Studied by 5 people
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
Note 
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