NSG 211 Test 1 Anxiety Study Guide Exemplars Generalized Anxiety Disorder Phobias Obsessive Compulsive Disorder Panic Disorder Stress Disorder Depression Postpartum Depression Bipolar Disorders Suicide Definitions: Apprehensive uneasiness or nervousness usually over an impending or anticipated event. Mood and Mood is defined as what a person feels. Affect is defined as the recognizable response a person has to his or her own feelings. 1. Describe mood and affect: Mood: The subjective state that the patient describes I Ex: Mood Lability changes or shifts), (Extreme optimistic), Euthymic (normal reasonably positive mood) Affect: The outward expression of a internal emotional state we Ex: Flat Affect (blank facial expression), Blunted (minimal emotional response), Labile (quickly changing), Inappropriate (not appropriate for Incongruent match topic) Mania: an unstable elevated mood in which delusion, poor judgement, and other signs of impaired reality testing are evident. During a manic episode, patients have marked impairment of social, occupational, and interpersonal functioning. Delusion: false belief held to be true even with evidence to the contrary Hallucination: A sense perception for which no external stimulus exists (internal auditory, visual, smell or taste stimuli) 2. Evaluate risk factors related to altered mood and affect: Gender, stress, trauma, family history, comorbid disorders (hypothyroidism) 3. Evaluate risk factors related to Anxiety: Age, gender, race, socioeconomic status, health conditions, poor inability to accurately assess the stressor, denial of the stressor, perceived lack of control, perceived lack of support, no experience handling stressful situations 3. Plan prevention strategies related to anxiety altered mood and affect: Primary: promote health, positive attitude, stress prevention, reduction in amount of poverty, racism, violence, and stress a person is exposed to. Secondary: Mood screening, screening Beck Anxiety Index (adults) and Spence Anxiety Scale, SAD PERSONS scale for suicide 4. Collect assessment data through the use of information technology including diagnostic and laboratory tests: Hx: perception of threat, past coping, medical and social Hx, acute stress, episodic acute stress, chronic stress, physical exam Hx and physical exam, suicide risk 5. Demonstrate the use of the nursing process, while providing culturally competent care across the life cycle: psychological, emotional, physiological, behavioral cognitive restructuring, assessing resources, developing an action plan psychotherapy 6. Implement safe caring and interventions: psychological, emotional, physiological, behavior cognitive restructuring and assessing resources, developing an action plan, slow down and lower voice Anxiolytics and Benzodiazepines Collaborative psychotherapy, therapists, physicians suicide precautions mood stabilizers, Collaborative psychotherapy, brain stimulation therapy, cognitive behavioral therapy 7. Prioritize care for clients: Safety of the patient is always number 1! Along with Tx with a benzo can fall under safety for the patient Psychological Responses: Irrational fear of an object, activity or situation that persists and leads to avoidance Physiological Responses: anxiety or fear Risk Factors: Family history, stressful event (trauma, illness) Impairments in Self Care: May not be able to put themselves in to any situation that contains the fear agent Medications to Treat: Benzodiazepines How can these Meds Kill? Respiratory depression Overdose Serotonin syndrome Alternative Treatments: Relaxation diaphragmatic breathing, muscle relaxation, meditation Calm environment Support services desensitization Additional Notes: Social Anxiety fear of being embarrassed in public settings or evaluated negatively. Public speaking is most common Obsessive Compulsive Disorder Psychological Responses: are related to thought processes Physiological Responses: are related to physical processes (actions). May complete the same actions dozens of times or more each day Risk Factors: Existing mental illness, substance abuse, ADHD, stress Impairments in Self Care: Time consuming and impact day to day activities, person is usually aware of the condition which can lead to anxiety, depression, rage, and potential destructive disorders Medications to Treat: SSRIs, tricyclics How can these Meds Kill? Tricyclics are very easy to overdose on. Alternative Treatments: triggers Setting goals Low stress Healthy coping Psychotherapy Transcranial magnetic stimulation Additional Notes: Difference between Obsession vs. Compulsion: Obsession is the thought (ex. Fear of germs), Compulsion is the act carried out (ex. Washing hands) You do not have to have both the obsession and compulsion to be diagnosed as OCD Panic Disorders Physiological Responses: Potentially violent outbursts, pain, arthritis, hypertension and other cardiovascular maladies Risk Factors: TBI, traumatic psychological event, serious injury, lack of social support system in wake of any of these Impairments in Self Care: Could possibly harm self or others in a traumatic state, insomnia Medications to Treat: SSRIs, Antidepressants, anxiolytics Prazosin (Minipress) Clonidine How can these Meds Kill? See previous sections on these drugs Orthostatic hypotension Alternative Treatments: Exposure therapy Short sentences Decreased stimuli Grounding techniques EMDR Additional Notes: acute stress disorder PTSD 1 month Major Depressive Disorder Psychological Responses: Catatonia, melancholy, powerlessness, low selfesteem Physiological Responses: Anergia, risk of events due to inactivity and poor diet, increased pain sensitivity, weakened immune system Risk Factors: Women more predisposed than men, lower socioeconomic status, seasonality (worse in the winter) status, medication side effects, hormonal disorders, personal Race is not considered a risk factor. DSM5 criteria for Major Depression Symptoms occurring during same period: Depressed mood, loss of interest, insomnia or hypersomnia, fatigue, feeling worthless or excessive guilt, decreased concentration, thoughts of suicide Impairments in Self Care: Extreme lethargy and demotivation may make even the most basic tasks indifference may affect regression may occur especially in youth Medications to Treat: SSRIs, MAOIs, Tricyclics How can these Meds Kill? SSRIs: This is not directly caused the drug itself, but because the drug can increase energy levels before it actually builds up therapeutic levels in the body, it can put suicidal patients at increased risk giving them the energy needed to carry out a suicide plan Serotonin syndrome is possible if used with MAOIs MAOIs: hypertensive crisis (avoid tyramine), contraindicated with other antidepressants. Tyramine also is found in beer, wine, aged cheese, organ meats, avocadoes, and other foods Tricyclics: Deadly