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ATI mental health ch 11: anxiety disorders

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1. Anxiety - normal anxiety is a healthy response to stress that is essential for survival
- Elevated or persistent anxiety can result in anxiety disorders causing behavior changes and impairment in
functioning.
- Anxiety disorders tend to be persistent and are often disabling
2. S/S of each level 1) Mild anxiety
of anxiety - restlessness
- increased motivation
- irritability
2) Moderate anxiety
- agitation
- muscle tightness
3) Severe anxiety
- inability to function
- ritualistic behavior
- unresponsive
4) Panic anxiety
- distorted perception
- loss of rational thought
- immobility
3. Anxiety disorders 1) Separation anxiety disorder
2) Specific phobias
3) Agoraphobia
4) Social anxiety disorder (social phobia)
5) Panic disorder
6) Generalized anxiety disorder (GAD)
4. Separation anxiety ● The client exhibits excessive levels of anxiety and concern when separated from someone to whom they have
disorder an emotional attachment, fearing that something tragic will occur resulting in permanent separation.
● The client's anxiety disrupts the ability to participate in routine daily activities.
● Physical manifestations of anxiety develop during the separation or in anticipation of the separation and
include headaches, nausea and vomiting, and sleep disturbances.
5. Specific phobias ● The client reports a fear of specific objects, such as spiders, snakes, or strangers.
● The client reports a fear of specific experiences, such as flying, being in the dark, riding in an elevator, or
being in an enclosed space.
● The client might experience anxiety manifestations just by thinking of the feared object or situation and might
attempt to decrease the anxiety through the use of alcohol or other substances.
6. Agoraphobia ● The client avoids certain places or situations that cause anxiety. This avoidance might disrupt the client's
ability to maintain employment or participate in routine activities of daily life.
● The client's fear and manifestations of anxiety are out of proportion with the actual danger of the place or
situation.
7. Social anxiety ● The client reports difficulty performing or speaking in front of others or participating in social situations due
disorder (Social to an excessive fear of embarrassment or poor performance.
phobia) ● The client might report physical manifestations (actual or factitious) in an attempt to avoid the social situation
or need to perform.
8. Panic disorder - Panic attacks typically last 15 to 30 min.
- Four or more of the following manifestations are present
during a panic attack:
◯ Palpitations
◯ Shortness of breath
◯ Choking or smothering sensation
◯ Chest pain
◯ Nausea
◯ Feelings of depersonalization
◯ Fear of dying or insanity
◯ Chills or hot flashes
- The client might experience behavior changes and/or persistent worries about when the next attack will
occur.
9. Generalized anxiety - The client exhibits uncontrollable, excessive worry for more than 3 months.
disorder - GAD causes significant impairment in one or more areas of functioning, such as work-related duties
- Manifestations of GAD include the following:
◯ Restlessness
◯ Muscle tension
◯ Avoidance of stressful activities or events
◯ Increased time and effort required to prepare for stressful activities or events
◯ Procrastination in decision making
◯ Seeks repeated reassurance
10. Obsessive compulsive 1) Obsessive compulsive disorder (OCD)
disorders 2) Hoarding disorder
3) Body dysmorphic disorder
11. Obsessive compulsive - The client attempts to suppress persistent thoughts or urges that cause anxiety through compulsive or
disorder (OCD) obsessive behaviors, such as repetitive hand washing.
- Obsessions or compulsions are time-consuming and result in impaired social and occupational
functioning.
12. Hoarding disorder - The client has an obsessive desire to save items regardless of value and experiences extreme stress with
thoughts of discarding or getting rid of items.
- The client's hoarding behavior results in social and occupational impairment and often leads to an unsafe
living environment.
13. Body dysmorphic - The client attempts to conceal a perceived physical flaw and practices repetitive behaviors, such as
disorder mirror checking or comparison to others, in response to the anxiety experienced over the perception.
- The client might have social and occupational impairment in response to the perceived physical defects
or flaws.
14. Anxiety disorders risk - More likely to occur in women. .
factors - Patients may experience anxiety due to an acute medical condition, such as hyperthyroidism or
pulmonary embolism. (It is important to assess the manifestations of anxiety in a medical facility to rule
out a physical cause)
- Adverse effects of many medications can mimic anxiety disorders.
