5. Anxiety Disorders & Nursing Approach

Question 1

TRUE/FALSE

• Anxiety is a vague feeling of dread or apprehension.
• Anxiety is not a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms.
• Feeling anxious is not part of the human condition.
• All people experience some anxiety at some time in their lives.
• Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person.
• Anxiety is unavoidable in life and can serve many positive functions such as motivating the person to take action to solve a problem or to resolve a crisis.

Answer 1

True
False
False
True
True
True

Question 2

TRUE/FALSE

• The term anxiety disorder refers to a group of conditions in which affected clients experience persistent anxiety that they cannot dismiss.
• Coping mechanisms are ineffective, and anxiety interferes with activities of daily living.
• People with anxiety disorders do not feel that the core of their personalities is being threatened, even when no actual danger exists.
• They perceive a threat, even if it is not present in reality.
• Stressors are not cited as causes of anxiety, and when the mind interprets events as threatening, it responds accordingly, with symptoms of anxiety.

Answer 2

True
True
False
True
False

Question 3

The widespread effects of the fight or flight response, mediated by the sympathetic nervous system, include:

Answer 3

• Heart rate and blood pressure increase.
• Blood flows to the muscles.
• Breathing rate increases.
• Perspiration increases.
• Blood clotting ability increases.
• Saliva production decreases.
• Digestion decreases.
• Immune response decreases.
• Energy-producing stored glycogen is released.

Question 4

Hans Selye, an endocrinologist, identified the physiologic aspects of stress, which he labeled The General Adaptation Syndrome.

He determined three stages of reaction to stress:

Answer 4

Alarm
Resistance
Exhaustion

Question 5

What happens during the Resistance stage?

Answer 5

• After the initial shock of a stressful event and having a fight-or-flight response, the body begins to repair itself. It releases a lower amount of cortisol, and your heart rate and blood pressure begin to normalize. Although your body enters this recovery phase, it remains on high alert for a while.
• The digestive system reduces function to shunt blood to areas needed for defense.
• The lungs take in more air, and the heart beats faster and harder so it can circulate this highly oxygenated and highly nourished blood to the muscles to defend the body by fight, flight, or freeze behaviors.

Question 6

What happens during the Alarm reaction stage?

Answer 6

• This natural reaction prepares you to either flee or protect yourself in dangerous situations. Your heart rate increases, your adrenal gland releases cortisol (a stress hormone), and you receive a boost of adrenaline, which increases energy.
• Stress stimulates the body to send messages from the hypothalamus to the glands (such as the adrenal gland, to send out adrenaline and norepinephrine for fuel) & organs (such as the liver, to reconvert glycogen stores to glucose for food) to prepare for potential defense needs.

Question 7

What happens during the The Exhaustion stage?

Answer 7

• This stage is the result of prolonged or chronic stress. Struggling with stress for long periods can drain your physical, emotional, and mental resources to the point where your body no longer has strength to fight stress. You may give up or feel your situation is hopeless.
• Occurs when the person has responded negatively to anxiety and stress.
• The body stores are depleted or the emotional components are not resolved, resulting in continual arousal of the physiologic responses and little reserve capacity.

Question 8

Levels of anxiety:

Answer 8

Anxiety can be: mild, moderate, severe or panic, affecting cognitive, psychological, and physical function accordingly.

Question 9

This level of anxiety is an asset to the client and requires no direct intervention.

People with with this level of anxiety can learn and solve problems and are even eager for information & teaching can be very effective.

Answer 9

Mild anxiety

Question 10

• In this level of anxiety the nurse must be certain that the client is following what the nurse is saying.
• The client’s attention can wander, and he or she may have some difficulty concentrating over time.
• Speaking in short, simple, and easy to understand sentences is effective.
• The nurse may need to redirect the client back to the topic if the client goes off on an unrelated tangent.

Answer 10

Moderate anxiety

Question 11

• In this level of anxiety the client no longer can pay attention or take in information.
• The nurse’s goal must be to lower the person’s anxiety level to moderate or mild before proceeding with anything else.
• It is also essential to remain with the person because anxiety is likely to worsen if he or she is left alone.
• Talking to the client in a low, calm & soothing voice can help.
• If the person cannot sit still, walking with him or her while talking can be effective.
• Helping the person to take deep even breaths can help lower anxiety.-

Answer 11

Severe anxiety

Question 12

• In this level of anxiety the person’s safety is the primary concern.
• He or she cannot perceive potential harm and may have no capacity for rational thought.
• The nurse must keep talking to the person in a comforting manner, even though the client cannot process what the nurse is saying.
• Going to a small, quiet, and non-stimulating environment may help to reduce anxiety.
• The nurse can reassure the person that this is anxiety, that it will pass, and that he or she is in a safe place.
• The nurse should remain with the client until the panic recedes. It is not sustained indefinitely but can last from 5–30 minutes.

