anxiety, substance abuse, personality dx, violence

agoraphobia

fear of being in places of situations where escape an be difficult or where no help is avail if panic symptoms occur

alarm reaction stage

helps prep body for potential defense needs

• stress stimulates body to send messages from hypothalamus to adrenal gland to send out adrenaline and norepinephrine

resistance stage

digestive system reduces its function to shunt blood to other areas needed for self-defense

• lungs take in more o2, heart beats faster & harder to defend fight, flight, or freeze behaviors

when person adapts to the stress

body responses relax, organs and systemic responses stop

exhaustion stage occurs when person has

responded negatively to anxiety & stress

• body stores are depleted & emotional components not resolved → constant arousal of physiologic responses

anxiety levels can be

mild, moderate, severe, panic

the nurse must determine the persons

anxiety level bc that dictates which interventions to use

for an anxious patient..

reassure safety & security, do not leave pt alone

use ________ when speaking to anxious pt

simple words, brief messages

symptoms in an anxious person

hyperventilation, CO2 in blood decreases → lightheaded, tachycardic, SOB, numbness, tingling in hands & feet, syncope

interventions for anxiety

limit stimuli, administer rx tranquilizing med, watch for se/efficacy of med, relaxation techniques

PTSD

maladaptive reaction to stressor, occurs within 3 months after onset of stressor and persists for 6 months or longet

treatments for anxiety

therapy (cognitive behavioral therapy), positive reframing, decatastrophizing, assertiveness training

assessments for anxiety disorders

ability to resume ADL, assess for self-destructive behavior, HRF suicide, problem solving strategies, support systems, asses spiritual needs

prescriptions for anxiety

most common is benzodiazepines, or ending with “am" - lorazepam, diazepam

prescription for generalized anxiety disorder

buspirone

• does not cause physical dependence

• SE dizzy, sedated, nausea, headache

elderly considerations w/ anxiety

if it’s 1st time, may be other condition, + rf falls, memory deficits, decreased response time/reflexes, + sedation

generalized anxiety disorder symptoms

excess worry, feels highly anxious 30% of time for 6+ months, unable to control focus of worries

• uneasy, irritable, muscle tension, fatigue, difficulty thinking, sleep alterations

panic disorder symptoms

15-30 mins rapid intense & escalating anxiety, palpitations, sweat, tremors, SOB, sense of suffocations, chest pain, nausea, abd distress, dizzy, paresthesia, chills, hot flashes

• onset mid adolescence-mid 30s

panic disorder tx

CBT, deep breathing, meds: benzos, SSRIs, tricyclics, anti HTN

obsessive compulsive disorders

recurrent & uncontrollable behaviors, know it’s irrational, makes pt feel in control, can be counting, praying, repetitive actions, checking, seeking assurance

ocd techniques

relaxation, flooding (escalating exposure), thought stopping, limiting number of times

• SSRis and tricyclics (fluvoxamine, clomipramine)

• electroconvulsive

dissociative disorders are characterized by

disruption of integral functions of conscious, memory, identity, or environmental perception,

• more prevalent w/ hx of childhood physical/sexual abuse

dissociative identity disorder

displays 2+ distinct identities, dominant at diff times, s/s include unremembered behaviors, loss of time, change in appearance/dress, uses diff voices, behaviors exhibit age differences

depersonalization/derealization disorder

persistent and recurrent feeling of being detached from mental processes or body or sensation of dream-like state, foggy, not out of touch w/ reality

tx for dissociative disorders

assess for safety risk, provide safe environment

somatization is the

transference of mental experiences & states into bodily symptoms

• presence of physical symptoms suggest med condition w/o demonstrable organic basis to account for it

• not under pt’s control

hypochondriasis

preoccupation w belief of having a serious disease

malingering

intentional fabrication of symptoms (physical or mental) for personal gain

munchausen syndrome

inflict injury on another to make themselves look heroic

nurse response to somatic illnesses

set firm & consistent limits, balance empathy w/ structure, minimize time & attention to the physical complaints

alcohol addiction tx

low protein diet, vitamin b, folic acid, thiamine supplements

nursing responsibilities r/t abdominal paracentesis

assess pt response & document output

antidote for high ammonia seen in liver disease

lactulose

thrombocytopenia

condition characterized by low # of platelets in blood, increases risk of bleeding & bruising (hemorrhage)

Wernicke/Korsakoff’s key syndrome

confabulation: filling in blanks of a story that they can’t and will never remember

s/s of withdrawal

coarse hand tremors, sweating, + pulse & BP, insomnia, anxiety, n/v

severe withdrawal may progress to…..