- Substance-induced anxiety is related to current use of a chemical substance or to withdrawal effects
from a substance, such as alcohol.
15. Standardized screening - Hamilton Rating Scale for Anxiety
tools for anxiety - Fear Questionnaire (phobias)
disorders - Panic Disorder Severity Scale
- Yale-Brown Obsessive Compulsive Scale ● Hoarding Scale Self-Report
16. RN care for anxiety - Provide a structured interview to keep the patient focused on the patient
disorders - Assess for co-morbid condition of substance use disorder
- Provide safety and comfort to the patient during the crisis period of theses disorders as patients in sever to
panic level anxiety are unable to problem solve and focus
- Provide a calm, quiet environment
- Remain with the patient during the worst of the anxiety to provide reassurance
- Perform a suicide risk assessment
- Provide milieu therapy that employs the following -- 1) A structure environment for physical safety and
predictability 2) Monitoring for, and protection from self harm or suicide 3) Daily activities that encourage the
patient to share and be cooperative
- Use of therapeutic communication skills (such as open ended questions to help the patient express feelings of
anxiety and to validate and acknowledge those feelings
- Use relaxation techniques with the patient PRN for relief of pain, uncle tension and feelings of anxiety
- Instill hope for positive outcomes (but avoid false reassurance)
- Enhance patient self esteem by encouraging positive statements and discussing past achievements
- Assist the patient to identify defense mechanisms that interfere with recovery
- Postpone health teaching until after acute anxiety subsides
17. Medications for 1) Selective serotonin reuptake inhibitor(SSRI) antidepressants
anxiety disorders - sertraline
- paroxetine
*the first line of tx for anxiety and OCDs
2) Serotonin-norepinephrine reuptake inhibitor(SNRI) antidepressants
- venlafaxine
- duloxetine
*effective anxiety disorder tx
3) Antianxiety medications
- helpful in treating the manifestations of anxiety disorders
4) Benzodiazepines
- diazepam
*indicated for short term use
5) Buspirone
*effective when managing anxiety and can be taken for long term tx of anxiety
6) BBs & ntihistamines
*helps decreasing anxiety level
7) Anticonvulsant
*used as mood stabilizer for anxiety disorder patients
18. Therapuetic 1) Cognitive behavioral therapy
procedures for 2) Behavioral therapies
anxiety disorders - Relaxation training
- Modeling
- Systematic desensitization
- Flooding
- Response prevention
- Thought stopping
19. Cognitive - The anxiety response can be decreased by changing cognitive distortions.
behavioral therapy - This therapy uses cognitive reframing to help the client identify negative thoughts that produce anxiety,
examine the cause, and develop supportive ideas that replace negative self-talk
20. Behavioral **They teach patins ways to decrease anxiety or avoidant behavior and allow an opportunity to practice technique
therapies
1) Relaxation training
- is used to control pain, tension, and anxiety. Refer to the chapter on Stress Management, which covers relaxation
training techniques.
2) Modeling
- allows a client to see a demonstration of appropriate behavior in a stressful situation. The goal of therapy is that the
client will imitate the behavior.
3) Systematic desensitization
- begins with mastering
of relaxation techniques. Then, a client is exposed to increasing levels of an anxiety-producing stimulus (either imagined
or real) and uses relaxation to overcome the resulting anxiety. The goal of therapy is that the client is able to tolerate a
greater and greater level of the stimulus until anxiety no longer interferes with functioning. This form of therapy is
especially effective for clients who have phobias.
4) Flooding
- involves exposing the client to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response.
This therapy is useful for clients who have phobias.
5) Response prevention
- focuses on preventing the client from performing a compulsive behavior with the intent that anxiety will diminish.
6) Thought stopping
- teaches a client to say "stop" when negative thoughts or compulsive behaviors arise, and substitute a positive thought.
The goal of therapy is that with time, the client uses the command silently.
21. Patient - Educate the client regarding identification of manifestations of anxiety.
education - Instruct the client to notify the provider of worsening effects and to not adjust medication dosages. (Warn the client
- anxiety against stopping or increasing medication without consulting the provider)
disorders - Assist the client to evaluate coping mechanisms that work and do not work for controlling the anxiety, and assist the
client to learn new methods (Use of alternative stress relief and coping mechanisms might increase medication
effectiveness and decrease the need for medication in most cases)

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