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7.anxiety disorders


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  • 2. Eustress  Stress from a positive experience----Wedding, Job promotions etc.  Can produce a great deal of anxiety even though is originated from a positive experience
  • 3. Anxiety Uncomfortable feeling of dread Occurs in response to stress that is extreme or over a long period of time. Stressors are different for everyone. What may be extremely stressful for one person may be relaxing to someone else. Anxiety is also influenced by culture. Some admit to it others keep it to themselves based on their culture. Higher levels of anxiety may result in behavioral changes. All anxiety disorders except OCD occur more in woman than men.
  • 4. Anxiety Mild anxiety is somewhat normal and healthy for an individual for cooping with stress. Nurses working with children and teen need to be aware that they experience anxiety and stress as well, but sometimes are unable to verbalize their feelings therefore display symptoms differently. For example, decrease in grades, eating habits change, sleeping patterns, withdrawal from friends and activities. Nurses can be instrumental in screening children for signs of anxiety. Anxiety is different from fear-fear is a response to a known threat.
  • 5. 4 Levels of Anxiety  Anxiety is ranked as mild, moderate, severe and panic.  Mild-able to recognize anxiety  Moderate-able to sustain attention on a focal point, may talk faster, vital signs increase, able to express and recognize anxiety  Severe-attention is focused on a small part of a specific area, may be unaware of anxiety, vitals increase, coping and relief measures used.  Panic-feelings of unreality, confusion, terror, self absorption, may use violence towards self, others. Loss of control, may run away-can result in exhaustion
  • 6. Resilience  Definition-the ability to withstand and recover from stress  A study on resilience was done on 750 servicemen who were held captive during the Vietnam War.  They were held prisoners for 6-8 years  Some of these men did not develop depression or post traumatic stress disorder (PTSD)  What protected these men?????
  • 7. 10 Characteristics of These Resilient Men           Optimism Altruism Moral Values Faith and Spirituality Humor Having a Role Model Social Support Facing Fear Having a Mission Training
  • 8. Types of Anxiety Disorders         Generalized anxiety disorder Panic disorder Agoraphobia Obsessive Compulsive Disorder Acute stress disorder Posttraumatic stress disorder (PTSD) Anxiety disorder due to a general medical condition Substance induced anxiety disorder
  • 9. Panic Disorder
  • 10. Generalized Anxiety Disorder (GAD)  Anxiety itself is the expressed symptom/ these are the “worry worts”.  Generally requires that excessive worry be related to 2 or more things that last 6 months or longer  These people worry excessively about money, health, family, being late, or work---even when there are no signs of trouble.  Physical symptoms- fatigue, HA’s, muscle tension, muscle pain, irritability, sweating, nausea, difficulty swallowing, trembling, etc….  People with this disorder usually avoid situations that produce their anxiety.
  • 11. Agoraphobia  Characterized by anxiety about being in places or situations where escape may be difficult  Situations include-being alone away from home in a crowd or standing in line; on a bridge or traveling in on a plane, train, bus etc…  Severely impairs social and occupational functioning when the individual avoids multiple anxiety producing situations.  It is important to know that not everyone that stays in the home has this….In some cultures its customary for the woman to stay in the home.
  • 12. Social Phobia  Characterized by a marked and persistent fear of social performance situations in which embarrassment may occur.  Phobia-definition- a persistent and irrational fear.  Social phobia only exists if the fear, avoidance, or anxiety about encountering the social situation interferes significantly with daily life.  Physical symptoms include-blushing, excessive sweating, nausea, GI distress, tremors, difficulty talking, etc….  Even after people with social phobia did the dreaded deed, they still have anxiety about how people are still judging them and how they were perceived.
  • 13. Obsessive Compulsive Disorder (OCD)
  • 14. Define Obsession – repetitive thought urge or emotion Compulsion – repetitive act that may appear purposeful
  • 15. OCD  People with this disorder are unable to stop the thought or action/behaviors become rituals.  It is doing the action or having the thought that reduces anxiety.  Some are such strict rituals that if interrupted, requires them to start over from beginning.  If person is prevented from performing obsession or compulsion, anxiety converts to body related symptoms.
