NSG 121 Midterm Exam 2 2025

Anxiety - -the most basic of human emotions. There is a perceived threat followed by a subsequent reaction. An adaptive response that occurs across the lifespan. Can be episodic or chronic. Can be a symptom or disorder. The first diagnosable psych diagnosis. Is more treatable and is the most common and mildest mental health disorder Dysfunctional behavior - -often a defense against anxiety. Often decreases as anxiety decreases Stages of the ANS fight or flight response - -alarm, resistance, exhaustion Mental health disorders continuum - -a spectrum from mold disorders to thought disorders Mood disorders - -anxiety, bipolar, MDD Thought disorders - -schizophrenia Schizoaffective disorder - -falls in the middle of the mental health disorders continuum since it is a mood and thought disorder ANS = - -SNS + PNS SNS - -ramps up PNS - -returns us to homeostasis Exhaustion stage of ANS - -occurs it we do not recover from he resistance stage Types of anxiety - -normal, acute, pathological Pathological anxiety - -occurs with an intensity that is out of proportion to the threat, and persists after the threat is resolved, and then gets generalized to nonthreatening situations. Can happen in the absence of a stressor. Is diagnosable Levels of anxiety - -developed by H. Peplau: mild, moderate, severe, panic level Mild anxiety - -occurs in everyday life Perceptual field in mild anxiety - -may have heightened perceptual field. Is alert and can see, hear, and grasp what is happening in the environment. Can identify issues that are disturbing and are producing anxiety NSG 121 NSG 121 Perceptual field in moderate anxiety - -has narrow perceptual field, grasps less of what is occurring. Can attend to more if pointed out by another (selected inattention) Perceptual field in severe anxiety - -has greatly reduced perceptual field. Focuses on details or one specific detail. Attention acettered. Completely absorbed with self. May not be able to attend to events in environment even when pointed out by others. The environment is block out, it is as if these events are not occurring Perceptual field in panic level anxiety - -unable to focus on the environment. Experiences the utmost state of terror and emotional paralysis, feels he/she "ceases to exist". May have hallucinations or delusions that take the place of reality Ability to learn in mild anxiety - -able to work effectively toward a goal and examine alternatives. Can alert the person that something is wrong and can stimulation appropriate action Ability to learn in moderate anxiety - -able to solve problems but not at optimal ability. Benefits from guidance of others. Can alert the person that something is wrong and can stimulation appropriate action Ability to learn in severe anxiety - -unable to see connections between events or details. Has distorted perceptions. Prevents problem solving and discovery of effective solutions. Unproductive relief behaviors are implemented, thus perpetuating a vicious cycle Ability to learn in panic level anxiety - -may be mute or have extreme psychomotor agitation leading to exhaustion. Shows disorganized or irrational reasoning. Prevents problem solving and discovery of effective solutions. Unproductive relief behaviors are implemented, thus perpetuating a vicious cycle Physical/other characteristics of mild anxiety - -slight discomfort. Attention-seeking behaviors. Restlessness. Irritability or impatience. Mild tension-relieving behavior: foot or finger tapping, lip chewing, fidgeting Physical/other characteristics of moderate anxiety - -voice tremors. Change in voice pitch. Difficulty concentrating. Shakiness. Repetitive questioning. Somatic complaints (e.g. Urinary frequency and urgency, headache, backache, insomnia). Increased respiration rate. Increased pulse rate. Increased muscle tension. More extreme tension relieving behavior; pacing, banging hands on table Physical/other characteristics of severe anxiety - -feelings of dread. Ineffective functioning. Confusion. Purposeless activity. Sense of impending doom. More intense somatic complaints (e.g. Dizziness, nausea, headache, sleeplessness). Hyperventilation. Tachycardia. Withdrawal. Loud and rapid speech. Threats and demands NSG 121 NSG 121 Physical/other characteristics of panic level anxiety - -experience of terror. Immobility of severe hyperactivity or flight. Dilated pupils. Unintelligible communication or inability to speak. Severe shakiness. Sleeplessness. Severe withdrawal. Hallucinations or delusions; likely out of touch with reality How we are effected by by anxiety - -both physiologically and cognitively. There is often overlap in anxiety disorders, and it is likely that a person may have 2-3 The most common coocurring psychiatric and mediacl disorders - -depression, substance use disorders Interventions for mild to moderate anxiety - -since the client has a decreased ability to concentrate, help the client to focus and problem solve using various therapeutic communication techniques. The nurse needs to remain calm, recognize the client's distress and be willing to listen Interventions for severe to panic levels of anxiety - -since the client is unable to problem solve and may not grasps what is occurring in the environment, communicate in short simple statements. Must be concerned with the patient's physical needs and safety Self care for nurses taking care of patients with anxiety - -the nurse may experience frustration and mental strain. Must protect themselves from burnout Internventiosn for mild to moderate levels of anxiety - -help the patient identify anxiety. Anticipate anxiety-provoking situations. Use nonverbal language to demonstrate interest (e.g. Lean forward, maintain eye contact, nod your head). Encourage the patient to talk about his or her feelings and concerns. Avoid closing off avenues of communication that are important for the patient; focus on the patient's concerns. Ask questions to clarify what is being said. Help the patient identify thoughts or feelings before the onset of anxiety. Encourage problem solving with the patient. Assist in developing alternative solutions to a problem through role play or modeling behaviors. Explore behaviors that have worked to relieve anxiety in the past. Provide outlets for dissipating excess energy (e.g. Walking, playing table tennis, daning, exercising) Interventions for severe to panic levels of anxiety - -maintain a calm manner. Always remain with the person experiencing an acute severe to panic level of anxiety. Minimize environmental stimuli; move to a quieter setting and stay wit the patient. Use clear and simple statements and repetition. Use a low-pitched voice; speak slowly. Reinforce reality if distortions occur (e.g. Seeing objects that are not there or hearing voices when no one is present). Listen for themes in communications. Attend to physical and safety needs when necessary (e.g. Need for warmth, fluids, eliminations, pain relief, family contact). Because safety is an overall goal, physical limits may need to be set; speak in a firm, authoritative voice. Provide opportunities for exercise (e.g. Walk with nurse, use a punching bag, play table tennis). When a person is constantly moving or pacing, offer high-calorie fluids. Assess need for medications NSG 121 NSG 121 When anxiety becomes a problem - -when it leads to maladaptive behavior, causes physical symptoms or it exceeds a tolerable level; causes dysfunction at work, in social situations or interferes with family functioning The most prevelant psychiatric disorder - -anxiety disorders. Effect 25% of US population Anxiety in men vs women - -effects more women than men, but woken are also more likely to seek treatment Barrier to seeking treatment for anxiety - -stigma Etiology of anxiety disorders - -biological, psychological, environmental Subtle signs of anxiety - -poor concentration, distractibility, talkativeness Overt symptoms of anxiety - -panic, compulsions In assessing for anxiety disorders - -make sure a complete physical exam is done. Assess for self-harm. Perform a psychosocial assessment. Assess culture DSM V anxiety disorders - -panic disorders, phobias, generalized anxiety disorder, anxiety due to other medical conditions, obsessive compulsive disorders, body dysmorphic disorder, hoarding Panic disorder - -consists of recurrent and unexpected "panic attacks" Panic attacks - -a set of symptoms that an individual experience