(Class 3,4,6 & 9) (25.3% of final exam) Stress, anxiety and anxiety disorders, Trauma and trauma informed care, Obsessive compulsive disorder, and Eating disorders

What are example of PTSD mood and cognition changes? (GIF MADE)

Fear

guilt/shame

Irritable

Anger/explosive anger

difficulty accessing positive emotion

Exaggerated negative emotions

Mistrust

What are example of PTSD hyperarousal symptoms? (DOE)

Easily startled

Overreactions to stimuli (threatening or nonthreatening)

Difficulty sleeping

What is acute stress disorder?

Development symptoms of PTSD after exposure to trauma from 3 days to 1 month after a traumatic event

What is the treatment plan for an acute reaction to trauma?

Assess Safety

Obtaining history and physical examination

Education

Brief psychotherapy sessions

Acute symptom management

What is the treatment plan for an chronic reaction to trauma?

Trauma focused therapy

Medications

psychological nursing assessment consists of (CLEMSS)

Severity of symptoms

Level of daily functioning/decline in functioning

Emotional response

Mood affect

Coping skills

Strengths assessment

Crisis definition

a time-limited event that triggers adaptive or nonadaptive response to maturational, situational, or traumatic events

What are the three types of crisis?

Developmental

Situational

Traumatic

What are types of physical trauma?

Accident

Self-inflected

Violence by others

What are types of psychological trauma?

Bodily Injury

Harassment

Embarrassment

Child abuse

SA

Domestic violence (witnessing or experiencing)

Acts of terrorism

Natural disasters

Childhood stress/trauma increases risk of which conditions?

Alcohol and drug use

ED

Mood Disorders

PTSD

SI

What reduces the impact of stress and promotes recovery from stressful experiences?

Resilience

What is the perception that an event or situation is a threat called?

Appraisal

What is PTSD? (HIMD)

Development of intrusive, dissociative, mood, cognitive, or hyperarousal symptoms following exposure to a traumatic event

What are examples of intrusions? (FIND)

Involuntary appearances of thought

Nightmares/dreams

Flashbacks

Dissociative rx

How do intrusive thoughts present in children under age six?

May not appear distressing and may be expressed through play

If the criteria does not meet the standard for ptsd in the presence of emotional or behavioral symptoms in response to a crises event, the patient has..

Adjustment disorder

What are trauma related disorders specific to kids?

Disinhibited social engagement disorder

Reactive attachment disorder

What is not recommended at the acute stage of trauma treatment?

Debriefing

Trauma focused therapy consists of...

CBT

EMDR

Stress management

Group therapy

Which medications are used for chronic rx to trauma?

SSRIs

SNRIs

Benzos

BB (propranlol)

Prazosin

What is prazosin used for in PTSD?

nightmares

What are the elements of trauma nursing assessment?

Safety

Physical

Psychological

What are nursing interventions for trauma?

Establish goals and wellness plans

Sleep hygiene

Interventions for families

Exercise and yoga

Nutrition

Substance use ed.

Who are the types of victims effected by a disaster?

Those who may/may not survive

Professionals rescuers

Everyone else impacted

What are the ABC's of psychological first aid?

Arousal

Behavior

Cognition

Arousal intervention

Decrease sensory stimulation, promote calm

Behavioral intervention

provide safety, restructure or rephrase your request

Cognition (or disorientation) intervention

Reality test and give clear info

What is the correct order of community recovery from disaster?

1. Pre-Disaster

2. Impact

3. Heroic

4. Honeymoon

5. Disillusionment

6. Reconstruction

What are the 4 R's of trauma informed care?

Realizes

Recognizes

Responds

Re-traumatization

What are the 6 key principles of trauma informed care?

