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Psychiatric/Mental Health - Exam 2
Anxiety - ANS-feeling of apprehension, uneasiness, uncertainty, or dread resulting from
a real of perceived threat
Mild Anxiety - ANS-occurs in normal experience of everyday life and allows individual to
perceive reality in sharp focus
Moderate Anxiety - ANS-perceptual field narrows; ability to think clearly is hampered but
learning and problem solving can still take place
Severe Anxiety - ANS-perceptual field greatly reduced; focus on one particular detail;
difficulty noticing what is going on; learning/problem solving not possible
Panic - ANS-most extreme level of anxiety and results in markedly dysregulated
behavior; unable to process what is going on and may lose touch with reality
Types of Anxiety Disorders - ANS-generalized anxiety disorder; phobic disorders
(phobias); panic attacks; panic disorders; obsessive compulsive disorder; stress
disorders
Common Medical Causes of Anxiety - ANS-COPD, PE, asthma, hypoxia, pulmonary
edema; angina, arrhythmia, CHF, HTN, hypotension, mitral valve prolapse;
hyperthyroidism, hypoglycemia, pheochromocytoma, carcinoid syndrome,
hypercortisolism; delirium, tremor, seizures, Parkinson's, akathisia, postconcussion
syndrome; hypercalcemia, hyperkalemia, hyponatremia
Specific Phobia - ANS-persistent, irrational fear of a specific object, activity, or situation
that leads to a desire for avoidance or actual avoidance; characterized by experience of
high levels of anxiety or fear; compromise daily functioning
Panic Attack - ANS-sudden onset of extreme apprehension or fear, usually associated
with feelings of impending doom; normal functioning suspended and perceptual field is
severely limited
Panic Disorder: DSM V Criteria - ANS-recurrent, unexpected panic attacks with the
presence of at least one of the following: concern or worry about future panic attacks or
maladaptive change in behavior; not attributable to a medical or substance use disorder
Psychiatric_Mental Psychiatric_Mental
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,Psychiatric_Mental Psychiatric_Mental
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Drugs for Panic Disorder - ANS-SSRIs: fluoxetine, paroxetine, sertraline
SNRIs: venlafaxine
benzodiazepines: alprazolam, clonazepam
Generalized Anxiety Disorder: DSM V Criteria - ANS-excessive anxiety and worry (6
months); difficulty controlling worry; associated with 3+ of the following: restlessness, on
edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle
tension, sleep disturbance; clinically significant distress or impairment, not attributable
to another medical or substance use disorder
Short-Term Goals: GAD - ANS-1. patient will state that immediate distress is relieved by
the end of the session
2. patient will be able to identify precipitants of anxiety by (date)
3. patient will identify strengths and coping skills by (date)
Interventions: GAD - ANS-1. stay with patient, speak slowly & calmly, short & simple
sentences, assure patient that you are in control and can help, brief directions,
decrease stimuli, administer antianxiety drug
2. encourage pt to discuss preceding events, tach cognitive therapy principle, ask
questions that clarify and dispute illogical thinking, encourage patient to provide
alternative interpretation
3. identify what has given relief in past, have patient write assessment of strengths,
reframe situation in ways that are positive
Nursing Process: GAD - ANS-assessment: determine if anxiety is the primary problem.
cultural/social background
diagnoses: anxiety, impaired socialization, fear, avoiding impaired coping, separation
anxiety, chronic low self-esteem
planning: include patient if possible
implementation: counseling, relaxation exercises, find community resources, promote
self-care activities, therapeutic dialogue, counter faulty thinking, manage
hyperventilation
evaluation: is the anxiety reduced, does patient recognize symptoms as anxiety-related,
does that patient continue to display S&S, is that patient able to use new behaviors,
does the patient perform self-care
Drugs for GAD - ANS-SSRIs: escitalopram, paroxetine
SNRIs: venlafaxine, duloxetine
benzodiazepines: alprazolam, chlordiazepoxide, clorazepate, diazepam, lorazepam,
oxazepam
Psychiatric_Mental Psychiatric_Mental
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buspirone
beta blockers
Teaching: Benzodiazepines - ANS-no alcohol, avoid operating machinery, avoid caffein
Surgical Interventions for GAD - ANS-gamma knife: creates lesions to form disconnect
of overactive circuits
DBS: implanted pulse generator uses low-dose current to reduce symptoms
Non-Pharmacological Interventions for GAD - ANS-CBT (CBT + medication = most
effective)
systematic desensitization
exposure/response prevention treatment
flooding
relaxation techniques
breathing retraining
Obsessions - ANS-thoughts, impulses, or images that persist and recur, so that they
cannot be dismissed from the mind
Compulsions - ANS-ritualistic behaviors an individual feels driven to perform in an
attempt to reduce anxiety
Obsessive-Compulsive Disorder: DSM V Criteria - ANS-obsessions, compulsions, or
both; not due to a substance or condition; not explained by another psychiatric disorder;
time-consuming (in excess of 1 hr per day)
Nursing Process: OCD - ANS-assessment: OCI-R tool
diagnoses: anxiety, obsession, compulsive behavior, impaired skin integrity, risk for
self-destructive behavior, disturbed body image, impaired socialization, fear, impaired
coping, chronic low self-esteem
evaluation: has functioning/distress improved, has anxiety been reduced, has skin
integrity improved, has fear lessened
Psychosis - ANS-altered cognition, perception, and/or an impaired ability to determine
what is real and what is not
Delusional Disorder - ANS-characterized by delusions that have lasted 1 month or
longer, usually not severe enough to impair functioning
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Psychiatric_Mental
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Psychiatric/Mental Health - Exam 2
Anxiety - ANS-feeling of apprehension, uneasiness, uncertainty, or dread resulting from
