ItiU 317: tiMT II

Chanter13:AnxietyandStressRelatedIllness

l. Anxiety?
Belravioral,ernotiona :.,.
l" cogrritive .,.lhvsiologicrespotrses'

2. Physiologicaspectsof stress:GeneralAdaptation Syndrome?

-

a.Alarmr-eactionstage-aclrenalgland send outadrenalinandnorepinephrinefor

fuel.
dilatestheplpils andorgansreconvertgl1cogento glucose.lto preparefor
defenses
thatneedit for defense.lungstakestnoreair in and li c

b. Resistancestage-bloodto areas
heart beats fasterandlrarderto circulatehighll'oxlgenatedandhighl--
rnourisheo
bloodtu the muscleto defend

arousalof the ph;-siologicrespollsesandlittlereserve

capacit1

c. Exhaustionphase-continual
3. AutonomicNervousSYstem?
ltespottses
to fcar and anxietr

4. Levels of Anxiet-v?
a.Mild anxiet-v- sensationthatincreaseandhelpsperson focus attentiotr to
learn" solve
problems,think.act. feel andprotectthemselves.Positivebecauscit allorvs
the
persolrto learn nerv belravior and solve problenls
b.ModerateAnxiety'-ield narrorved task."flrepersoncan still
perceptualf to irnrnediate
processinfonnation. solve problemsandlearn rrerv tlringsrv/ assistance
from
others.

c. SevereAnxietl'-perceptualfielclreducesto onc dctail or scaltered

details.cannot
complctc tasl<s l'eelingsof dreacl or terror andcan not beredircctedto
atask;
ps1'choloigical of 1-achycardia. and chcst pain
slrnptoms diaphoresis.

d. Panic Anxietr'- perceptualficltl reducccl to fircr"rs on sclf.

distorted perceptiorr.possible
delusionand hallucination. tlrought. arrd complete
[,ost of ratiorral delusion.
phvsicalimmobility,and muteness: ma).bolt or run.suicidal
l\'lild Anxietr' NloderateAnrietr Severe A rrxietr PanicAnxietv
Ilcsl i cssn css \4Ltsclctcnsiorr Sevclc hcatlaclrcs iVlirv holl
irn(1r'u11 or
l: id rrctinp )iirrrholcs is NVI) IrlnrohrIc lrnil ntute
(ll" huttcrllics '()Uilrlrnul)ulsc I re nrlrlirrr: [)ilatcrl trutrls
f)illlcultr' slccpinq clrlncl rcs I(rgid slirncc I lll' arrdpulsc
I Ivnclscnsilililr to noisc )rr rtrorrth irrr,l (il rLpsr.t Vcrliqo
arriltralc I'liqht.lielrt or' licczc
I{trpiil spccclr irnd hislr ['uelrtcaltliu
voicr:pilch
l'cqucnlurilrillr()lr ( lrcsl txrirr

5. Working with anxious clients?

Wilh anxietr clicnts might ttot be able to pavatterrtion.
csp.rvilhsevercanxictr: use slrort.
sit-npleiurd casr'-to-understand is effectir,e arrd ensLrre

scntence clientis taking irr

inlbrntatiottcorreclly. Witlr seve reanxietr the goalis to lower il to
lesser anxieg ancl
rcmain rvith client. During panicler,'elsal'et1is inrportant it c:an
lastlionr fivc 1o-10
rnins.I'alk ilt a contttrrting rrrannerin a
srnall.cluiet.nonstirrirrlaling

tnalllcr

6. Short-termanxiety?
Can be treated with anxiolvtic medications. Mostof tlresedrugs are
benzoc{iazepirres.
'uvlrichhavea potentialfor abuseand dependencr. Theidealuse is no longer
tlran 4-6
rvks.Side effects for Anxiolr,ticare drorvsiness.
sedalion.poorcoordinationand impairecl
Inemoryor cloudeclsensorium.Teachclientthatit does not
treatrvhatcausedtheanxietv
bLrt"iusttheslmptoms,benzodiazepines
makesonealcoholdrink lrave the effect of three
drinksso client shouldn'tdrink
7.Typesof Anxiety disorders?
a.. Posttraurnatic stt'essdisordertPf SD) tl.Specilicphobia'
b. Socialphobia e. OUD
c.GeneralizeclAnxietl,disorder(GAD) t. Acste stressdisortler
Agoraphobiarv/orry/o panic disorder-- ("fearof thernarketplace"or 1'ealof
bcitts
Sg.

oLrtside) or avoidance of placcsor situations fromrvhichescape

anxietl'about
mighttre clifficult or helprnightbe unavailable. PrirnaryCiain-tlre
relief of
anxict-\achicvcdbr perforrnirrg behavior ingir.

tlre Specif ic attxietr'-driven (sta1

the house). Sec-ondangairr-attcnticlrr

reccivctl frotn others as a result of tlrese

bclrlviors

h.Panicdisorder-at leastonentontlr of
recurrcntlrncxpectedpzrnicaltacks(sttddcrronsel
of feelirrgof irnpendingdoorn)thatcausesconstantconcern.I5-i0 rninsof
ra;lid.intense.cscalatinganxietl'wi1hcmotionalfcar and phvsiological
isconrtbrt;palpitation.srvcating.trernors.SOB.scnseof sullbcalion. clrcst
pain.... ... ....Treatment: behavior deep brcathing and
coguitive techniques.
rclaxationan duredications asRenzodiazepine.

