Week 5 Part 2: Anxiety Flashcards
Anxiety
A sense of psychological distress
Is transient anxiety normal
yes it is a normal response to job interviews, tests, walking into unfamiliar places, and other scenarios
feeling anxious, frightened, uneasy, or worried are all normal responses to life experiences that are perceived as disruptive, threatening or dangerous
Anxiety provides what
the motivation for achievement, a necessary force for survival
Are anxiety and stress the same thing
No, they are commonly interchangeably used but they are not the same
Stress is not a disorder - it is a normal part of life with no good or bad connotations.
However, often what causes anxiety is stress
stress is more transient but anxiety will persistently persist even without a stressor
What does it mean when stress is described as individualized
it is unique to each person and what one may perceive as stressful may not be perceived that way by others
anxiety can present differently among people as well
Frequently stressors are cited as causes of anxiety, when the mind interprets events as threatening, the body…
responds with the signs and symptoms of anxiety
Physiologic Response: Fight or Flight Changes
HR and BP Increase
Blood flow to muscles increase
RR increases
Perspiration and Blood Clotting Increases
Saliva Production, digestion, immune responses all decrease
energy producing stored glycogen is released
Anxiety as a ____
continuum
What does it mean that anxiety acts as a continuum
It affect cognition, psychological, and physical functioning all while being rated as MILD, MODERATE, or SEVERE
Mild anxiety results in…
improved functioning with heightened awareness
As anxiety increases beyond mild…
it interferes with all aspects of functioning
cognitive functioning becomes distorted and the body must endure extended periods of high physical alertness
Anxiety disorder
a group of conditions in which the affected person experiences persistent anxiety that cannot be dismissed
coping mechanisms are ineffective
the anxiety interferes with ADLs
Persons with Anxiety feel…
the core of their personalities are threatened when there is no actual danger
How are anxiety and fear different
Anxiety is an emotional process and fear is a cognitive one
Anxiety effects what 3 main things
Sensation
Cognition
Verbal Ability
Effects of Mild Anxiety
heightens sensation, sight, hearing, able to learn and verbalize rationally
Effects of Moderate Anxiety
begins to dull perceptions
can attend to greater sensory input if directed
Effects of Severe Anxiety
perceptions become increasingly distorted, become scattered, and disorganized
Effects of Panic (What comes after severe anxiety)
perception grossly distorted
cannot differentiate real from imaginary stimuli
When does anxiety require intervention
When it is of greater than expected intensity based on context
When it prevents fulfillment of professional, personal, or social roles
When it is accompanied by flashbacks, obsessions, or compulsions
When you are unable to attend to daily and social activities
When it lasts longer than expected given the precipitating stress/events
What is the most common of all psychiatric illnesses
anxiety disorders
Anxiety Disorders are more common in what groups
- Women > Men
- Minority children and children from low SES environments at risk
- Those with familial predispositions
Adaptive and Maladaptive Coping Mechanisms for Anxiety
withdrawal or retreating from the anxiety provoking situations
acting out –> Discharging anxiety through aggression
Psychsomatization
Avoidance - evasive behaviors
Problem solving systematic method for addressing difficult situations
Psychosomatization
physiologic expression of anxiety
Anxiety disorder barriers to treatment
lack of knowledge r/t nature and prevalence
Lack of knowledge of the positive response to treatments
social stigma
cost - 42 billion each year
misdiagnosis and untreated
2 Important Theories about Anxiety Disorders
Neurobiological Theories
Psychological Theories
Neurobiological Theories about Anxiety Disorders
50% of all affected people have a similarly affected relative
Genetic mutation with the development of COD
Bodys ability to regulate serotonin and GABA are likely to lead to anxiety disorders
Hippocampus - processing threatening stimuli and encoding information into memories
Locus coeruleus - initiates responses to danger could be overactive potential for PTSD
Striatum - area of the brain involved in motor control and thought to be involved with OCD
Psychological Theories about Anxiety disorders
low self esteem
shyness
timid as a child
critical or angry parents
long term abuse
violence
poverty
anxiety resulting from conditioning - developed by linking dangerous or fear inducing events with a neutral event
Panic
Intense apprehension
terror without any real threat accompanied with somatic or cognitive symptoms
the next level above anxiety
Characteristics of Panic
over response to stressors
incorrectly perceives circumstances
can feel depersonalized, derealization
very debilitating and may feel out of body
Characteristics of Panic
over response to stressors
incorrectly perceives circumstances
cognitive symptoms = can feel depersonalized, derealization
somatic symptoms = choking, dizziness, chest pain, sweating, vertigo, fainting, hot and cold flashes, fear of dying, going crazy
How long do panic attack last
10-30 minutes all the way to continuing up to 1 Hour
Panic Disorder
characterized by recurrent panic attacks, onset of which are unpredictable, and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort
onset unpredictable
Agoraphobia
characterized by the same symptoms of panic disorder
in addition, the individual experiences FEAR of being in places or situations from which escape may be difficult or embarrassing or in which help might not be available in the event that a panic attack should occur
The limitations of panic disorder and agoraphobia become so severe…
it diminishes QOL and leads to depression
Generalized Anxiety Disorders (GAD)
characterized by chronic, unrealistic, and excessive worry and anxiety for at least 6 MONTHS!!!
