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T/F Anxiety is contagious.
It's also subjective which means that each person is going to experience it differently.
What levels of anxiety are there?
- mild: present in day to day living, no effect on sensory input.
- moderate: focus only on immediate concern. will filter out all unnecessary sensory input/information.
- severe: focus in narrowed on a specific detail. Behavior is aimed at relieving anxiety. Will need direction ("take two deep breaths") in order to focus on other aspects.
- panic: severe disorganization, feelings of terror/dread, decreased ability to think, distorted perception of reality.
What is the GABA system and how does it relate to anxiety?
- Receptors in amygdala and hippocampus within limbic system (emotions)
- Has an inhibiting effect in firing rates of cells
- GABA reduces firing rate in areas of anxiety disorders
- Mechanism in some medications for anxiety
What mediates flight/fight?
What are some theoretical frameworks for anxiety?
- Psychoanalytic: conflict between id and superego
- Interpersonal: from the bond between infant and mother
- Behavioral: results when something interferes with goal attainment
- Biological: Brain chemicals regulate anxiety & body responds to sympathetic system
What are some precipitating factors for anxiety?
- Situational crisis
- Maturational crisis: event that is a normal part of growth and development.
- Threat to physical integrity
- Medical disorders
- Threats to self-esteem & body image
- Genetic makeup
What are the elements of coping?
- Defense mechanisms
- Coping responses
- Problem-solving ability
- Economic assets
- Supportive people
- Cultural & spiritual beliefs
What are some examples of poor coping strategies?
- Use of substances
- Can’t let go
- Victim behavior
- Gets stuck
See handout on defense mechanisms
What are some NANDAs for anxiety
- Cognitive responses
- Affective responses
- Behavioral responses
What are some possible nursing intervensions for anxiety?
- Keep patient safe
- Remain calm. Anxiety is contagious, and then it is probably self-perpetuating and exacerbating.
- Encourage verbalization in a 1:1 format
- Use distraction. Give them a task, visualization/imaging, refocus topic on something over which they have control, etc.
- Provide information
- Provide a quiet environment
- Discuss potential causes-precipitants
- Ask what they usually do to cope
- Assist with problem-solving
- PRN medication if needed
What are some techniques to deal with anxiety?
- Diet: carbs-->sleep, protein-->insomnia.
- Positive self-talk
What is Cognitive restructuring
A way of reframing a situation so that it does not cause anxiety.
Antianxiety medications and long-term medications for maintenance can help the process.
Limit use of chemical substances.
What are some interventions for preventing or mitigating severe anxiety and panic attacks?
- Remain calm and stay with patient. Have antianxiety meds ordered BEFORE THE ATTACK OCCURS!
- Isolate patient
- Decrease environmental stimulation
- Administer medication (Benzodiazepine for panic attack)
- Provide structure
- Be directive in instructions. "Sit down. Take a deep breath. Take another deep breath."
- Nonverbal intervention. Gentile touch, deep, relaxing breaths, slow monotone speech. Slow down incrementally until they are calm.
May take as long as 10 minutes to bring'em back down.