suclr SSRI antidepressants.

tricl'c I icattti clelrressant ive

andhlpcrtc:tts

8.DefenseMechanisms?
Cognitive distortions that a personuses unconsciously to maintain a
senseof lreing in
controlof a situation. to lessendiscomfoft and to deal rv/ stress

9. Treatment? Usually involves medications andtherapy.

a lS!_t!!y,ql_Cirarl1-qg-turning rregative rnessasL's
irrtopositivcIncsslse

b.Dqql4{Lt}plfjz"UlC-uscolcluestionsto
morerealisticallrappraisethr'question(cg.
What's tlrc uorsc thal canhappcn'.)
Or isthat likelr"l)

c.A!5l4!v9!fcs!llo!11!fg-to help slient leanr takecontrol of lil'c

siluation: usins "l"
slatetncrnls and to conrrnunicateconcernsor rreed to otlrers
to identif-r'Ieelings
10.Anxietv medication:
I l.Application of the Nursing Process:Panic Disorder?

a.History-scekstreattnentafter sevet'al
panicattacks.fhinkstlrer,arcgoingcrazr o
havinga heart attack. flrev cannotidentil\trigger
b.(ieneralAppearanceand motor Behavior- increasespcechrate. pitclr and
volr.rme.
dil'fictrltl'sittingattdAutomatisms (autornatic. rnaurrcrisrrr
unconscious (eg.
tapping finger..iingling kevsor twistirrg liair)

c. Mood and af'f'ect-during a panicattack depersonalization of bcing

(f'eerlings
disconttecteclfi'clmthemselvers) (sensirrg arenot

and<Jerealization tlrattlrings
real)

d.ThoughtProcessesandConfent-believcdthevilre d1ing.
lostngcolrfrolor"going
insarre."suicicleand thoughts are disorganizecl
e.Sensoriumand Intellectual Processes-c'onfrrsecl
and clisoriented
{. Judgment issuspcndcd(clientcan run out into a specding car) and
Insight pnll afier
the client is cducate-d

aboutpanicdisorcler

g.Self-concept: eva Iualethemse I ves negative l,-

Ir. Roles and relationships- because' anticipation anotlierpanicattack.
inteuse of'lraving
alterationsdue to ar,'oidance occupational.

in lheir social. or famih life

i Phvsiologic antl self care concerns-problernsrvithsleepingantl eating:
lossof
appeliteor eating constantlv.

12.Interventionsfor PanicDisorder?
a'
promotingsafetlandcomfort:useasoothing.calmvoiceandgivebriefdirectionto
assuresafety

b.Using Therapeutic communication:evaluatetlreuseof touch because

lv/ highanxieh,
thel'caninterpretit as athreat.Whenanxietvdiminishesuseopen-ended

cotnmunicationteclrniques'
guidedimagery(imaginea safe place) and

c. ManagingAnxietv:relaxatioirtecSniques.
prog.essiverelaxation(personprogressivelytightens.holds.andthenrelaxes
musciegrollpsthroughrhl'thmicbreathing)

d. providingCliJntanclfamilyeducation-
clientshouldunderstandthattherapiesand
drugsc1on,tCUREtlredisorderbutaremethodsto helptherncontrolandmanage
it. Encourageclientto exerciseregularlyto
metabolizeadrenalin.reducespanic
reactionsandf productionof endorphins
13.Phobias?
f'earof a spccificob.iectora socialsitualiontltatcaltses

lllogical.ilrtense.persistent
ettremc-clistressanclinterfercsrv/ rrorrrral
functioning.LJsualll'doncltresttltf,rornpast
that

personnrighlrreverhad contact arrdtlrevusuallruttderstattd

thcirfearis ttttttsttal

negatiyeexperiences.

attdirrational'

14.Thethreecategoriesof phobias?
a.Agoraphobia
b. SpecificPhobia
l. Naturalenvironment(storms)
z blood-irr.iection
Phobias

3.Sitr,rational on a bridgc-....)
phobia(hcingin clcvator.
+.AnimalPlrobia

lvhen confronting situation

involvingpeople. fhe fear is rooted in lorv self-esteem andconcern
about others-iudgments. interacting

c. Socialphobia- becoming severelyanxiousor incapacitatecl

such as nraking speeches. rv/ the
oppositc......Withseveralsocialphobiasit'sknown as generalized

social
phobia.

15.Treatmentfor phobias?
*belravioral
desensitization-cxposcsthe client OR
Flootling-a rapid clcsensilization tlrevcorrfront

thcrapr'- S_vstematic lrrogrerssivclr

rvlrere tlrcphobicolr.joct(pictLrrcor
actual ob.ject) r-rrttil anxictr

in no lttttger procluc:e

16.OCD?
Recurrent.persistent, thoughts. images. or impulses
intrusiveandunr.vanted that cause
rnarked anxiety and interferes w/ interpersonal. social or occupational
function.
Compulsionis ritualistic or repetitive behaviors or menlal acts that a
personcarries out
continuousll,in an attemtrrt to neutralize anxietl . It diagnosedrvhen it
interf'eresw/ person
functioning. The client understands thatritualsare unusual ancl
unreasonable

I7. Common compulsions?

