7 Anxiety Disorders2

8/9/2019 7 Anxiety Disorders2

1/47

Anxiety Disorders


2/47

ANXIETY DISORDERS AnxietyVague,

subjecti e non s!eci"ic "ee#ing$

%uneasiness, a!!re&ension%tension,"ee#ing o" dread ori'!ending doo'

(auses) resu#t o" t&reat to one*s+io#ogic, &ysio#ogic and Socia#Integrity) externa# in"#uences


3/47

Ty!es o" AnxietySigna# Anxiety) - &obic Disorders.

reci!itant is identi"ied

A #earned anxiety res!onse)resu#ts "ro'situations success"u##y re!ressed orco!ed /it& using anot&er de"ense

'ec&anis'


4/47

Trait anxiety A "unction o" ersona#ity structure0in1 /it& de e#o!'enta# !rocess2e ents

3ay be #in1ed to unreso# edcon"#ict2con"usion -Anxiety Diat&esis.a!re)dis!osition to anxiety /&en ex!osedto stressor$E$g$$ One &ad a c&ronica##y i## 'ot&erand is o er!rotecti e /2o/n c&i#dren$


5/47

State AnxietyDe e#o!s in con"#ict or stress"u#situationsEx!eriences #i'ited contro#

Anxiety occurs be"ore t&e situationarisesE$g$$ 4o'an /&o a oids 'a1ing a!!t/2 3D a"ter "inding breast 'ass and&as a strong "a'i#y &x$ O" cancer$


6/47

5ree 5#oating Anxietyer asi e sense o" dread or doo'

(annot be attac&ed to any idea or

e ent3ay resu#t in !anic state i" stressorsexceed t&e indi idua#s abi#ity to co!e$


7/47

0e e#s o" Anxiety6i#degard e!#au 7Inter!ersona#Re#ations in Nursing 89:;< identi"ied5our stages o" anxiety on a continuu'3i#d3oderate

Se ere anicanic


8/47

+e&a iora# = &ysio#ogicc&anges in 3i#d Anxiety

erce!tua# "ie#d/idens

> a/areness ='oti ation

> !rob#e' so# ing =#earning

Irritab#eRe#ated c#ient Needs?

Rest#essness7butter"#ies insto'ac& s#ee! disturbance3ore sensiti e tonoise


9/47

+e&a iora# = &ysio#ogicc&anges 3oderate Anxiety

I''ediate tas1oriented

Attenti e toi''ediate tas1Di""icu#ty/2concentration,but

can be redirected

V2S nor'a# @increased5re uent urinationDry 'out&2'usc#etension

> rate o" s!eec&

dia!&oretic


10/47


11/47

+e&a iora# = &ysio#ogicc&anges in anic #e e# anxiety

Bnab#e to !rocessen iron'enta# sti'u#iDistorted !erce!tions

(an on#y "ocus on se#" Ris1 "or se#" &ar'Bnab#e to co''unicateIrrationa#t&oug&ts2be&a iors

ossib#ede#usions2&a##ucinations

(an run a/ay "ro'scene or(an be i''obi#iCed= 'uteDi#ated !u!i#s

> +2 , , R

5#ig&t,"ig&t or "reeCereaction


12/47


13/47

syc&odyna'ic 3ode#(once!t ie/s Anxiety as a /arning to t&eego

T&ree ty!es Anxiety identi"iedREA0ITY Anxiety-!ain"u# e'otiona# ex!erience resu#ting"ro' !erce!tion o" danger in externa# /or#d.3ORA0 Anxiety -T6E Ego*s ex!erience o" ui#t andS&a'e.NEBROTI( Anxiety -!erce!tion o" t&reat according toone*s instincts.

Neurotic sx*s de e#o! to de"end against anxiety


14/47

Inter!ersona# 2Socia#

syc&o#ogy 3ode#s2Anxiety Anxiety is t&e res!onse to externa#en iron'entSu##i an?


