nr 326 final exam guide mild anxiety heightened perception increased awareness increased alertness learning is enhanced restlessness irritability may remain superficial with others rarely expe
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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
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