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Mental Health Nursing: Anxiety Disorders
Stress Produces Anxiety
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Anxiety Disorders Objectives
At the completion of this unit you will be able to: Explain anxiety and five specific anxiety disorders Identify behavioral and physical manifestations of anxiety disorders Describe nursing care and treatment modalities for anxiety disorders
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Anxiety Disorders Stress and anxiety can be associated with both positive and negative situations
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Anxiety Disorders Eustress: stress associated with positive experiences. Stressor: any person or situation that produces anxiety. What is stressful to one person might be relaxing to another.
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Anxiety Disorders Anxiety is: A feeling of uneasiness or apprehension
A response to extreme or prolonged periods of stress An uncomfortable feeling of dread
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Anxiety may be influenced by one’s culture:
Anxiety Disorders Anxiety may be influenced by one’s culture: Some believe that personal problems should be kept to themselves Others believe it is therapeutic to acknowledge and discuss stress Machoism
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Anxiety Disorders Free-floating anxiety: a gut feeling that something bad may happen; feeling of impending doom. Stressor is not clear. Signal anxiety: A clear & known stressor causes stress & anxiety
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Anxiety Disorders In Children & Teenagers
Stress & Anxiety Indicators: Withdrawal from friends and usual activities Changes in eating habits Changes in sleeping patterns Decline in school performance
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Anxiety Disorders In Children & Teenagers
More than 50% of juveniles who are offenders of the law &/or are incarcerated also have a mental illness that is associated with anxiety and substance abuse.
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Anxiety Disorders Freud’s Psychoanalytic Theory
Unconscious forces act to determine personality & behavior Id: primitive drives, pleasure principle; i.e.: hunger, sex Ego: Rational & reasonable; buffer between the outside world & the id Superego: Conscious distinctions between right & wrong.
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Anxiety Disorders Freud’s Psychoanalytic Theory
Anxiety is caused by conflict between the id and the superego.
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Anxiety Disorders Sympathetic Nervous System Responses
Initiates the “fight or flight response” Epinephrine & norepinephrine are released. ↑ BP, ↑pulse, pupil dilation
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Anxiety Disorders Effects of chronic or uncompensated stress
Review Table 11-1 (p. 188)
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Anxiety Disorders Effects of chronic or uncompensated stress
Individuals with stress/anxiety are 2/3s more likely to develop cold and flu symptoms than those who are not.
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Anxiety Disorders Suppressed anger also has the same negative effects on general health. Chronic anger is frequently associated with chronic headaches.
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Anxiety Disorders Anxiety Types
Generalized Anxiety Disorder Excessive worry or stress that is related to 2 or > things & lasts > 6 months. Must show 6 or > symptoms of anxiety
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Anxiety Disorders Anxiety Types
Generalized Anxiety Disorder Symptoms: Nausea, dry mouth, muscle aches, restlessness, shakes, fatigue, polyuria, chills, hot flashes, sleep disturbances, dry mouth, nausea, vomiting, palpitations, difficulty swallowing
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Anxiety Disorders Anxiety Types
Generalized Anxiety Disorder Nursing Actions: Calm milieu, open communication, explore causes & effects of anxiety, encourage enjoyed activities, suicide precautions, document behaviors.
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Anxiety Disorders Anxiety Types
Panic Disorder Extreme fear that cannot be controlled. Panic Attack Agoraphobia Diagnosis requires 4 out of 12 DSM symptoms.
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Anxiety Disorders Anxiety Types
Common Symptoms of Panic Disorder Fear, dissociation, nausea, diaphoresis, chest pain, shaking, Increased pulse, unsteadiness Interventions: are the same as those for anxiety disorder
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Anxiety Disorders Anxiety Types
Common Symptoms of Panic Disorder
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Anxiety Disorders Anxiety Types
Phobia Most common anxiety disorder Irrational fear Individuals are aware that it is an irrational fear Estimated that 700 different things cause phobias
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Anxiety Disorders Anxiety Types
Phobia Arachnophobia Ophidiophobia
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Anxiety Disorders Anxiety Types
Phobia Subcategories Agoraphobia: fear of being in open spaces. Social phobia: fear humiliation in social situations Simple phobia: fear of a specific thing (i.e.: claustrophobia, hematophobia, acrophobia)
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Anxiety Disorders Anxiety Types
Obsessive-Compulsive Disorder (OCD)
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Anxiety Disorders Anxiety Types
Obsessive-Compulsive Disorder (OCD): 2 Parts Obsession: repetitive thought, urge, or emotion Compulsion: repetitive act that may appear purposeful Behaviors are ritualistic and occur to reduce anxiety Unable to stop the thought or action.
