Mental Health Nursing I NURS 1300 Unit IV Anxiety Disorders and Crises

1. Mental Health Nursing INURS 1300Unit IVAnxiety Disorders and Crises

2. Objective 1Define stress, stressors, and anxiety • Stress • a state of bodily or mental tension resulting from factors that tend to alter an existent equilibrium • necessary for growth and development • Stressor • anything that necessitates an adaptive response on the part of the individual

3. Objective 1 (cont’d) • Anxiety • a vague and sometimes intense sense of impending doom or apprehension that may appear to have no clearly identifiable cause • often an early response to illness

4. Objective 2Describe the “fight-or-flight” syndrome • 1st stage of the general adaptation syndrome • Body’s response to perceived threat or danger • Hormones released to give body strength • increases heart rate • slows digestion • shunts blood flow to major muscle groups

5. Objective 3Define the four levels of anxiety • Mild anxiety • client able to focus attention • motivates learning and personal growth • Moderate anxiety • optimal level for learning • client focused on immediate concerns • Severe anxiety • ability to think is clouded • problem solving is impaired • Panic anxiety • inability to communicate or function effectively • misperceptions of surrounding events • client may react impulsively by running or striking out

6. Objective 4Describe various coping mechanisms used to deal with stress and anxiety • Imagery • Deep-breathing • Meditation • Yoga • Therapeutic touch • Music therapy • Biofeedback

7. Objective 5Describe the major defense mechanisms See Defense Mechanisms handout

8. Objective 6Be able to discuss generalized anxiety, panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder

9. Generalized Anxiety Disorder (GAD) • Characterized by chronic anxiety and unrealistic, excessive worry and tension • Concurrent physical symptoms occur in the absence of organic conditions • fatigue • headaches • muscle aches and tension • difficulty swallowing • trembling and twitching • irritability • sweating and hot flashes

10. Panic Disorder • Characterized by recurrent panic attacks • episodes of intense apprehension of variable length • accompanied by feelings of impending doom • often occur in familiar places, where there is seemingly nothing threatening to the individual • Concurrent physical symptoms include: • increased pulse • elevated blood pressure • trembling • diaphoresis • shortness of breath • chest pain • nausea

11. Phobias A phobia is an irrational, persistent fear of certain situations, objects, activities, or persons The main symptom is the excessive, unreasonable desire to avoid the feared subject Phobic fear interferes with daily life

12. Obsessive-Compulsive Disorder (OCD) • Obsessions = recurrent, unwanted thoughts • Compulsions = repetitive behaviors • often performed with the hope of preventing obsessive thoughts or making them go away • hand washing, counting, checking, cleaning • provides only temporary relief • not performing rituals results in marked increase in anxiety • Time-consuming; causes distress or impairment • Client aware thoughts and behaviors are irrational, but feels powerless to stop

13. Post-Traumatic Stress Disorder (PTSD) • PTSD = a cluster of symptoms experienced following a distressing event • event is outside the range of normal experiences • event produced intense fear, helplessness, and/or horror • Characteristic symptoms of PTSD include: • dissociative flashbacks • sustained high level of anxiety/arousal or a general numbing of responsiveness • intrusive recollections or nightmares of the event

14. Objective 7Be able to discuss somatoform disorders to include types, risk factors, signs and symptoms • Somatoform disorders = physical ailments for which no medical explanation has been found • Types of somatoform disorders • conversion disorder • pain disorder • hypochondriasis • body dysmorphic disorder

15. Conversion Disorder • Disorder in which emotional distress or unconscious conflicts are expressed though physical symptoms • Sudden onset of symptoms following a stressful experience • Involves involuntary loss of one or more bodily functions in which diagnostic testing uncovers no physical cause • Risk factors • medical illness • dissociative disorder • personality disorder

16. Pain Disorder • Persistent and chronic pain at one or more sites in which psychological factors are thought to play a role • Suffering is so severe that it impairs client’s ability to function • Risk factors • underlying medical condition • fibromyalgia • migraines • uncontrolled or inadequately managed pain • depression and/or anxiety

17. Hypochondriasis • Excessive preoccupation or worry about having a serious illness • Characteristics include: • fears that minor bodily symptoms may indicate serious illness • constant self-examination and self-diagnosis • preoccupation with one’s body • Fear is persistent and disabling in spite of reassurances that no organic pathology can be found

18. Body Dysmorphic Disorder • Exaggerated belief that body is deformed or defective in some specific way • Most common complaints involve imagined or slight flaws of the face or head • Risk factors • chemical imbalance of the brain • obsessive-compulsive disorder (OCD) • eating disorder • generalized anxiety disorder (GAD) • higher socioeconomic status • strict cultural standards

19. Objective 8Describe the major types of crisis and what crisis intervention means Major types of psychiatric crisis include: 1. Suicidal thinking or behaviors 2. Homicidal thinking or behaviors 3. Acute psychotic symptoms 4. Sudden change in mental status 5. Violence resulting from a mental disorder

20. Objective 8 (cont’d) Crisis intervention = the provision of emergency psychological care to clients in order to restore their level of functioning and to prevent or decrease potential negative effects of the crisis Intervention consists of: • preventing clients in crisis from harming themselves or others • administering medications • providing a supportive, therapeutic environment

21. Objective 9Identify medical treatment and nursing interventions for the client with an anxiety or somatoform disorder

22. Medical treatment: • therapies • individual psychotherapy • cognitive therapy • behavior therapy • group therapy • medications • anxiolytics • antidepressants Nursing interventions: • anxiety R/T severe stress AEB patient’s self-report/agitation/appearance • ineffective coping R/T severe stress AEB development of somatic symptoms • disturbed body image R/T body dysmorphic disorder AEB expression of repugnance with imagined defect or minor physical anomaly

23. Objective 10Identify major drugs used, actions, side effects and nursing interventions for the client with an anxiety disorder or somatoform disorder See Medications for Clients with Anxiety/Somatoform Disorders handout