ritunl

a.Checkirrg e. louching. rubbingor tapping

b.countingritual F. hoarding iterns
c.rv'aslringancl scrubbing until the skin is rar,v g.orclering
d. pravingand chantirrg h.cxlribiting rigid performance
i. Havingaggressivcurges(tothrorva chilcla irall)
18.Treatment of OCD?
Optimal treatment is rnedication w/ behavioraltherapr'. Exposure
isassistingthe client
in confronting situations tlrey usually avoid.ResponsePreventionfocuseson
delal ing
or avoiding perfonnanceof rituals and the personlearnsto tolerate the
anxiety'and
recognizeno consequences.
19.Applicationof the nursing process: OCD (assessment0?
Yale-BrownObsessiveCompulsiveScale
a.Histor,y'-ritualsbeqanrnanr,\'earsbefore
b.GeneralAppearanceand motor Behal'ior-
tense"anxious.rvorried.anclfi"etlirl
?
c. Mood and AITect-repoftoverrvliclmingf-eelingsof anxietf in response to
the
obsessional images
tlroLrghls. or urgc

butciifficLtltl. or pa1ing
attentiontvhen obsessions arestrong

d.Thoughtprocessesand content- intellectual: conccntrating

are irraliottitl. sound-iLrdEnent
knorvthe house issal'e)butcant act on tlretrt

e.Judgmentand insight- recognizesobsessions tnakes (l

to control

f. Sell'-concept-{'eelslike thel are "goirrgcra4'." prorverlcssltc:ss

J and relationshrps
h Ph-v-siotogic trouble sleeping. loss ol'appelite or

g.Role and relationships-l'ulfilling life roles successfullr sull'er.

and self-care considerations-
rrnrvantecl llersolral

rveightloss arrd in severe cases ltvgieltenral sLrl'f-er

20.Interventionfor OCD?
a.Use therapeutic communication-dicussingfeelings and managitrg anxiety
b. Teachrelaxationand behavioral techniques
c.Completinga daily routine- client initially ma1' needadditionaltime to
allor.v for
rituals; don't internrptor ternpt to stop rituals because
anxiety'escalate
4
-'dramatically.Overallthe client has to be rvillingto change.

21.GeneralizedAnxiety Disorder(GAD)?
6 months ol'persistenl anclexsessivewona ancl anxietr. Feerls highh
anxiotrs at leasl
50% of the lirnt:firr6 rnonthsor morc. Pcrsonhas three or
rnoresvlnptorrs:ulreasirress.
irritabilitl'.rnuscletension.fatigue.clifficultl'thinking and sleep
alteration. ElTective
treatmentsare Buspirone (Buspar)anclSSRIatrlidepressants

22. Posttraumatic Stress Disorder?

Occursrvhen tlrev rvitnessedan extraordinarily
terri[,ingandpotentiallydeadll event.
Aftenvardstlrevre-experiences and responds
it through dreams or waking recollections
dcrfcnsivelv. newbehaviorssuch as sleep difficLrlties,
Thevdevelop hrpervigilance,
thinking difficulties. severestarlledresponseand agitation. Reginswithin3
mnths to vrs
after evcnt ancl may last a l'erv mnths or vrs.

23.Treatmentandinterventions?
a.groupor individual thrrrap)in thc cornmunitr to addrcss crpclicncc.
b.cogrtitir,'ebehavioraltherapv andsubsequent
to deal rv/ thoughls feelingandbclirvior
ol-tratrnra srrrvivors

ancl abuse

c.reassociationlbl dissclciatit-rr
d. Paxil ancl Zolofl usecl to trcrat P'fSD successfrillv
24. Applicationof the nursing process (assessment)?
a. Background- reveal history of abuse or trauma
b.General Appearance and motor Behavior- appearshvperalertand react to
evell
small environmental noises lv/ a staflle response. anxiolrsor agitated
and
diffi culty sitting sti ||
c. Mood and Aff'ect- frighten look or scared or agitated and hostile
dependingon the
experience
d.Thoughtprocessand content- may repoft hallucinations voices in their
and buzzing
lreads,self-destructive and suicidal ideation

thoughts.

e.Sensoriumand intellectual Process- usualll,'oriented to realit,r.:'"

except when
experiencinga flashback or dissociative episodes.lrecauseduringexperience
unable to communicateat all. There are memorygaps- periods for
rvhichtlre_v
haveno clear memories. Therealso intrusive tlroughtsor ideas of self'-
harm

f. .Iudgment and Insight-rvith progressed treatment The

tlrevcanbe knor.vledgeable.
abilitl to make decisionor solve problemsmaybeirnpaired

g. Self concept- lorvself-esteem.believethev are going crazl

h.Rolesand relationship-difficultl'lviall tlpes of relationships
becauseabiliry,'totrlrst
others is severelv compromised.
Ll
i. Physiologic Consideration- difficultl,'sleeping.overeatingor lackof
appetite. use of
alcohol and other drugs to blot out intrusive thoughts and memories
25.Intervention?
a.prornotingthe client's safel1'- assesssr"ricideintention and fcrllorv
nteasurenreut
b. helping the client cope lvitlr stress and emotion-
groundingteclrnique(increasecontact
ivith realitl' thror-rghthesenses)for those rvho are dissociating or
experiencing
flashback.Reorientingthem.Breathingandrelaxationor engage in positive
distraction
viervthe client asa survivor rather thatt a
victirn allorvs thernto seetlremsclves to survive their ordeal.

