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Anxiety
Chronic
| Question | Answer |
|---|---|
| anxiety | is a response arising in anticipation of a perceived or actual threat to oneself or significant relationships; mental uneasiness, apprehension, dread, foreboding, and feelings of helplessness; occurs during an everyday situation |
| free floating anxiety | characterized by excessive worry that is hard to control and whose focus may shift from moment to moment; not connected to a specific stimulus |
| neurotransmitters most closely involved w/ anxiety | GABA, nor-epinephrine, serotonin |
| GABA | calms firing nerves in the CNS; high levels improve focus; low levels cause anxiety; also contributes to motor control and vision |
| norepinephrine | affects attention and responding actions in the brain and involved in fight or flight response; contracts blood vessels, increasing blood flow |
| serotonin | contributes to well being and happiness; helps sleep cycle, and digestive system regulation; affected by exercise and light exposure |
| amygdala | "emotional brain" ; focus of much research related to feelings of anxiety, fear, and anger, which are elicited in this area |
| hippo-campus | stores memory related to fear |
| locus coeruleus | produces anxious behaviors |
| brain stem | heart rate and respirations are controlled |
| frontal cortex | assists with appraisal of a threat and is the center of cognitive processes |
| thalmus | integrates all sensory stimuli |
| basal ganglia | responsible for tremors associated with anxiety |
| risk factors | dysregulation of neurotransmitters such as serotonin, nor-epinephrine, GABA, and a neuropeptide known as cholecystokinin; childhood adversity, witnessing/experiencing trauma, Fam. Hx of anxiety disorders, social factors, serious or chronic illness, personality factors, multiple stressors |
| prevention | may include journaling, avoid unhealthy substance use |
| anxiety disorders | excessive, irrational fear and dread, worry, muscle tension; ANS stimulation |
| chronic anxiety may result in physical symptoms | constipation, diarrhea, epigastric distress, heartburn, musculoskeletal aches and pains |
| GAD (generalized anxiety disorder) | go through their days filled with intense tension and worry, even if no external stressors are present; worrying is out of proportions to stressor; interferes with daily functioning, and occurs for at least 6 months |
| GAD manifestations | difficulty relaxing, startle easily, trouble falling asleep, somatic symptoms include aches, muscle tension, fatigue, HA, digestive issues, irritability, feeling out of breath, hot flashes, sleep disturbances |
| Panic Disorder | characterized by sudden attacks of terror, sometimes accompanied by pounding heart, sweating, fainting, dizziness, feeling flushed or chilled, hands may tingle or become numb, nausea, chest pain, breathlessness, sense of unreality, fear of impending death, terror; usually last around 10 minutes |
| phobias | experience intense, persistent fear or anxiety associated with a particular object or situation, called a stressor, and tend to avoid that stressor at all costs. contact with the stressor causes severe panic |
| mild-moderate | still able to teach |
| mild anxiety manifestations | increase in sensory perception and arousal; increase in alertness; sleeplessness; increase in motivation; restlessness and irritablity |
| moderate anxiety manifestations | narrowing of perceptual field and attention span; reduction in alertness and awareness of surroundings; feeling of discomfort and irritability, self-absorption, increased restlessness, increase in RR, HR, muscle tension; increase in perspiration; rapid speech, louder tone, and higher pitch |
| Severe anxiety manifestations | perceptual field greatly reduced, difficulty following directions, feelings of dread, horror, need to relieve anxiety, HA, dizziness, nausea, trembling, insomnia, palpitations, tachycardia, hyperventilating, diarrhea |
| panic manifestations | inability to focus, perception distorted, terror, feelings of doom, bizarre behavior, dilated pupils, trembling, sleeplessness, palpitations, pallor, diaphoresis, muscular in-coordination, immobility or hyperactivity, incoherence |
| Mild anxiety clinical therapies | typically resolved by an individuals coping mechanisms. may be helpful to accentuate focus and concentration Pt. who are distressed may benefit from sleep hygiene , relaxation techniques, behavior therapy, massage, aromatherapy |
| moderate anxiety clinical therapies | cognitive and behavior therapy to identify triggers and learn improved coping techniques; integrative therapies such as yoga, acupuncture, massage; low dose anti-anxiety medications if symptoms don't improve with other therapies or if the medications exacerbate chronic conditions |
| severe anxiety clinical therapies | perceptual field greatly reduced; difficulty following directions; feelings of dread, horror; need to relieve anxiety; HA, dizziness, nausea, trembling, insomnia; palpitations, tachycardia, hyperventilating, diarrhea |
| Panic clinical therapies | immediate structured intervention required; immediate therapies include the following: place in a quiet environment, use of repetitive task to diffuse energy, administer meds long-term therapy include: psychotherapy, pharmacologic therapy, relaxation techniques, improved sleep hygiene, integrative health, nutrition consultation, mental health counseling |
| Benzodiazepines (alprazolam) | potentiate the effect of the naturally occurring inhibitory neurotransmitter GABA, leading to promotion of relaxation and a decrease in the subjective experience of anxiety |
| Benzo. Nursing Considerations | not rec. for long-term use bc of habit-forming properties monitor for excess sedation and dizziness use cautiously in Pt. w/ impaired hepatic function and monitor LFTs councel Pt. to avoid alcohol in combination with these meds |
| Non-benzodiazepines (buspirone) | some act as a dopamine agonist in the brain and also inhibit serotonin reuptake producing antianxiety effects |
Created by:
melsniv
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