2007-Anxiety Disorders

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Information about 2007-Anxiety Disorders

Published on December 17, 2008

Author: aSGuest6886

Source: authorstream.com

By Mercedes Perez-Millan, ARNP MSN : By Mercedes Perez-Millan, ARNP MSN Anxiety Disorders INTRODUCTION : INTRODUCTION Stress is…. Anxiety is…. Fear is…. Defense mechanisms… Coping mechanisms… LEVELS OF ANXIETY : LEVELS OF ANXIETY Mild Moderate Severe Panic Varcarolis Table 13-1 p. 214 ANXIETY DISORDERS THEORY : ANXIETY DISORDERS THEORY GENETIC BIOLOGICAL BIOCHEMICAL NEUROANATOMICAL ANXIETY DISORDERS THEORY- continued : ANXIETY DISORDERS THEORY- continued PSYCHOLOGICAL FREUD LEARNING COGNITIVE CULTURAL CONSIDERATION ANXIETY DISORDERS : ANXIETY DISORDERS PREVALENCE One of the most common type of psychiatric disorders in the USA Affecting 13.3% of Americans ages 18-54 years-old Produces considerable functional impairment and distress COMORBIDITY Major depression Substance abuse PANIC DISORDER (P.D.) : PANIC DISORDER (P.D.) Panic disorder (P.D.) Assessment Characterized by recurrent panic attacks, onset of which are unpredictable. Manifested by intense apprehension, fear, or terror associated with feelings of impending doom and intense physical discomfort. Panic Attack - Characteristics : Panic Attack - Characteristics “Flight and fight” symptoms Racing heart, chest pains, dizziness and nausea, chocking sensations, breathing difficulties, numbness and tingling, trembling and diaphoresis Feelings of having a heart attack Feelings of going crazy Fear of loss of control Decreased perceptual ability Decreased cognitive abilities Panic Disorder with Agoraphobia : Panic Disorder with Agoraphobia Assessment Characterized by same symptoms characteristic of panic disorder. In addition, affected person experiences a fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of a panic attack Generalized anxiety disorder (G.A.D.) : Generalized anxiety disorder (G.A.D.) Assessment Characterized by chronic, unrealistic, and excessive anxiety and worry lasting at least 6 mo.. Restlessness, fatigue, difficult concentrating, irritability, muscle tension, sleeping disturbances. Panic and G.A.D. Nursing Diagnosis : Panic and G.A.D. Nursing Diagnosis Panic level of anxiety related to real or perceived threat to biological integrity or self-concept. Powerlessness related to impaired cognition. Panic and G.A.D. Outcomes : Panic and G.A.D. Outcomes The client Is able to recognize signs of anxiety and intervene to prevent panic levels. Uses coping mechanisms to prevent panic anxiety when stressful situations occur. Verbalizes acceptance of life situations over which he or she has no control. Panic and Generalized Anxiety Disorder Planning/Implementation : Panic and Generalized Anxiety Disorder Planning/Implementation For severe or panic anxiety levels Stay with the client and provide support Reduce environmental stimuli Keep demands to a minimum Encourage physical activity like walking Administer meds in a timely manner Assist in relaxation breathing techniques Teach to limit nicotine, caffeine Promote sleep with comfort measures Slide 14: PHOBIAS A persistent irrational fear which is out of proportion to the object, activity or situation. Phobias Assessment : Phobias Assessment Specific phobia: Object or situation Animal Environment Blood, injection Situation Social Phobia: Assessment : Social Phobia: Assessment Excessive fear of a social situation or a performance situation in which the affected person might do something embarrassing or be evaluated negatively by others. Agoraphobia : Agoraphobia Fear of being in places or situation from which escape might be difficult or help might not be available. Phobias Nursing Diagnosis : Phobias Nursing Diagnosis Fear related to causing embarrassment to self in front of another, to being in a place from which one is unable to escape, or to a specific stimulus. Social isolation related to fears of being in a place from which one is unable to escape. Phobias Outcomes : Phobias Outcomes The client Is able to functions in the presence of the phobic object or situation. Uses coping mechanisms to maintain anxiety at a manageable level. Voluntarily attends group activities and interacts with peers. Phobias Implementation : Phobias Implementation Do not force client to be in contact with phobic object. Help the