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    Chapter 13: Anxiety, Anxiety Disorders, and Stress-Related Illness

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    Hershey Cordero Briones
    This document discusses anxiety, anxiety disorders, and stress-related illness. It defines anxiety and differentiates it from fear. It describes anxiety disorders and their features. It discusses anxiety as a response to stress and outlines different levels of anxiety from mild to panic. It provides guidance on working with anxious clients and considers cultural factors. It examines specific anxiety disorders like generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder. It also discusses treatments, nursing assessments, and the importance of self-awareness for nurses.

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    Chapter 13: Anxiety, Anxiety Disorders, and Stress-Related Illness

    Uploaded by

    Hershey Cordero Briones
    38 views38 pages
    This document discusses anxiety, anxiety disorders, and stress-related illness. It defines anxiety and differentiates it from fear. It describes anxiety disorders and their features. It discusses anxiety as a response to stress and outlines different levels of anxiety from mild to panic. It provides guidance on working with anxious clients and considers cultural factors. It examines specific anxiety disorders like generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder. It also discusses treatments, nursing assessments, and the importance of self-awareness for nurses.

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    This document discusses anxiety, anxiety disorders, and stress-related illness. It defines anxiety and differentiates it from fear. It describes anxiety disorders and their features. It discusses anxiety as a response to stress and outlines different levels of anxiety from mild to panic. It provides guidance on working with anxious clients and considers cultural factors. It examines specific anxiety disorders like generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder. It also discusses treatments, nursing assessments, and the importance of self-awareness for nurses.

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    Attribution Non-Commercial (BY-NC)
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    Download as ppt, pdf, or txt
    38 views38 pages

    Chapter 13: Anxiety, Anxiety Disorders, and Stress-Related Illness

    Uploaded by

    Hershey Cordero Briones
    This document discusses anxiety, anxiety disorders, and stress-related illness. It defines anxiety and differentiates it from fear. It describes anxiety disorders and their features. It discusses anxiety as a response to stress and outlines different levels of anxiety from mild to panic. It provides guidance on working with anxious clients and considers cultural factors. It examines specific anxiety disorders like generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder. It also discusses treatments, nursing assessments, and the importance of self-awareness for nurses.

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    Chapter 13: Anxiety, Anxiety Disorders, and Stress-Related Illness

    Anxiety Vague feeling of dread or apprehension Different from fear (feeling afraid or threatened by identifiable stimulus representing danger) Anxiety disorders: key feature of excessive anxiety with behavioral, emotional, cognitive, physiologic responses Stress: wear and tear of life on the body

    Anxiety as a Response to Stress General adaptation syndrome (physiologic aspects of stress; identified by Selye)
    Alarm reaction stage (preparation for defense) Resistance stage (blood shunted to areas needed for defense) Exhaustion stage (stores depleted; emotional components unresolved)

    Levels of Anxiety Mild: special attention; increased sensory stimulation; motivational Moderate: something definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected

    Levels of Anxiety (contd) Severe: trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry Panic: fight, flight, or freeze response; increased vital signs; dilated pupils; cognitive processes focusing on defense

    Working with Anxious Clients Self-awareness of anxiety level Assessment of persons anxiety level Use of short, simple, easy-to-understand sentences Lower persons anxiety level to moderate or mild before proceeding

    Working with Anxious Clients (contd) Low, calm, soothing voice Safety during panic level Short-term use of anxiolytics

    Question Tell whether the following statement is true or false: Anxiety and fear are considered to be two different things.

    Answer True Anxiety is different from fear. Anxiety is a vague feeling of dread or apprehension. Fear is a feeling of being afraid or threatened by an identifiable stimulus representing danger.

    Anxiety Disorders Agoraphobia with or without panic disorder Panic disorder Specific phobia; social phobia Obsessive-compulsive disorder (OCD) Generalized anxiety disorder Acute stress disorder Posttraumatic stress disorder

    Anxiety Disorders (contd) Incidence: most common psychiatric disorders in United States More prevalent: women; people under 45 years old Onset, clinical course are variable

    Anxiety Disorders: Etiology Biologic theories


    Genetic theories Neutochemical theories (GABA, serotonin)

    Psychodynamic theories
    Intrapsychic/psychoanalytic theories (Freud and defense mechanisms) Interpersonal theories (Sullivan, Peplau) Behavioral theory

    Cultural Considerations Each culture has rules for expressing, dealing with anxiety Asian cultures: often with somatic symptoms; koro Hispanics: susto (high anxiety as sadness, agitation, weight loss, weakness, heart rate changes); due to supernatural spirits or bad air from dangerous places and cemeteries invading body

    Treatment Combination of medications, therapy Medications: anxiolytics; antidepressants Cognitive-behavioral therapy


    Positive reframing (turning negative messages into positive ones) Decatastrophizing (making more realistic appraisal of situation) Assertiveness training (learn to negotiate interpersonal situations)

    Question Tell whether the following statement is true or false: The neurotransmitter dopamine is associated with anxiety disorders.

