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Unit IV Objectives
Anxiety & Stress Related Disorders, Trauma, Group & Family Interventions
N
Los Angeles Harbor College Associate Degree Nursing Program
Description:^ Unit
IV
â^
Anxiety
Anxiety
Related
Disorders,
Personality
Disorders,
Therapeutic
Groups,
Family
Interventions
Adaptive and maladaptive levels of anxiety are discussed, as are disturbed patters of coping with anxiety, including the nonâpsychotic clinical syndromes. Assessment and nursing interventions for each level of anxiety are delineated. Adaptive andpathologic manifestations of defense mechanisms are explored. This unit prepares the learner to recognize rigid patterns ofliving manifested in personality disorders. The use of the group process in the mental health setting is explored with anemphasis on group therapy. Methodologies for group interaction are examined, as are group leadership styles. Assessment offamily structure, phases of the family life cycle, and healthy versus unhealthy family function are presented. Different types offamily therapy are explored. Estimated
time
of
achievement
: One week.
Objectives
Course
Content
Learning
Activities
After appropriate study of the assigned resources,and assigned practice of the communication skills,the nursing student will be able to:
1.^
Differentiate the terms stress, anxiety, fear,normal anxiety, acute (state) anxiety, andchronic (trait) anxiety.
2.^
Compare and contrast behaviors(perceptual field, ability to learn, physicalcharacteristics) of mild, moderate, severeand panic levels of anxiety.
3.^
Propose interventions and communicationtechniques for mild to moderate and severeto panic levels of anxiety.
4.^
Examine the defining characteristics andreasons for using defense mechanisms.
5.^
Differentiate between the defensemechanisms presented (altruism,sublimation, humor, suppression,repression, displacement, reaction
Understanding
Anxiety
and
Anxiety
Defenses
Basics of anxietyLevels of anxietyInterventions for anxiety reductionDefense mechanisms Anxiety
Disorders PrevalenceComorbidityEtiology/TheorySeparation Anxiety DisorderPanic DisorderPhobiasAgoraphobiaSocial Anxiety DisorderObsessive Compulsive DisorderBody Dysmorphic DisorderHoarding Disorder
Read Varcarolisâ Foundations ofPsychiatric Mental Health Nursing, 7
h
Ed.Chapters:3: Anxiolytic Medications (52â53)15: Anxiety and ObsessiveâCompulsiveRelated Disorders24: Personality disorders33: Therapeutic Groups34: Family InterventionsDiscussion/LectureClinical ExperiencesDaily Charting
Anxiety & Stress Related Disorders, Trauma, Group & Family Interventions
formation, somatization, undoing,rationalization, passive aggression, actingâout, idealization, splitting, devaluation,projection and denial).
6.^
Compare and contrast adaptive andmaladaptive uses of defense mechanisms.
7.^
Examine the prevalence and comorbiditiesof anxiety disorders.
8.^
Distinguish the genetic, biologic,psychological and cultural factors leadingto anxiety disorders.
9.^
Differentiate clinical manifestations of eachanxiety disorder.
Examine feelings that may manifest whenworking with patients who have anxietydisorders.
Propose nursing diagnoses for patientswith anxiety disorders.
Formulate outcome criteria.
Plan for patient centered interventions fora patient with anxiety disorders.
Characterize the five types of interventionsused for anxiety disorders (anxietyreduction techniques, coping enhancement,hope instillation, selfâesteem enhancement,and relaxation therapy).
Evaluation of outcome criteria.
Examine evidenceâbased treatment foranxiety disorders.
Relate five different classes of medicationused to treat anxiety disorders.
Relate the mechanism of action, sideeffects, nursing implications, and patientteaching for anxiolytics.
