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chapter 13

Anxiety disorders

QuestionAnswer
Anxiety is a vague feeling of dread or apprehension;it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms. threat to the ego.
Fear which is feeling of afraid or threatened by a clear identifiable external stimuls that represents danger to a peron
Anxiety disorders comprise a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiological responses.
stress the wear and tear that life causes on the body.
examples of stress causing events marriage, children, snakes, a new job, a new school, and leaving home.
General adaptation syndrome Alarm reaction stage resistance stage exhaustion stage
alarm reaction stage stress stimulates the body too send messages from the hypothalamus to the glands and organs to prepare for potential defense needs.
resistance stage the digestive system reduces fx to shunt blood to areas needed for defense;by flight, fight, or freezebehaviors
exhaustion phase occurs when the person has responded negatively to anxiety and stress: body stares are depleted or the emotional components are not resolved, resulting in continual arousal of the physiologic responses and little reserve capacity.
sympathetic nerve fibers "charge up" the vital signs at any hint of danger to prepare the bodys defense
Parasympathetic nerve fibers reserve this process and return the body to normal operating conditions until the next sign of threat reactivates the sympathetic response.
mild anxiety is a sensation that something is different and warrants attention. Sensory stimulation ^ and helps the person focus attention to learn,solveproblems,think,act,feel,and protect their self.often motivates people to make changes or to engage in goal-directed
moderate anxiety is the disturbing feeling that something is wrong, the person becomes nervous or agitated person can still process info, solve problems, and learn new things w/ assistance can be redirected.
severe anxiety and Panic more primitive survival skills take over, defense responses ensue, and cognitive skills dec significantly. person has trouble thinking and reasoning. pt becomes restless, pacing, irritable, angry. only cognitive process focus only on the persons defense.
what to do first when working w/ anxious pts assess the persons level of anxiety b/c that determines what interventions ae likely to be effective.
mild anxiety Tx requires no direct intervention
moderate anxiety Tx be certain that the clien is following what the nurse is saying. speak in short , simple easy to understand sentences. nurse must stop and assess if the pt is still following
Severe anxiety Tx goal is to lower pts anxiety to Moderate or mild before proceeing with anything else. remain with the client. talk to pt in low calm and soothing voice. help the pt take deep even breaths .
panic level anxiety Tx safety is primary concern. nurse must keep talking to pt in comforting manner. goto small quiet and non stimulating room, nurse should remain w/ the client.
Nurse must be aware of their own anxiety level, remaining calm and in control is essential if the nurse is going to work effectively with the client.
diagnosing anxiety disorders when anxiety no longer fx as a signal of danger or a motivation for needed change but become chronic and permeates major portions of the persons life , resulting in malsdaptive behaviors and emotional disability.
agroraphobia an anxiety about or avoidence of places or situations from which escape might be difficult or in which help might be unavailable
symptoms of agoraphobia avoids being outside alone or at home alone, avoids traveling in vehicles; impaired ability to work,difficulty meeting daily responsibilities(e.g. grocery shopping, or going to appts); knows response is extreme
panic disorder is characterized by by recurrent, unexpected panic panic attacks that cause constant concern. Panic attack is the sudden onset of intense apprehension, fearfulness or terror associated w/ feelings of impending doom.
symptoms of panic disorder a discrete episode of panic lasting 15-30 min w/ four or more of the following :palpitations, sweating, trembling, or shaking, SOB, choking or smothering sensation, chest pain or discomfort, nausea, derealization or depersonalization, etc pg 233
specific phobia is characterized by significant anxiety provoked by a specific feared object or situation, which often leads to avoidence behavior
symptoms of specific phobia marked anxiety response to the object or situation, avoidance or suffered endurance of object or situation; ignificant distress or impairement of daily routine, occupation, or social functioning;adolescents and adults recognize their fear as excessive.
social phobia is characterized by anxiety provoked by certain types of social or performance situations, which often leads to avoidance behavior
symptoms of social phobia fear of embarrassment or inability to perform; avoidance or dreaded endurance of behavior or sitation; recognition that response is irrational or excessive;belief that others ae judging them negatively; significant distress or impairment in relationships
obsessive- compulsive disorder involves obsesions( thoughts, impulses, or images) that cause marked anxiety or compulsions ( repetitive behaviors or mental acts) that attempts to neutralize anxiety
symptoms of OCD recurrent persistant unwanted intrusive thoughts impulses or images beyond worrying about realistic life problems attempts to ignore suppress or neutralize obsessions w/ compulsions that are mostly ineffective.
generalized anxiety disorder GAD is characterized by at least 6 mon of ersistant and excessive worry and anxiety
sympptoms of (GAD) apprehensive expectations more days than not for 6 mon or more about several events or activities; uncontrollable worrying; significant distress or impaired social or cooupational fx & 3 of the following symptomsrestlessness, easily fatigued,pg233
acute stress disorder the dev of anxiety, dissociation, and other symptoms w/i 1 mon of exposure to an extremely traumatic stressor; it lasts 2 days -4wks.
symptoms of acute stress disorder exposure to traumatic event causing intense fear, helplessness, or horror, marked anxiety symptoms or ^ arousal; significant distress or impaired fx ; persistent reexperiencing of the event &3 of the following emotional numbing detachment feeling dazed
PTSD is characterized by the reexperiencing of an extremely traumatic event, avoidance of stimuli associated w/ the event, numbing of responsiveness and persistent ^ arousal ; it begins w/i 3 mon - years after the event and may last a few months or years
NE role in Anxiety disorder an excessof NE is suspected in panic disorder GAD and PSTD
Freud saw a person's innate anxiety as the stimulus for behavior, he described defense mechanisms as the humans attempt to control awareness of and to reduce anxiety
defense mechanisms are cognitive distrotions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort and to deal with stress.