Answer 12

Panic-level anxiety

Question 13

TRUE/FALSE

• Short-term anxiety cannot be treated with anxiolytic medications.
• Benzodiazepines are commonly prescribed for anxiety.
• Benzodiazepines have don’t have a high potential for abuse and dependence, however, so their use should be short-term, ideally no longer than 4 to 6 weeks.
• These drugs are designed to relieve anxiety so that the person can deal more effectively with whatever crisis or situation is causing stress.

Answer 13

False
True
False
True

Question 14

Types of anxiety disorders include the following:

Answer 14

• Agoraphobia with or without panic disorder
• Panic disorder
• Specific phobia
• Social phobia
• Generalized anxiety disorder (GAD)
• Acute stress disorder
• Posttraumatic stress disorder
• Obsessive-compulsive disorder (OCD)

Question 15

Agoraphobia is:

Symptoms include:

Answer 15

• It is anxiety disorder about or avoidance of places or situations from which escape might be difficult or in which help might be unavailable.

Symptoms:

-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 appointments)
- Knows response is extreme.

Question 16

Panic disorder is:

Symptoms:

Answer 16

• It is characterized by recurrent, unexpected panic attacks that cause constant concern.
• Panic attack is the sudden onset of intense apprehension, fearfulness, or terror associated with feelings of impending doom.

Symptoms:

• A discrete episode of panic lasting 15 to 30 minutes with four or more of the following:
  palpitations, sweating, trembling or shaking,
  shortness of breath, choking or smothering sensation, chest pain or discomfort,
  nausea, derealization or depersonalization,
  fear of dying or going crazy, paresthesia, chills or hot flashes.

Question 17

Specific phobia is:

Symptoms:

Answer 17

• It is characterized by significant anxiety provoked by a specific feared object or situation, which often leads to avoidance behavior.

Symptoms:

• Marked anxiety response to the object or situation.
• Avoidance or suffered endurance of object or situation.
• Significant distress or impairment of daily routine, occupation, or social functioning.
• Adolescents and adults recognize their fear as excessive or unreasonable.

Question 18

Social phobia is:

Symptoms:

Answer 18

• It is characterized by anxiety provoked by certain types of social or performance situations, which often leads to avoidance behavior.

Symptoms

• Fear of embarrassment or inability to perform.
• Avoidance or dreaded endurance of behavior or situation.
• Recognition that response is irrational or excessive.
• Relief that others are judging him or her negatively.
• Significant distress or impairment in relationships, work, or social life.
• Anxiety can be severe or panic level.

Question 19

Generalized Anxiety Disorder:

Symptoms:

Answer 19

• It is characterized by at least 6 months of persistent and excessive worry and anxiety.

Symptoms:

• Apprehensive expectations more days than not for 6 months or more about several events or activities.
• Uncontrollable worrying
• Significant distress or impaired social or occupational functioning.
• 3 of the following symptoms: restlessness, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance.

Question 20

Acute Stress Disorder:

Symptoms:

Answer 20

• It is the development of anxiety, dissociation, and other symptoms within 1 month of exposure to an extremely traumatic stressor; it lasts 2 days to 4 weeks.

Symptoms:

• Exposure to traumatic event causing intense fear, helplessness, or horror.
• Marked anxiety symptoms or increased arousal;
  significant distress or impaired functioning.
• Persistent re-experiencing of the event.
• Three of the following symptoms: sense of emotional numbing or detachment, feeling dazed, derealization, depersonalization, dissociative amnesia (inability to recall important aspect of the event).

Question 21

Posttraumatic Stress Disorder:

Symptoms:

Answer 21

It is characterized by the reexperiencing of an extremely traumatic event, avoidance of stimuli associated with the event, numbing of responsiveness & persistent increased arousal;
it begins within 3 months to years after the event and may last a few months or years.

