unit 3 comp

Therapeutic Relationship

A professional, goal-directed relationship focused on client growth using trust, empathy, boundaries, and unconditional positive regard.

Trauma-Informed Care

Care approach that assumes all clients may have trauma; emphasizes safety, choice, collaboration, empowerment, and trust.

Transference

Client unconsciously transfers feelings about a significant person onto the nurse.

Countertransference

Nurse unconsciously transfers personal feelings onto the client; requires self-awareness to prevent boundary issues.

Milieu Therapy

Use of the therapeutic environment to promote safety, structure, and healing.

Cognitive Behavioral Therapy (CBT)

Therapy focused on changing maladaptive thoughts to influence emotions and behaviors; first-line for anxiety and OCD.

Exposure Therapy

Gradual, controlled exposure to anxiety-provoking stimuli to reduce avoidance and fear response.

Nurse's Role in Mental Health Therapies

Provide equitable care, establish therapeutic relationships, teach coping skills, support medication adherence, and promote wellness and prevention.

Selective Serotonin Reuptake Inhibitors (SSRIs)

First-line meds for anxiety, OCD, panic disorder; increase serotonin availability.

Examples of SSRIs

sertraline, fluoxetine, paroxetine, citalopram

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Treat anxiety and panic by increasing serotonin and norepinephrine.

Examples of SNRIs

venlafaxine, duloxetine

SSRI/SNRI Nursing Considerations

Delayed onset (2-6 weeks), monitor for serotonin syndrome, increased suicide risk early in treatment.

Benzodiazepines

CNS depressants used short-term for acute anxiety; enhance GABA.

Examples of Benzodiazepines

lorazepam, alprazolam, clonazepam, diazepam

Lorazepam (Ativan)

Preferred benzo in older adults and liver impairment.

Benzodiazepine Side Effects

Sedation, confusion, ataxia, anterograde amnesia, dysarthria.

Benzodiazepine Risks

Dependence, tolerance, withdrawal, respiratory depression.

Benzodiazepine Withdrawal

Can cause seizures and psychosis; must taper slowly.

Benzodiazepine Drug Interactions

Alcohol, grapefruit juice, antacids, cimetidine, disulfiram → ↑ toxicity.

Flumazenil

Benzodiazepine reversal agent; does NOT reverse respiratory depression and may precipitate seizures.

Buspirone (Buspar)

Non-sedating anxiolytic; no dependence; delayed onset (3-6 weeks); first-line adjunct.

Sedative-Hypnotics

CNS depressants used for sleep; risk of dependence and respiratory depression.

Stress

Physical and psychological response to internal or external demands.

General Adaptation Syndrome (GAS)

Three-stage stress response: alarm → resistance → exhaustion.

Alarm Stage

Acute SNS activation preparing for fight-or-flight.

Resistance Stage

Adaptive coping stage attempting to restore balance.

Exhaustion Stage

Depleted resources leading to illness and burnout.

Fight-or-Flight-Freeze-Faint-Fawn Response

Automatic survival responses to perceived threat.

Eustress

Positive stress that promotes growth and adaptation.

Distress

Negative stress causing emotional and physical harm.

Acute Stress

Short-term response to immediate stressor.

Chronic Stress

Prolonged stress exposure; ↑ risk of cardiovascular disease, mood disorders, substance use.

Toxic Stress

Persistent stress without protective factors causing long-term neurological and physiological damage.

Adverse Childhood Experiences (ACEs)

Early trauma linked to lifelong mental and physical health risks.

Protective Childhood Experiences (PCEs)

Positive relationships and environments that buffer stress effects.

Problem-Focused Coping

Directly addressing the stressor.

Emotion-Focused Coping

Managing emotional response to stress.

Avoidant Coping

Avoiding the stressor; often maladaptive.

Defense Mechanisms

Unconscious strategies to reduce anxiety.

Adaptive Defense Mechanisms

Healthy strategies (sublimation, altruism).

Maladaptive Defense Mechanisms

Distort reality and impair functioning (projection, displacement).

Anxiety

Normal stress response that becomes disordered when excessive, prolonged, or impairing.

Levels of Anxiety

Mild → moderate → severe → panic.

Anxiety Cycle

Stress → anxious thoughts → physiological response → behavioral response → reinforcement.

Generalized Anxiety Disorder (GAD)

Excessive, uncontrollable worry for ≥6 months with physical symptoms.

Panic Disorder

Recurrent, unexpected panic attacks with fear of losing control or dying.

Panic Attack

Sudden surge of intense fear with palpitations, SOB, chest pain, dizziness.

Social Anxiety Disorder

Fear of social situations and negative evaluation.

Separation Anxiety Disorder

Excessive fear related to separation from attachment figures.

Selective Mutism

Failure to speak in specific social settings despite ability to speak.

Specific Phobia

Irrational fear of specific object or situation.

Agoraphobia

Fear of places where escape may be difficult.

Obsessive-Compulsive Disorder (OCD)

Presence of obsessions, compulsions, or both causing significant distress.

Obsessions

Intrusive, unwanted thoughts causing anxiety.

Compulsions

Repetitive behaviors performed to reduce anxiety.

Body Dysmorphic Disorder

Preoccupation with perceived physical flaws.

Hoarding Disorder

Persistent difficulty discarding possessions.

Trichotillomania

Recurrent hair pulling.

Excoriation Disorder

Recurrent skin picking.

Recognize Cues

Identify manifestations, triggers, duration, intensity, and functional impact.

Analyze Cues

Prioritize safety, coping ability, and distress level.

Generate Solutions

Create SMART goals with client collaboration.

Take Action

Use therapeutic communication, milieu control, and medications.

Evaluate Outcomes

Assess symptom reduction, safety, and coping effectiveness.

GAD-7

Screening tool for generalized anxiety.

HAM-A

Measures anxiety severity.

SCARED

Pediatric anxiety screening tool.

LSAS

Social anxiety assessment scale.