Anxiety & Anxiety Disorders

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Anxiety & Anxiety Disorders
2012-02-14 23:33:52
Anxiety Disorders

Anxiety & Anxiety Disorders
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  1. Anxiety is defined as...
    a vague feeling of dread
  2. Anxiety also is...
    Unwarranted by this situation

    Accompanied by feelings of uneasiness and apprehension.
  3. Anxiety vs. Fear
    With fear there is omething or somemone that is dangerous.
  4. General Adaptation Syndrome

    Alarm reaction stage:
    Adrenalin, norepinephrine release of glycogn stores.
  5. General Adaptation Syndrome

    Resistance stage:
    Blood is shunted AWAY from GI to heart, lungs, and muscles resulting in INCREASE oxygen and preparation for fight, flight or freeze.
  6. Possible outcomes of General Adaptation Syndrome:

    If a person adapts to stress, their body's responses..
    return back to normal
  7. Possible outcomes of General Adaptation Syndrome:

    If a person fails to adapt to stress they will experience...
    exhaustion, where the body's stores are depleted and the client has little or no reserve.
  8. Nursing considerations with mild anxiety:
    Client very susceptible to learning and solving problems, they are "eager for information".

    Educate, educate, educate!

    Teach stress management

    Emphasize problem-solving.
  9. What type of anxiety?

    The client is able to focus on task at hand but forget multi-tasking.
    Moderate anxiety
  10. What type of anxiety?

    They are selectively attentive and their perceptual field is decreased.
    Moderate anxiety
  11. What type of anxiety?

    Able to learn but not to their full potential.
    Moderate anxiety
  12. What type of anxiety?

    Nurse's role is more assistive, hands on and facilitative.
    Moderate anxiety
  13. What type of anxiety?

    Feedback from the client is useful
    Moderate anxiety
  14. Moderate Anxiety:
    • The client is able to focus on task at hand but forget multitasking.
    • They are selectively attentive and their perceptual field is decreased.
    • Able to learn but not to their full potential.
    • Nurse's role is more assistive, hands on and facilitative.
    • Feedback from the client is useful.
  15. Nursing considerations for moderately anxious client:
    • Are they following what you are saying?
    • Speak in short simply and eat to understand sentences.
    • Teach relaxation and coping skills
    • Redirect client PRN based on feedback.
    • Focus on coping and problem solving.
  16. Nursing goal when dealing with anxiety:
    To prevent client's anxiety from worsening or progressing.
  17. What type of anxiety?

    Perceptual field is further reduced - sees one detail or scattered details.
    Severe anxiety
  18. What type of anxiety?

    Cannot complete tasks, solve problems or learn new material.
    Severe anxiety
  19. Snapshot of a person dealing with severe anxiety:
    • Cannot relieve their anxiety
    • Sense of awe, dread or horror
    • Ritualistic behavior

    • Headache
    • Trembling, pale, crying
    • Vertigo
    • Chest pain
    • N/V/D
    • Tachycardia
  20. Nursing considerations for clients with severe anxiety:
    • The person with severe anxiety cannot focus or solve problems.
    • Remain with the person!
    • Talk in a low, calm and soothing voice.
    • I they cannot sit still, walk with them
    • Encourage deep even breathing.
    • Provide structure - consider exercise.
  21. What type of anxiety?

    Perceptual field focuses on self.
    Cannot process information
  22. What type of anxiety?

    May be mute
    Distorted perceptions could result in delusions or hallucinations
  23. What type of anxiety?

    May bolt or run
    Could be suicidal
  24. Symptoms of panic:
    • Perceptual field focuses on self
    • Cannot process information
    • May be mute
    • Distorted perceptions could result in delusions or hallucinations
    • May bolt or run
    • Could be suicidal
  25. Overview of panic:
    • Can involve the loss of rational thought.
    • Can result in loss of touch with reality
    • At risk for fight or flight.
  26. Nursing care for the client experiencing panic:
    • The person's safety is your primary concern!
    • Prevent harm.
    • Select a safe, quiet, and non stimulating environment.
    • Reassure the client that they are safe and the anxiety will pass.
    • Remain with them at all times until the panic has passed (5-30 minutes)
  27. Which level of anxiety?

    Slight physical arousal, sharp perceptions and able to learn/cognate.
  28. Which level of anxiety?

    Physical changes noted narrowed perceptual field, less attentive.
  29. Which level of anxiety?

    Physical symptoms increased, poor concentration, apprehensive.
  30. Which level of anxiety?

    Terror, have shut down, mentally but in adrenaline overload
    Dangerous and unpredictable behavior.
  31. Act like a "nurse".
    • Therapeutic verbal tone
    • Role model with relaxation and breathing techniques.
  32. Who identified the four levels of anxiety and nursing considerations of each level?
    Hildegard Peplau
  33. Medications for short term anxiety disorders - anxiolytic drugs
    • Benzodiazepines:
    • Diazepam (valium)
    • Chlorazepate (tranxene)
    • Alprazolam (xanax)
    • Chlordiazepoxide (librium)
    • Clonazepam (klonopin)
    • Lorazepam (ativan)
    • Oxazepam (serex)

    • Nonbenzodiazepines:
    • Buspirone (Buspar)
  34. Chronic anxiety disorders:
    • Symptoms no longer serve as a signal of danger
    • Condition has become chronic
    • Adversely affects the client's functioning - socially and occupationally
    • Maladaptive behavior
    • Represents an emotions disability
  35. Anxiety disorders:
    • Panic, with or without agoraphobia
    • Phobia (social or specific)
    • OCD
    • Generalized anxiety disorder
    • PTSD and Acute stress disorder
    • Dissociative disorder
    • Anxiety due to a medical condition
    • Substance induce anxiety disorder
  36. Biological Theories:
    Genetic, inherited tendencies, moderate in heritability

    • Chemical:
    • GABA deficient
    • Excess norepinephrine
    • Serotonin imbalances
  37. Psychodynamic theories:
    • Overuse of defense mechanisms
    • Learned behavioral responses
  38. Treatment of anxiety disorders:
    Medications (anxiolytic, antidepressants, and or beta blocker drugs)
  39. Uses treatment and methods such as positive reframing to assist in changing one's maladaptive behavior.
    Cognitive behavior therapy
  40. In cognitive behavior therapy
    The therapist initially works with the client making them aware of their negative thinking and how it affects personal feelings and behaviors.
  41. Methods used in cognitive behavioral therapy:
    • Positive reframing
    • Positive coping statements
    • Decatastrophizing
    • Assertiveness training
  42. "This is anxiety, it will go away"
    "It's gunna be ok, just gotta stay calm"
    Positive reframing
  43. "I've done this before (passed tests), I can do it again"
    • Positive coping statements
    • Positive self-talk
  44. What's the worst thing that could happen?

    Thought stopping
    Distraction to stop the negative thoughts or actions.
  45. "I feel angry when you do not listen to me and leave the room when I am speaking"
    Assertiveness training
  46. Assertiveness training:
    Helps the client assume control over life and situations.
  47. Uses "I" to frame their concerns, needs and feelings to others.
    Assertiveness training
  48. Goals for stress management:
    • Manage your symptoms - do not allow them to manage you
    • Be pro-active to decrease stressors
    • Consider use or medications short term.
    • Become proficient with non pharmacologic strategies.
  49. Mental health promotion for nurses and nursing students:
    Anxiety is a warning sign that you are not dealing with stress effectively.

    • Heed warning
    • Change coping skills