1. The Client Experiencing Anxiety
Chapter 12
The Client Experiencing Anxiety

2. Anxiety Universal human experience Autonomic response
Includes subjective feelings of dread
Physical symptoms:
Increased heart rate
Increased blood pressure
No specific source or reason
State when person feels strong sense of dread, accompanied by physical symptoms of Increased heart rate, elevated blood pressure without having source or reason for emotion

3. Fear Like anxiety: Focused on specific object or event
Autonomic response
Includes subjective feelings of dread
May include same physical symptoms
Focused on specific object or event

4. Stages of Anxiety
Mild anxiety-day to day tensions and is alert, with increased perceptual field
May be useful. Motivational
Moderate anxiety-narrowed perceptual field
Focuses on immediate concerns
Severe anxiety focuses on specific detail
Reduced perceptual field
Panic-feelings of dread or terror
Causes disorganization of personality
(continued)

5. Anxiety Disorders Distinct from normal anxiety
Interfere with ability to function in daily life
Six are particularly important p 215 (12.2)
General anxiety disorder, panic disorder, agroaphobia, phobia, obsessive compulsive disorder, PTSD

6. Generalized Anxiety Disorder
Anxiety focused on variety of life events or activities; excessive when occurs more days than not for more than 6 months; DX of exclusion
Symptoms:primary-excessive dread or anxiety (3 or more of symptoms.
Restlessness
Fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
DSM difficult to control and causes significant distress or impairment in functioning

7. Panic Disorder
Episodes of intense anxiety that begins abruptly and peaks within 10 minutes
Symptomsat least 4 of these
Palpitations
Trembling
Shortness of breath
Fear of losing control
Fear of dying; numbing/tingling, chills, altered reality. Strong association between panic disorder and major depressive disorder; commonly in young people with onset common between adolescence and mid-thirties; could be genetic component.
Have a higher risk of suicide than does non-affected population

8. Agoraphobia
Acute anxiety and fear in any setting from which individual may have trouble escaping; fear of crowds (or being home alone)
Symptoms:
Avoidance of anxiety-provoking situations
Avoidance of going out therefore they become homebound
Linked with panic disorder

9. Phobia
Persistent, irrational, excessive fear of specific object or situation (social phobias are referred to social anxiety disorder)
Symptom: experiences severe anxiety when under social stress ie: speaking or performing in public
Interference with life activities
Intervention: social skills training and exposure to social situations
DSM –fear must be excessive or unreasonable; must be recognized as such by phobic individual and must result in significant social, occupational or academic disruption. Repeated exposure leads to diminishing of anxiety.; common stereotypes show women are twice as likely to have symptoms of specific phobia than men

10. Obsessive-Compulsive Disorder
Recurrent thoughts coupled with repetitive actions or behaviors
Cannot stop thoughts or behaviors
Symptoms:
Repetition of behaviors that individual recognizes as unreasonable, intrusive and inappropriate and cause marked anxiety and distress
Use of compulsive behavior relieve the anxiety
Begin in young people during adulthood or before; for people resistant to drugs, neurosurgical procedures include reversible deep brain stimulation using implanted electrodes and a pacemaker like device

11. Post-Traumatic Stress Disorder
Re-experience of significant, life-threatening event; anxiety disorder that occurs after a frightening event, most often an accident, crime or battle
Symptoms:
Dreams
Hallucinatory-like flashbacks
Impairment of social functioning; persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (APA,2000)
Commonly seen in military situations
Half recover within 3 months but others continue for a year or more
Pts exposed to provoking stimuli have greater activation of the amygdala and DECREASED activation of cortical brain centers that normally suppress amygdala activity

12. Causes of Anxiety Disorders
Infantile conflicts involving sexual development
Adversity- a measure of how strong a given stimulus for anxiety is.
Trait anxiety- is an abstract but measurable personality characteristic based on the everyday observtion that some quite normal individuals appear to experience more anxiety than others.
Occur in response to environmental stimuli

13. Treatment of Anxiety Disorders
Psychotherapy
Insight-based or behaviorally based treatment for pts highly motivated and symptoms are not crippling; psychoanalysis is best known insight therapy; behaviorally the clients can learn to identify the common stimuli that cause anxiety, develop plan to respond to stimuli and problem solve when situations arise.Emergency TX is help person cope and prevent PTSD
Pharmacotherapy p 229 and NIH booklet—know meds
Combination therapy- meds and psychotherapy

14. Nursing the Anxious Client
Build trust
Model client’s world
Be accepting of client’s world and assure along the way

15. Assessment Begin with objective information
E.g., increased pulse, increased blood pressure, respiratory rate, etc.
Ask about cognitive responses
E.g., ability to concentrate, disorientation, etc.

16. Nursing Diagnosis Will address human response to disorder
See pg 234 and forward to read care plans.

17. Outcome Identification
Based on realistic outcomes
Set goals in collaboration with client
May take weeks or months for improvement

18. Planning/Interventions
Establish trust
Use therapeutic listening
Establish positive nurse-client relationship
Understand and accept symptoms as real
Implement specific interventions directed toward alleviating symptoms

19. Evaluation Ask: Have expected outcomes been achieved?
Are expectations realistic?