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Anxiety Disorders Anxiety Types
Obsessive-Compulsive Disorder The thought or action is a substitute for the source of anxiety. Individuals with this disorder tend to be rule-oriented and perfectionistic
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Anxiety Disorders Anxiety Types
Obsessive-Compulsive Disorder If the individual is prevented from performing the act, the anxiety converts into somatic symptoms.
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Anxiety Disorders Anxiety Types
Post-Traumatic Stress Disorder Develops in response to a emotional or physical trauma that could not be controlled.
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Anxiety Disorders Anxiety Types
Post-Traumatic Stress Disorder Common Causes Solders in war Rape victims Witnessed suffering Experienced the effects of violent acts or storms
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Anxiety Disorders Anxiety Types
Post-Traumatic Stress Disorder World Trade Center
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Anxiety Disorders Anxiety Types
Post-Traumatic Stress Disorder Survivor Guilt Guilt experienced by survivors of a traumatic event.
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Anxiety Disorders Anxiety Types
Post-Traumatic Stress Disorder Symptoms May appear immediately or be repressed for years. Flashbacks: reliving or acting out the traumatic event. Social Withdrawal Low self-esteem
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Anxiety Disorders Anxiety Types
Post-Traumatic Stress Disorder Symptoms (continued) Changes in relationships & difficulty forming new relationships Irritability and outbursts of anger with seemingly no obvious reason Depression Chemical dependency: self-medicating
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Anxiety Disorders Anxiety Types
Post-Traumatic Stress Disorder Nursing Interventions Communication & listening skills Develop a working rapport First step is important: encourage the patient to express thoughts & feelings about the traumatic event Help to identify the source Validate the patient’s feelings
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Anxiety Disorders Medical Treatment
Psychopharmacology Antianxiety Medications Benzodiazepines Strong potential for dependency Antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors
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Anxiety Disorders Antianxiety/Anxiolytic Medications
Uses: Treatment of anxiety, stress, mild depression, ETOH withdrawal, muscle relaxation Action: Depress activities of the cerebral cortex (CNS Depressant) Benzodiazepines: largest sub-category of anxiolytics
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Anxiety Disorders Anixolytics
Benzodiazepines: 1) Chlordiazepoxide (Librium) 2) Lorazepam (Ativan) 3) Diazepam (Valium) 4) Alprazolam (Xanax)
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Anxiety Disorders Benzodiazepines:
Side effects & Precautions: Fatigue, drowsiness, postural hypotension & ataxia Potential for physical & psychological dependence Confusion in the elderly Sleep pattern disturbance Potentiates ETOH and other narcotics
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Anxiety Disorders Medical Treatment
Psychotherapy Individual treatment Group therapy Systematic desensitization Counseling: concentrate esteem needs & reality
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Anxiety Disorders Alternative Interventions
Biofeedback Form of behavior modification Promotes relaxation
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Anxiety Disorders Alternative Interventions
Hypnosis Is a licensed profession Needs to be done routinely to be effective
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Anxiety Disorders Alternative Interventions
Aromatherapy Essential oils: aid in relaxation
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Anxiety Disorders Alternative Interventions
Teaching deep breathing and other relaxation techniques provides an avenue for individuals with an opportunity to manage their anxiety independently
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Anxiety Disorders Nursing Interventions
Maintain a calm milieu Minimizing stimuli helps the individual to focus and find their center. II. Encourage activities: should be of interest, enjoyable, and have meaning to the individual. Should not cause stress. Provide diversion; individual will think about something else.
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Anxiety Disorders Nursing Interventions
III: Maintain open communication: Encourage individual to verbalize feelings and thoughts. Show respect and encourage reflection to facilitate understanding themselves. Individuals need to feel that they have value. Observe affect & body language: reveal more about thoughts, esteem, attitudes, & feelings.
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Anxiety Disorders Nursing Interventions
Observe for suicidal thoughts: risk of suicide results from feelings of decreased self-worth and low self-esteem. Any statements made in relation to suicide need to be reported. Ask if they have a plan. Document changes in behavior: i.e.: they ways in which the individual responds to the nurse, to other people, to treatments, or in interactions.
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Anxiety Disorders Concluding Statements
Trust & communication techniques are important skills for the nurse. Interventions that facilitate a calm milieu are also important. Therapies and psychopharmacology should be individualized to the individual.
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Anxiety Disorders Closure
Table 11-2 (p. 194): Review common anxiety disorders Test Questions (p ) What is a therapeutic Milieu? (p. 126: lets read together)
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