11. eye anxiety,personality

8/9/2019 11. Eye Anxiety,Personality.....

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ANXIETYANXIETY


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Vague sense of impending doomVague sense of impending doom

Subjective response to stressSubjective response to stress

Is a state of apprehension,Is a state of apprehension,

uneasiness, uncertainty oruneasiness, uncertainty or

tension experienced by antension experienced by an

individual in response to anindividual in response to an

unknown objectunknown object or situation.or situation.


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Signs and SymptomsSigns and Symptoms


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Signs and symptomsSigns and symptoms

MILDMILD

PhysicalPhysical -- PR, RR, BP,PR, RR, BP,

pupillary dilatation, sweatingpupillary dilatation, sweating

CognitiveCognitive -- Attentive andAttentive andalertalert

EmotionalEmotional -- Minimal use ofMinimal use ofdefensesdefenses


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MODERATEMODERATE

PhysicalPhysical -- Nausea, Anorexia, Vomiting,Nausea, Anorexia, Vomiting,

Diarrhea, Constipation, RestlessnessDiarrhea, Constipation, Restlessness

CognitiveCognitive -- narrowed perceptual field &narrowed perceptual field &

selective inattentionselective inattention

EmotionalEmotional -- use of any defenseuse of any defense

mechanism availablemechanism available


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SEVERESEVERE

PhysicalPhysical -- s/sx becomes the flow ofs/sx becomes the flow ofattentionattention

CognitiveCognitive perceptual field is greatlyperceptual field is greatly

narrowed, focus of attention is trivialnarrowed, focus of attention is trivialeventsevents

EmotionalEmotional defense mechanism operatedefense mechanism operate


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PANICPANIC

PhysicalPhysical s/sx ofs/sx of

exhaustion ignoredexhaustion ignored

CognitiveCognitive personalitypersonality

disorganizeddisorganized

EmotionalEmotional defensedefensemechanism failmechanism fail


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Ineffective individual copingIneffective individual coping

Anxiety

Anxiety

Nursing DiagnosesNursing Diagnoses


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Nursing Management:Nursing Management:

BeBe

CCalmalmAAdminister medicationsdminister medications

LListenisten

MMinimize environmental stimuliinimize environmental stimuli


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ANXIETY DISORDERSANXIETY DISORDERS


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Panic DisorderPanic Disorder

An individual may suddenly experienceAn individual may suddenly experience

frightening and uncomfortablefrightening and uncomfortable

symptoms.symptoms.

May include terror, sense of unrealityMay include terror, sense of unreality

or fear of loosing control.or fear of loosing control.

Attack: 1 minute and 1 hourAttack: 1 minute and 1 hour


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Phobic DisorderPhobic Disorder

Phobia is anPhobia is an irrational fearirrational fearof an object,of an object,

place, activity or situation.place, activity or situation.

Avoidance will allow the individual to beAvoidance will allow the individual to befree from anxiety.free from anxiety.


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Examples:Examples:

AgoraphobiaAgoraphobia -- is the fear of open placesis the fear of open places

and of being alone in public places.and of being alone in public places. Social phobiaSocial phobia -- is an irrational fear ofis an irrational fear of

criticism, humiliation or embarrassment.criticism, humiliation or embarrassment.

A

crophobiaA

crophobia -- fear of heightsfear of heightsAlgophobiaAlgophobia -- fear of painfear of pain

ClaustrophobiaClaustrophobia -- fear of enclosed placefear of enclosed place

ThanatophobiaThanatophobia -- fear of crowdsfear of crowds

PathophobiaPathophobia -- fear of diseasefear of disease

MonophobiaMonophobia -- fear of being alonefear of being alone


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Generalized Anxiety DisorderGeneralized Anxiety Disorder

(GA

D)(GA

D)Unrealistic, excessive anxiety and isUnrealistic, excessive anxiety and is

unable to control worry.unable to control worry.

Clients may experience:Clients may experience: FatigueFatigue

IrritabilityIrritability

RestlessnessRestlessness

Muscle tensionMuscle tension

Sleep disturbanceSleep disturbance


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Obsessive CompulsiveObsessive Compulsive

DisorderDisorder Is characterized by recurrent obsessions andIs characterized by recurrent obsessions and

compulsions that interfere with normal life.compulsions that interfere with normal life.

ObsessionObsession Refers to persistent, painful intrusive thought,Refers to persistent, painful intrusive thought,

emotion or urge that one is unable to suppress oremotion or urge that one is unable to suppress orignore.ignore.

CompulsionCompulsion Refers to repetitious uncontrollable act andRefers to repetitious uncontrollable act and

sometimes a purposeful act to prevent a certainsometimes a purposeful act to prevent a certain

mistake in an event or situation.mistake in an event or situation.