c. lielping to promotetlre client's self-esteem-

as stlong enough a
nrolc cnlp()\vclirrg

irnagc

d. Establishingsocialsupport- support peopleor activities in the

communit,'-and a local
crisis hotline ftrr self harm thoughts or urges
24. Acute StressDisorder?
Anxietr. clissociation and other svlnptolrs r.vithirrI nrontlrof
cxposureto extremelv
trautnalicstressorand lasts 2-zl rvks. Sirnilar to Pl'SD.thcvL'\pcrieuce
a traurnaticevcnt
but their response is morc dissociative to thc side sense
(puttingtlroushts ).1'lreperson
that the evenl rvasutrreal arrd f'orgets some aspects thrr-rLrgh
emotional

arnrresia.
cletacllrrent

27. Typesof dissociative disorders?

a. Dissociativeamnesia-can'tremetnberimpoftantinformation
b. I)issociativelugue-cpisocles tr:tvelirrgto anothcr citr'.
of leal'ing u,/o aur erplanation.
tunablerenrenrber ma\/ assume

identitl.. a nelv idcntitr.

c. Dissociativeidentity disorder-tr.vo or personalitr'

or moredistinctidentities

d. l)cpersonalizationd iso rtltr-rccut'rerrl fcelingof'lreingdetached

28. Rapeand Sexual Assault?
A crime of violence ancl hurniliation throughsexual
of the victirn expressed means:
sexual itrtercottrse Sodomy forced actsof I'ellatioarrdanal
against rvill or consent.
penetration

29.Date rape(acquaintancerape)?
Ma\ occttr on a f irst clate,otta ridelrorne frrim a part\'.or
rvlrentlrctrvopeoplehave
knurvncach othcr lbr sornetime.

30.Fourcategoriesof male rapists?

a.sexualsadist- arousal frornthepainof their victims
b.exploitivepredators-use'stlre victim as ob"iects for gratification
c.inadequatemen-believetlrat no women r,vouldlravesex w/ themandare obese
rvith
farrtasics
oI sex

d. men for r.vhom rapeis a displaced expressior.r

of angerand rage

31.Treatmentand intervention?
Signstrseclto educateabor"rtdate rape antl ale( rvornenlo the
clraracteristics rvhcr
gf rnerr
arelikell'tocotnntitdatingviolenccltlroservhoexpressnesativitiesatrotrt,u
vornerr.

actingtough.engagingin heavr drinking. exhibitirrg.jealousr.

belittlecornnrcnts.

rnaking
expressingangerandusingintirnidation.

Therapv and;rrophylactictreatment{i'rr
sexltaltransmittedcliseasesuchasChlarnidiaor gonorrhea areofT'erecl.

lt takes I I'r or
morefor survivors of rape to regain previoLrs levclof fi.rnctionilrg.

32.CommunityViolence?
Few people responsiblehavebeendiagnosedrv/a ps-
vchiatricdisorder:conductdisorder.
s
Chapter15:MoodDisorder

33.Mooddisorders(affectivedisorders)?
Pervasivealterationsirrertrotionsthatarernanifcstedby depressiotr.tnania
or bcltlt.
agitation!prolactinlervels
to enlarge in lvotnen andtenderin tr:ell

a.anergia-lack of energr'). exhar"rstiorr" c;llrsittgbrcast

b.diminishedlibido"erectileandorgastnicc1rsflnctiort
c.menstrllalirregularitics
11.rveightgairr
eff'ect:posturalhrpolensiott" antl
taclrl'cardia

e.lrost causedrninorcardiovascular trralpitation

34. Categoriesof mood disorders?
a.rna-iordepression episode in nearll all activities
disorder-depression or loss of pleasure
thatlasts for at least tr,vorveehs.Sy'mptomsmal' include 4 or morel
change in
appetiteor sleep.ps1'chomotoractivitr,.J energ),. feelings of
rvortlrlessness

or
guilt.difficultvconcentrating.or making decisions. or recurrentthoughtsof
deatlr
or surcidal ideation.plansor attempts.

b.bipolar disorcler- diagnoscdrvherrrnoodcvcles betrveen

extretnest'natriaatrcl
tlepressiotr.
35.Mania?
Abnormalmood that is persistentlvelevated.expansive.or irritable lcrr
about a rveekor
longer for some people. At least 3 or more symptoms accompan)-
manicphase;inflated
self-esteem.or grandiosit-v.'. ( unrelenting,

J need for sleep. pressuredsDeech rapid, often

loucltalkingw/opauses, to others). unconnected

cantlisten llight of ideas( racing, thoughts).

distractibilitr'. in goaldirected or psychomotoragitation.and

J involvernent activities
excessiveinvolverneut activitiesw/ potential

in pleasure-seeking 1orpainfirl
consequences
andpoor.judgment

36.Hypomania?
Irlevated.expansivc.or irritablc rrrood lastirrg4 clars incluriing llrrec
or above svmptoms
37.Bipolar I disorder?
One or more manic or mixecl episodes Lrsually' accompaniedb1" ma.ior
depressive
episodes
38.Bipolar II disorder?
Onc'or ntorc ttra"ior episode b1 at lcastorrehr'pornaniccpisocle
deirrcssive accomparried

