7.5 Anxiety Disorder and Nursing Process Flashcards
Panic Disorder Assessment
- Recurrent panic attacks that manifest as intense apprehension, fear, terror and associated feelings of impending doom by intense physical discomfort.
- Can feel like a heart attack.
- Sudden, unexpected and unpredictable.
MUST INCLUDE AT LEAST 4 OF THE BELOW SYMPTOMS
- Palpitations, pounding heart, increased HR
- Sweating
- Trembling/Shaking
- Sensation of SOB or Smothering
- Fear of losing control or dying
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Derealization (feelings of unreality) or depersonalization (feelings of being detached to oneself)
- Dizzy/Lightheaded
- Chills/Heat sensations
- Paresthesia
- USUALLY LASTS MINUTES WITH FEELINGS OF NERVOUSNESS OR APPREHENSION BETWEEN ATTACKS
- DEPRESSION IS COMMON
General Anxiety Disorder (GAD) Assessment
- Persistent unrealistic excessive anxiety which occur more days than not over 6 month period.
- Can cause impairment in social/occupational functioning
- May avoid activities or spend excessive time preparing for said activities
- Individual continuously seeks reassurance from others.
Nursing Diagnosis
- Panic Anxiety (panic disorder or GAD)
- Powerlessness (panic disorder or GAD)
- Fear (Phobias)
- Social Isolation (Agoraphobia)
- Ineffective Coping (OCD)
- Ineffective Role Performance (OCD)
- Disturbed Body Image (Body Dysmorphia)
- Ineffective Impulse Control (Hair-pulling disorder)
Outcomes
- Can patient recognize signs of escalating anxiety before reaching panic levels
- Can they maintain anxiety at tolerable levels and make independent decisions
- Can they functionally adapt in the presence of phobic objects
- Do they have a plan of action for responding to the presence of phobic objects
- Can they maintain anxiety to manageable levels without resorting to ritualistic behaviors
- Can they verbalize realistic perceptions of their appearance by expressing positive body image
- Can they verbalize better adapting strategies for coping with situations other than pulling hair
Goals for Panic Anxiety
- Intervene before anxiety escalates and help patient recognize symptoms of anxiety
Interventions
- DO NOT LEAVE CLIENT ALONE
- Use brief messages when they are in panic.
- Explore reasons of the panic attack
- Low stimuli surroundings
- Breath into paper bag if hyperventilation occurs
Ineffective Impulse Control
- Help client cope with stress in a way where they do not pull out their hair and eventually discontinuing this behavior
- Assist with habit reversal training
- Offer support during setbacks
Fear
- Response to perceived danger
- Help client function in presence of phobic object
- Help explore underlying feelings contributing to irrational fears
Disturbed Body Image
- Help patient understand that their concerns are exaggerated and out of proportion
- Involve clients in activities to reinforce positive sense of self
Individual Psychotherapy
Supportive Psychotherapy
- Designed to help patient identify personal strengths and explore adaptive coping mechanisms.
Insight-Oriented Psychotherapy
- Help clients identify and resolve psychological conflicts related to anxiety
Cognitive Therapy
- Assists individuals to reduce anxiety responses by altering distortions.
- Discourages client dependence on therapist which is common in anxiety disorders.
- Encourages self-sufficiency
Behavior Therapy
- Treats hair pulling disorder
- Covert desensitization and habit reversal therapy
- HRT - patient becomes aware of hair pulling and substitutes it for better coping strategies.
- Systematic Desensitization - Gradually exposed to phobic stimulus
- Implosion therapy - Therapist floods patient with information concerning things that can trigger anxiety. This therapy is guided by a patients response to anxiety-provoking situations
Anxiety Treatment
- Breathing exercises
- Progressive muscle relaxation
- Imagery
- Mindfulness/Meditation
- Exercise