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PostPost--Traumatic Stress DisorderTraumatic Stress Disorder

(PT

SD)(PT

SD) Is the delayed reaction of the person who has beenIs the delayed reaction of the person who has been

involved or exposed to a traumatic events.involved or exposed to a traumatic events.

Symptoms of this disorder are:Symptoms of this disorder are:

intense psychological distressintense psychological distress

feeling of detachment or estrangement from othersfeeling of detachment or estrangement from others

insomniainsomnia

decreased concentrationdecreased concentration avoidance of thoughts and feelingsavoidance of thoughts and feelings

recurrent distressing dreamsrecurrent distressing dreams

inability to recall an important aspect of the traumainability to recall an important aspect of the trauma


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Nursing InterventionsNursing Interventions

Calm and nonjudgmental approach toCalm and nonjudgmental approach toconvey acceptance.convey acceptance.

Use short and simple sentences or words.Use short and simple sentences or words.

Help the client develop an increaseHelp the client develop an increasetolerance to anxiety.tolerance to anxiety.

Help the client to:Help the client to: develop a problemdevelop a problem--solving and copingsolving and coping

skills of the client.skills of the client. develop the ability to remain calm indevelop the ability to remain calm in

anxietyanxiety--producing situations.producing situations.


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Approach: kindApproach: kind--firmnessfirmness

Systematic desensitization (phobicSystematic desensitization (phobicdisorders)disorders)

Clients with ritualistic behaviorClients with ritualistic behavior

(obsessive(obsessive--compulsive disorder)compulsive disorder)should not be prohibited orshould not be prohibited or

reprimanded.reprimanded.

Biofeedback, change of the scenery,Biofeedback, change of the scenery,

therapeutic touch, hypnosis, massagetherapeutic touch, hypnosis, massageor relaxation exercises.or relaxation exercises.

Administer medications, as ordered.Administer medications, as ordered.


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Anxiety RelatedAnxiety Related

DisordersDisorders


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Somatization DisorderSomatization Disorder

Free floating anxiety disorderFree floating anxiety disorder

Clients:Clients:

express emotional turmoil or conflict throughexpress emotional turmoil or conflict throughphysical symptoms.physical symptoms.

Usually seek for repeated medical attention.Usually seek for repeated medical attention.

May exhibit antisocial behavior and mayMay exhibit antisocial behavior and may

attempt suicide.attempt suicide.

Associated with anxiety and depressionAssociated with anxiety and depression


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Conversion DisorderConversion Disorder

A condition in which an anxietyA condition in which an anxiety--

provoking impulse is convertedprovoking impulse is converted

unconsciously into functional symptoms.unconsciously into functional symptoms.

Unconscious counterpart of malingeringUnconscious counterpart of malingering

Examples: Paralysis, blindness, loss ofExamples: Paralysis, blindness, loss of

touch or pain sensation, dyspnea,touch or pain sensation, dyspnea,seizures or convulsionsseizures or convulsions


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HypochondriasisHypochondriasis

An individual presents anAn individual presents an

unrealistic orunrealistic or

exaggerated physicalexaggerated physical

complaints.complaints.

The person becomes,The person becomes,

preoccupied with the fearpreoccupied with the fear

of developing or havingof developing or havingalready a disease oralready a disease or

illness in spite of medicalillness in spite of medical

reassurance.reassurance.


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Body Dysmorphic DisorderBody Dysmorphic Disorder

Preoccupation with an imagined defect inPreoccupation with an imagined defect in

his or her appearance.his or her appearance.

Slight physical abnormality = excessiveSlight physical abnormality = excessiveconcern / anxietyconcern / anxiety


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Dissociative AmnesiaDissociative Amnesia

Inability to recallInability to recall extensive amount ofextensive amount of

importantimportant informationinformation

Caused by traumaCaused by traumaCharacterized by:Characterized by:

DisorientationDisorientation

Purposeless wanderingPurposeless wandering

Impairment in ability to perform ADLImpairment in ability to perform ADL

Rapid recovery generally occurRapid recovery generally occur


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PERSONALITYPERSONALITY

DISORDERSDISORDERS


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Are pervasiveAre pervasiveand inflexibleand inflexiblepatterns ofpatterns offunctioning thatfunctioning thatis stableis stable

overtime, andovertime, andleads to distressleads to distressor impairment.or impairment.


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Types of PersonalityTypes of Personality

DisordersDisorders

(according to classification)(according to classification)


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Eccentric Personality DisorderEccentric Personality Disorder

(T

ypeA

)(T

ypeA

) ParanoidParanoid (Suspicious and distrustful)(Suspicious and distrustful)

Persons who display pervasive and longPersons who display pervasive and longstand suspiciousness.stand suspiciousness.