1. Safety

2. Trustworthiness and transparency

3. Peer support

4. Collaboration and mutuality

5. Empowerment, voice, and choice

6. Cultural, historical, and gender issues

Severe anxiety characteristics

Most times not able to acknowledge anxiety

perception is VERY narrowed

scattered attention

sense of Doom or Dread

self-absorbed

purposeless activity

The General Adaptation Syndrome consists of:

Alarm rx

Resistance

Exhaustion

Allostatic Load is:

the amount of physiological changes that have built up from chronic stress.

What is the biggest priority in a nursing assessment of stress?

SAFETY!

What are the nursing assessments of stress?

Safety

Physical Functioning

Medication and Substance Use

Psychological Assessment

Anxiety definition

An uncomfortable feeling of apprehension or dread that occurs in response to internal or external stimuli

What are the 7 anxiety disorders?

Separation AD

Selective Mutism

Specific Phobia

Social AD

Panic Disorder

Agoraphobia

Generalized AD

GAD definition

Excessive worry >6 months

GAD symptoms

restlessness or feeling keyed up or on edge

being easily fatigue

difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance

Panic Disorder definition

recurrent unexpected panic attacks; persistent concern or worry about additional panic attacks or their consequences and/or a significant maladaptive change in behavior related to attacks

Panic Disorder symptoms

Palpitations,

sweating,

trembling, shaking,

SOB,

feeling of choking,

CP/discomfort,

nausea abd distress,

dizziness,

unsteady, lightheaded, faint,

unreality,

fear of losing control,

fear of dying,

chills or hot flushes,

derealization or depersonalization

What is the spectrum of anxiety?

mild

moderate

Severe

panic

mild anxiety characteristics

Able to self-report anxiety

perception widens

usually during appropriate situations

those effected can still move toward their goals (i.e. athletes in competition, or students for exams.)

Moderate anxiety characteristics

Able to self-report anxiety

Perception narrows

inattentive

those effect benefit from guidance

somatic complaints

impaired problem solving

Panic anxiety characteristics

Can't acknowledge their anxiety

those affected feel like they're dying

feeling of terror

panic disorder symptoms

What are the physical symptoms of anxiety? (cardiovascular)

sympathetic: palpitations

Parasympathetic:

lower BP

What are the physical symptoms of anxiety? (Respiratory)

Rapid breathing

SOB

Choking feeling

What are the physical symptoms of anxiety? (Neuromuscular)

Easily startled

Tremors

What are the physical symptoms of anxiety? (Skin)

FLushed face

Cold sweats

Hot

Styes

Hives

What are the physical symptoms of anxiety? (Gastrointestinal)

Stummy hurt (ab pain, gastro pain feelings)

Not hungry

What are the physical symptoms of anxiety? (Eyes)

Pupil dilation

What are the physical symptoms of anxiety? (Urinary)

Increase feelings of urinary urges

What are the Affective symptoms of anxiety?

Edgy

impatient

Uneasy

Nervous

Tense

wound-up

Anxious

Fearful

Apprehensive

scared

freighted

alarmed

terrified

jittery

jumpy

What are some defense mechanisms for anxiety?

Displacement

Denial

Suppression

Intellectualization

What is the most common psychiatric disorder treated by healthcare providers?

Anxiety Disorders

What the risk factors for anxiety disorders?

Depression

Medical conditions

Family hx

Substance use

Early childhood trauma

Behavioral inhibition

Which populations is panic more likely in?

Females

Middle age (onset 20-24 years old)

Low SES

Widowed, separated or divorced

Norepinehrine...

Increase: anxiety states, mania, schizo

Decrease: Depression

Serotonin...

Increase: anxiety states,

Decrease: Depression

GABA..

Increase: Reduced anxiety

Decrease: Anxiety disorders, schizo

What is a nursing assessment of anxiety?

SAFETY

Physical functioning

Psychological functioning

Psychological Functioning assessment entails:

Onset

Duration

Situation

Cognitive, behavioral, and social assessment

What are the gold standard meds for anxiety disorders?

SSRI's

SSRI considerations

Takes 4+ weeks to become effective

NOT PRN

may not cover "breakthrough" anxiety

Buspirone considerations:

Routine admin (NOT PRN)

NO known abuse potential

Taking with food may help absorption

What are routine meds for anxiety?