delirium tremens (acute alcohol psychosis)

• life-threatening d/t loss of consciousness & airway impairment

s/s of delirium tremens

diaphoresis, disorientation, hallucinations, seizures, physical aggression

nursing interventions for delirium tremens

prevent thru carefully assessing/pt hx, place pt on benzos to prevent withdrawal, if DT begins → benzos, decrease stimuli, continuously assess LOC/MS, use CIWA (clinical institute withdrawal assessment), reality orientation, safety, hydration, nutrition (thiamine, folic acid)

lorazepam is given 1st to help with

delirium tremens

clinical institute withdrawal assessment (CIWA) for alcohol is

most objective & best validated tool to assess severity of alcohol withdrawal

disulfiram (antabuse) is used to

prevent alcohol relapse, makes pt ill even if they use mouthwash, alcohol pad

acomprosate (campral)

reduces physical & emotional discomfort associated w abstinence

naltrexone (revia)

reduces cravings for alcohol

ondasetron (Zofran)

used in males hrf alcohol dependence

tx for overdose

• gastric lavage, activated characoal

• cooling blanket, iv nitrates, iv benzos, respiratory support, detox and rehab, tricyclics/other antidepressants

in rehab, the pt should be assessed for

codependence - maladaptive coping mattern on part of the family member

barbituates

dangerous cns depressant, narrow therapeutic to toxic range, addictive

narcotics include

demerol, dilaudid, codeine, percs, lortab, oxys, fentanyl, heroin

drugs used for detoxification of opiates

methadone: synthetic narcotic sub for heroin

revia: opioid antagonist

characteristics of personality disorders

maladaptive traits, identity problems, failure to conform, dysfunctional relationships, dx’d in adulthood

antisocial personality disorder

disregard for others, deceit & manipulation, believes a dog eat dog world

• give time out to regain internal control (? nurse or pt?)

borderline personality traits

unstable, impulsive, diverse behaviors, splitting: unable to weigh positive and negative attributes

• suicidal gestures, threats, and attempts

borderline personality disorder tx

cognitive restructuring, thought stopping, positive self-talk, decatastrophizing

histrionic traits

emotional, dramatic, theatrical, attention seeking, seductive, exaggerate relationships, mood shifts, vague physical complaints, guided by feelings not logic

paranoid personality

pervasive mistrust, guarded, restricted affect

schizoid personality

pattern of detachment from social relationships where person experiences restricted range of emotions, not influenced by praise or criticism, no desire for relationship

schizoid personality traits

flat affect, emotion expressed in cold/aloof manner, poverty of thought, indifferent to others’ feelings, chooses solitary activities

schizotypal

pattern of acute discomfort in close relationships, exhibits odd, eccentric behaviors, inappropriate affect, no friends

antisocial traits

pattern of disregard for and violation of rights for others

• steals, vandalism, fighting, running away from home, pathological liar, conning, failure to meet financial obligations, reckless, impulsive, manipulative

borderline personality traits

indulges in self-destructive activities, reckless driving, binge eating, substance abuse, see self & others as either good or bad

narcissism traits

pattern of grandiosity, need for admiration, lack of empathy, envious of others

medication to suppress impulsive and aggressive behavior

anticonvulsants: Carbatrol, tegretol, depakote, topamax

medications used for borderline & schizotypal

risperdal and zyprexa, haldol

people with anorexia may

binge and purge at times

bulimia

overeating followed by vomiting or laxatives, diuretics, enemas

medications used to promote weight gain

amitriptyline and cyproheptadine

medication used d/t antipsychotic effect for bizarre body image distortions, also associated w/ weight gain

olanzapine (Zyprexa)

interventions for eating disorders

family or individual therapy, early intervention, focus on their coping skills, self esteem, self acceptance, relationships, assertiveness, CBT/CBT-E

CBT-E

enhanced, addresses perfectionism, mood intolerance, low self esteem, interpersonal difficulties

CBT is the most effective treatment for

eating disorders

antidepressants used for eating disorders

desipramine, imipramine, amitriptyline, nortriptyline, phenelzine, fluxetine

nsg dx for eating disorders

deficient, fluid volume, constipation, fatigue, activity intolerance, body image & self-esteem issues

eating disorders interventions

skin integrity/dehydration, discourage daily bathing, monitor vs, assess oral cavity (dryness, sore), freq oral care, monitor lab values

nursing interventions for rape victims

do not leave alone, ask do you feel safe, do not give advice → give services list