Anxiety

Question 1

What is anxiety? What makes it an anxiety disorder?

Answer 1

Anxiety is a normal and unavoidable human response to an actual or perceived threat
It is a common human emotion that is often difficult to define (words used to describe anxiety reflect one’s inner experience, subjective)
Anxiety becomes a symptom of a disorder or pathological condition when it interferes with ability to function

Question 2

What are some different anxiety disorders?

Answer 2

Panic disorder
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Acute stress disorder
Generalized anxiety disorder (GAD)
Phobias; for example, social phobia, agoraphobia, and specific phobia

Question 3

What are 2 morbidity complications of anxiety?

Answer 3

HTN and cardiac arrythmias

Question 4

What are some of the theories of causation of anxiety? How do these theories overlap across the biopsychosocial and spiritual domains?

Answer 4

Psychosocial theories
Psychodynamic influences
Behavioural influences
Biological theroies
Neurobiological influences
Genetic vulnerability
Peplau describes anxiety as unexplained discomfort

Question 5

What are the 4 levels of anxiety?

Answer 5

1) mild (motivating)
2) moderate (narrowing perceptual field)
3) severe (can’t make decisions/problem solve)
4) panic (intense fear with physical symptoms)

Question 6

What are some treatment options for anxiety?

Answer 6

Pharmacological therapy
Individual psychotherapy
Biofeedback
Functional neurosurgery
Cognitive behaviour therapy
Informational interventions
Music
Dietary changes
Self-monitoring and symptom diary
Cognitive restructuring
Exposure therapies → systematic desensitization or flooding
Abdominal breathing
Progressive muscle relaxation
Exercise
Guided imagery

Question 7

Pharmacological therapy

Answer 7

Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are the drugs of choice for treating both depressive disorders and anxiety disorders
Benzodiazepines may also be used in conjunction with these agents
Herbal preparations

Question 8

What are some of the different rating scales PMHNs can use in their assessment of anxiety disorders?

Answer 8

Hamilton Rating Scale (each item scored on a scale of 0-4 with a total score of 56)
- 14-17 (mild)
- 18-24 (moderate)
- 25-30 (severe)

Question 9

Therapeutic use of self (nursing assessment)

Answer 9

Nursing process is therapeutic when the nurse and the patient can come to know and respect what is the same and different about eachother (share in the solution of the problem)

Question 10

Biologic assessments

Answer 10

Rule out life threatening causes
Assess for environmental causes or triggers
Detailed history of previous/similar experiences
Substance use → recent stimulant or psycho-stimulant use, illegal drugs
Pain
Sleep patterns

Question 11

Psychological assessments

Answer 11

Assessment to determine patterns → this includes helping to identify triggers, antecedent events
Includes overall MSE
Suicidal tendencies
Cognitive thought patterns
Avoidance behaviours

Question 12

Social assessments

Answer 12

Determine patient’s understanding of how anxiety or panic symptoms and avoidance behaviours have affected their life
Assessment of cultural factors

Question 13

Spiritual assessments

Answer 13

Assessing for meaning in the patient’s life → where do they find their meaning or reason for living?

Question 14

MILD Anxiety interventions

Answer 14

Learning is possible → nurse assists the patient to use the energy that anxiety provides to encourage learning

Question 15

MODERATE Anxiety interventions

Answer 15

The nurse needs to check their own anxiety so that the patient does not empathize with it
Encourage the patient to talk: to focus on one experience, to describe it fully, then to formulate the patient’s generalizations about that experience

Question 16

SEVERE Anxiety interventions

Answer 16

Learning is less possible → allow relief behaviours to be used but do not ask about them
Encourage the patient to talk: ventilation of random ideas is likely to reduce anxiety to a moderate level (then proceed from there)

Question 17

PANIC Anxiety interventions

Answer 17

Learning is impossible → nurse needs to stay with the patient
Allow pacing and walk with the patient
No content inputs to the patient’s thinking should be made by the nurse
Short phrases by the nurse (direct, to the point of the patient’s comment, and investigate) and match the patient’s energy and behaviours
Do not touch the patient