so much discomfort causes interference with ADLs and relationships
persistent and chronic s/s of muscle tension, autonomic hyperactivity, apprehension, feeling “on edge,” inability to concentrate, chronic fatigue, impaired sleep patterns, and depression
Phobia
a persistent irrational fear attached to an object or situation that objectively DOES NOT POSE A DANGER
may be simple and specific to certain situations, events, and objects
ex: acro (heights), calustro (closed spaces), etc
What is an important difference between panic attacks and phobias
panic attacks can be unpredictable but phobias are ALWAYS anticipated and never unexpected
When phobias are accompanied with panic attacks that is a ….
panic disorder
Social Phobia
compelling fear and desire to avoid situations that involve strangers or scrutiny from others
fear of speaking in front of others, eating, and using public bathrooms
Nursing Diagnoses for Panic Disorders
panic and anxiety r/t real or perceived threat to biological integrity or self concept evidenced by inability to perform ADL’s s/t …
Powerlessness r/t impaired cognition evidenced by inability to complete tasks of bathing s/t…
Goals for Treating Anxiety Disorders
The client:
- is able to recognize signs of escalating anxiety
- is able to intervene so that anxiety does not reach levels of panic
- is able to discuss long term plan to prevent panic or anxiety when stressful situations occur
- practices techniques of relaxation daily
- engages in physical exercise 3x a week
Obsessive Compulsive Duisorder
Cluster C personality disorder - Anxious or Fearful
Significant impairment and distress linked to an obsession and a compulsion to act on in order to reduce anxiety
not exactly an anxiety disorder as there is no real connection
can be mild or severe and if not treated can become so uncomfortable it can lead to depression or suicide
What sets OCD apart from an anxiety disorder
OCD has compulsion linked to an obsession, and compulsions decrease anxiety related to the obsessions
OCD is time consuming, it takes up how much of a persons day
more than 1 hour a day!
Obsessions
recurrent, intrusive, persistent ideas, thoughts and impulses - cognitively invasive
usually clients see them as repugnant and meaningless but remain preoccupied with them
Compulsions
ritualistic behaviors that clients are compelled to perform in order to prevent or reduce anxiety
Acute Stress Disorder
occurs within the 1st month of exposure to extreme trauma like combat, rape, or physical assault
symptoms will begin shortly after the incidence with dissociation occurring with detachment, dream state, poor memory and dissociative amnesia of what was encountered
usually resolves within 2-28 days
Post Traumatic Stress Disorder
Acute Stress Symptoms continuing greater than 1 month with additional symptoms of generalized anxiety, intrusive thoughts, flashbacks, nightmares, sleep disturbances, and a need to avoid triggers
can cause low self asteen, loss of positive and trusting attitudes, and sense of being damaged
After ___ months, PTSD is considered chronic
3 months
Acute Stress Disorder usually resolves…
in 2-28 days
General Clinical S/S of all Anxiety Disorders
substance abuse and use
barbiturate and benzodiazepine dependence
chronic relationship difficulties
frequent healthcare services for somatic complaints
negative outlook
obsessive or compulsive behaviors
eating disorders
sometimes can become healthcare dependent for their somatic complaints and issues
Diagnostic Testing for Anxiety Disorders
Testing should be done to rule out any underlying illnesses and stressors that could be leading to s/s related to anxiety
Identification should be done as well to differentiate medical illness from anxiety - and once an anxiety disorder is identified the goal is to improve s/s and decrease recurrence
Treatments for Anxiety Disorders
CBT - recognize thoughts that cause anxiety - gain insight and learn new responses
Relaxation - desensitization, replacing anxiety with relaxation responses
Psychopharmacology - SSRIs, Buspirone, beta Blockers, TCAs
Benzodiazepines
What is the issue in using Benzodiazepines for anxiety disorders
they should only be used in the short term and at the lowest dose without discontinuing abruptly as it can cause dependence/withdrawal
Nursing Diagnoses for Stress and Anxiety Disorders
Anxiety r/t perceived threat or stress (state)
Ineffective coping r/t inadequate individual resources (states)
Ineffective breathing r/t hyperventilation r/t severe anxiety (state)
Desired outcomes for treatment of anxiety disorders
client will report a decrease in aggressive behaviors and a decrease in the intensity of anxiety
the client will report the effective use of coping strategies to deal with symptoms of anxiety
client will demonstrate breathing techniques to control anxiety and hyperventilation
Successful management of an anxiety disorder involves…
helping the client ID thoughts and behaviors that lead to anxiety, ID stressors, then finding effective coping strategies that are developed with the client and the nurse through a therapeutic and holistic approach
