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Unit IV: Anxiety & Stress Related Disorders, Trauma, Group & Family Interventions, Study notes of Nursing

A course outline for Unit IV of the Associate Degree Nursing Program at Los Angeles Harbor College. The unit covers anxiety and anxiety-related disorders, personality disorders, therapeutic groups, and family interventions. Topics include adaptive and maladaptive levels of anxiety, defense mechanisms, group therapy, family structure, and different types of family therapy. The unit also covers the prevalence, comorbidities, etiology, and clinical manifestations of anxiety disorders and personality disorders.

What you will learn

  • What are the prevalence and comorbidities of anxiety disorders and personality disorders?
  • What are the different levels of anxiety and their characteristics?
  • How do defense mechanisms play a role in anxiety disorders?

Typology: Study notes

2021/2022

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Unit IV Objectives Anxiety & Stress Related Disorders, Trauma, Group & Family Interventions N343
34
LosAngelesHarborCollege
AssociateDegreeNursingProgram

Description:
UnitIV‐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non‐
psychoticclinicalsyndromes.Assessmentandnursinginterventionsforeachlevelofanxietyaredelineated.Adaptiveand
pathologicmanifestationsofdefensemechanismsareexplored.Thisunitpreparesthelearnertorecognizerigidpatternsof
livingmanifestedinpersonalitydisorders.Theuseofthegroupprocessinthementalhealthsettingisexploredwithan
emphasisongrouptherapy.Methodologiesforgroupinteractionareexamined,asaregroupleadershipstyles.Assessmentof
familystructure,phasesofthefamilylifecycle,andhealthyversusunhealthyfamilyfunctionarepresented.Differenttypesof
family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,and
chronic(trait)anxiety.
2. Compareandcontrastbehaviors
(perceptualfield,abilitytolearn,physical
characteristics)ofmild,moderate,severe
andpaniclevelsofanxiety.
3. Proposeinterventionsandcommunication
techniquesformildtomoderateandsevere
topaniclevelsofanxiety.
4. Examinethedefiningcharacteristicsand
reasonsforusingdefensemechanisms.
5. Differentiatebetweenthedefense
mechanismspresented(altruism,
sublimation,humor,suppression,
repression,displacement,reaction
UnderstandingAnxietyandAnxiety
Defenses
Basicsofanxiety
Levelsofanxiety
Interventionsforanxietyreduction
Defensemechanisms

AnxietyDisorders
Prevalence
Comorbidity
Etiology/Theory
SeparationAnxietyDisorder
PanicDisorder
Phobias
Agoraphobia
SocialAnxietyDisorder
ObsessiveCompulsiveDisorder
BodyDysmorphicDisorder
HoardingDisorder
ReadVarcarolis’Foundationsof
PsychiatricMentalHealthNursing,7h
Ed.
Chapters:
3:AnxiolyticMedications(52‐53)
15:AnxietyandObsessive‐Compulsive
RelatedDisorders
24:Personalitydisorders
33:TherapeuticGroups
34:FamilyInterventions



Discussion/Lecture


ClinicalExperiences
DailyCharting
pf3
pf4
pf5

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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

‐^

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 non‐psychotic 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 Varcarolis’ Foundations ofPsychiatric Mental Health Nursing, 7

h

Ed.Chapters:3: Anxiolytic Medications (52‐53)15: Anxiety and Obsessive‐CompulsiveRelated Disorders24: Personality disorders33: Therapeutic Groups34: Family InterventionsDiscussion/LectureClinical ExperiencesDaily Charting

Anxiety & Stress Related Disorders, Trauma, Group & Family Interventions

formation, somatization, undoing,rationalization, passive aggression, acting‐out, 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, self‐esteem enhancement,and relaxation therapy).

Evaluation of outcome criteria.

Examine evidence‐based 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 DisorderSelf‐Assessment of the nurse working withanxious patientsHamilton Rating Scale for AnxietyNursing DiagnosesNursing interventions for anxiety disordersTeamwork and Safety GuidelinesEvidence‐based 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 (Yalom’s 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 self‐help 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 thefamily’s sociocultural context whenassessing and planning family‐centeredinterventions.

Appraise the process of a three‐generationgenogram.

Identify ten potential nursing diagnoses for

Etiology/TheoryDSM‐V 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 disorderObsessive‐Compulsive personalitydisorderAvoidant Personality disorder Personality

disorder

NOS

Assessment/Assessment toolsSeparation‐individuationSelf‐assessment 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 insight‐orientedfamily therapy and behavioral familytherapy.

Behavior therapy/behavior modificationCognitive therapyCognitive‐behavioral therapy (CBT) Therapeutic

Groups

Definition of groupPhases of group developmentRoles of group membersTherapeutic factors in groupsRole of the nurse in therapeutic groupsPsychoeducational groupsTherapeutic milieu groupsSelf‐help groupsChallenging patient behaviors in the group Family

Interventions Family Functions ManagementBoundariesCommunicationEmotional SupportSocialization Family Theory BoundariesTriangulationScapegoatingDouble BindHierarchyFamily Life CycleDifferentiationSociocultural contextMultigenerational Issues