disorders焦虑症课件

Anxiety Disorders ANXIETY DISORDERS vAnxietyVague, subjective non specific feeling. *uneasiness, apprehension *tension,feeling of dread or impending doom vCauses- result of threat to ones Biologic, Physiologic and Social Integrity- external influences Types of Anxiety Signal Anxiety- (Phobic Disorders) Precipitant is identified A learned anxiety response-results from situations successfully repressed or coped with using another defense mechanism Trait anxiety A function of Personality structure Link with developmental process/events May be linked to unresolved conflict/confusion (Anxiety Diathesis)a pre-disposition to anxiety when exposed to stressor. E.g One had a chronically ill mother and is overprotective w/own children. State Anxiety Develops in conflict or stressful situations Experiences limited control Anxiety occurs before the situation arises E.g Woman who avoids making appt w/PMD after finding breast mass and has a strong family hx. Of cancer. Free Floating Anxiety Pervasive sense of dread or doom Cannot be attached to any idea or event May result in panic state if stressors exceed the individuals ability to cope. Levels of Anxiety Hildegard Peplau “Interpersonal Relations in Nursing 1952” identified Four stages of anxiety on a continuum Mild Moderate Severe Panic Panic Behavioral urban living; hx. Of worry or rumination;poor physical health; low socioeconomic status; stressful life events;depression SOB,choking,smothering sensation Behavioral manifestations of Phobias PHOBIAS avoidance of object or situation Significant distress or impairment of daily routines,occupation or social functioning. Fear recognized as excessive or unreasonable Post Traumatic Stress Disorder (PTSD) C/b re-experiencing an extremely traumatic event(begins within 3 months to years after event lasting months or years Person avoids the stimuli associated with the event, numbing of responsiveness,increased arousal PTSD-characteristics Intense fear /helplessness/horror upon exposure Dreams,flashbacks, Physical/psychological distress over reminders of the event Avoids memory provoking stimuli Feeling detached or estranged from others Increased arousal (irritability,angry outburst,sleep problems,hypervigilance,exaggerated startle response) PTSD interventions Promote desensitization through gradual exposure to event or situation similar to the event Teach relaxation techniques Provide individual therapy to address loss of control issues Encourage use of support groups Encourage use of hypnotherapy Generalized Anxiety Disorder C/b at least 6 months of persistent, excessive worry and anxiety. Uncontrollable worrying Significant distress w/impaired social or occupational functioning 3 of the following:restlessness, fatigues easily,difficulty w/concentration, thought blocking,irritability, muscle tension sleep disturbance. Interventions Attend to physical symptoms Assist client to identify thoughts that arouse the anxiety & their bases Assist client to change unrealistic thoughts to more realistic thoughts Use cognitive re-structuring Administer anti-anxiety medications as prescribed Obsessive Compulsive Disorder Obsessions ( thoughts, impulses or images) which cause marked anxiety or Compulsions(repetitive behaviors or mental acts) Recurrent, persistent, unwanted thoughts impulses or images Attempts to ignore,suppress,or neutralizes obsessions with compulsions are mostly ineffective. OCD interventions Identify the situation that precipitates the behavior Do not interrupt compulsive behaviors Allow time for compulsive rituals Provide safety related to behaviors Provide schedule to distract behaviors Set limits on rituals that may interfere with client well-being Establish written contract-decrease frequency of compulsive behaviors Developmental considerations Child Adolescent Adult Elder Cultural Considerations for Anxiety disorders in: Hispanic African American Asian European- American Middle Eastern The nurse is working with the family of a client with Obsessive Compulsive D/O.Which of the following should the nurse incorporate in the teaching plan? A.) the thoughts images and impulses are voluntary B.) the family should pay immediate attention to symptoms C.) the thoughts, images and impulses worsen the stress D.) OCD is a chronic disorder not responsive to treatment A client displays isolation, bizarre behaviors, unsafe actions and poor hygiene. Which will be the first priority in the nursing care plan? A.) Safety B.)Hygiene C.)Isolation D.) Bizarre behaviors The nurse would analyze the symptoms of muscle rigidity, GI upset, rapid speech,and need to urinate as which level of anxiety? A.) Mild B.) Moderate C.) Severe D.) Panic A client has recently