client describe feelings prior to a response to a phobic object Help identify alterative coping mechanisms to manage anxiety about encountering a phobic situation Practice relaxation techniques with client Obsessive-Compulsive Disorder (OCD) : Obsessive-Compulsive Disorder (OCD) Assessment data Recurrent obsessions or compulsions that are distressing and time-consuming and produce severe distress and impairment. Obsessions- Unwanted persistent thoughts Compulsions- Unwanted repetitive actions Rituals- Repetitive actions that the person must do over and over to decrease anxiety Obsessive-Compulsive Disorder (OCD) Nursing Diagnosis : Obsessive-Compulsive Disorder (OCD) Nursing Diagnosis Ineffective coping related to underdeveloped ego,… possible biochemical changes. Ineffective role performance related to need to perform rituals… Obsessive-Compulsive Disorder (OCD) Outcomes : Obsessive-Compulsive Disorder (OCD) Outcomes The client Is able to maintain anxiety at a manageable level. Identifies situations that produce anxiety and result in rituals. Able to use more adaptive coping strategies to deal with stress. Is able to function without the need for ritualistic behaviors. Obsessive Compulsive Disorder (OCD) Implementation : Obsessive Compulsive Disorder (OCD) Implementation Convey acceptance of the client, despite ritualistic behaviors. Allow time to perform rituals. Never interrupt a ritual! Encourage limit setting on ritualistic behaviors as part of the established treatment plan. Use active listening to encourage verbalization of feelings. The focus is in the development of more adaptive methods of coping with anxiety. Post-Traumatic Stress DisorderPTSD : Post-Traumatic Stress DisorderPTSD Reaction to a severe traumatic situation. Re-experiencing traumatic event, nightmares and “flashbacks” Experiences of persistent numbing of responsiveness, the person refuses to talk, feels detached or turned off by others. Avoidance of activities, people, events, or places arousing memories of the trauma. Increased anxiety, irritability, hypervigilance, difficulty concentrating, high startle response. Post-traumatic Stress Disorder Nursing Diagnosis : Post-traumatic Stress Disorder Nursing Diagnosis Post-trauma syndrome related to distressing event . Dysfunctional grieving related to loss of self… or others…after the event. Disturbed sleep pattern related to intrusive thoughts, fear. Post-traumatic Stress Disorder Outcomes : Post-traumatic Stress Disorder Outcomes The client Able to verbalize feelings and attend support group. Can identify goals for future. Includes significant others in the recovery process. Verbalizes no ideas or intent of self-harm. Identifies adaptive coping mechanisms and community resources. Gets enough sleep to avoid risk of injury. Post-traumatic Stress Disorder Planning/Implementation : Post-traumatic Stress Disorder Planning/Implementation Use implementations to reduce anxiety (see panic anxiety interventions). Validate for the client severity of trauma experienced. Help verbalize his thoughts and feelings. Teach about coping mechanisms and support groups. Refer to AA, NA if substance abuse is a problem. Anxiety Disorders : Anxiety Disorders Substance Induced-Symptoms of anxiety due to the use of a substance or within a month of stopping using it. General Medical Condition- Symptoms of anxiety are a direct physiological result of a medical condition. Client/Family Education : Client/Family Education Teach about Illness What is? Symptoms Management of Illness Medications Stress Management Support services Crisis hotline, support groups, psychotherapy. Treatment Modalities Psychopharmacology : Treatment Modalities Psychopharmacology Antidepressants- SSRIs- (1st line treatment)* TCAs- Anafranil (OCD) SNRI- Venlafaxine (Effexor) MAOIs Anti-Anxiety- Benzodiazepines Buspirone (BuSpar) (GAD, Social phobias) B- blockers- (PD, PTSD, Social Phobia) Treatment Modalities : Treatment Modalities Individual psychotherapy Group/family therapy Cognitive-behavioral therapy (CBT) Behavior therapy Relaxation training Modeling Systematic desensitization Flooding Thought stopping Milieu Treatment Modalities Alternative : Treatment Modalities Alternative Exercise Meditation Relaxation Breathing Guided Imagery Hypnosis Yoga Massage Herbal- Valerian, Linden flower tea

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