Anxiety and PTSD

These flashcards cover key concepts, definitions, and interventions related to anxiety and PTSD, as outlined in the lecture notes.

What is anxiety defined as?

• Anxiety is defined as a subjectively distressful experience activated by the perception of threat, which has both a potential psychological and physiologic etiology and expression.

What defines a panic disorder (not a panic attack)?

• Usually unexpected and occurs for no apparent reason

• Experiencing distinct and extreme periods of physiologic, and psychological hyperarousal.

What is agoraphobia?

• Fear and anxiety associated with travel or location.

• Examples: closed spaces (elevator), open spaces (park), not being able to escape or have a way out

What is generalized anxiety disorder vs panic disorder?

Generalized Anxiety Disorder:

• Worry is chronic and excessive over various aspects of life (e.g., work, school, relationships)

• Must include at least (3) or more symptoms.

• Anxiety is persistent, occurring most days for at least 6 months

• Worry is difficult to control and causes significant distress or impairment

Panic Disorder:

• Characterized by recurrent, unexpected panic attacks

• Panic attacks are intense episodes of fear or discomfort that peak within minutes

What are the (3) three C’s of Cognitive Therapy?

• Catch: identify the thought that came before the emotion; what triggered the event?

• Check: reflect on how accurate and useful the thought is.

• Change: change the thought to a more accurate or helpful one as needed.

What are examples of behavioral therapies?

• Relaxation training

• Modeling

• Systematic desensitization

• Flooding (a type of exposure therapy used in behavioral therapy to help people confront and overcome their phobias or intense anxieties w/out a gradual buildup)

• Response prevention (Prevents the person from engaging in a compulsive behavior or ritual after being exposed to a trigger)

• Thought stopping (cognitive technique used to interrupt or “shut down” unwanted or intrusive thoughts. Used for intrusive thoughts in OCD, anxiety, PTSD, or depression)

What are the clinical signs of mild anxiety?

• Typical experience

• Identifiable cause

• Mild discomfort, restlessness, irritability, impatience

• Tension-relieving behaviors (foot-tapping, fidgeting, nail-bitting)

• Mild restlessness but can still focus

• Speech is clear and coherent.

• Slight increase in muscle tension.

Ex: A 25-year-old graduate student, Maya, is slightly nervous about her upcoming thesis presentation. She is tapping her foot but is otherwise alert and able to concentrate. She states, “I’m a bit jittery, but I’m excited too.”

What are signs of moderate anxiety?

• Slight reduced perception and processing of information, selective inattention

• Concentration difficulties, tiredness, pacing, shakiness

• Voice quivers, mild tremors

• Increased HR and RR, shallow breathing, headaches, backache, insomnia

• Can benefit from instructions from others

Ex #1: A 42-year-old parent, Mark, awaits lab results for his child who is undergoing testing for a chronic illness. He paces in the waiting room, sweating slightly and repeatedly asking the nurse for updates.

Ex #2: Sarah, a 30-year-old client, is scheduled for a minor surgical procedure. She repeatedly checks her phone, fidgets with her hands, and complains of a slight headache and stomach upset. She can still converse but is visibly tense.

What are signs of severe anxiety?

• Distorted perceptions

• Inability to learn and problem-solve

• Behaviors are automatic

• Confusion, feelings of impending doom, HTN, tachycardia, loud and rapid speech, purposeless/aimless activity

• Unable to take instructions

Ex: A 50-year-old client, Robert, is in the emergency department with chest pain. After ruling out acute cardiac issues, he remains extremely anxious, hyperventilating, unable to follow directions, and repeatedly saying, “I can’t breathe; I’m going to die.”

What are panic-level of anxiety?

• Markedly disturbed behavior and dysfunction in speech, dilated pupils, severe shakiness,

• Withdrawal or disassociation, inability to sleep, delusions and hallucinations

• May lose touch with reality, experiences extreme fright or horror, severe hyperactivity, flight or immobility

Ex: A 28-year-old graduate student, Jamal, is experiencing a sudden panic attack during finals week. He feels overwhelming terror, is shaking uncontrollably, has chest tightness, and states, “I’m going to lose my mind. I have to get out of here right now!”

How long do panic attacks usually last?

• Panic attacks typically last 15 to 30 minutes

How many manifestations need to be present in order to be considered a panic attack?

Four (4) or more of the following:

• Palpitations

• Shortness of breath

• Choking or smothering sensation

• Chest pain

• Nausea

• Feelings of depersonalization/dissociation

• Fear of dying or insanity

• Chills or hot flashes

What are the five types of defense mechanisms?

• Conversion: where emotional distress is transformed into physical symptoms. Ex: a person experiencing anxiety may develop migraines or stomachaches as a response.

• Repression: involves unconsciously blocking unpleasant thoughts, feelings, or memories from awareness. For example, a person may not remember a traumatic event that has caused them distress.

• Dissociation: involves a disconnection from thoughts, feelings, or sense of self. This can manifest as feeling detached from reality or experiencing a gap in memory about personal information.

• Depersonalization: a feeling of observing oneself from outside the body or losing a sense of personal identity, which can occur during times of extreme stress.

