Transcript Anxiety Responses and Disorders

Anxiety Responses and Disorders
NUR 305
Rochelle Roberts RN MSN
Anxiety Disorder
• Most common psychiatric
disorder
• Affects 10 - 25% of the
American population
• Involves one’s body,
perceptions of self, and
relationships with others.
• Occur twice as often in
women as in men
Anxiety Responses
• A diffuse
apprehension
• Vague in nature
• Associated with
feelings of uncertainty
• An emotion without a
specific object
• Is communicated
interpersonally
Defining Characteristics of
Anxiety
• a threat to one’s selfesteem
• an energy that can’t be
observed directly
• based on certain
behaviors
• is contagious
4 Levels of Anxiety (Peplau)
• Mild level-person is alert
and perceptual field is
increased; can motivate
learning and produce
personal growth.
• Moderate level-person
focuses only on immediate
concerns; involves
narrowing of the
perceptual field.
• Severe level- marked by a
reduction in the perceptual
field. The person focuses
on a specific detail.
Levels of Anxiety (continued)
• Panic level- associated with dread and
terror. Person is unable to do things even
with direction. Involves disorganization of
the personality and can be life threatening.
Person is unable to communicate or
function effectively.
Anxiety and Physiological
Changes
• Predominance of the
sympathetic
autonomic nervous
system. (prepares the
body to deal with an
emergency situation)
This is the fight or
flight reaction.
Behavioral Responses
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Physical tension
Tremors
Lack of coordination
Hyperventilation
Startle reaction
Restlessness
Cognitive Responses
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Impaired attention
Poor concentration
Forgetfulness
Confusion
Nightmares
Errors in judgment
Fear of losing control
Affective Responses
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Nervousness
Tension
Fear
Frustration
Terror
Jitteriness
Helplessness
Theories regarding origin of
anxiety
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Psychoanalytic (Freud)
Interpersonal (Sullivan)
Behavioral
Family studies
Biological basis
Precipitating Stressors
• Threats to physical integrity suggest
impending physiological disability.
• Internal sources: physiological failure;
heart, immune system, temperature
regulation
• External sources: exposure to infection,
environmental pollutants, lack of adequate
housing, food, clothing and trauma.
Precipitating Stressors
(continued)
• Threats to self-esteem
• External sources: loss
of a valued person
through death, divorce
or re-location, change
in job status.
• Internal sources:
interpersonal problems
at work, or when
assuming a new role.
Coping Mechanisms for Mild
Anxiety
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Crying
Sleeping
Smoking
Cursing
Exercise
Drinking
Limited selfdisclosure
Coping Mechanisms (continued)
Moderate, severe, and
panic levels of anxiety
require more energy to
cope with the threat.
These coping mechanisms
are categorized as task
oriented and egooriented reactions.
Task-Oriented Reactions
• Attack behavior:
can be destructive
hostility or
constructive
problem-solving
Task-Oriented Reactions cont.
• Withdrawal
behavior: this can
be physical or
psychological
withdrawal
Task-Oriented Reactions
(continued)
• Compromise:
involves changing
usual ways of
operating,
substituting goals,
and sacrificing
aspects of personal
needs
Ego-Oriented Reactions
• Defense mechanisms are used to protect
the self. They are the first line of psychic
defense and operate at an unconscious level.
They involve a degree of self-deception and
reality distortion.
• One must evaluate if the defense
mechanism is adaptive or maladaptive..
Defense Mechanisms
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Compensation
Denial
Displacement
Dissociation
Identification
Intellectualization
Introjection
Projection
Ego-Defense Mechanisms cont.
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Rationalization
Reaction Formation
Regression
Repression
Splitting
Sublimation
Suppression
Undoing
Formulating Nursing Diagnoses
• Determine the quality
& quantity of anxiety
experience by the
patient.
• Is the patient’s
response out of
proportion to the
threat?
Formulating Nursing Diagnoses
(continued)
• Explore how the patient is coping with the
anxiety.
• Is it constructive or destructive?
• Determine the overall effect of the anxiety.
Is it stimulating growth or interfering with
effective living?