39.Related disorders?
a. Dysthymic disorder- least 2 ;-earsof clepressed
mood for morc davs than not lv/ sorne
additional.less severe s)nrptoms and do not meet tlre criteria for a
major
depressive

b.Cyclothymic disorder-21rs of numerous periodsof both lrypomanic

svmptoms and
don'tmeet the criteria for bipolar disorder
c. Substance-inducedmooddisorder- disturbance in mood flrom
dircctphy'siologic
consequence substance
of ingested

d. Mood disorder due to generalmedical condition

e . Seassonal affectivedisorder(SAD)-It1lvinterdepressionor fall-onset
SAD. . .. Begin
lateautumn and abates in spring and summer. Srrrptomsf sleep"appetite and
carbohyclrates conflict.irritabilitr'(:yspring_
craving. weight gain.interpersonal
onset SAD... ....late springor earh sumnrer until earlv fall.
Svrnptomsinsomnia.
weight loss. poorappetite

f. Postpartumor "maternity" blues- crying spells. sadness.insomniaand

anxiet,v-. I da1
after delivery and peakin 3 to 7 dals
g.Postpartumdepression-criteria for majt'rr depressive episodesrvithonset
4 rvks of
deliven
(
h.Postpartumpsychosis-within 3 rvks... ... begins rv/ fatigue.
sadness,emotional
labiliq,. poor memorr. and confusion and progressing to delusions.
hallucinations.poorinsightand.judgrnentand loss of contact with reality.
40. Etiology of depression?
Bioclrernicalirnbalances, stressors evenls that
rv/psychsocial and intcrpersonal
appearsto trigger c-crtain changesin tlre- brain.Gencralcieficitin
serotonilt arrd
norepinephrine

4L Treatm ent for depression? (antidepressant)

a.Cvclic antidepressants- oldesttricyclicmeds: relieves ht'rpelessness.

helplessness.
anhedonia.inappropriateguilt.suicidalideationand dail.v mood variations.
Lag
periodof l0-14 dar,s before reachesserumlevel tlrat beginsto
alters\.mptoms.
take 6 wks to reach fulleffect. Contraindicatedin severeimpaired liver
function
and Ml recovery.used of MAOI. glaucoma.BPFI.urinarl retention or
obstruction.DM. hvperth-vroidism.

CVD. renal irnpairmentor respiratory,

disorders.

b. MonoamineOxidaselnhibitors(rr,rol)-usedinfiequerrtlldrre to
potentialsidc
el'lbctsantl interaction rv/nLlrncrousclrugs,esp. ll1'pcrtensive crisis
resull rvhcrr
ingestedt1'ratninc-containing svrxptoms
foodsand fluid or other meclicatit'rn...
arc occipital lrcadache. NV" clrills.slvcatilrg. nuchal

lrvperterrsiorr. r'estlessrrc'ss.
rigiditl^ dilated ptrpils.fcv'er. l'hiscarrleacl

and rnotoragitation. to lrrperpvreria.

ccrehral lrelnorrlrage arrd deatlr.

c. SelectiveSerotonin Reurrtake [nhibitors (ssnls)-rnosteffective.

produce ferv
sedating.anticholinergicand cardiovascular side effects (saferto use in
elderly
c lierrts)
d. Atvpicalantidepressant-rvhenclient has an adequate to or side effects
usec'l response
fromSSRI

e.lllectroconvulsivetherapy (t:<'l')-treat dcplessiorr lirrthosc llro do

not response to
antidepressaltts intolcrrablc ell'ccts.Pregnantw'omensau
or rvho cxtrrericncc sic'lc
sal'elvhaveIiC'l-rv/no lrartn to thc fetus. (llierrtsu'lroare suicidal
rnarbcsir,err
l:C'I i{'thcrc arcconcernsfor thcir saf'etvrvhilervailin-ulor l'ull
effectof'
antidcpressaltt Proceclurc: placeilto tlre lread bilateralor

tneclication. clectrodcs
unilateral (lessnrenx,rllrss bul nrorc proccrlulcs

than trilltcrat) ancla deliverv of e lectrical

intpulsesto llre lrrain. this causes a scizure. Believedtlrat the shock
stirnulales
brain chcrrrister)' t() con'cct thechcrnicalinrbalanccof'depression. on

Monitored
elcctroencepltalogram reccivesa slrofl-acting anc$lrelfulalxg5cje

(t,r.r;).Client

to reducgltgi!{\' o!{\a! d srgl\soJ'tlrcscizure(cg( t.nrc-r.nrc

-relaxant/paralrtic

. r'rrsclseontr.ctions)

f. Psy'chotlrerapy-
interpersonaltherapy focus on difficr]lties in relationships.
Behavioraltherap,v focus on irnproving social skills. Cognitivetherapy
focus
on hor,v thepersonthinksabout the self. otlrersandthe future and
interprets their
experiences

42.Applicationof the nursing process:Depression?

a.History- bchavioral changcsfionrclicnt or others
b.Generalappearanceand motor behavior-sacl. posture
looksill. sloLrched rvr head
downntinirnaleve contact. psychomotorrefardation,latencv of response,
agitationor anxiety (r.vringing andcant sit still). psychomotor

of the hands

agitatiOn (,l hrx'I-vrrtovcnrontand thought...cg. Pacing,

accclcratetlthinkinganrl lfsumentlli}cncss)

c. Mood and affect- hopeless" burclen.{iustrated.angrr' at thcmselvesor

others"
anhedonia. apathetiC inotcaringaboutrulrhing)
cl.Thoughtprocessand content- slou'thinking pessirnistic
process. thinking.ruminate
(goingovel tlrc sanre lhoushr)may harre delusions
e.Sensoriumand intellectual Process-somehave difficultl rvlorientation
f. Roles and relationship-difficultl'lhlfillingroles and
r"esponsibilities
g. Physiologicand selt'-care considerations-weiglrt loss" lack of
appetite"sleep
distLrrbances^
loscirr sexual activities"nrerrimpoteuce-neglect of personal
h_rgierrc.cortstipalion