Distinguish the potential interactionbetween Kava Kava and anxiolytic
Hair Pulling and Skin Picking DisordersGeneralized Anxiety DisorderSelfâAssessment of the nurse working withanxious patientsHamilton Rating Scale for AnxietyNursing DiagnosesNursing interventions for anxiety disordersTeamwork and Safety GuidelinesEvidenceâbased treatmentPatient teaching for anxiety medicationsPsychobiologic interventions
Antidepressants
(SSRI,
SNRI,
TCA,
MAOI)
Citalopram (Celexa)Escitalopram (Lexapro)Fluoxetine (Prozac)Fluvoxamine (Luvox)Paroxetine (Paxil)Sertraline (Zoloft)Vilazodone (Viibryd)Duloxetine (Cymbalta)Milnacipran (Savella)Venlafaxine (Effexor)Amitriptyline (Elavil)Amoxapine (Asendin)Clomipramine (Anafranil)Desipramine (Norpramin)Doxepin (Adapin, Sinequan)Imipramine (Tofranil)Maprotiline (Ludiomil)Mirtazepine (Remeron)Nortriptyline (Aventyl, Pamelor)Trazodone (Desyrel)Trimipramine (Surmontil)Isocarboxazid (Marplan)Phenelzine (Nardil)Tranylcypromine (Parnate)
Mental Status AssessmentProcess RecordingsPrep/pathophysiology sheetsHistory and AssessmentsNursing Care PlansCase StudiesRole PlaySimulated ExperienceOnline Student Resources:http://evolve.elsevier.com/VarcarolisAnswer key to chapter reviewquestionsAnswer key to critical thinkingguidelinesCase Studies and nursing care plansNCLEX review questionsPre and post testsKaplan Resources:http://nursing.kaplan.comFocused psych review testsPsychiatric case studiesNCLEX text bankAudio Visuals: DVD 25
Anxiety Disorders:
Medications
Anxiety & Stress Related Disorders, Trauma, Group & Family Interventions
intervention strategies for personalitydisorders and the rationale for use(antidepressants, mood stabilizers,anxiolytics, and antipsychotics).
Categorize basic concepts related to groupwork.
Differentiate phases of group development.
Compare and contrast task andmaintenance roles of group members.
Analyze therapeutic factors that operate inall groups (Yalomâs principles).
Relate the role of the nurse in leadingtherapeutic groups.
Examine seven types of groups commonlyled by basic level registered nurses.
Relate the purpose of psychoeducation,milieu, and selfâhelp groups.
Propose interventions for challengingbehaviors of group members(monopolizing, complainer, demoralizer,silent person).
Explore the characteristics of healthyfamily function.
Differentiate between functional anddysfunctional family patterns of behavioras they relate to the five family functions(management, boundaries, communication,emotional support, and socialization).
Analyze the meaning and value of thefamilyâs sociocultural context whenassessing and planning familyâcenteredinterventions.
Appraise the process of a threeâgenerationgenogram.
Identify ten potential nursing diagnoses for
Etiology/TheoryDSMâV criteriaClinical presentations for the 11 personalitydisorders Cluster
A
(Odd
and
Eccentric)
Paranoid personality disorderSchizoid personality disorderSchizotypal personality disorder Cluster
B
(Dramatic,
Emotional,
or
Erratic)
Antisocial personality disorderHistrionic personality disorderNarcissistic personality disorderBorderline personality disorder Cluster
C^
(Anxious
or
Fearful)
Dependent personality disorderObsessiveâCompulsive personalitydisorderAvoidant Personality disorder Personality
disorder
NOS
Assessment/Assessment toolsSeparationâindividuationSelfâassessment when working with patientswith personality disordersNursing diagnosesOutcome criteriaPlanningNursing interventionsTeamwork and Safety GuidelinesCounseling strategiesPatient educationPsychopharmacology
AntidepressantsAnxiolyticsMood stabilizersAntipsychotics Dialectical behavior therapy (DBT)
Anxiety & Stress Related Disorders, Trauma, Group & Family Interventions
family interventions.
Distinguish outcomes relevant to eachnursing diagnosis.
Compare and contrast insightâorientedfamily therapy and behavioral familytherapy.
Behavior therapy/behavior modificationCognitive therapyCognitiveâbehavioral therapy (CBT) Therapeutic
Groups
Definition of groupPhases of group developmentRoles of group membersTherapeutic factors in groupsRole of the nurse in therapeutic groupsPsychoeducational groupsTherapeutic milieu groupsSelfâhelp groupsChallenging patient behaviors in the group Family
Interventions Family Functions ManagementBoundariesCommunicationEmotional SupportSocialization Family Theory BoundariesTriangulationScapegoatingDouble BindHierarchyFamily Life CycleDifferentiationSociocultural contextMultigenerational Issues