SSRI

Buspirone

Other (non SSRI) antidepressants

Atypical antipsychotics

Anticonvulsants

Benzodiazapines MOA

potenitates GABA

What are the indicaitons for benzos?

Anxiety (particularly GAD) and insomnia

Shorter acting benzos include:

Alprazolam, Lorazepam

Longer acting benzo include:

diazepam, clonazepam

Benzo side effects

Sedation and CNS depression

(i.e. drowsiness, intellectual impairment, memory impairment, ataxia and reduced motor coordination, paradoxical confusions, agitation or delirium, GI disturbances, worsening mood or lability)

Benzo considerations

Etoh potentiates CNS depression; could lead to overdose and death

Tolerance develops over time (ONLY PRN)

Psychological dependence more likely to develop with sustained use

Withdrawal may occur is stopped abruptly

What are PRN meds for Anxiety Disorders?

Benzos

Atypical antipsychotics

Anticonvulsants

Beta-blockers (olol)

Hydroxyzine

Which PRN anxiety med is preferred for pts w/Eating Disorders or Children?

Hydroxyzine

3 MULTIPLE CHOICE OPTIONS

Buspirone side effects

dizziness, sedation, nausea, headache

Examples of Response Prevention Therapy?

Cue cards for response

Saying "STOP" when conscious of anxiety during obsessive thoughts

What is OCD?

Presence of obsessions, compulsions, or both that impact functioning

What is an obsession in OCD?

persistent, uncontrollable intrusions of unwanted thoughts

What are common obsessions in OCD?

Contamination

Pathological doubts

Somatic (Body Dysmorphia)

Depressive mood

What are compulsions in OCD?

unwanted repetitive behavior patterns or mental acts intended to reduce anxiety

What are common compulsions in OCD?

Hand washing

Ordering

Checking

Praying

Counting

Repeating words silently

What is the biological factors etiology of OCD?

Dysregulation of serotonin

Twin Studies

What is the behavioral factors etiology of OCD?

Fear or anxiety becomes a learned response

Compulsions and obsessions are a conditioned mechanisms to neutralize anxiety

What is the number one nursing assessment/priority for OCD?

Skin Integrity maintenance

What are the three biologic symptoms to look for when assessing a known OCD patient?

Dermatitis or eczema

Blooding gums

Alopecia

What does a MSE for an OCD patient look like? (Mood and Affect)

Anxious dread w/ obessioms

depressed

What does a MSE for an OCD patient look like? (Thought processes and content)

Obsession intrudes persistently into conscious

Obsession is seen as an ego alien (irrational)

What does a MSE for an OCD patient look like? (Behavior)

50% do not resist compulsion

May become uneasy or anxious when resisting

What does a MSE for an OCD patient look like? (Insight)

80% of individuals w/OCD recognize their behavior

Nursing interventions for OCD include: (SIMP SNAP)

Safety

Inform

Manage Medical

Psychoedu

Sleep monitor/encourage

Nutrition monitor/encourage

Arbitrary (do not forbid rituals)

Positive (reward non-ritualistic behavior)

What are the two main therapies for OCD?

Response Prevention

Graduated Exposure Therapy (GET)

What is Response Prevention?

Patient is gradually taught to disengage from ritualistic behavior or thought patterns

What is Graduated Exposure Therapy?

Slow exposure to stressful/anxiety inducing situations

Which medication is first line for OCD?

SSRIs (Fluvoxamine, Fluoxetine, Sertraline, Paroxetine)

Which medication is third line for OCD?

TCAs (Clomipramine, Imipramine)

What are the instructions for using SSRIs in OCD?

Use at MAX dose

Min 10-12 weeks

What is a binge eating episode?

eating more food than most people would eat, in similar circumstances, in within TWO hours AND feeling guilty after

BED is _______ prevalent in white and non-white pop?

Equally