in overdose. No alcohol. Orthostatic hypotension, cardiac issues Atypical antidepressants: Alternative Treatments: Electroconvulsive therapy Additional Notes: Dysthymic Disorder (Persistent Depressive Disorder): Mild but form of depression years) All antidepressants carry a black box warning for increased SI in adolescents Psychological Responses: Irritability, loss of libido, sleep disturbances, fear of being unable to provide for infant Physiological Responses: Fatigue, loss of appetite, Risk Factors: Hormonal changes tryptophan metabolism, cellular alterations, can lead to psychosis Impairments in Self Care: Unable to care for self and ba Medications to Treat: antipsychotics How can these Meds Kill? Serotonin syndrome Overdose Possible transference to breast milk Alternative Treatments: Support groups Additional Notes: Can happen for up to a year after childbirth, protect the kid from harm Bipolar Disorders Bipolar I: Characterized really high and low Acute mania. Bipolar II: Hypomania, does not get up to the degree of Bipolar I. Cyclothymia: At least 2 years of chronic mood disturbance. Minor depression and hypomania. Psychological Responses: Hallucinations delusions (in type 1 mania), a feeling that nothing can go wrong (mania), increased libido (mania) Physiological Responses: Constant state of exhilaration, risk taking behaviors, hyperactivity (mania) Risk Factors: Family history, substance abuse, Impairments in Self Care: Patient may be acutely psychotic, rendering them physically incapable of taking care of themselves or preventing harm. Depressive state can lead to refusal of basic (eating, bathing) Medications to Treat: Mood stabilizers: Lithium, Depakote, Lamictal, Latuda Antipsychotics How can these Meds Kill? Lithium toxicity: levels in the blood Most drugs should never be stopped abruptly Alternative Treatments: Electroconvulsive therapy may be used IF Patient does not respond to medication Patient has adverse reactions to medication life is at risk from or exhaustion therapy, milieu group Additional Notes: mood dysregulation usually diagnosed for adolescents Out of control behavior a week for over a year in different settings Reorient patient, calm, short sentences, take care of physical needs Drink plenty water and adequate sodium intake to avoid lithium toxicity Suicide Psychological Responses: Suicidal ideation, anhedonia (inability to feel anxiety, feelings of irritability or anger Physiological Responses: Insomnia or hypersomnia, anergia (lack of Risk Factors: Mental illness, terminal diagnosis, status, substance Foundational Information: decrease leads to depression and commonly seen with Increase leads to anxiety states decrease leads to and increase leads to schizophrenia and mania High levels associated with anxiety and depression decrease leads to increase leads to anxiety states Butyric Acid decrease leads to anxiety disorders, schizophrenia, mania, Huntington Increase leads to reduced anxiety, schizophrenia, and mania increase leads to decrease leads to Alzheimer disease, Huntington chorea, and Parkinson disease Legal HIPPA exception: duty to allowance of warning people who a homicidal person indicates as a subject to kill Cannot confirm or deny a patient is at the hospital or facility Behavioral restraints (ABSOLUTE LAST are never PRN 4hours, 2 hours, 1 hour temporary detaining order for 72 hours and a hearing is evaluated Criteria for admission Danger to Unable to protect self from harm Levels of Anxiety: only expanded perceptual field, cognition increases ex. Test taking physical heart racing ability to talk down Severe and keep them medicate (benzo), help bring dilated pupils, rapid speech Personality has three parts: immediate, pleasure principle, avoiding pain based in reality, controls and rational thinking, serves as balance between self and environment unconscious and conscious, uncompromising, basis of shame and guilt, morals of psychosocial development throughout life Each stage represents developmental milestones or tasks. Completion of task in each stage is necessary to resolve developmental and for psychosocial developmental growth to occur. Importance is result for individual when task is not fully mastered for feelings, behaviors reflect lack of completion Maslow identified: A of as fulfillment of highest potential Seen as founder of mental health nursing as a science The art of nursing Provide care, compassion, and advocacy Enhance comfort and The science of nursing Application of knowledge to Understand a broad range of human problems and psychosocial phenomena Intervene in relieving suffering and promote growth Major paradigm shift in nursing Levels of Moderate, Severe, Panic Focus on interpersonal relationships and stages of relationship Preintroduction, Orientation, Working, Termination scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the The client is expected to learn adaptive coping and interaction and relationship skills that can be generalized to other aspects of his or her life. Current focus of care is on short stays and is often more biologically based. Every interaction is an opportunity for therapeutic intervention Antidepressants (that are not Wellbutrin (Bupropion), Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Venlafaxine (Effexor) Side insomnia, wt. loss, tachycardia, rebound depression Contraindicated with stevens Johnson syndrome and risk for suicide MAOI 14 days prior to avoid hypertensive crisis and increase slowly to reduce risk of seizures. Amitriptyline (Elavil) reuptake of neurotransmitters Side sedation, impotence, orthostatic hypotension, blurred vision, dry mouth, edema, constipation, and muscle tremors Adverse seizures, dysrhythmias OD monitor for drug toxicity Contraindicated in pregnancy and recent MI Mood Lithium (1st choice for bipolar Disrupts NA exchange, increase GABA, reduce dopamine and glutamate availability Adverse coma, amnesia, angioedema, blurry vision, serotonin syndrome, confusion, abdominal pain Therapeutic (acute), 1 is good, (long term) maintain sodium and water intake Toxicity diarrhea, lethargy, tremors, increased HR, low muscle Test BG and treatment dialysis and furosemides Lamotrigine, Depakote, Valproic Acid Stabilize neuronal membranes controlling NA Adverse steven Johnson syndrome, angioedema, blurry vision, confusion, amnesia, abdominal pain Possible coma, death, and SI Do not take with other medications Therapeutic 74 drowsiness, incoordination, coma, dizziness, lethargy Serotonin Everything goes up and you die Steven Johnsons body rash that blisters up and peels Test review: putting it on another person Hopelessness symptom for suicide risk Situational someone being there during difficult times Dysthymic disorder is for at least 2 years Cutting (superficial) is not an indication for signs of depression is because of risk of harm to self or ba

