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Psych Wk 2 - Part II

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cdunbar4's version from 2017-01-22 21:54

PTSD

Question Answer
Stress reduction techniqueselicit relaxation response; physical activity; social support
PTSD caused by traumatic events-what is happening in the brain?Thalamus transmits fearful info., such as fearful memories, sights and sounds to the amygdala which is overactive in response & ↑ signal sent to brainstem, motor structures & endocrine system.
Symptoms of PTSDflashbacks, avoidance of stimuli associated with trauma, experience of persistent numbing of responses, persistent sx of ↑ arousal
Psychotherapeutic tx strategies for PTSDCognitive behavior therapy; eye movement desensitization & reprocessing; SSRI's; group therapy; family therapy
Nursing care of clients with PTSD
Characteristics of clients experiencing mild anxietyseldom a problem; tension in response to events of day-to-day living, prepares people for action
Moderate anxiety characteristicsless alert to events occurring in env't; attention span & ability to concentrate ↓'s; may need help with problem solving; muscle tension & restlessness
Severe anxiety characteristicsperceptual field is so greatly diminished that concentration centers on one particular detail only, or on many extraneous details. Attention span extremely limited & cannot complete even the simplest task. Physical sx include h/a, palpitations, insomnia & emotional sx.
Defense mechanismscompensation; denial; displacement; identification; intellectualization; introjection; isolation; projection
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Anxiety Disorders

Question Answer
Panic disorder-lasts about15-30 minutes
Social Phobiafear of embarrassment, unable to perform in front of others, has dread of social situations, believes that others are judging negatively & has impaired relationships
G.A.D. Generalized anxiety disorderuncontrollable, excessive worry for >3months; significant impairment in one or more areas of functioning
OCDpersistent thoughts or urges; time-consuming; impaired social & occupational functioning
Nursing care of clients experiencing anxiety disordersstructured interview to keep client focus; assess comorbid condition of substance use disorder; provide safety & comfort to the client; remain with client during worst anxiety to provide assurance; perform suicide risk assessment; provide safe env't for other client & staff
1st line med tx for trauma & stressor-related disordersSSRI antidepressants
Medications that can be used short-termsedative hypnotic anxiolytics such as diazepam
Meds used to manage anxietynonbarbituate anxiolytics such as buspirone
Other medsbeta blockers, antihistamines
Panic disorder has to have 4 of the following present:palpitations; SOB; choking sensation; chest pain; nausea; feelings of depersonalization; fear of dying or insanity; chills or hot flashes
Agoraphobiaclient avoids being outside & has impaired ability to work or perform duties
Specific phobiasfear of objects (spiders, snakes, strangers); fear of specific experiences (flying, dark, elevators, enclosed spaces)
GAD manifestationsrestlessness, muscle tension, avoidance of stressful activities or events, ↑ time & effort required to prepare for stressful activities or events, procrastination in decision-making, seeks repeated reassurance
Patient-Centered carerelaxation techniques for relief of pain, muscle tension & feelings of anxiety; instill hope for positive outcome (AVOID FALSE REASSURANCE); enhance self-esteem; assist client to Id defense mechs that interfere with recovery; postpone health teaching until after acute anxiety episode subsides. *clients experiencing a panic attack or severe anxiety are unable to concentrate or learn.
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Somatoform Disorders

Question Answer
Conversion disorderloss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism. Most obvious/classic sx’s are those that suggest neurological disease. Some instances may be precipitated by psychological stress.
somatization method of coping with psychosocial stress by developing physical symptoms
In order for a dx to be made, what must be ruled out as a cause of the patient's symptoms?medical, neurological, substance use or other coexisting psychiatric disorders
Identity assessmentidentify themselves, behavior, voice, dress might signal the alter personality
Nursing care-Memorycan the patient remember recent and past events, Is the patient memory clear and complete or partial and fuzzy, is the patient aware of gaps in memory, such as lack of memory of events –graduation or wedding, do patient’s memories place the self with family, in school, or in an occupation, does the patient ever lose time or have blackouts, does the patient ever find herself or himself in places with no idea how she or he go there
Nursing care-any history of epilepsy, history of early trauma, sexual or physical, recent injury such as concussion. Have you found yourself wearing clothes you cannot remember buying? Have you had strange persons great and talk to you as though they were friends? Does your ability to engage in things such as athletics, artistic activities, or mechanical tasks seem to change, do you have differing sets of memories about childhood?
Nursing care-MoodIs the patient depressed, anxious or unconcerned. Most patients with dissociative identity disorder seeks help when personality is depressed. Shift mood- observe
Nursing care-impact on patient and familyhe memory loss impairs normal relationships. May have both family and work problems.
Nursing care-Suicideassess for suicide. Observe for expression of hopelessness, helplessness, worthlessness and verbalization of other behavior
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Section 4

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