  • 16. Examples of OCD Check several times that doors are locked before able to sleep. This actually can lead to inability to sleep! Washing hands nonstop to the point of chapped raw skin. Counting and cleaning are also examples.
  • 17. OCD  Performing rituals only provide temporary relief though. People with this disease also realize that obsession are excessive or unreasonable.  Obsessions usually take more than one hour a day and interfere with normal healthy lifestyle, socially, work and relationships.  OCD is sometimes accompanied by depression, eating disorder, substance abuse, ADHD, or other anxiety disorders.  Treatments which combine medications and behavioral therapy are often effective.
  • 18. Nursing Interventions For OCD  Limit, but do not interrupt, the compulsive acts.  Teach the client to use alternate coping methods to decrease anxiety.  Client’s behavior maybe frustrating to staff and family. Power struggles often result. Consistency to the approach to care is critical.  Assess the client’s needs carefully.  Provide an environment that has structure and predictability as a strategy to decrease anxiety.  Risk associated with the use of alcohol and drug abuse.
  • 19. Acute Stress Disorder  Exposure to traumatic event causes numbing, detachment, amnesia about event for no more than 4 weeks following event.
  • 20. Post Traumatic Stress Disorder (PTSD)
  • 21. PTSD  Is developed in response to unexpected emotional or physical trauma that could not be controlled.  Can be actual or threatened.  Can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened,  Events may include—violent personal assaults, natural or human caused disaster accidents or military combat.  Family members of victims also can develop the disorder.  Can occur in people of any age, including children and adolescents.
  • 22. Symptoms of PTSD        Flashbacks Difficulty concentrating Memories Nightmares or frightening thoughts Emotional numbness Sleep disturbances Depression anxiety and irritability or outbursts of anger for no apparent reason
  • 23. PTSD  Social withdrawal, feelings of low self esteem, changes in relationships with significant other and difficulty starting new relationships, chemical dependency as a physical or behavioral response to traumatic experience.  Anniversaries of events can trigger symptoms.
  • 24. Treatment for PTSD  Cognitive behavioral therapy, group therapy and exposure therapy in which the person is gradually and repeatedly re-lives the frightening experience under controlled setting. Suggest giving people opportunity to talk about their experiences very soon after a catastrophic event may reduce symptoms of PTSD.  Trust and communication and listening skills are very important tools for nurses.  Encouraging points to express thoughts and feelings surrounding the experience.
  • 25. Survivor Guilt  A feeling of guilt expressed by survivors of a traumatic event.  Why me? Or why not me?  Treat similar to PTSD.  It is important to validate the patients feelings regarding situation.  Honesty and genuineness in communication with these patients will help build a working rapport.
  • 26. Interventions For the Client With an Anxiety Disorder  Maintain calm milieu-minimizing stimuli helps patient keep centered and focused.  Maintain open communication.  Encourage patient to verbalize all thoughts and feelings with honesty helps with trust observe nonverbal communication.  Observe for signs of suicidal ideations. If suspect; observe and confront and document any suspicions or statements  Document changes in behavior any change no matter how small  Encourage activities provide diversion and concentration on something other than stress and anxiety producing situation. Should be purposeful and not busy work not competitive either.
  • 27. Interventions for anxiety cont’d  Psychopharmacology-ant anxiety meds valium. Xanax. Short term due to dependency.  Individual psychotherapy  Group therapy  Systematic desensitization-slowly reintroducing anxiety causing object.  Hypnosis  Imagery  Relaxation exercises  Biofeedback  Safety and comfort during crisis period  Remain with patient during acute attack
  • 28. List nursing interventions for the client with anxiety          Assist patient to identify precipitants and patterns to anxiety Calm manner Open communication Encourage use of positive self talk Encourage problem solving and assist to develop alternative solutions When anxiety has passed help patient to identify and evaluate coping mechanisms that did work and those that have not worked Assess your own level of anxiety Communication techniques Open ended questions to assess patients feelings