43. Depressionrating scales?

a. ZungSelf-RatingDepressionScaleandBeckdepressioninventory'-used for
general
public ands course of treatmentto detennine improvementfrom the client
prospective
b.TheHamiltonRatingScalefor f)epression- cliniciarr-
rateddepressionscaletlratrales
belravior

44. Interventionsfor depression?

a.Providesaf-et1,-knorv suicidal
plansarrclsuicidalideationancll'ollorvsuicide
prccarrliorts
b. Promoletherapeutic even if tron-conrtrutticativc cansitrv/clients
relationships-\'ot-l
fcrra felvrnitrutesat intervalstlrroughoutthe clal'to slrorv
genuineintercst ancl
caring.Avoidbeing overll checrful. Assessabilityto pcrforrn ADI-s rv/
Global
taskfirst. Reestatrlish nutrition. to rcurainout ol'hacl dLrrirrg

balance [:rncclurage
theday to prortlote sleeping at niglrt

c. Provideclientandfarnil;- teaching- goal is to rcverse negativeviervs

of the future.
irrrprovesell-irrrage gainconrpetcncc
andhclp clierrts atrdsell'ntastctl

45.Treatmentfor Bipolar?
Lifetimeregimenof medications of antimanic agent(lithium)or
anticonvulsant
medicationsuseclas a rnood stabilizers.

46.Lithium?
A salt corrtainecl Il cotnpelcs sites
irr the lruman bodr. 75% thelapeutic. lbr salt rcrcepttrrs
and afl'E:cts ions attd glucosc Pcakisl0 rniri 1o 4 hrs.It

Ca.K. r"nagnesium tnctabolisrn.

lrarrier and distribrrtcs

crossesthc blotr-brain andplacenta irr sucat ar.rd brcastmilkrn,rt

rcconrnrerrtterilrimcslcr).Olrset of'action is-i-14da1 siclc'cfl'ects.
in t'1 s.25t% have clilflctrltl'rv/
trcattnentregimen^ or renal disease for lithirrnr.

tlrug intsractions rvhichis contraindicatcd

['.s.t,'t'ltrilharupy

not u,taltrlilurirtgtrr:ttlcrnunit' ,\lugc

47.Application of the nursing process: Bipolar disorder?

a.History- due to-iumpingfrom subject to sub-ject. making it difficult to
follorv. obtairr
datain severalshort sessions andtalk to lamily' menrbers.
b.Generalappearanceand motor behavior- difficult sitting still.
rvearsclothes that
reflectelevatedmood: brightll
colored.flamboyant.attentiongetting.sexr"rally
suggestive.e.g.Wearlots of makeup and *pressuredspeeclt
activitv.grandiosity'ancl of rvellbeing.
angrv.verbally aggressive tone. and sarcasticandirritable.mavgofrom
loud laughter to episodes of crying

c. Mootl and affect-euphoria.exuberant false sense

and
tangentialif,"-. pro.iectsat one tirne andcantcompletethern.talks non-

d. thoughtprocessand content- confused thinking.tlight idea.

circumstantialit,r
startsman."-
stopaboutplansandpro.iects.andmay'havegrandiosedelusion

e.Sensorium and intellectualProcess-oriented to personandplacebutrarell

time.
concentrationor pavingattentionis irnpaired.and rnay' have
lrallucinations
f. Judgmentpoorandinsight limited
g. Role and relatinnship-too distracted andhyperactiveto payattentionto
fulfill roles
or ADL
h. Physiologic and self-care consideration-cango da,vsw/o sleep or food
arrd not even
realize they' arehungry or tired. Onthebrinkof phy'sicalexhaustionbutare
unrvilling or unable to stop.rest or sleep. and ignorepersonalhvgiene
P
48.lntervention for bipolar (manic)?
a.Providesal'ety-linotvsnicideplansand ideation.. Monitor the client's
rvlrereabouts
and behaviors frequentlr,due other clients' spaces.
to client intruding

b.Meeting physiologic needs-medicationto help relax. hecltime routine,

Becausethe-v
ma)'too"bus1'"to sit dou'n and eat offer finger foods tlrel can eat
rvlrile movirr.u
alouncl.such as sandrviches.
proteinbars.and fbnified shal<cs.

c.Ilrovide fherapeutic communication-sirnplesentenccand ask clientto

repeatlrriel'
tnessageto etrsure 1her.'gotit.askc:lierrtto identil'r, cachpelson. place
orthirrg
being discuss to be ableto tbllorv rvlrat thevarereferringto
d.Promoteappropriate behavior- monitor belravioruntil it less irrpulsive
c.Managing medication- litlriurrr ler,elis 0.,5-l rnL:q/l-. lcvel
0.tinraintenance
tt'eattnent
L5 mtiq/!, and'l'oxiclevelsare I .5 rnt:c1ll. and is latal in
overdose.Drink
aclcquate and continue of'dietarltable salt. I laving too

rvater rv/usual arnourrt

tnuch salt reduccs receploravailabilitlfur lillriurn andf
lithiurrexcretiolr.so
levelsrvillbe lorv. I{'too muchrvaterit diluted and 1oo littlc rvater
resultsin
toxicitl .'fhrroid functiort test as a baseline cluring

arrdcl6rnntlrs lithiunr treatr"nent

and renal status. Corrtraindicatcd rcnal l'unction

rv/cornprorniscd or urinarl
retentionor lolv salt clictsor diuretics.