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Test 1 NSG 211 Study Guide

Course: Health Care Concepts II (NSG 211)

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University: Germanna Community College

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NSG 211 Test 1 Anxiety & Mood/Affect Study Guide

Exemplars

- Generalized Anxiety Disorder

- Phobias

- Obsessive Compulsive Disorder

- Panic Disorder

- Post-traumatic Stress Disorder

- Depression

- Postpartum Depression

- Bipolar Disorders

- Suicide

Definitions:

Anxiety- Apprehensive uneasiness or nervousness usually over an impending or

anticipated event.

Mood and Affect- Mood is defined as what a person feels. Affect is defined as the

recognizable response a person has to his or her own feelings.

1. Describe mood and affect:

Mood: The subjective emotional/feeling state that the patient describes “How I feel”

Ex: Mood Lability (intense/frequent changes or shifts), Elated/Euphoric (Extreme

joy/overly optimistic), Euthymic (normal non-depressed, reasonably positive mood)

Affect: The outward expression of a person’s internal emotional state “What we see”

Ex: Flat Affect (blank facial expression), Blunted (minimal emotional response),

Labile (quickly changing), Inappropriate (not appropriate for topic/situation),

Incongruent (doesn’t match topic)

Mania: an unstable elevated mood in which delusion, poor judgement, and other signs

of impaired reality testing are evident. During a manic episode, patients have

marked impairment of social, occupational, and interpersonal functioning.

Delusion: false belief held to be true even with evidence to the contrary

Hallucination: A sense perception for which no external stimulus exists (internal

auditory, visual, smell or taste stimuli)

2. Evaluate risk factors related to altered mood and affect:

Gender, stress, trauma, abuse/neglect, family history, comorbid disorders

(hypothyroidism)