• Derealization: a feeling of detachment from the surrounding environment, as if the world is not real. It may feel like living in a dream or movie.

What characterizes normal anxiety?

• Normal anxiety is a healthy life force necessary for survival and motivates people to act.

What are the consequences of anxiety?

• Consequences of anxiety can include restlessness, muscle tension, avoidance of stressful activities, sleep disturbances, and increased risk of morbidity.

What are the levels of anxiety, from mild to panic?

• Mild, Moderate, Severe, Panic-Level.

What are common nursing interventions for mild to moderate anxiety?

• Therapeutic communication, calm presence, evaluate past coping mechanisms,

• Explore alternatives, encourage participation in activities.

• At this level, your role is supportive and educational, helping the client use their own coping skills.

• If the client can still follow directions, engage in problem-solving, and communicate clearly, they’re likely in mild to moderate anxiety.

What are the manifestations of a panic attack?

• Palpitations, shortness of breath, choking sensation,

• Chest pain, nausea, fear of dying, chills or hot flashes.

• Loss of gross motor skills such as: inability to move or frozen in place, uncoordinated or jerky movements, unable to walk due to shaking or tremors, muscle rigidity or collapse due to overwhelming fear.

What are the common anxiety disorders?

• Separation anxiety disorder, specific phobias, agoraphobia,

• Social anxiety disorder, panic disorder, generalized anxiety disorder.

What are nonpharmacologic interventions for anxiety and PTSD?

• Cognitive therapy, behavioral therapies, relaxation training,

• Modeling, systematic desensitization, and grounding techniques.

What key aspect must nursing assessments focus on in anxiety patients?

• Observing for verbal and nonverbal indicators of anxiety, such as tremors and rapid speech, and identifying triggers.

What are the stages of the stress response using the general adaptation syndrome model?

• Alarm reaction: Initial drop in stress resistance.

• Resistance: The body adapts, and stress resistance increases.

• Exhaustion: Prolonged stress depletes the body’s resources, leading to a sharp decline in stress resistance, and leading to burnout and increased risk of serious illness.

What is Trichotillomania?

Demonstrating a pattern of ritualized behavior defined by serially and intentionally pulling out one’s hair.

• Behaviors are triggered by boredom and/or anxiety

• Results of behavior reduce tension, lead to form of gratification, and pleasure or a sense of relief

What is excoriation disorder?

• Excoriation disorder is characterized by repeated picking at one's own skin, leading to noticeable skin damage.

Examples:

• Physical manifestations commonly found on hands, face, arms, or multiple body sites

• May pick pimples, scabs, or previous picked areas of skin

• Use of picking with fingers, tweezers, rubbing

• Extensive time daily is spent picking

• Often client attempts to cover with clothing or makeup

Appropriate nursing interventions for patients with PTSD include:

• Reassuring patients that feeling distress even after many years have passed is normal.

• Encourage expression (crying, talking about trauma) as part of the healing process

• Recognize possible triggers and the characteristics re-experiencing (flashbacks, nightmares).

What is OCD (Obsessive-Compulsive Disorder)?

• OCD is marked by unwanted, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) performed to reduce anxiety associated with those thoughts.

What is social anxiety disorder?

Social anxiety disorder involves intense fear and avoidance of social situations due to the fear of being judged or embarrassed.

What is agoraphobia?

Agoraphobia is the fear of being in situations where escape might be difficult or help unavailable, often leading to avoidance of public places.

What are the (4) Nurse-Client relationship phases?

• Pre-interaction, Orientation, Working, Termination.

Examples of the Nurse-Client Pre-interaction phase include:

🟣 Pre-Interaction Phase

• Nurse prepares before meeting client

• RN reflects on personal beliefs, values, and biases

• Reviews client data and anticipates needs

Examples of the Nurse-Client Orientation phase include:

🔵 Orientation Phase

• First meeting; establish trust and rapport

• Identify client needs and set mutual goals

• Clarify roles, set boundaries, and address health literacy

Examples of the Nurse-Client Working phase include:

🟢 Working Phase

• Implement interventions collaboratively

• Client begins to accept help and gain independence

• Promote autonomy and problem-solving

• Maintain trust and therapeutic communication

Some common techniques that nurses use to implement therapeutic nonverbal communication are:

• S: Sit squarely to the client

• O: Open posture

• L: Lean forward

• E: Eye contact​​​​​​​

• R: Relax

When considering a client who is exhibiting paranoia, poor judgment, or aggressive behaviors, it is important for the nurse to make minor adjustments to SOLER such as:

• S: sit at an angle rather than squarely to the patient to avoid coming across as confrontational.

• U: uncross arms and legs

• R: relax

• E: eye contact

• T: touch

• Y: your intuition

What is generalized anxiety disorder (GAD)?

Generalized anxiety disorder is characterized by chronic and excessive worry over various aspects of life, often accompanied by symptoms like restlessness, fatigue, and irritability.

What is hoarding disorder?

Hoarding disorder involves difficulty discarding possessions, resulting in clutter that interferes with personal living space and functioning.