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ANXIETY DISORDERS

- Perceptual field is closed

 

o

Unable to solve problems

ANXIETY

o

Safety and survival is the main focus

- According to authors Kaplan and Sadock, anxiety is “a

o

SUICIDAL

diffuse, unpleasant, vague sense of apprehension”

- Hallucinations and delusions may occur

- It is often a response to an imprecise or unknown threat

- Anxiety is an alerting signal; it warns of impending danger

Nursing Intervention

and enables the individual to take measures to deal with

o

Reduce environmental stimuli

threat. The response to a threat is unknown, internal, vague,

o

Provide safety

or conflicting in origin

o

Stay with the client

o

Do not touch the client

LEVELS OF ANXIETY

o

GUIDE FIRMLY or Physically take control

o

RESTRAINTS if needed

- Mild (+1)

- Moderate (+2)

- Severe (+3)

-

Panic (+4)

MILD (normal tension of everyday life)

- Physiologic Response

ETIOLOGY OF ANXIETY DISORDERS

-

- Biochemical

- Neuroanatomic

- Psychodynamic

Genetic

o

Slight discomfort

CATEGORIES OF ANXIETY DISORDERS

o

Restlessness

- Panic Disorder

o

Tapping

- Obsessive-Compulsive Disorder (OCD)

- Non-physiologic Response

- Generalized Anxiety Disorder

o

Attentive

- Phopic Disorder

o

Impatient

- PTSD

o

Learning capacity increases

o

Alert

PANIC DISORDER

o

Perceptual field heightened

-

Sudden onset of intense apprehension, fear or terror THAT

o

Excited

LASTS FOR 15 to 30 MINUTES

o

Irritable

Nursing Intervention

Findings:

-

Intense fear

o

Listen

- Palpitations

o

Promote insight and problem solving

- Increased heart rate

o

Accept mild anxiety as normal

- SOB

o

Tolerate mild anxiety and benefit from it

- Choking sensation

MODERATE (focuses and responds to immediate problem)

- Physiologic (SNS) Response

o Increases PR, RR, Shakiness, Stuttering

- Selective inattention

- Difficulty concentrating

- Perceptual field decreased (narrowed)

- Slow pacing

- Only focuses on the problem without considering the surrounding

- Starts perspiring and has gastric distress

Nursing Intervention

- Calm and rational discussion

- Refocus attention

- Relaxation techniques

- Paresthesia

- Depersonalization

- Derealization

Nursing Interventions:

- Stay with the client

- Remove anxiety producing stimuli

- Intervene to protect client from acting out that may hurt himself or others, client is acting out because of fear.

- Brown Paper Bag for hyperventilation

- Anti-anxiety drugs

PHOBIC DISORDER

- Persistent or irrational fear of specific objects, activities, or situation that leads to loss of sense of security.

o

Deep breathing

Types

o

Crying

1. Agoraphobia fear of being alone, or in public places

o

Music

2. Social Phobia fear of public speaking in which public scrutiny

o

Exercise

may occur.

o

Yoga

3. Specific Phobia fear of specific object, animal, or situation

o

Meditation

- Zoophbia animals

o

Guided Imagery

- Nyctophobia dark

o

Tai Chi

- Genophobia dirt

- ORAL ANXIOLYTICS if needed

SEVERE (focus is on just part of a problem)

- Physiologic (SNS) Response

o Increases BP, Headaches, tremors, rigid posture, dry mouth, profuse sweating, hyperventilation

- Prepares for fight or flight

- May experience severe muscle tension

- LIMITED (greatly reduced) perceptual field, very frantic

- Focuses on part (details) of the problem ONLY

- Can’t decide

- Very confused inability to think abstractly

- RITUALISTIC BEHAVIOR (purposeless activities)

Nursing Intervention

- Listen

- Encourage expression of feelings to reduce pressure

- Reduce stimuli

- Use kind, firm SIMPLE DIRECTIONS

- Use TIMEOUT (seclusion)

- INTRAMUSCULAR ANXIOLYTICS if needed

PANIC (focuses on self)

- Physiologic Response

- Astraphobia storms, thunder & lightning

- Acrophobia height

- Claustrophobia enclosed places

- Pyrophobia fire

- Ochlophobia crowds

Nursing Interventions

- Gradually expose client to the feared object through SYSTEMATIC DESENSITIZATION

- FLOODING is an abrupt exposure to the feared object. The goal

is to rid the client’s phobia in one or two sessions

- Help client to describe her feelings prior to a response for a phobic object

- Help the client identify alternative coping strategies

o REFRAMING

- Practice relaxation techniques with the client

- Teach client about medications as part of the tx plan

o ANXIOLYTICS

OBSESSIVE-COMPULSIVE DISORDER (OCD)

- Is an anxiety disorder and is characterized by recurrent,

repetitive

unwanted

thoughts

(obsessions)

and/or

behaviors (compulsions)

- Repetitive behaviors are often performed with the hope of preventing obsessive thought or making them go away such as

o

Immobility or severe hyperactivity, cool, clammy skin,

o

Handwashing

pallor, dilated pupils, severe shakiness

o

Counting

o

Actual fight, flight, or freeze

o

Checking

- Out of control

o

Cleaning

o Has an irrational behavior, hysterical or mute

- Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.

