NUR 256 Mental Health Exam 4 Study Guide

Levels of Anxiety & Perceptual Fields Mild: Heightened perceptual field; alert, can see/hear/grasp the environment; identifies disturbing issues; enhances problem solving. Moderate: Narrowed perceptual field; grasps less; can attend to more if pointed out (selective inattention); problem solving not optimal. Severe: Greatly reduced perceptual field; focuses on one detail; completely absorbed with self; may not attend to environment even when pointed out; feels dread/confusion/doom. Panic: Unable to focus on even one detail; misperceptions common; disorganized/irrational reasoning; terror, immobility, severe hyperactivity; hallucinations/delusions; out of touch with reality. Physical Symptoms by Anxiety Level Mild: Slight discomfort, attention-seeking, restlessness, easily startled, irritability, mild tension-relieving behaviors (foot tapping, fidgeting). Moderate: Voice tremors, poor concentration, shakiness, somatic complaints (headache, insomnia, urinary frequency), increased respiration/pulse/muscle tension, pacing. Severe: Feelings of dread/confusion/impending doom, diaphoresis, withdrawal, loud/rapid speech, threats and demands, chest discomfort, nausea, dizziness. Panic: Terror, unintelligible communication, numbness/tingling, SOB, chest pain, trembling, chills, palpitations, severe withdrawal, hallucinations. Anxiety Disorders GAD: Excessive worry 6 months about multiple events; difficult to control worry; 3+ of: restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance; must impair functioning. Panic Disorder: Recurrent unexpected panic attacks (4+ symptoms peaking within minutes): palpitations, sweating, trembling, SOB, choking, chest pain, nausea, dizziness, chills, paresthesia, derealization, fear of losing control/dying. Followed by ≥1 month of concern about more attacks or behavioral change. Agoraphobia: Fear of public situations with no help or escape; client acknowledges the behavior is not constructive but cannot stop. OCD: Person understands behavior is irrational but cannot stop. Obsession = thought; Compulsion = behavior. Cycle never ends; ritual temporarily relieves anxiety then anxiety returns. Social Anxiety Disorder: Severe fear provoked by social situations that could be evaluated negatively by others. Separation Anxiety: Developmentally inappropriate concern over being away from significant other. Common Phobias • Acrophobia – heights • Agoraphobia – crowds/open places • Claustrophobia – closed spaces • Mysophobia – germs/dirt • Nyctophobia – dark • Hematophobia – blood • Hydrophobia – water • Zoophobia – animals Anxiety – Key Nursing Points • To diagnose, anxiety must affect functioning (can't sleep, calling into work, unable to do daily activities). • Physical responses to stress: increased heart rate and blood sugar. • Teach stress reduction: exercise, deep breathing, relaxation, guided imagery. • To reduce anxiety: distract, talk, meditate, deep breath, exercise, guided imagery. • Mild/moderate anxiety can alert the person something is wrong and stimulate action. Severe/panic prevent problem solving. • First nursing action for severe anxiety: LOWER the client's current anxiety before teaching. Stress Busters Sleep: 7-9 hours recommended; go to bed 30-60 min early; sleeping later disrupts body rhythms. Exercise: 150 min/week moderate aerobic; at least 3 hours before bedtime; decreases anxiety/depression. Caffeine: No more than 4 cups/day; wean off gradually. Music: Familiar music promotes relaxation; decreases agitation in older adults. Massage: Slows heart rate, relaxes body, improves alertness. Pets: Reduce stress, provide social support. 2. Defense Mechanisms Defense mechanisms are ALL involuntary — the patient is unaware they are using them. EXCEPTION: Suppression is conscious (deliberately postponing dealing with something). Main purpose: REDUCE ANXIETY. Key Defense Mechanisms Altruism: Unconscious motivation to care for others; meeting needs of others to receive gratification. Adaptive: donating anonymously. Maladaptive: compulsive rescuing to detriment of self. Compensation: Counterbalancing perceived deficiencies by emphasizing strengths. Adaptive: shorter man excels in business. Maladaptive: drinks alcohol when self-esteem is low. Conversion: Transforms anxiety into physical symptom (e.g., becoming blind after witnessing spouse flirt). Almost always pathological. Denial: Escaping unpleasant thoughts by ignoring their existence. Adaptive: 'No, I don't believe you' initially after death