    Answer False The neurotransmitters, GABA, and serotonin are thought to play a role in anxiety disorders.

    Elder Considerations Late-life anxiety disorders


    Phobias (GAD most common) Often associated with another condition, such as depression, dementia, physical illness, or medication toxicity or withdrawal

    SSRIs as treatment of choice for anxiety disorders in the elderly

    Mental Health Promotion Anxiety as warning of not dealing with stress effectively

    Mental Health Promotion (contd) Tips for managing stress:


    Positive attitude; belief in self; acceptance of lack of control over certain events Assertive communication; expression of feelings: talking, laughing, crying Realistic goals; personally meaningful activity Well-balanced diet, exercise, adequate rest/sleep Use of stress management techniques

    Panic Disorder Discrete episodes of panic; no stimulus for panic response Avoidance behavior Primary, secondary gain

    Panic Disorder (contd) Treatment


    Cognitive behavioral techniques Deep breathing, relaxation Benzodiazepines, SSRIs, tricyclic antidepressants, antihypertensives (clonidine, propranolol)

    Panic Disorder and Nursing Process Application


    Assessment
    Hamilton Rating Scale for Anxiety (Box 13.1) History General appearance, motor behavior (automatisms) Mood, affect (depersonalization, derealization) Thought process, content (disorganized thoughts, loss of rational thinking)

    Panic Disorder and Nursing Process Application (contd)


    Assessment (contd)
    Sensorium, intellectual processes (confusion, disorientation) Judgment, insight Self-concept (self-blaming) Roles, relationships (avoidance of others) Physiologic, self-care concerns (sleeping, eating)

    Panic Disorder and Nursing Process Application (contd)


    Nursing diagnoses Outcome identification Interventions
    Safety, comfort Therapeutic communication Anxiety management Client, family education

    Evaluation

    Question Which of the following would a nurse expect to assess in a client with a panic disorder? A.Rational thinking B.Blaming of others C.Automatism D.Organized thoughts

    Answer C. Automatism A client with panic disorder would demonstrate automatisms, irrational thinking, self-blame, and disorganized thoughts.

    Phobias Intense illogical persistent fear Categories: agoraphobia; specific phobia; social phobia (social anxiety disorder) Categories of specific phobia: natural environment; blood-injection; situation; animal; other types

    Phobias (contd) Treatment


    Behavioral therapy: positive reframing; assertiveness training; systematic desensitization; flooding Medications (Table 13.3)

    OCD Obsessions: recurrent, persistent, intrusive, unwanted thoughts, images, impulses causing marked anxiety Compulsions: ritualistic or repetitive behaviors or mental acts carried out continuously to neutralize anxiety

    OCD (contd) Treatment


    Medications (Table 13.3) Behavior therapy
    Exposure Response prevention

    OCD and Nursing Process Application Assessment


    Yale Brown Obsessive-Compulsive Scale (Box 13.2) History General appearance, motor behavior (tense, anxious; embarrassment) Mood, affect (overwhelming anxiety) Thought process, content (obsessions out of nowhere)

    OCD and Nursing Process Application (contd)


    Assessment (contd)
    Judgment, insight (obsessions as irrational but unable to stop them) Self-concept (powerlessness) Roles, relationships Physiologic, self-care considerations (sleeping problems)

    Data analysis

    OCD and Nursing Process Application (contd)


    Outcome identification Intervention
    Therapeutic communication Relaxation techniques Behavioral techniques Daily routine completion Client, family education

    Evaluation

    Question Tell whether the following statement is true or false: A client with OCD believes that the obsessions are rational but he cant stop them.

    Answer False A client with OCD knows that the obsessions are irrational but he cant stop them.

    Other Anxiety Disorders Generalized anxiety disorder


    Chronic; longer than 6 months Treatment: Buspirone, SSRIs

    Posttraumatic stress disorder: reexperiencing traumatic event

    Other Anxiety Disorders (contd) Acute stress disorder


    More dissociative response than PTSD Event unreal, person unreal, or forgetting some aspects of event through amnesia, emotional detachment, muddled obliviousness to environment

    Self-Awareness Issues Need to understand how, why anxiety behaviors work Nurses as vulnerable as others to stress, anxiety Everyone occasionally suffers from stress, anxiety Avoid trying to fix clients problem Use techniques to manage stress, anxiety in personal life

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