been involved in assisting with the clean-up from a flood that washed away many homes in his area and caused loss of life.Which of these interventions would assist the client in dealing with the traumatic experience. A. Provide the opportunity to talk about the experience. B. Encourage the client to leave the area in order to forget the experience. C. Suggest admission to a mental health facility. D. Arrange for a minister to speak with the client. Appropriate discharge criteria for a client with chronic anxiety disorder is the client will- A.) experience no more anxiety B.) suppress the anxiety symptoms and focus on the future C.) Identify situations and events that trigger anxiety D.) recognize the need to take medications for the rest of his/her life to control anxiety The nurse is working with a client with chronic anxiety. The goal is that the client will identify early warning symptoms of anxiety.The nurse would analyze the client as moving towards this goal when the client: A.) begins to connect panic symptoms with thoughts about a recent break-up in a relationship. B.) is free of anxiety for one week C.)practices relaxation techniques daily and when anxiety increases D.)recognizes that others also experience anxiety in varying situations A client is to receive medication therapy for an anxiety disorder. To reduce the risk of dependence and problems related with withdrawal, which of the following agents would the nurse most likely anticipate as being prescribed? (select all that apply) Paroxetine (Paxil) Sertaline (Zoloft) Lorazepam (Ativan) Venlafaxine (Effexor) Clonazepam (Klonopin) The nurse assesses a client with a diagnosis of Generalized Anxiety disorder for which of the following symptoms? Fear and avoidance of specific situations or places. Persistent obsessive thoughts Re-experience of feelings associated with traumatic events Unrealistic worry about a number of events in ones life. A 4 year-old girl who is a victim of a bomb blast that demolished the building which housed her daycare constantly builds block houses and blows them up. She also has nightmares frequently. Which one of the following diagnoses is appropriate for the nurse to make regarding this child? Post-trauma response related to terrorist attack as evidenced by destructive behaviors and sleep disturbance. Explosive disorder related to dysfunctional personality as evidenced by destructive behaviors. Sleep disturbance related to emotional trauma as evidenced by nightmares. Ineffective individual coping related to internal stressors as evidenced by destructive behaviors and nightmares. Nursing Care Plan: Anxiety Assessment data: Appearance,Behavior,Conversation i.e.: Wringing hands,decreased communication,restlessness, irritability,pacing,decreased attn, poor impulse control Identify stressors- intra,inter, extrapersonal Identify lines of defense Goals/expected outcomes: Short term: The client will: be free of injury Discuss feelings of dread or anxiety Respond to relaxation techniques Demonstrate ability to perform relaxation Implementation: anxiety Remain with client at all times if level is severe or panic(safety important) Remove client to Quiet area( client is not able to deal with excessive stimuli) Remain calm upon approaching client(client will feel more secure if you are in control of situation) Use short simple clear statements(impaired ability to deal with abstractions/complexities) Use PRN meds as indicated Nursing interventions: Educate client re use of caffeine, nicotine etc.(prevents/minimizes cardiovascular responses i.e. Inc heart rate and jitteriness) Provide instruction regarding anxiety reduction stretagies Progression relaxation techniques Listening to smoothing music or relaxation tapes When planning discharge for a client with chronic anxiety the nurse directs the goal of promoting a safe environment at home.The most appropriate maintenance goal should focus on which of the following: A.Continues contract with a crisis counselor B.Identifying anxiety producing situations C.Ignoring feelings of anxiety D.Eliminating all anxiety from daily situations A client with OCD is admitted to the psychiatric unit for hand washing rituals. The day after admission she is scheduled for lab tests. To assure that he client is there on time, the nurse should: Remind the client several times of her appointment. Limit the number of hand washings Tell her it is her responsibility to be there on time Provide ample time for her to complete her rituals. A client admitted for ritualistic behaviors is constipated and dehydrated. Which nursing intervention would this client most likely comply with? Drinking Ensure between meals Drinking extra fluids with meals Drinki