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What is anxiety?
- -Defined as a vague feeling of dread
- -Unwarranted by the situation
- - Accompanied by feelings of uneasiness and apprehension
What is the difference between Anxity vs Fear?
With fear, there is something or someone that is dangerous
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
- -The client is able to focus on task at hand but forget multi-tasking!
- -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
Nursing considerations with mild anxiety
- -Are they following what you are saying?
- -Speak in short, simple, and easy-to-understand sentences
- -Teach relaxation and coping skills
- -Redirect client prn, based on feedback
- -Focus on coping and problem-solving
What is the Nursing Goal for Patients with anxiety?
To prevent client’s anxiety from worsening or progressing
what are some symptoms of severe anxiety?
- -Perceptual field is further reduced—sees one detail or scattered details
- -Cannot complete tasks, solve problems, or learn new material
Snapshot of a person experiencing severe anxiety
- -Cannot relieve their anxiety
- -Sense of awe, dread, or horror
- -Ritualistic behavior
- -Trembling, pale, crying
- -Chest pain
- -Nausea, vomiting, diarrhea
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
- If they cannot sit still, walk with them
- Encourage deep, even breaths
- Provide structure—consider exercise
What are some 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 runCould be suicidal
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)
Medications for short-term anxiety disorders-anxiolytic drugs
- Diazepam (valium)
- Chlorazepate (tranxene)
- Alprozolam (xanex)
- Chlordiazepoxide (librium)
- Clonazepam (klonopin)
- Lorazepam (ativan)
- Oxazepam (serex)
- Buspirone (BuSpar)
Chronic anxiety disorders
- Symptoms no longer serve as a signal of danger
- Condition has become chronic
- Adversely affects the client’s functioning—socially, occupationally.
- Maladaptive behavior
- Represents an emotional disability
What are some Anxiety disorders?
- Panic, with or without agoraphobia
- Phobia (social or specific)
- disorder (OCD)
- Generalized anxiety disorder
- Posttraumatic stress disorder (PTSD) and Acute stress disorder
- Dissociative Disorders
- Anxiety due to a medical condition
- Substance-induced anxiety disorder
What are some Biological theories about anxiety disorders?
- Genetic—inherited tendencies—moderate heritability
- GABA deficient
- Excess norepinephrine
- Serotonin imbalances
What are some Psychodynamic theories of anxiety disorders?
- Overuse of defense mechanisms
- “Learned” behavioral responses
Treatment of anxiety disorders
- Medications (anxiolytic,antidepressants, and/or beta blocker drugs)
- Cognitive-behavioral therapy
What is cognitive behavior therapy?
- Cognitive behavior therapy uses treatment and methods such as positive reframing to assist in changing one’s maladaptive behavior.
- The therapist initially works with the client making them aware of their negative thinking and how it affects personal feelings and behaviors.
What are some Examples of methods used in cognitive behavioral therapy?
- Positive reframing
- Positive coping statements
- Decatastrophizing Assertiveness training
What is an example of Positive Reframing
”This is anxiety, it will go away”
What is an example of Positive coping statements or Positive Self-talk?
“I’ve done this before (passed tests), I can do it again.”
What are some exmaples of Decatastrophizing?
- What’s the worst thing that could happen?
- Distraction to stop the negative thoughts or actions
What are some examples of Assertiveness training?
- Helps the client assume control over life and situations
- Uses “I” to frame their concerns, needs, and feelings to others
- “I feel angry when you do not listen to me and leave the room when I am speaking”
What are some Strategies for dealing with stress?
- Stay positive
- Realize there are certain things you cannot control
- Communicate assertively
- Learn to relax
- Eat well balanced meals
- Regular exercise
- Limit caffeine and alcohol
- Get enough rest and sleep
- Set realistic goals and expectations
- Learn progressive relaxation, imagery, journaling, meditation
Goals for stress management
- Manage your symptoms—do not allow them to mange you.
- Be pro-active to decrease stressors
- Consider use of medications short-term
- Become proficient with non-pharmacologic strategies
- Learning and teaching progressive muscle relaxation, guided imagery, and assertiveness training
The Relaxation Response
- Based on the premise that a physical state of deep rest counteracts the body’s fight or flight responses.
- 1.The client exerts deliberate tension to a muscle group followed by….
- 2.Subsequent relaxation of that muscle group resulting in muscle relaxation as the tension ebbs away
- 3.Controlled breathing increases the effectiveness of the process
What is the Procedure for progressive muscle relaxation
- Step One—sit in a comfortable place away from noise or distractions
- Step Two—clear your mind and focus on your breathing
- Step Three—clear your mind
- Step Four—take several “controlled breaths” (breathe in through your nose and out through your mouth very slowly)
Progressive muscle relaxation component
- Start with your hands and tense them for 8-10 seconds then release and relax the same area for 8-10 seconds
- Follow a progression with all body areas
- Arms, shoulders, neck…
- Forehead, eyes, jaw…
- Stomach, buttocks…
- Thighs, calves, feet, and toes…..
What are some Suggested verbal cues for relaxation procedure?
- It’s okay
- it go
- Stay calm
- Trust in God
- All things are passing
- *To assure success, practice twice a day for at least one week
What are some Precautions with relaxation therapy?
- If the patient has a history of muscle spasms, back problems, or serious injuries—current or in the past—special variations and consultations may be needed
- The relaxation response may produce orthostatic hypotension
What is guided imagery?
The use of relaxation and mental visualization to improve mood and/or physical well-being.
What are some Benefits from guided imagery?
- Reduction of stress and anxiety
- Decrease pain
- Improved cardiovascular
- Enhanced healing
- Enhanced sleep and rest
- Improves self-confidence
- Assist in dealing with losses
- Special forms of imagery used with ,Healing,Pain control, and Mental rehearsal
What are some Precautions with guided imagery?
- May induce sleep or decrease reaction time
- Images may provoke negative visualizations
- Should be considered adjunctive therapy
What are some suggestions for guided imagery?
- Allow at least 15-20 minutes
- Wear comfortable clothes
- Dim the lights and close your eyes
- May use music, nature sounds, etc. during the process
- Avoid and remove all distractions
What are some techniques for guided imagery?
- Attain a relaxed state first
- May use deep-breathing or imagine you are climbing stairs and with each step you are more relaxed
- Imagery is most effective when the mind and the body are still
- Special place
- No interruptions
- Focus on details: sight, smell, sound, senery, overall mood
- Once you have arrived at your special place—Work through fears,Address uncertainties,Confront problems or challenges,Let it go, and Attain enlightenment
What is Assertiveness training?
Purpose—to increase control over life’s situations by communicating needs and fostering self assurance
Exercise in assertiveness training
- Write a sentence summarizing a recent stressful situation
- Write a sentence that assertively addresses the situation
- Use tact and diplomacy
What is Meditation?
- Making a choice to focus your mind on something