dysfunctional emotions and actions.
Selective serotonin reuptake inhibitors (SSRIs)
Group therapy with others who have had traumatic experiences |
|
|
Term
| What are some drugs used to treat flashbacks, avoidance and numbing with PTSD? |
|
Definition
| SSRI antidepressants, second-generation antipsychotics |
|
|
Term
| What is used to treat treatment resistant PTSD? |
|
Definition
| Second-generation antipsychotics, anticonvulsants |
|
|
Term
| What is used to treat PTSD panic attacks? |
|
Definition
| Antidepressants, monoamine oxidase inhibitors (MAOIs), high-potency benzodiazepines |
|
|
Term
| What is used to treat PTSD hyperarousal? |
|
Definition
| Antidepressants, benzodiazepines, anticonvulsants |
|
|
Term
| What is used to treat PTSD nightmares? |
|
Definition
|
|
Term
| What is the MAJOR difference between acute stress disorder and PTSD? |
|
Definition
PTSD - Last > 1 month
ASD - -last 3days- 1 month |
|
|
Term
| What are other differences in ASD and PTSD? |
|
Definition
-ASD
Manifest immediately following traumatic event
Re-experiences through: distress when reminded, dreams, images, flashbacks
Manifest: amnesia r/t event, absent emotional response, decreased awareness, severe anxiety-irritability, sleep disturb.
-PTSD
Manifest any time after the event, months or years
Re-experiences through: intrusive recollection of event, dreams, flashbacks, illusions, hallucinations
Manifest: irritability, concentration, sleep disturb., avoid people, lack of feelings. |
|
|
Term
| Andrew, a hospice nurse for 5 years and a member of your nursing team, is demonstrating a blunted affect and is not completing patient care documentation in the required timeframe. As a peer, what is your best action? |
|
Definition
Ask Andrew what he feels is causing him to fall behind in his work.
*B. Developing a trusting relationship with peers and being honest allows for openness and promotes beneficial dialog. |
|
|
Term
|
Definition
Universal Human Experience
Is the most basic emotion.
Dysfunctional behavior is often a defense against anxiety.
When behavior is recognized as dysfunctional, interventions can be initiated by the nurse to reduce anxiety.
As anxiety decreases, dysfunctional behavior will frequently decrease. |
|
|
Term
|
Definition
| FEAR = Is a reaction to a specific danger. |
|
|
Term
| What is anxiety defined as? |
|
Definition
| Is a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized |
|
|
Term
| What is the co-morbidity of anxiety disorders? |
|
Definition
Of those with an anxiety disorder, 90% develop another psychiatric disorder.
Patients frequently seek relief of physical symptoms. |
|
|
Term
| Who is more affected by anxiety disorders? |
|
Definition
|
|
Term
| What are highly co-occurring disoders with anxiety? |
|
Definition
| substance abuse, major depressive disorder (MDD) |
|
|
Term
| What are frequently co-occurring disorders with anxiety? |
|
Definition
| eating disorder, bipolar disorder, dysthymia |
|
|
Term
| What are common co-occurring MEDICAL conditions with anxiety? |
|
Definition
| cancer, heart disease, hypertension, irritable bowel syndrome, renal or liver dysfunction, reduced immunity |
|
|
Term
| What is chronic anxiety associated with? |
|
Definition
| increased risk for cardiovascular morbidity and mortality |
|
|
Term
Charlie is 19 years old with an ileostomy caused by rectal surgery for cancer, which has rendered him sexually impotent. He is admitted to the psychiatric unit and is unable to state his name.
What kind of anxiety? |
|
Definition
|
|
Term
Alex has a chemistry test this morning. She “crammed” for the test the previous night but did not study before. She has an upset stomach and headache.
What kind of anxiety? |
|
Definition
|
|
Term
Mr. Jones has not left his house for 3 months. He tells his family, “I know this is not normal, but I just can’t go outside.” His wife died 3 years earlier.
What kind of anxiety? |
|
Definition
|
|
Term
How does mild anxiety affect your Perceptual field
Ability to learn
Physical characteristics
Other behavioral characteristics |
|
Definition
Perceptual - Heightened
Learn - Able to work effectively towards a goal
Physical Characteristics - Slight discomfort, attention seeking behaviors, restlessness, irritability, impatience, etc. |
|
|
Term
How does moderate anxiety affect Perceptual field
Ability to learn
Physical characteristics
Other behavioral characteristics |
|
Definition
Perceptual - narrow
Learn - Able to learn but not optimally
Characteristics - Voice tremors, change in pitch, difficulty concentrating, shakiness, repetitive ?, increased breathing, sweathcing, pulse etc. |
|
|
Term
How does severe anxiety affect:
Perceptual field
Ability to learn
Physical characteristics
Other behavioral characteristics |
|
Definition
Perceptual - greatly reduced
Learn - Unable to see connections btwn details
Characteristics - Dread, ineffective fxn, confusion, etc. |
|
|
Term
|
Definition
Perception: Unable to focus on environment
Learn: May be mute or have extreme psychomotor agitation
Characteristics: Terror, immobility, dilated pupils, unintelligible communication, severe shakiness, |
|
|
Term
| What are immature defense mechanisms? |
|
Definition
Passive aggression
Rationalization
Acting out
Dissociation
Devaluation
Idealization
Splitting
Projection
Denial |
|
|
Term
| What are intermediate defense mechanisms? |
|
Definition
Displacement
Reaction formation
Somatization
Undoing |
|
|
Term
| What are healthy defense mechanisms? |
|
Definition
Altruism
Sublimation
Suppression
Humor |
|
|
Term
| What are the anxiety disorders? |
|
Definition
Panic disorder (PD)
PD with agoraphobia
Phobia
Social anxiety disorder (SAD) or social phobia
Generalized anxiety disorder (GAD)
Anxiety caused by a medical condition
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder and acute distress disorder (see Chapter 10) |
|
|
Term
|
Definition
Feelings of terror
Suspension of normal function
Severely limited perceptual field
Misinterpretation of reality
Suddenly occurrence of panic attacks (not necessarily in response to stress)
Increased rates of suicide and suicide attempts |
|
|
Term
| What are the symptoms of a panic attack? |
|
Definition
| Palpitations, chest pain, diaphoresis, muscle tension, urinary frequency, hyperventilation, breathing difficulties, nausea, feelings of choking, chills, hot flashes, and gastrointestinal symptoms |
|
|
Term
| What usually happens with a panic attack? |
|
Definition
Someone is rushed to the emergency department with signs and symptoms of a heart attack.