49.Suicide?
The intentional act of killing oneself.
50.Suicidal ideation?
'l'hirrkirrg

aboLrtkillingoncsclf'.Active suicitlal ideation-a pcrsontlrirrltsabout

ancl seeks
rvavsto comnrit stticicle. suicidalideation-person dic or

Passivc thinks aboul rvantirrgttt

rvislreslherrvcredcaclbrrt has no planstocausctheir dcath.
Mcssagccaltbeclircctor
i nd ilcct.

51.Riskybehaviors?
A few giveno warning sign thel'.iust placethcrnselves situations
in riskl or dangerous

52.Lethality assessment?
l.il<clihoocl ittingsLricide
of conrrn

53. Interventions for Suicide?

a.Using an authoritative role- maintainingcontrol
b.Providea safe environment- denl' accessto materials oncleaningcarts.
their orvn
meds.sharp scissors.
penknives.rernovesharpobjects.shoelaces.belts"lighters.
matclres.pencils. andeven clothing w/ c{rawstrings. ql0mins if'
pens. Observe

lethalityis low. for highlethalit;-one-to-onesupervision(directsightof

and no

more than 2-3 fi arvayfromstaff member for all activities.

c. Initiating a No-Suicide Contract- client aggress to keep

themselvessafeand to notifi
staff at the first impulse to harm themselves
d.C-reatinga suppoft system List
Chanter 12: Grief and Loss /{-\
s4.criefl

fl h \

Sub.iectivecnrotiotrancla{t'ecttlrat are normal respor}sc to tlre

experienceof'loss. | I

' \

55.Grieving (bereavement)t \*,r'

Processof experiencing grief
56.Anticipatorygrievingf
f1
F-acingan ir.nminent of'thelossor death in thc

loss to grapplerv/ the verv real possibilitr

f I )
ttear futttt'c A./

57.Mourning?
Outrvard expression of grief.e.g.givinga funeral. rvake
58.Types oflosses?
a.ph1'siologic
loss(c.gamputati<xr)
oi prrhlic

b. safetl' loss (c{onrcstir violencc)

c. Iossof securitvatrd a sense of belonging ilossol'alor,r'donc)
d. loss of se'lf-esteem (changcin hou apersonis raluecl at *ork or
rclationships)
e. lossrelatedto self-astualization-extcrnal or irlternalclisis that
blocl<sor inhibits
strivingtorvards fulfillrnent (c,g.losinglropc or lirnrily)
ol'nrarliagc

59.Kubler-Ross's stages of grieving?

a.Denial-shockand disbelief
b.Anger-expressedtorvardsGod. relatives. friendsor health care providers
e
c.Bargaining- asking God for more time
d.I)epression- results wlren awarenessof the loss becomesacute
e.Acceptarrce-shows evidence of coming to tenns rv/ death
60.Bowlby's phasesof the grieving process?
a.numbnessand denying- stunned as not perceivingrealitr
b.vearningfor the lost lovetl one-c.rhibiting andcn ing
angcr. profound sorr()w

c.disorganizationand emotional despair rv/ dilficult.t lunctioning-besins

to
unclcrstandtlre loss perrranencc
d.reorganizinganrl reintegrating thesenseol'solf to pulllil-
ebacl<together:re-
c-stablislr ol'personal . direction.anclpurposelirr livirrg anclgairrs
a sel.lse identitl
independence

andcorrfiilencc

61.Physiologic responses to griefl

Anxiety.insomnia.[readaches. rveiglrt loss. lack of energy'.
impaired appetite. palpitation,
indigestion.clrangesin immune and endocrine svsterns

62.DisenfranchisedGrief?
(lrief'ovcra lossthat is rtol or cannol be acknon'ledged nrorrrncd or /
z:\.
openlr,'. prrbliclr
srrlrportccl

sociallr,.

, +'

a.a rcluliorrslriplrnsnolegilirnac): crlllnraritalir[lairs

c g slrnc\c\ rrralrilrgc. , /

\
b.the loss itsclIis not recognizec[ or scen associallv sigrrificanl: eg.
Prcrratrl
)
death. itboftiott. dcathof a pct \/

c.tlregriever is nclt rccognizcd. c.g. clrilclren are lookccl at as

una[:le togricle
or,'crra dcath
grieving)?
A responseoutsideof normal : 1t;occurringrvherrapersonis void of
emotion.(:)Grieves
for prolongedperiods.1:1[-las expression to the event

63.Compl ication grieving(Dystunctional

of griefthat seem disproportionate

64. Characteristicsof Susceptibility?

Peoplervhoarevulrrerablcto complicatedgrieving: I
l. lou'se lf-esterenr l. l.rv trust in othcrs ?
3. a previous ps1 chiatric disordcr' 4. previoussuicidetlrreatsor
attcnrpts \
( <
\t
)
5. absent orLrnlrelpfulfarnill mernbers 6. Arnbivalent attaclrrncnt
7.dependentattachment tl.insecureattachntent
)
9.persorr'sperceptiorr
65. Risk factors leading to vulnerability?
a. Death of a spouse or child
b. Death of a parent
c. Sudden.unexpectedanduntimel,vdeath
d. Multiple deaths
e. Death by suicide or murder
66. Reactions from complicated grieving?
a.physicalreaction- impaired imrnunesvsteln.f adrenoco(icalactivilies.f
levelsof
scrurnprolactin and gror.vthlrorrnrtnes.psvclrosornaticdisorder and f
rnortalitr'
fromlreaftdisease.
b. emotional reaction- depression. anxietvor panicdisorclers.delaled or
inhibited grief'

lu
andchronicgriel

67.Factorsthat influencethegrieving person'sreturnto homeostasis?