More common in menMore common in men

SchizoidSchizoid (Socially distant and detached)(Socially distant and detached)

Pattern of detachment from socialPattern of detachment from socialrelationshiprelationship

Chooses solitary activitiesChooses solitary activities

Topics are inanimate objects and ideasTopics are inanimate objects and ideas


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SchizotypalSchizotypal (Odd and eccentric)(Odd and eccentric)

mild schizophreniamild schizophrenia

Acute discomfort in closeAcute discomfort in closerelationshipsrelationships

Cognitive or perceptual distortionCognitive or perceptual distortion


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DramaticDramatic--Erratic Personality DisorderErratic Personality Disorder

(Type B)(Type B)

(Difficulty feeling concern with others)(Difficulty feeling concern with others)

AntisocialAntisocial (aggressive and(aggressive andmanipulative)manipulative)

Pattern of disregard for the violationPattern of disregard for the violationof the rights of othersof the rights of others

Low selfLow self--esteemesteem

BorderlineBorderline (destructive and unstable)(destructive and unstable)

Characterized by patterns ofCharacterized by patterns of

instability in relationships, selfinstability in relationships, selfimage and moodimage and mood

SelfSelf--mutilating behaviormutilating behavior

Affective instabilityAffective instability

More common in womenMore common in women


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HistrionicHistrionic (emotional and dramatic)(emotional and dramatic)

Excessive emotionally and attentionExcessive emotionally and attention

seeking behaviors that are dramaticseeking behaviors that are dramaticand egocentricand egocentric

Exaggerated expression of emotionExaggerated expression of emotion

Overreaction to minor eventsOverreaction to minor events

NarcissisticNarcissistic (boastful /(boastful /superiority complex)superiority complex)

Grandiosity and need forGrandiosity and need for

constant admirationconstant admiration Exploitation of others forExploitation of others for

fulfillment of own desirefulfillment of own desire


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Anxious or FearfulAnxious or Fearful

Personality Disorder (Type C)Personality Disorder (Type C) AvoidantAvoidant (inferiority complex)(inferiority complex)

Social inhibitionSocial inhibition

Feelings of inadequacy and sensitivityFeelings of inadequacy and sensitivity

Low selfLow self--esteemesteem Social withdrawal in spite of a desire forSocial withdrawal in spite of a desire for

affection and acceptanceaffection and acceptance

DependentDependent (submissive)(submissive)

Submissive clinging behavior related toSubmissive clinging behavior related toexcessive need to be cared for by othersexcessive need to be cared for by others

Lack of selfLack of self--confidenceconfidence

Perceive self as helpless and stupidPerceive self as helpless and stupid


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ObsessiveObsessive--CompulsiveCompulsive (perfectionist)(perfectionist)

Preoccupied with:Preoccupied with:

orderlinessorderliness PerfectionismPerfectionism

inflexibilityinflexibility

need to be in controlneed to be in control

Formal and serious interpersonal relationshipFormal and serious interpersonal relationship

Judgmental of self and othersJudgmental of self and others

PassivePassive--AggressiveAggressive Intentional inefficiencyIntentional inefficiency

Passive resistance to demands for adequatePassive resistance to demands for adequateperformance in both occupational and socialperformance in both occupational and social

functioningfunctioning


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Nursing Diagnosis:Nursing Diagnosis:

Ineffective individual copingIneffective individual coping

SelfSelf--esteem disturbanceesteem disturbance

Nursing Care:Nursing Care:

ConsistencyConsistencyLimit settingLimit setting


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Disorders CommonlyDisorders CommonlyDiagnosed to ChildrenDiagnosed to Children


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AUTISMAUTISM


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Characterized by:Characterized by:

Impairment in communication skillsImpairment in communication skills

Presence of stereotyped behavior, interestsPresence of stereotyped behavior, interestsand activities.and activities.

Associated with impairment on socialAssociated with impairment on social

interactionsinteractions

treatable but not curabletreatable but not curable

more common among boysmore common among boys

usually diagnosed at age 2usually diagnosed at age 2

Main problem: Interpersonal functioningMain problem: Interpersonal functioning

Most acceptable cause:Most acceptable cause:

Biological factorsBiological factors -- brain anoxia, intake ofbrain anoxia, intake of

drugsdrugs


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OOdd playdd playNNot cuddlyot cuddly

EEcholaliacholalia

CCrying tantrumsrying tantrums

HHead towards anythingead towards anything

IInanimate object attachmentnanimate object attachment

LLoves to spin objects / selfoves to spin objects / self

DDifficulty interacting with othersifficulty interacting with others


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WWants blocksants blocks

AActs as deafcts as deaf

RResists normal teaching method / routineesists normal teaching method / routinechangeschanges

