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Pyschosocial CH10WK3
Stress, Anxiety, Coping and Crisis
| Question | Answer |
|---|---|
| The stressor that precipitates anxiety is: | whatever the individual perceives as a danger, a loss, or a threat to safety and security. |
| external stressor (Objective) | measureable data |
| internal stressor (subjective) | less evident to others; room for interpretation |
| Psychodynamic Model r/t anxiety | Freud; Need to control anxiety stems from conflicts between the Id (instincts) and the Superego (conscience). |
| Biologic Model r/t anxiety | The effects of stress can be observed by the objective measurements of structural and clinical changes in the body; sypathetic nervous system activity (flight or flight) |
| Levels of Anxiety | mild, moderate, severe, panic |
| Mild +1 level of anxiety - Psychomotor | Preparation of body for constructive action Slight muscle tension Slight fidgeting Energetic Good eye contact |
| Mild +1 level of anxiety - Emotional | Occasional slight irritability Feeling challenged Confident (Use of adaptive coping mechanisms) |
| Mild +1 level of anxiety - Cognitive | Alertness Awareness of surroundings Concentration Accurate perceptions Attentiveness Logical reasoning and problem-solving skills |
| Mild +1 interventions | discuss source, help w/ problem solving skills, normalize it for them |
| Moderate +2 level of anxiety - Psychomotor | Preparation of body for protective action Moderate muscle tension Increased blood pressure, pulse, and respirations Startle reflex Slight perspiration Difficulty sitting still Repeated fidgeting Periodic slow pacing Increased rate of speech Spora |
| Moderate +2 level of anxiety - Emotion | Feeling uncomfortable, on edge, keyed up Motivated to decrease anxiety Increased irritability Decreased confidence (Use of palliative coping mechanisms) |
| Moderate +2 level of anxiety - Cognitive | Difficulty in concentrating Easily distracted, can focus with assistance Circumstantiality Tangentiality Loose associations Narrowed perceptions Decreased attention span Misperception of stimuli Problem solving and reasoning skills with effort, or |
| Moderate +2 interventions | Ask them what helped in the past, or try somethiing new; revert their attention; relate feelings to the behaviour (anxiety is just a feeling - “tell me what youre feeling right now”); prolem solving; oral meds; |
| Severe 3+ level of anxiety - Psychomotor | Preparation of body for fight-or-flight Extreme muscle tension Increased perspiration Continuous and rapid pacing Reflex responses Loud or rapid speech, or both Poor eye contact Somatic symptoms Sleep disturbances |
| Severe 3+ level of anxiety - Emotional | Extreme discomfort Feeling of dread Hypersensitivity Defensiveness with threats and demand (Use of maladaptive coping mechanisms) |
| Severe 3+ level of anxiety - Cognitive | Distorted perceptions Difficulty focusing, even with assistance Flight of ideas Ineffective reasoning and problem-solving skills Disorientation Delusions and hallucinations, if prolonged Suicidal or homicidal ideations, if prolonged |
| Severe 3+ interventions | decrease the stimuli they are receiving; give simple directions; opportunity for IM or IV meds |
| Panic 4+ level of anxiety - Psychomotor | Actual flight, fight, or immobilization Suicide attempts or violence Depletion of body resources Eyes fixed Hysterical or mute Incoherent |
| Panic 4+ level of anxiety - Emotional | Feeling overwhelmed and out of control Rage Desperation Feeling totally drained (Use of dysfunctional coping mechanisms) |
| Panic 4+ level of anxiety - Cognitive | Disorganized perceptions Disorganized or irrational reasoning and problem solving Neologisms Clang associations Word salad Out of contact with reality Personality disorganization |
| Panic 4+ interventions | you will take over; maybe some restraints; |
| Adaptive | Solves the problem that is causing the anxiety, so the anxiety is decreased. The patient is objective, rational, and productive – w/ an adaptive activity it becomes more manageable |
| Palliative | Temporarily decreases the anxiety but does not solve the problem, so the anxiety eventually returns. Temporary relief allows the patient to return to problem solving |
| Maladaptive | Unsuccessful attempts to decrease the anxiety without attempting to solve the problem - the anxiety remains. |
| Dysfunctional | Is not successful in reducing anxiety or solving the problem. Even minimal functioning becomes difficult, and new problems begin to develop. |
| Role of the Nurse | Identify coping strategies that the patient knows and is using. Identify coping strategies that the patient knows but is NOT using. Identify coping strategies that the patient does not know. |
| Common adaptive coping techniques taught by the nurse | Problem solving Assertiveness Positive self-talk and self-acceptance Stress and anger management Communication and relationship skills Conflict resolution Time management Community living skills |
| Common palliative techniques taught by the nurse: | Visualization, guided-imagery, prayer, meditation; Deep-breathing; Relaxation training; Yoga; Healthy lifestyle choices; Avoiding smoking, drinking, and other substances; Decreasing self-destructive behaviors, such as avoidance; Engaging in laughter, hobb |
| additional palliative techniques | Avoiding debt Affirmative, positive, and empowering thinking Increasing self-confidence Increasing self-awareness Listening to calming music Getting a massage, with or without aromatherapy |
| Relationship between Anxiety and Illness | Individuals feel increasing pain and discomfort as anxiety escalates. If long-term maladaptive or dysfunctional coping behaviors are displayed, a physiologic health problem, or even psychosis, might develop. Prolonged exposure to stressors alters the th |
| Crisis – anxiety to the extreme | A crisis results in a period of severe disorganization resulting from the failure of an individual’s usual coping mechanisms, the lack of usual resources, or both. |
| Crisis | Disorganization period cannot be tolerated emotionally or physically for more than 4-6 weeks; Without help, individual might become physically ill, become violent, or commit suicide to escape the pain. |
| Crisis Intervention | Initial focus is on preventing harm to self, harm to others, or further decompensation (survival, safety, and security). Might be necessary to make decisions on behalf of the individual and provide concrete instructions on what to do next. Find out what |
| Generalized Anxiety disorder | excessive and unrealistic worry about two or more life circumstances for 6 months or longer |
| Panic disorder | begins as a series of acute or unprovoked anxiety(panic) attacks involving an intense, terrifying fear. The attacks do not occur on exposure to an anxiety-causing situation as phobias do. |
| Phobias | irrational fear of a specific object, activity or situation. |
| Social Phobia | fear of being humiliated, scrutinized or embarrassed in public |
| Simple or specific Phobia | fear of a specific object or situation |
| Obsessive-Compulsive Disorder – | an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing anxiety, or by a combination of such thoughts (obsessions) and behaviors (compulsions). |
| Obsession | unwanted thought, idea, image or urge that a patient recognizes as time-consuming and senseless but that repeatedly intrudes into the consciousness despite attempts to ignore, prevent, or counteract it. |
| Compulusion | a repetitive, intentional, purposeful behavior performed to decrease the anxiety associated with an obsession. |
| Acute Stress Disorder | symptoms during or immediately after the distressing event |
| Post traumatic stress Disorder | symptoms that occur 1 month or more after the trauma |
| Anxiety | Also primary symptom in many psychiatric disorders. Persistent , irrational anxiety or episodic anxiety usually treated with both pharmacologic and nonpharmacologic therapies. |
Created by:
MarieG
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