4 Primary NANDA Nursing
Diagnoses
• Anxiety
• Ineffective coping
• Readiness for
enhanced coping
• Fear
Examples of Expanded NANDA
Diagnosis
• Anxiety: moderate anxiety related to financial
pressures, as evidenced by episodes of stomach
pain and heartburn.
• Ineffective coping: related to father’s death as
evidenced by inability to concentrate and
psychomotor agitation and depression.
• Readiness for enhanced coping: related to
mother moving in with daughter secondary to
stroke related disability, as evidenced by
modification of living environment.
Examples of NANDA Diagnoses (cont.)
• Fear: related to impending biopsy as
evidenced by generalized hostility toward
staff and family.
Medical Diagnoses
• Patients with mild or
moderate anxiety have
no medically
diagnosed health
problem. However,
patients with more
severe levels of
anxiety usually have
neurotic disorders that
fall under anxiety
orders in the DSM-IVTR.
DSM –IV-TR Anxiety Disorders
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Panic disorder with or without agoraphobia
Agoraphobia
Specific phobia
Social phobia
Obsessive-compulsive disorder
Posttraumatic stress disorder
Acute stress disorder
Generalized anxiety disorder
Outcome Identification and
Nursing Goals
• The patient will demonstrate adaptive ways of
coping with stress.
• Short-term goals can break the expected outcome
down into readily attainable steps.This allows the
patient and nurse to see progress even if the
ultimate goal appears distant.
• The highest priority short-term goal should
address safety and lowering the anxiety level. The
reduced level of anxiety should be evident in a
reduction of behaviors associated with severe or
panic levels.
Nursing Outcome Indicators for
Anxiety Self-Control
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Monitors intensity of anxiety
Plans coping strategies for stressful situations
Uses effective coping strategies
Monitors duration of episodes
Monitors length of time between episodes
Maintains adequate sleep
Seeks information to reduce anxiety
Controls anxiety response
Practice Guidelines
(Severe &Panic Levels of Anxiety)
• Establishing a trusting relationship
• Be aware of your own feelings of anxiety, as a
nurse. These can interfere with the therapeutic
process.
• Protecting the patient. Do not force severely
anxious patients into situations they are not able to
handle.
• Do not ask “why” questions. Patients don’t
understand why their symptoms have developed.
Practice Guidelines (cont)
(Severe levels of anxiety)
• Modifying the environment- identify anxietyproducing situations and attempt to reduce
them.Assume a quiet,calm manner and decrease
environmental stimulation. Limiting the patient’s
interaction with other patients will minimize the
contagious aspects of anxiety.
• Supportive measures include warm baths,
massages, and whirlpool baths.
• Encouraging patient’s interest in
activities.(walking, hobbies, physical exercise)
Medications
• Benzodiazepines: ie.
Xanax, Librium, Valium,
Ativan, Serax, Tranxene)
• Anxiolytic: BuSpar
• SSRI’s: Celexa, Prozac,
Paxil, Zoloft
• Tricyclics: Elavil,
Norpramin, Anafranil,
Tofranil, Pamelor
• MAOI’s: Nardil
Nursing Practice Guidelines
( For Moderate Levels of Anxiety)
• When patient’s anxiety is reduced to a moderate
level, the nurse can help with problem-solving
efforts to cope with stress.
• Long term goals focus on helping the patient
understand the cause of the anxiety and learn new
ways of controlling it.
• Goals include pt. education, recognition of the
anxiety, insight into the anxiety, and coping with
the threat. C.B.T. can be used and promotion of
the relaxation response.
Cognitive Behavioral Therapy
• Involves 3 therapeutic strategies:
• Anxiety reduction: relaxation, biofeedback,
systematic desensitization.
• Cognitive Restructuring: monitor thoughts and
feelings, examining alternatives, reframing.
• Learning new behavior: role-modeling, role
playing, social skills training, learning new ways
of coping with stress.
Promote the Relaxation Response
• It’s in the scope of nursing
practice
• It requires no special
equipment
• It does not need a
physician’s supervision
• Patient can practice
techniques on their own
• It can be implemented in
various settings.