notification. Maladaptive: still talking about deceased spouse in present tense after 3 years. Displacement: Transferring emotions from true source to another object. Adaptive: child yells at teddy bear instead of bully. Maladaptive: child's fear of father becomes fear of animals. Dissociation: Compartmentalizing uncomfortable aspects of oneself; disruption in consciousness/memory/identity. Adaptive: artist mentally separates from noisy environment. Maladaptive: perpetually disconnected from reality due to abusive childhood. Identification: Attributing oneself the characteristics of another. Adaptive: 8-year-old plays teacher. Maladaptive: boy idolizes neighborhood pimp. Intellectualization: Analyzing situation from emotionally detached viewpoint. Adaptive: analyzes options after tornado. Maladaptive: focuses on household tasks instead of grieving with children. Projection: Unconscious attribution of our negative qualities onto others (hallmark of blaming/scapegoating). Maladaptive only. Adaptive: N/A. Rationalization: Justifying illogical actions by developing acceptable explanations. Adaptive: 'I didn't get the raise because the boss doesn't like me.' Maladaptive: excusing malicious treatment of a child. Reaction Formation: Keeping unacceptable feelings out of awareness by developing the opposite emotion/behavior. Adaptive: recovering alcoholic talks about evils of drinking. Maladaptive: unconscious hostility toward daughter → overprotection. Regression: Reverting to earlier, more primitive/childlike patterns. Adaptive: 4-year-old with new sibling starts sucking thumb. Maladaptive: adult loses promotion and starts handing in sloppy work. Repression: Unconscious exclusion of unacceptable thoughts/feelings from awareness. Adaptive: forgets spouse's birthday after fight. Maladaptive: unable to enjoy sex due to repressed childhood trauma. Splitting: Inability to integrate positive and negative qualities of self/others into cohesive image. Maladaptive only: idealizing people then becoming disillusioned when they have flaws. Sublimation: Transforming negative impulses into less damaging/productive ones. Adaptive: angry at boss → writes heroic story. Maladaptive: N/A. Suppression: (CONSCIOUS) Deliberately postponing dealing with a disturbing situation. Adaptive: businessman sets aside divorce news until after his speech. Maladaptive: ignoring breast lump for 3 weeks before vacation. Undoing: Making up for a regrettable act. Adaptive: brings spouse concert tickets after flirting with secretary. Maladaptive: compulsively washes hands around attractive women. 3. Crisis Intervention Types of Crises Maturational: Role change milestones (Erikson); expected life transitions. Examples: entering retirement, graduating high school, turning 40. Situational: Unexpected life changes — divorce, serious illness, death. Adventitious: Major natural/man-made disaster or crime of violence. Examples: rape, sexual assault, living through a tornado, rock concert riot. Levels of Crisis Prevention Primary: Prevention; recognize potential problems; teach coping skills. Example: teaching stress-reduction to a first-year college student. Secondary: Early identification and stabilization during acute phase to avoid prolonged crisis; safety is priority; hospital/facility-based. Tertiary: Long-term support so no further crises or damage; goal = optimal level of functioning. Foundation & Phases of Crisis • Crisis is self-limiting, usually resolves within 4-6 weeks. • After resolution, patient emerges at a higher, same, or lower level of functioning. Goal: return to pre-crisis level. • During crisis, people are often MORE receptive to outside intervention. • Crisis intervention deals only with the PRESENT problem (here and now). • Nurse must be willing to take an ACTIVE, DIRECTIVE role. • Phase 1: Stressor → increased anxiety → coping/defense mechanisms. • Phase 2: Mechanisms fail → anxiety rises → disorganized, trial and error begins. • Phase 3: Trial and error fails → severe/panic anxiety → fight or flight. • Phase 4: No solution → overwhelmed → personality disorganization, depression, confusion, violence, suicide. Assessment & Guidelines Assessing: (1) Perception of the event, (2) Support systems (family/friends/church), (3) Coping mechanisms (healthy vs. unhealthy). Always ask about past coping strategies. • ALWAYS assess for suicidal/homicidal thoughts — physical safety is FIRST. • Following natural disaster: Determine safety FIRST → anxiety reduction → suicidal ideation. • Take steps to make patient feel safe and l