Anxiety Flashcards
What are characteristics of anxiety?
Anxiety is fed by fear
Influenced by need to control fear
Encourages avoidance of fearful stimuli
How can anxiety disorders be managed?
Acute management
Cognitive Behavioural Therapy
Problem solving
Behavioural therapy
Pharmacology
Counselling
Relaxation therapy
What are some nursing strategies for acute management for: Hyperventilation, panic attacks,
Hyperventilation
Calm coaching, cupped hands, paper bag, timed breathing, use the nose
Panic Attacks
The ten commandments
Short, simple and audible sentences;
“Listen to my voice. Take some slow deep breaths. In, two, three; out two, three. Anxiety is taking over here. Listen to me so we can calm it down.”
Reduce stimuli
Stay with the person
What are the 6 steps of problem solving?
Step 1. Identifying the problem
Step 2. Generating solutions through brainstorming
Step 3. Evaluating the solutions
Step 4. Choosing the optimal solution
Step 5. Planning
Step 6. Reviewing
What are some longer term nursing strategies for trauma informed care and psychological formulations?
Taking a historical view
Understand what the person is experiencing through the context of why
Insight offers treatment direction
Predisposing factors (what has led to the problem)
Precipitating factors (triggers)
Perpetuating factors (what makes things worse)
Protective factors (what helps)
What are some longer term nursing strategies for reflection and relaxing?
Practice relaxation
Help the individual identify their strengths
Encourage client to identify: (ABC)
Antecedent – What happened prior?
Behaviour – What did you do?
Consequences – What happened next?
What should a nurse not do when helping with someone with anxiety?
Take over
Dismiss
Falsely reassure
What are the two theories related to anxiety?
Biological and learning
What is the biological theories hypothesises?
The evolutionary argument
Genetic inheritance
Altered brain chemistry
What is the learning theories hypothesises?
Cognition theory
Socio-ecological theory
What are the different types of anxiety disorders?
Generalised Anxiety Disorder
Panic Disorder
Specific Phobia
Social phobia
Somatoform Disorders
Acute Stress Disorder
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder
Agoraphobia
What is panic disorder defined as?
Defined as strong physical responses that often leave the person in fear of dying or losing control.
What is specific Phobia defined as?
A marked and persistent fear that is excessive or unreasonable cued by the presence or anticipation of a specific object or situation e.g. heights, animals, seeing blood. Exposure to phobic stimulus almost invariably provokes an immediate anxiety response which might take the form of a panic attack
What is a social phobia defined as?
Social phobia often called social anxiety disorder goes beyond shyness. Features include hypersensitivity to criticism, negative evaluation or rejection. Often have difficulty being assertive have low self-esteem and feelings of inferiority. This can result in avoidance and poor social skills. Severe social phobia may result in having no interpersonal relationships, isolation and can lead to suicidal ideation, DSM-5 has specific diagnostic criteria for this.
What is somatoform disorders?
Somatoform Disorders focuses on physical symptoms in anticipation of a serious illness or disease
People often have a strong conviction that they are seriously ill and will frequent hospitals and medical centres in attempts to find a solution
What is acute distress disorder?
A transient response to a severe trauma the characteristic symptoms of anxiety, dissociation and other intense autonomic arousal occur within 1 month after exposure to the stressor.
What are the symptoms of acute distress disorder?
3 or more of the following symptoms;
Numbing, detachment or no emotional response.
Being in a daze,
Derealisation (A feeling that you and/or your surroundings are not real and/or experience your surroundings through a diffused light, fog or mist.)
Depersonalisation (An altered sense of one’s physical being. Includes feelings outside of one’s body, physically cut off or distanced from people, floating, observing oneself from a distance, like one is in a dream, or one’s body is physically changed in shape or size.)
Dissociative amnesia (The primary symptom of dissociative amnesia is the sudden inability to remember past experiences or personal information. Some people with this disorder also might appear confused and suffer from depression and/or anxiety.)
