thoughts generate compulsive, repetitive behaviors in effort to reduce the anxiety associated with the thoughts o attempts to suppress compulsive behaviors generates more anxiety and can be time-consuming and disrupt ADL’s o vicious cycle o inability to “let it go” Acute stress disorders/posttraumatic stress disorders o anxiety/fear resulting from traumatic experiences o mild, moderate, severe o the anxiety becomes a conditioned response to a specific stimulus sound, person, situation etc… o upon the stimulus, emotions of the traumatic event can be re- experienced in dreams, thoughts, behaviors XI. Somatoform Disorders as maladaptive expressions of severe Anxiety manifested as transformation of anxiety into physical symptoms occurs at unconscious level symptoms lack physical/ organic etiology symptoms strongly believed as real despite lack of etiology pathological way of expression of anxiety Pain Disorders chronic; can impair ADL’s musculoskeletal conditions, neuropathies Hypochondrias preoccupied that a severe medical problem exists seeks excessive time seeking health care Conversion disorder neurological deficits in voluntary motor or sensory function o symptoms preceded by conflict or emotional distress o demonstrates “La Belle Indifference” individual appears indifferent toward loss of function XII. Dissociative Disorders as maladaptive expressions of severe Anxiety unconscious splitting of anxiety from awareness Depersonalization o Emotional and cognitive separation from “real” self o Sense of detachment o involuntary o “going through the motions” Dissociative amnesia o inability to remember significant personal information
o usually results from a traumatic experience Dissociative fuge o abrupt physical flight and travel away from the field of conflict o follows stressful event Dissociative identity disorder o disorder preceded by severe sexual, emotional or physical abuse in childhood o mental partitions are created as distinct personalities so that primary “self” can escape o during stress/anxiety two or more distinct personalities can emerge XIII. Assessment of Anxiety Disorders ask for specific symptoms o autonomic or neurological monitor level of anxiety o incongruent physical complaints / motor agitation / poor comprehension ask about stressors o causative factors for anxiety assess for defense mechanisms o over-use; inappropriate use inquire regarding suicide / violence o poor impulse control / anger issues substance use o alcohol o panicogenic stimulants caffeine, nicotine, pseudoephedrine assess coping behavior (adaptive-maladaptive) o adaptive or maladaptive support systems o availability of them o assess quality of interpersonal relationships determine any secondary gains o unconscious-conscious o benefits resulting from symptoms XIV. Nursing Diagnosis • Anxiety • Alteration in physiologic states • Sensory-perceptual alterations • Altered thought processes • Social isolation
• Substance abuse
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- Fall '19
- Severe Anxiety, The Unconscious