a real of perceived threat
Mild Anxiety - ANS-occurs in normal experience of everyday life and allows individual to
perceive reality in sharp focus
Moderate Anxiety - ANS-perceptual field narrows; ability to think clearly is hampered but
learning and problem solving can still take place
Severe Anxiety - ANS-perceptual field greatly reduced; focus on one particular detail;
difficulty noticing what is going on; learning/problem solving not possible
Panic - ANS-most extreme level of anxiety and results in markedly dysregulated
behavior; unable to process what is going on and may lose touch with reality
Types of Anxiety Disorders - ANS-generalized anxiety disorder; phobic disorders
(phobias); panic attacks; panic disorders; obsessive compulsive disorder; stress
disorders
Common Medical Causes of Anxiety - ANS-COPD, PE, asthma, hypoxia, pulmonary
edema; angina, arrhythmia, CHF, HTN, hypotension, mitral valve prolapse;
hyperthyroidism, hypoglycemia, pheochromocytoma, carcinoid syndrome,
hypercortisolism; delirium, tremor, seizures, Parkinson's, akathisia, postconcussion
syndrome; hypercalcemia, hyperkalemia, hyponatremia
Specific Phobia - ANS-persistent, irrational fear of a specific object, activity, or situation
that leads to a desire for avoidance or actual avoidance; characterized by experience of
high levels of anxiety or fear; compromise daily functioning
Panic Attack - ANS-sudden onset of extreme apprehension or fear, usually associated
with feelings of impending doom; normal functioning suspended and perceptual field is
severely limited
Panic Disorder: DSM V Criteria - ANS-recurrent, unexpected panic attacks with the
presence of at least one of the following: concern or worry about future panic attacks or
maladaptive change in behavior; not attributable to a medical or substance use disorder
Psychiatric_Mental Psychiatric_Mental
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Psychiatric_Mental
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,Psychiatric_Mental Psychiatric_Mental
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Drugs for Panic Disorder - ANS-SSRIs: fluoxetine, paroxetine, sertraline
SNRIs: venlafaxine
benzodiazepines: alprazolam, clonazepam
Generalized Anxiety Disorder: DSM V Criteria - ANS-excessive anxiety and worry (6
months); difficulty controlling worry; associated with 3+ of the following: restlessness, on
edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle
tension, sleep disturbance; clinically significant distress or impairment, not attributable
to another medical or substance use disorder
Short-Term Goals: GAD - ANS-1. patient will state that immediate distress is relieved by
the end of the session
2. patient will be able to identify precipitants of anxiety by (date)
3. patient will identify strengths and coping skills by (date)
Interventions: GAD - ANS-1. stay with patient, speak slowly & calmly, short & simple
sentences, assure patient that you are in control and can help, brief directions,
decrease stimuli, administer antianxiety drug
2. encourage pt to discuss preceding events, tach cognitive therapy principle, ask
questions that clarify and dispute illogical thinking, encourage patient to provide
alternative interpretation
3. identify what has given relief in past, have patient write assessment of strengths,
reframe situation in ways that are positive
Nursing Process: GAD - ANS-assessment: determine if anxiety is the primary problem.
cultural/social background
diagnoses: anxiety, impaired socialization, fear, avoiding impaired coping, separation
anxiety, chronic low self-esteem
planning: include patient if possible
implementation: counseling, relaxation exercises, find community resources, promote
self-care activities, therapeutic dialogue, counter faulty thinking, manage
hyperventilation
evaluation: is the anxiety reduced, does patient recognize symptoms as anxiety-related,
does that patient continue to display S&S, is that patient able to use new behaviors,
does the patient perform self-care
Drugs for GAD - ANS-SSRIs: escitalopram, paroxetine
SNRIs: venlafaxine, duloxetine
benzodiazepines: alprazolam, chlordiazepoxide, clorazepate, diazepam, lorazepam,
oxazepam
Psychiatric_Mental Psychiatric_Mental
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Psychiatric_Mental
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, Psychiatric_Mental Psychiatric_Mental
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Psychiatric_Mental
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buspirone
beta blockers
Teaching: Benzodiazepines - ANS-no alcohol, avoid operating machinery, avoid caffein
Surgical Interventions for GAD - ANS-gamma knife: creates lesions to form disconnect
of overactive circuits
DBS: implanted pulse generator uses low-dose current to reduce symptoms
Non-Pharmacological Interventions for GAD - ANS-CBT (CBT + medication = most
effective)
systematic desensitization
exposure/response prevention treatment
flooding
relaxation techniques
breathing retraining
Obsessions - ANS-thoughts, impulses, or images that persist and recur, so that they
cannot be dismissed from the mind
Compulsions - ANS-ritualistic behaviors an individual feels driven to perform in an
attempt to reduce anxiety
Obsessive-Compulsive Disorder: DSM V Criteria - ANS-obsessions, compulsions, or
both; not due to a substance or condition; not explained by another psychiatric disorder;
time-consuming (in excess of 1 hr per day)
Nursing Process: OCD - ANS-assessment: OCI-R tool
diagnoses: anxiety, obsession, compulsive behavior, impaired skin integrity, risk for
self-destructive behavior, disturbed body image, impaired socialization, fear, impaired
coping, chronic low self-esteem
evaluation: has functioning/distress improved, has anxiety been reduced, has skin
integrity improved, has fear lessened
Psychosis - ANS-altered cognition, perception, and/or an impaired ability to determine
what is real and what is not
Delusional Disorder - ANS-characterized by delusions that have lasted 1 month or
longer, usually not severe enough to impair functioning
Psychiatric_Mental Psychiatric_Mental
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