Must persistently re-experience the traumatic event in at least 1 of the following ways;
Re-current images
Re-current thoughts or dreams
Illusions
Flashbacks
Distress
The symptoms must last at least 2 days and can persist for up to 4 weeks after the trauma if the symptoms persist beyond 1 month after the trauma it then becomes PTSD
What are triggers for Post traumatic stress disorder?
military combat, violent personal assault, disaster, accidents, childhood sexual abuse for example
What is the definition of generalised anxiety disorder?
Excessive anxiety & worry occurring more days than not for a period of at least 6 months, about a number of events or activities. The individual finds it difficult to control the worry
What is Obsessive Compulsive disorder defined as?
Recurrent obsessions or compulsions that are severe enough to be time consuming (they take more than one hour a day) or cause marked distress or significant impairment
What are some physical responses to anxiety?
Hyperventilation
Diversion of blood flow
Instinctive (primitive brain) survival mode
Dissociation
Stress Hormones
Changes in metabolism, insulin production and digestive system
Muscle tension
Racing Heart
Rapid breathing
Fear
Increased blood pressure
Dilated pupils
Muscle fatigue from tension
Sweating
Clenched jaw
Irritation of digestive tract
Immune system suppression
What can people with panic disorder experience?
Physiological; tachycardia, sweating, shaking, dyspnoea, chest pain, dizziness, nausea, tingling and a sense of depersonalisation
Psychological; a sense of imminent death or doom, fear of losing consciousness, engaging in rapid safety behaviours i.e phoning ambulance
People with panic disorder tend to focus on symptoms rather than the cause and help focuses on safety, avoidance and dependency rather than context
What is panic disorder?
Unpredictable experiences of intense, episodic surges of anxiety
Panic Disorder
Symptoms- intense serge if anxiety, psychological worry and physical symptoms, tachycardia, tight chest, shaking, dizziness and nausea
Treatment- management of panic attack, stay with the person, breathin coaching
long term- CBT, education
Social Phobia
Symptoms- pronounced, persistent fear of social situations, especially where they fear criticism regarding failure, performance
Treatment-
Agoraphobia
Symptoms- fear of not being able to escape an area e.g. mall if becoming anxious.
Treatment- panic management
Specific Phobia
Symptoms- disappropriate fear of risk to an object or situation poses.
Treatment- CBT with gradual exposure
Adjustment Disorder
Symptoms- intense stress response to a potential or actual serious illness or significant event
Treatment- support of psychological stress/distress
mindful, solution focused nursing no need for pharmacological intervention
Acute Stress Disorder
Symptoms- similar to PTSD except shorter time frame of symptoms exhibited
Treatment- trauma focused CBT
Post Traumatic-Stress Disorder
Symptoms- presents following direct witness to a traumatic event
Treatment- trauma focused CBT, trauma focused therapy, SSRI’s or SNIR’s potentially
Obsessive Compulsive Disorder
Symptoms- intrusive thoughts that become obsessed with associated behaviour aim to reduce feelings of anxiety associated with thoughts
Treatment- CBT, SSIR’s
Generalised Anxiety Disorder
Symptoms- constant, excessive worry that is not specific
Treatment- education and active monitoring non-facilitated self-help, guided self-help, CBT, SSRI
applied relaxation
Outline causes of anxiety disorder
genes, trauma, and nurture
Panic Attack
Symptoms- feeling of doom, death, or panic. increased heart rate, increase resps BP, pupils dilate, chest pains, tingling in extremities
Nursing management- remain with the person, remain calm, reasure they will not faint, die or loose control, encourage to continue breathing
Hyperventilation
Symptoms- rapid, shallow breathing, may be associated with dizziness, tingling in extremities
Nursing management- guided breathing, paper bag, cupped hands.
Therapeutic/interpersonal use of self; Anxiety
psychoeducation, relaxation and distraction, mindfulness, validation of experience, encouraging social support, trauma informed care.
Cognitive behavioural therapy; Anxiety
helps make sense of consumers experiences, values, beliefs, attitudes and day to day thoughts in the context of emotional and behavioral response.
Antidepressants; Anxiety
useful in managing associated mood disorders. do not provide an immediate response
Mood stabilizers; Anxiety
useful in managing associated mood disorder do not provide an immediate response