Symptoms

• Exposure to traumatic event involving intense fear, helplessness, or horror; reexperiencing (intrusive recollections or dreams, flashbacks, physical and psychological distress over reminders of the event).
• Avoidance of memory-provoking stimuli and
  numbing of general responsiveness (avoidance of thoughts, feelings, conversations, people, places, amnesia, diminished interest or participation in life events, feeling detached or estranged from others, restricted affect, sense of foreboding).
• Increased arousal (sleep disturbance, irritability or angry outbursts, difficulty concentrating, hypervigilance, exaggerated startle response).
• Significant distress or impairment.

Question 22

Obsessive-compulsive disorder (OCD):

Answer 22

• It involves obsessions (thoughts, impulses, or images) that cause marked anxiety and/or
  compulsions (repetitive behaviors or mental acts) that attempt to neutralize anxiety.
• 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 with personal, social, and occupational function.

Question 23

Obsessions are:

Answer 23

• Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function.
• The person knows these thoughts are excessive or unreasonable but believes he or she has no control over them.

Question 24

Compulsions are:

Answer 24

• Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.
• Usually, the theme of the ritual is associated with that of the obsession, such as repetitive hand-washing when someone is obsessed with contamination or repeated prayers or confession for someone obsessed with blasphemous thoughts.

Question 25

Common compulsions include the following:

Answer 25

• Checking rituals (repeatedly making sure the door is locked or the coffee pot is turned off).
• Counting rituals (each step taken, ceiling tiles, concrete blocks, or desks in a classroom).
• Washing and scrubbing until the skin is raw
• Praying or chanting
• Touching, rubbing, or tapping (feeling the texture of each material in a clothing store; touching people, doors, walls, or oneself).
• Hoarding items (for fear of throwing away something important).
• Ordering (arranging and rearranging furniture or items on a desk or shelf into perfect order; vacuuming the rug pile in one direction).

Question 26

Treatment for OCD:

Answer 26

• Like for other anxiety disorders, optimal treatment for OCD combines medication and behavior therapy.
• Behavior therapy specifically includes exposure and response prevention.
• Exposure involves assisting the client to deliberately confront the situations and stimuli that he or she usually avoids.
• Response prevention focuses on delaying or avoiding performance of rituals.
• The person learns to tolerate the anxiety and to recognize that it will recede without the disastrous imagined consequences.
• Other techniques, such as deep breathing and relaxation, also can assist the person to tolerate and eventually manage the anxiety.

Question 27

Obsessive-compulsive Spectrum Disorders:

Answer 27

• Obsessive-compulsive disorder
• Hoarding disorder
• Body-dysmorphic disorder
• Trichotillomania
• Excoriation (Skin-Picking) Disorder

Question 28

• It is characterized by the persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions.
• For individuals who hoard, the quantity of their collected items sets them apart from people with normal collecting behaviors.
• They accumulate a large number of possessions that often fill up or clutter active living areas of the home or workplace to the extent that their intended use is no longer possible.

Answer 28

Hoarding disorder

Question 29

Preoccupation with an imagined defect in appearance.
If a slight physical anomaly is present, the person’s concern is markedly excessive.
The preoccupation causes clinically significant distress or impairment in functioning.
Body dysmorphic disorder is problem of
- Perception
- Somatosensory Disturbance
- Global/Idealized Values
- Faulty Beliefs
- Information Processing Biases

Answer 29

Body dysmorphic disorder

Question 30

Body dysmorphic disorder is problem of:

Answer 30

• Perception: Actually sees nose as big.
• Somatosensory: Feels nose is big.
• Global/Idealized Values: I value beauty as a goal to pursue.
• Faulty Cognitions: Because my nose is big, I will be alone and isolated all my life. Overgeneralization.
• Information Processing Biases: Looking in the mirror and focusing immediately on the nose. Selective attention to details, rather than the whole.

Question 31

• The recurrent pulling out of one’s hair, which results in hair loss.
• The impulse is preceded by an increasing sense of tension and results in a sense of release or gratification from pulling out the hair.
• The most common sites for hair pulling are the scalp, eyebrows, and eyelashes but may occur in any area of the body on which hair grows.
• Pain is seldom reported to accompany the hair pulling, although tingling and pruritus in the area are not uncommon.

Answer 31

Trichotillomania (Hair Pulling Disease)

Question 32

• It is characterized by recurrent skin picking resulting in skin lesions.
• Individuals with excoriation disorder must have made repeated attempts to decrease or stop the skin picking, which must cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
• Resulting problems may include medical issues such as infections, skin lesions, scarring and physical disfigurement.

Answer 32

Excoriation (Skin-Picking) Disorder