NNo fear of dangero fear of danger

IInsensitive to painnsensitive to pain

NNo eye contacto eye contact

GGiggling or silly laughingiggling or silly laughing


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Nursing InterventionsNursing Interventions

Environment:Environment:

safesafe

consistentconsistent

Encourage the client to participate for selfEncourage the client to participate for self--carecare Speak calmly when giving instructionsSpeak calmly when giving instructions

Use simple words or phrasesUse simple words or phrases

Repeat instructions as necessary.Repeat instructions as necessary. HaloperidolHaloperidol -- symptomatic relief forsymptomatic relief for

hyperactivity, stereotypical and selfhyperactivity, stereotypical and self--destructivedestructive

behaviorbehavior


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MENTALMENTAL

RETARDATIONRETARDATION


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Not a mental illness.Not a mental illness.

Problem of inadequate mental functioning.Problem of inadequate mental functioning.

Onset: 18Onset: 18

IQ below 70IQ below 70

Manifested by subManifested by sub--average intellectualaverage intellectual

functioning in:functioning in:

CommunicationCommunication

SelfSelf--carecare

Home livingHome living

Social skillsSocial skills

Health and safetyHealth and safety


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CausesCauses

HHIV/ AIDS / rubella infectionIV/ AIDS / rubella infectionAAlcoholic motherlcoholic mother

TThyroid deficiencyhyroid deficiency

EExcessive lead poisoningxcessive lead poisoning

DDamage to the brainamage to the brain


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NNeurological / neurodevelopmental impairmenteurological / neurodevelopmental impairment

EExact gestational age is not reachedxact gestational age is not reached

(premature)(premature)

OOpiate intoxicationpiate intoxication

NNutritional deficiency (lack in Folic Acid)utritional deficiency (lack in Folic Acid)

AAnoxianoxia

TToxemia (pregnancyoxemia (pregnancy--induced hypertension)induced hypertension) EEnvironmental factorsnvironmental factors

SSevere RH incompatibilityevere RH incompatibility


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LevelsLevels

Mild/moronMild/moron

IQ: 51IQ: 51--7070

Difficulty adapting to schoolDifficulty adapting to school

EducableEducable needs assistanceneeds assistance

Moderate/ImbecileModerate/Imbecile

IQ: 36IQ: 36--5050

Poor awareness of needs of othersPoor awareness of needs of others

TrainableTrainable needs moderate supervisionneeds moderate supervision


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Severe/IdiotSevere/Idiot

IQ: 20IQ: 20--3535

Unable to learn academic skills with poorUnable to learn academic skills with poormotor development and minimal speechmotor development and minimal speech

Needs complete and close supervisionNeeds complete and close supervision

ProfoundProfound

Below 20Below 20

Has minimal capacity for sensorimotorHas minimal capacity for sensorimotorfunctionfunction

Needs custodial care with a totally structuredNeeds custodial care with a totally structured

environmentenvironment


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Nursing DiagnosisNursing Diagnosis: Self: Self--care deficitcare deficit


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Principles ofNursing CarePrinciples ofNursing Care

Protective careProtective care

Education of the familyEducation of the family

Their involvement is an important factorTheir involvement is an important factorin the plan of care to promote progressin the plan of care to promote progress

and to minimize the stress.and to minimize the stress.

RepetitionRepetition

Role modelingRole modeling

RestructuringRestructuring


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ATTENTION DEFICITATTENTION DEFICIT

HYPERACTIVITY DISORDERHYPERACTIVITY DISORDER


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Common in boysCommon in boys

Usually diagnosed before age 7Usually diagnosed before age 7

Problems:Problems:

InattentionInattention

HyperactivityHyperactivity

ImpulsivityImpulsivity


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OObstinacybstinacy

NNegativismegativism

EEgocentrismgocentrism

FFighting syndromeighting syndrome

AAggressivenessggressiveness

TTolerance is lowolerance is low


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DDifficulty concentratingifficulty concentratingEExcessive talkingxcessive talking

FFidgetingidgeting

IInterrupt/intrudes on othersnterrupt/intrudes on others

CChild exhibits hyperactivityhild exhibits hyperactivity

IIndulges in destructive behaviorndulges in destructive behaviorTTemper tantrumsemper tantrums


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Nursing DiagnosisNursing Diagnosis: Potential for injury: Potential for injury


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Principles ofNursing Care:Principles ofNursing Care:

Provide nutrition and safetyProvide nutrition and safety Environment:Environment:

structuredstructured

enable appropriate reaction to theenable appropriate reaction to theenvironmental stimulienvironmental stimuli

Plan a firm and consistent environment inPlan a firm and consistent environment in

which limits and standards are set.which limits and standards are set.

Drug of choiceDrug of choice:: MethylphenidateMethylphenidate

(Ritalin)(Ritalin)


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11. eye anxiety,personality

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