NR 326 Final Exam Guide (Answered) Complete Solution

NR 326 Final Exam Guide Mild anxiety -heightened perception -increased awareness -increased alertness -learning is enhanced -restlessness -irritability -may remain superficial with others -rarely experiences as distressful -motivation is increased Moderate Anxiety -reduced perceptual field -reduces alertness to environmental events -decreased ability to learn -decreased attention span -decreased ability to concentrate -increased restlessness -increased HR and RR -gastric discomfort -increased muscular tension -increase in speech rate, volume, and pitch -a feeling of discontent, can have impairment in personal relationships (begins to focus on self) Severe Anxiety -greatly diminished; only single detail focused -inability to focus elsewhere when pointed out -extremely poor ability to learn -HA, dizziness, nausea, trembling, insomnia, palpitations, tachycardia, hyperventilation, urinary frequency, diarrhea -feelings of dread, horror -total focus on self and intense desire to relieve the anxiety Panic -unable to focus on even one detail in environment -misperceptions of environment -no ability to learn -dilated pupils, labored breathing, severe trembling, incoherence, sleeplessness, palpitations, diaphoresis and pallor, muscular incoordination, immobility or purposeless hyperactivity -feelings of terror/doom -bizarre behavior - shouting, screaming, running wildly around, hallucinations, delusions, and extreme withdrawal into self Generalized Anxiety Disorder -uncontrollable excessive worry 6 months without known cause -SX: muscle tension, avoidance of stressful events, difficulty making decisions, restlessness (hand wringing), and constant seeking reassurance with significant impairment in functioning -tx: group and individual therapy, meds for anxiety/depression -NI: CBT, use a non-judgmental approach, relaxation techniques, modeling, reframing, use Hamilton A tool for assessment Panic Disorder -recurrent panic attacks accompanied by worry about future attacks -onset is sudden, trigger is often unidentifiable -sx: include desire to escape, chest pain, chills, hot flashes, choking sensation, depersonalization, dizziness, nausea, palpitations, SOB, sweating, trembling, fear of loss of control, decreased peripheral vision -tx: benzodiazepines for acute sx, SSRIs which can treat both anxiety and depression -NI: remain calm, spend time with client, offer reassurance, use clear, concise, direct approach, and reduce environmental stimuli -can develop into agoraphobia social anxiety disorder -clients experience excessive fear of social or performance situations -clients report difficulty performing or speaking with excessive fear of embarrassment when having to speak in front of others -physical manifestations can be actual or reported (factitiously) in an attempt to avoid the situation of having to speak in front of others -tx: propanolol a beta blocker -NI: assist the client to discuss fears and teach use of relaxation training and behavioral therapy techniques such as reciprocal inhibition PTSD -caused by a psychologically traumatic event -sx may persist for more than 1 month and cause a significant amount of impairment and distress -avoidance of stimuli associated with trauma -hypervigilence, emotional numbing, flashbacks -tx: group and individual therapy, medication for insomnia (prasozin for nightmares), anxiety, and/or depression -NI: supportive, non-judgmental approach, encourage expression of feelings, and encourage healthy coping mechanisms Major Depressive Disorder -sx: sadness, hopelessness, powerlessness, helplessness, difficulty concentrating, irritability, SI, impacts sleep, appetite, and energy levels -tx: SSRIs, NSRIs, TCAs, MAOIs, CBT, 1:1 psychotherapy, ECT, support groups -NI: close monitoring for safety, suicide precautions, removal of unsafe items, medication education including black box warnings (suicide risk after 1 week), education on serotonin syndrome, discontinuation syndrome, food and drug interactions, promotion of group therapy sessions (CBT), ensuring client has developed a crisis management plan and has outside support contacts and phone numbers prior to discharge Bipolar Disorder -Bipolar I Disorder: episodes of depression and mania -Bipolar II Disorder: depression and hypomania over time