a.adequateperceptii'nof the situation:whatdoesit mean to them?
Adaptivedenial-
clientgrad|alll,adusrsto therealityof theloss.With effectivecommunication
skillscanhelpclientin adaptivedenialmovetowardsacceptance
thosewlroarecloseto theclientthatcan

b. adequatesituationalsupport....assess
proviclesllppoft.....tt"tunf
internetresourcesareavailableto lrelpclientfincl
to grievingprocess

information.supportgrollpsandactivitiesrelated

copedrv/ significant

c.adequatecoping.....compareandcontrastrva}s in wlrichthe1"
lossin t6* purt and Lelpingthemrevieu,strengtlrsandrenerva sense of
personal
power.Encouragethemto careforthemselves"volunteerandchurchor other
activitiescanrenewfeelirrgsof self-rvortlr

68.Assessmentof grieving?
lnvolvesobservil[ all dirnensious response:tlrinking 1c.grritrrcl"
feelings
t-rf lrutnatr
lrorvperson is acting rtrclravi.ral).

b0d1's reactiotr

valuesairdbelie{.srspir-irrrirr).

icn*rri.ral).

1plrrsiologic1

Chapter 10: Anger, Hostility and aggression

69.Anger?
to a real or perceivedprovocationand can
A strong.uncomfortable.emotionalresponse
resLrltfrom flrustration.hurt or beirrgafraid.Positiveif expressed
asserlively.resultingin
resolvingconflicts.solveproblemsandmake decision. AngeractivatestheFight-
orflight
response.Negativedeniesit. suppress inappropriatel-v-.

it or if expressecl resulting
in plrr.'sicalor emotionalproblemsor interferesw/ relationships.

70.Hostility?
Al(A Vcrbal aggrcssiorr....ernotion verhalabuse^ violatiotl
tlrlouglr lack of coopcration.
o1'rulesor llorrns. belralior.lts dottc to irrtinriclate ctnotionalhartn

or threatenirrg or cattse
to another alftl cifn lead to plrl,sical aggt'essi0n tirllacksorrn
lrcrsrxt. ol'

jurr1o anolhcr otrlestluctiolt

ltr()pcrt\)
7l . Complicationof suppressing or denying anger?
Migraines headaches, ulcers, CAD andemotionalproblems(depression

and low self-esteem).

Help express angerwith role-playing using assertive communication
techniques: (.I"
statementsn that expressfeelingsandare specific to the situation.

72.Catharsis?
by engaging [rLrt
Explessingarrger in aggressive. saf'eactivities.e.g.hitting a punching
bag or y,elling.Ilorvever.tlris increase
ratherlhanalleviatearrgeratrclntaybe
contraintlicatcd.

73.Hostility and Aggression?Stages/phase

a.triggerphase c.crisisplrase
b.escalationphase d. recovery phase
74.Intermittent explosive disorder?
E,pisodes impulsesthatrcsultsirrseriousassaultsor dostructionof
prclpertr.
ol'aggressi'r,e

75.Acting out?
Immature defense mechanismlrow the personsdealrvithemotionalconflicts or
stressors
through action rather than through reflectionor feelings

76.Treatment?
Aggressionfocusesonthe underlving problenror psrchiatricdiagnosis.Lithium
has
been effective in treating aggressir.e client. Carbamazcpinc used to
treat aggression
associaterv/dementia,psvchosisandpersonalitldisorders.

77.Interventions for angry client?

a.Early assessment. and verbal interaction canpreventanger escalating to
medication

lt
ph.vsicalaggression.

b. engaging the hostile personin dialogue is most effective to preventthe

behavior from
escalating to phy'sicalaggression.
c. managing the environment: grolrpand plannedactivities. e.g.
pla.vingcardsgames.
discussing movies discussion groups r.vhen thel are calm, one to one
interaction
can indicategenuineinterest. For conflict or disputes w/ one anotlrer.
offer
problernsolving or conflict resolution and expressing feeling w/
assertive
communication techniques
d. managing aggressive behavior:
(l ) trisserphases-approachin a nonthreatening cahn rnanner and use clear
sirnple. short
statements.Show empathy, encourageexpressingfeelings, try to move to
quiet
areaancioffel meds(PRN).When anger subsideuse relaxation techniques.
(2) escalationphase-providedirection in a cahn, firm voice, clirect
tirneout l'orcooling
off in a quietarea or in theit room, and tell them the behaviol is not
acceptable.
lf continues to escalate lnitially-l-6staff rnernbers
obtain assistance. rvithinsight
a technique krrorvnas"showof force."

(3) Crisisphase physicalaggressiveand decision for seclusion or

restrairrt. Eachstal'f
rnembertake a lirnb, heacl and torso if needed. Restraintsareapplieclto
each
limb ancl fastenedto the bed frame.PRN med givenif not alreacly given(lM)
(4) Recoveryphase-regains control. Encourage to talk about situation
ortriggers. Explore
alternativesfor future onsets,documerrtinciclentreportsancl florv slreets
Aftel restraintsor seclusion is rernoved. cliscussbehavior irr calm
rationalmannerandreintegrateinto milieu anditsactivities.

lu