over use of defense mechanisms stops them from learning a variety of appropriate methods to resolve anxiety producing situations
harry stack sullivan viewed anxiety as being generated from problems in interpersonal relationships
behavioral theorists view anxiety as being learned through experiences. people can change or "unlearn" behaviors through new experiences.
treatment for anxiety disorder cognitive-behavioral therapy is used successfully to treat anxiety disorder. Positive reframing means turning negative messages into positive messges into positive messages.
decatastrophizing involves the therapists use of questions to more realistically appraise the situation. "whats the worse thing that can happen"
assertiveness training helps the person take more control over life situations. negotiate interpersonal situations and foster self assurance. they involve using "I" statements to identify feelings and to communicate concerns or needs to others.
elder considerations anxiety that starts for the first time in late life is frequently associated w/ another condition such as depression, dementia, physical illness, or medication toxicity or withdrawl, phobias, particularly agoraphobia, and GAD ar the most common.
Tx for anxiety in elderly (SSRI)selective serotonin reuptake inhibitor
tips for managing stress Keep a positive attitude and believe in yourself. accept there are events you cannot control. communicate assertively w/ otherstalk about your feelings to others and express your feelings through laughing crying and so forth. learn to relax. exercise reg.
panic disorder is composed of discrete episodes of panic attacks, that is 15-30 min of rapid, intense, escalating,anxiety in which the person experiences great emotional fear as well as physiological discomfort.
panic disorder diagnosed when when the person has recurrent, unexpected panic attacks that followed by at least 1 mon of persistent concern or worry about future attacks or their meaning or a significant behavioral change related to them.
primary gain is the relief of anxiety acheived by performing the specific anxiety-driven behavior such as staying in the house to avoid the anxiety of lesvinga safe place.
secondary gain is the attention received from others as a result of these behaviors.
Tx for panic disorder conitive behavioral techniques. deep breathing and relaxation, benzodiazepines, SSRI antidepressants, tricyclic antidepressants, and antihypertensives (Clonidine)
automatisms automatic unconscious mannerisms. ex tapping finger, jingling keys twisting hair. geared towards anxiety relief and ^ in frequence and intensity with the pts anxiety level.
interventions for panic disorder provide a safe enviroment and ensure clients privacy during a panic attack. remain with the pt during panic attack. help pt focus on breathing.talk to pt in a calm reassuring voice. teach client to use relaxation techniques.pg 239
client family edu rev breathing control,& relaxation techniques. discuss (+) coping strategies. encourage exercise. emphasizes the importance of maintaining prescribed medication and follow up. time management. maintain contact w/ community and support groups.
phobia is an illogical intense and persisitent fear of a specific object or a social situation that cause extreme distress and interferes w/ normal functioning.
3 categories of phobias Agoraphobia, specific phobia, social behavior.
agoraphobia fear of leaving a safe place
specific phobia irrational fear of an object or a situation
social phobia which is anxiety provoked by certain social or performance situations.
diagnosis of phobia made only when the phobic behavior significantly interferes w/ the person's life by creating marked distress or difficulty in interpersonal or
types of specific phobias natural enviromental, blood -injection phobia, situational phobia, animal phobia, others.
natural enviromental phobias fear of storms, water, heights , or other natural phenomena.
blood-injection phobias fear of seeing one's own or others' blood, traumatic injury, or am invasive medical procedure such as an injection
situational phobias fear of being in a specific situation such as on a bridge or in a tunnel, elevator, small room, hospital, or airplane
animal phobias fear of animals or insects(usually specific type; often this fear develops in childhood and can continue through adulthood in both men and women ; cats dogs are the most common phobic objects.
other types of specific phobias ex fear of getting lost while driving if not able to make all right turns(and no left) to get to one's destination
social phobias also known as social anxiety disorder, the person becomes severely anxious to the point of panic or incapacitation when confronting situations involving people.
fear is rooted in low self-esteem and concern about others' judgments.
Tx of phobias behavioral therapy, teaching relaxation techniques, setting goals, discussing methods to achieve those goals and helping the client to visualize phobic situations
systematic (serial)desensitization in which the therapist progressively exposes the client to the threatening object in a safe setting until the pts anxiety decreases.
flooding is a form of rapid desensitization in which a behavioral therapist confronts the client w/ the phobic object( either a picture or the actual object) until it no longer produces anxiety.
obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere w/ the interpersonal , social.or occupational function.
compulsions are ritualistic or repetetive behaviors r mental acts that a person carries out continually in an attempt to neutralize anxiety.
common compulsions checking rituals, counting rituals, washing and scrubbing, touching,rubbing,or tapping,hoarding, ordering, exhibiting rigid performance, having aggressive urges.
OCD is diagnosed only when these thoughts, images and impulses consume the person or he or she is compelled to act out the behaviors to a point at which they interfere w/ personal, social, and occupational function.
Tx of OCD madication and behavior therapy, exposure and response prevention.
exposure involves assisting the client to deliberately cnfront the situations and stimuli that he or she usually avoids.
response prevention focuses on delaying or avoding performance of rituals.
therapeutic communication the nurse encourages the client to talk about feelings and to describe them in as much detail as the client can tolerate
exposure and response therapy pt must be willing to engage in exposeure and response prevention. these are not techniques that can be forced on the client
nursing interventions for OCD offer encouragement, support and compassion. be clear w/ the client that you belive they can do it, encourage the pt to talk about feelings, obsessions and rituals in detail. gradually dec time for the client to carry out rituals. p246
client/ family teaching for OCD teach about OCD. review the importance of talking openly about obsessions, compulsions and anxiety. emphasize medication compliance as an important part of treatment. discuss necessary behavioral techniques for managing anxiety.
Created by: 661814337