Nursing Intervention

- Convey acceptance of the client, despite ritualistic behavior

- Insomnia

- OCD

- Depression post traumatic stress disorder

- Muscle spasms and seizures

-

Alcohol withdrawal

o

Allow client time to perform rituals

ACTION

o

Encourage limit setting on ritualistic behaviors as part of the established tx plan (DIVERSIONAL THERAPY)

-

Action of the drug is to enhance the action of GABA, decrease the firing rate of neurons resulting in lowering of anxiety.

o

Encourage expression of feelings

 

- Keep a journal

 

BENZODIAZEPINE

   

o

Assist client in listing all of the objects and places that triggers anxiety as part of exposure-response prevention program

XANAx

Alprazolam

KloNOPIN

Clonazepam

- Teach client about medications as part of the tx plan

VAlium

Diazepam

o

Anafranil and Luvox to control symptoms

LIBRIum

Chlordiazepoxide

 

SERAx

Oxazepam

POST TRAUMATIC STRESS DISORDER (PTSD)

TRANXene

Clorazepam

-

Characterized by re-experiencing of an extremely traumatic event that is outside the range of usual human experience.

NON-

BENZODIAZEPINE

-

Traumatic events is usually re-experienced as flashbacks, nightmares.

BUSpar

Buspirone

 

AMbien

Zoldipem

Findings

-

Feeling of isolation and detachment

Adverse Effects:

-

Difficulty in sleeping

 

1. Diminished mental alertness

 

-

Depression

2. Dizziness

-

Violent Outburst of anger

 

3. Drowsiness

 

Caution about driving

 

Nursing Intervention

 

Caution about operating hazardous activity

- Promote ct safety

*Drop in BP of 20 mmHg (systolic) warrants withholding the

o

Discuss self-harm thoughts

 

drug and notifying the physician.

 

o

Develop plan with client to go to safe place when having destructive thoughts and impulse

 

Symptoms

 

Management

- Help cl to cope with stress and emotions

Acute/Common

 

o Use grounding techniques to help ct who is dissociating or experiencing flashbacks

Drowsiness

 

Help with activity caution when using machinery

- Distraction techniques

 

Ataxia

 

Caution with activity; prevent falls

o

Physical exercise

Listening to music

Feelings of

 

Discourage social isolation

o

detachment

o

Talking with others

   

Observe carefully; offer support, Be alert for disinheriting of control over socially unacceptable impulse

o

Engaging in a hobby

Increase irritability

o

Make a list of activities and provide materials close at hand

and hostility

- Help ct promote self esteem

 

Anterograde

amnesia

 

Inability to recall event that occur while the drugs is active

o

Refer client as “survivor” and not a “victim”

o

Make a list of people and activities in the community for client to contact when he/she needs help

Rare

 

o

Protect the ct from acting out violently with disregard for safety to self or others

Assist the ct in developing new adaptive coping skills.

Increased

o

appetite/ weight

gain

 

Weight control measure

GENERALIZED ANXIETY DISORDER (GAD)

Nausea

 

Dose with meals, decrease dose

Headache

 

Usually respond to mild analgesic

- Characterized

by excessive, uncontrollable and often

Confusion

 

Decrease dose

Benzodiazepine Withdrawal Syndrome

 
 

irrational

worry

about

everyday things that is

disproportionate to the actual source of worry.

- This excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are overly concerned about everyday matters such as

Mild symptoms

Severe symptoms

1. Insomnia

1. Diarrhea

2. Dizziness

2. Hyperthermia

 

o

Health issues

 

3. Headache

3. Seizure

o

Money

4. Tinnitus

4. Hypotension

o

Death

5. Anorexia

5. Psychosis

o

Family problem

 

6. Vertigo

o

Friend problems

7. Agitation

8. Anxiety

 

o

Relationship problems

o

Word difficulties

 

Findings

- Fatigue

- Fidgeting

- Headache

- Nausea numbness in hands and feet

- Muscle tension

- Muscle aches

- Difficulty swallowing

- DOB

- Difficulty concentrating

- Trembling, twitching, irritability

- Sweating, insomnia

- Hot flashes and rashes

*These symptoms must be consistent and ongoing, persisting at least 6 months

Nursing Intervention

- SAME AS ANXIETY

MANAGEMENT OF ANXIETY DISORDER Anxiolytics Psychotherapy

ANTIANXIETY DRUGS USES -

Anxiety

PSYCHOTHERAPY

- Involves talking with a trained mental health professional to learn how to deal problems like anxiety disorders

O

Psychiatrist

O

Psychologist

O

Nurse therapist

O

Social worker

O

Counsellor

3 General Types of Psychotherapy

- Cognitive therapy helps the patient to gain insight of their irrational thoughts or faulty belief system

- Behavioral therapy thru systematic desensitization uses relaxation techniques and carefully planned exposure to the feared object or situation gradually to help individual overcome his fears and enable him to learn to control the anxious responses.

- Cognitive behavioral therapy helps the patient understand the patterns of thinking so that they can react differently to situations that cause anxiety.