An extensive workup is negative for cardiac problems.
The patient needs a referral for the potential diagnosis and treatment of an anxiety disorder (e.g., PD). |
|
|
Term
|
Definition
Is an intense and excessive level of anxiety and a fear of being in places and situations from which escape is impossible.
Feared places are avoided to control anxiety. |
|
|
Term
|
Definition
Specific objects or situations include dogs, spiders, heights, storms, water, blood, and closed spaces, among others.
Are common, but do not usually cause much difficulty. |
|
|
Term
| What is a social anxiety disorder? |
|
Definition
Is severe anxiety provoked by exposure to a social or performance situation.
Fear of saying something foolish, not being able to answer questions in a classroom, eating in the presence of others, and performing on a stage, among others
Fear of public speaking is the most common. |
|
|
Term
| What is generalized anxiety disorder? |
|
Definition
Is a chronic disorder associated with severe distress.
Is characterized by excessive anxiety or worry.
Lasts 6 months or longer.
Self medication may lead to substance disorders.
Symptoms include restlessness, fatigue, poor concentration, irritability, muscle tension and sleep disturbances. (diagnosis- must have at least 3 |
|
|
Term
| How does GAD differ from other anxiety disorders? |
|
Definition
Cognitive dysfunction, Impaired functioning
Poor health-related outcomes
No fear of external object or situation |
|
|
Term
| What systems are effected by anxiety? |
|
Definition
Respiratory
Cardiovascular
Endocrine
Neurologic
Metabolic |
|
|
Term
| How can one be diagnosed with an anxiety disorder? |
|
Definition
| Evidence must be present in the history, physical examination, and/or laboratory findings to diagnose the medical condition. |
|
|
Term
| What is OCD characterized by? |
|
Definition
| obsessions and compulsions |
|
|
Term
|
Definition
| Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause significant anxiety or distress |
|
|
Term
|
Definition
| Unwanted, repetitive behavior patterns or mental acts intended to reduce anxiety but not to provide pleasure or gratification |
|
|
Term
| What are the most severe symptoms of OCD? |
|
Definition
Center on dirtiness, contamination, and germs and occur with corresponding compulsions such as cleaning and hand washing.
Include persistent thoughts of sexuality, violence, illness, and death. |
|
|
Term
| What about mild compulsion? |
|
Definition
“Normal” individuals may experience mild obsessive-compulsive behaviors.
Mild compulsions are valued traits in U.S. society. |
|
|
Term
| He asks you, “How will I ever be able to go to the beach or be with a girl with this gross bag hanging on my stomach? |
|
Definition
“This has to be extremely difficult for you to face.
Stating that Charlie’s condition is extremely difficult to face lets him know that you are actually listening to and thinking about what he is saying. This helps establish trust so that the conversation can possibly continue. |
|
|
Term
The suitcase contains three T-shirts, three pajama bottoms, and a toothbrush wrapped in several layers of plastic wrap. You return the suitcase to him.
Klim begins to unfold and refold his clothing slowly and repetitively.
What is your best nursing action? |
|
Definition
Continue the interview and allow Klim to continue as long as he is not harming himself or others.
During the initial hours of Klim’s hospitalization, he needs to be allowed to continue his ritual as long as it does not pose harm to himself or others. You will need to begin to set appropriate behavior limits later |
|
|
Term
| What are behaviors of hoarding of people without OCD? |
|
Definition
Exhibits compulsive and disabling hoarding.
Results in social isolation.
No extreme disruption occurs in the performance of ADLs.
Has difficulty discarding possessions.
Has strong urges to save items.
Exhibits distress when discarding items.
Accumulation results in clutter.
Interventions of third parties (family members, cleaners, authorities) are staged. |
|
|
Term
| What are the behaviors of hoarding of people WITH OCD? |
|
Definition
Excessively collects items, and exhibits a failure to discard items.
Approximately 50% of patients who exhibit hoarding have co-occurring OCD.
OCD and excessive hoarding are associated with:
Increase in co-morbidity
Impairment in performing activities of daily living (ADLs)
Reduced insight
Poor response to treatment
Genetic and neurobiologic profile |
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