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I.

Definition Generalized anxiety disorder (or GAD) is characterized by excessive, exaggeratedanxiety and worry about everyday life events with no obvious reasons for worry. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worrying about health, money, family, work, or school. In people with GAD, the worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, and relationships.

II.

Etiology

The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry, and environmental stresses -- appear to contribute to its development. Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families. Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety. Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.

III.

Assessment and Findings

What Are the Symptoms of GAD? GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include: Excessive, ongoing worry and tension An unrealistic view of problems Restlessness or a feeling of being "edgy" Irritability Muscle tension Headaches Sweating Difficulty concentrating Nausea The need to go to the bathroom frequently Tiredness Trouble falling or staying asleep Trembling Being easily startled In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessivecompulsive disorder, and phobias), suffer from depression, and/or try to self-medicate by using drugs or alcohol.

How GAD diagnosed? If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical exam. Although there are no lab tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of symptoms. The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms -including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school. How GAD treated? How Is GAD Treated? If no physical illness is found, you may be referred to a psychiatrist or psychologist,mental health professionals who are specially trained to diagnose and treat mental illnesses like GAD. Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy. Medication: Drugs are available to treat GAD and may be especially helpful for people whose anxiety is interfering with daily functioning. The drugs most often used to treat GAD in the short-term (since they can be addictive) are from a class of drugs called benzodiazepines. These medications are sometimes referred to as "tranquilizers," because they leave you feeling calm and relaxed. They work by decreasing the physical symptoms of anxiety, such as muscle tension and restlessness. Common benzodiazepines include Xanax, Librium, Valium, and Ativan. Antidepressants, such as Paxil, Effexor, Prozac, Lexapro, and Zoloft, are also used to treat GAD. These antidepressants may take a few weeks to start working but they're more appropriate for long-term treatment of GAD. Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of therapy, in which you learn to recognize and change thought patterns and behaviors that lead to anxious feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically. In addition, relaxation techniques, such as deep breathing and biofeedback, may help control the muscle tension that often accompanies GAD. DRUG TYPE Antidepressants EFFECT

Slow down breakdown of acetylcholine, increasing the amount available for the functioning of the brain cells. Fast-onset-of-action. Have a muscle-relaxing and anxiety-relieving action, which produces calming effects. They may also be used to aid sleep. Reduce some of the physical symptoms of anxiety (such as increased heart rate, shakiness, or palpitations). Has a calming action by stimulating the brain. It may need to be taken for several weeks before the full benefit is seen

Benzodiazepines (minor tranquilizers) Beta Blockers

Buspirone

DRUGSTUDY
Generic Name Classific ation Dosage Action

Indication

Contraindic ation

Side effects

Nursing Consider ation

Benzodiaz epine

antihista mine

Brand Name: Benadryl

Capsule s: 25 and 50 mg. Tablets: 12.5, 25, and 50 mg. Strips: 12.5 and 25 mg. Elixir, oral solution , liquid: 12.5 mg per teaspoo n (5 mL). Suspen sion: 25 mg per 5 ml. Injectio n: 50 mg per ml

Benzodiaz epines work by increasing the efficiency of a natural brain chemical, GABA, to decrease the excitability of neurons. This reduces the communica tion between neurons and, therefore, has a calming effect on many of the functions of the brain.

Diphenhydra mine is an antihistamine used to relieve symptoms of allergy, hay fever, and the common cold. These symptoms include rash, itching, watery eyes, itchy eyes/nose/thr oat, cough, runny nose, and sneezing Can also be used to help you relax and fall asleep.

benzodiaze pines may cause respi ratory depression, For that reason, they are contraindic ated in people with > sleep apnea

Drowsiness, dizziness, cons tipation, stomach upset, blurred vision, or dry mouth/nose/thr oat may occur

Take meds as prescribe d Take with a full glass of water

>bronchitis,
>COPD

Monitor elevated ALT levels

Nursing cares to patient with Anxiety:

1. 2. 3. 4.

Help the patient establish a bedtime routine (e.g., reading a book, drinking a glass of warm milk). Encourage only as much activity and stimulation during the day as the person can tolerate without becoming excessively fatigued. Allow for rest periods or naps throughout the day. Relieved physical discomfort and emotional distress, which inhibit proper rest.

5. 6.

7. 8.

Judiciously administer sleep medications as prescribed to help the person sleep better. To mitigate anxiety and distress, listen to the person and encourage expression of feelings about the accident, surgery or injury. Answer questions honestly; avoid being overly pessimistic but avoid giving false hopes too. Keep the person informed about the progress of healing. Teach people to report signs and symptoms of complications. To increase independence, encourage and teach the person to participate in nursing cares, when possible. Recognize, too, that health care providers are not immune from strong reactions and feelings when confronted with people who have suffered massive injuries. Clinicians find it particularly difficult when the injury has just occurred and produces significant disfigurement. Finally, pay attention to the physiologic and psychologic needs of the whole person. Carry out a systematic plan of action to ensure that you meet all of the injured persons immediate needs. Try to accept the persons negative emotions, and also understand and accept your own.