15/47

+e&a iora# 3ode#2Anxiety+ased on 0earning t&eory) etio#ogy o"sx*s based on genera#iCation o" anear#ier trau'atic ex!erience to a benignsetting or object$

0in1s !ast ex!eriences /it& !resentres!onses @ anxiety occurs /&en a7signa#< !redicts a !ain"u# or "eared e ent3ay be #in1ed to TSD


16/47

E!ide'io#ogy o" Anxiety

Disorders Anxiety D2O*s ))) @ FG o" !o!u#ation3ore !re a#ent in /o'en ;;)HH y2o = inse!arated2di orced grou!Exce!t "or O(D*s and Socia# &obias @anxiety greater in /o'en(#ients /2'ajor De!ression @8F$FG inc$ris1"or !anic d2o and 8:2 G ris1 "or agora!&obia8J)8;G o" genera# !o!u#ation &a e si'!#e!&obias


17/47

E!ide'io#ogy o" Anxiety

Disorders in t&e O#der Adu#t$: @8J G o" e#ders su""er "ro' Anxiety disorders8J)8:G o" 4o'en K : y2o see1 &e#! "ro' 3D-6ege#, et$a# ;JJ;.

RISL "actors? "e'a#eM urban #i ingM&x$ O" /orry or ru'inationM!oor !&ysica# &ea#t&M#o/ socioecono'ic statusM stress"u# #i"ee entsMde!ression = a#co&o#is'

AD @ 'ost co''on anxiety D2O in t&e e#der#y(2b /orry) co)exist /2de!ression$


18/47

+e&a iora# 'ani"estations o"

anic attac1sANI( ATTA(L)sudden onset @intensea!!re&ension)"ear"u#ness)terror assoc/2i'!ending doo')#asts 8:) J 'inutes

H or 'ore sx*s i$e$$!a#!itations, s/eating,tre'b#ingM SO+,c&o1ing,s'ot&eringsensation


19/47

+e&a iora# 'ani"estations o"

&obias6O+IAS @ a oidance o" object orsituation

Signi"icant distress or i'!air'ent o" dai#yroutines,occu!ation or socia# "unctioning$5ear recogniCed as excessi e orunreasonab#e


20/47

ost Trau'atic Stress

Disorder - TSD.(2b re)ex!eriencing an extre'e#ytrau'atic e ent-begins /it&in 'ont&sto years a"ter e ent @#asting 'ont&s oryears

erson a oids t&e sti'u#i associated /it&t&e e ent,nu'bing o" res!onsi eness,increasedarousa#


21/47

TSD)))c&aracteristicsIntense "ear 2&e#!#essness2&orror u!on ex!osureDrea's,"#as&bac1s,

&ysica#2!syc&o#ogica# distress o er re'inders o"

t&e e ent A oids 'e'ory !ro o1ing sti'u#i5ee#ing detac&ed or estranged "ro' ot&ersIncreased arousa# -irritabi#ity,angry outburst,s#ee!!rob#e's,&y!er igi#ance,exaggerated start#eres!onse.


22/47

TSD inter entionsro'ote desensitiCation t&roug&

gradua# ex!osure to e ent or situationsi'i#ar to t&e e entTeac& re#axation tec&ni ues

ro ide indi idua# t&era!y to address#oss o" contro# issuesEncourage use o" su!!ort grou!sEncourage use o" &y!not&era!y


23/47

enera#iCed Anxiety Disorder (2b at #east 'ont&s o" !ersistent,excessi e /orry and anxiety$

Bncontro##ab#e /orryingSigni"icant distress /2i'!aired socia# oroccu!ationa# "unctioning

o" t&e "o##o/ing?rest#essness, "atigueseasi#y,di""icu#ty /2concentration, t&oug&tb#oc1ing,irritabi#ity, 'usc#e tension s#ee!disturbance$


24/47

Inter entions Attend to !&ysica# sy'!to's Assist c#ient to identi"y t&oug&ts t&atarouse t&e anxiety = t&eir bases

Assist c#ient to c&ange unrea#istict&oug&ts to 'ore rea#istic t&oug&tsBse cogniti e re)structuring

Ad'inister anti)anxiety 'edications as!rescribed


25/47

Obsessi e (o'!u#si e

Disorder Obsessions @- t&oug&ts, i'!u#ses ori'ages. /&ic& cause 'ar1ed anxiety or(o'!u#sions-re!etiti e be&a iors or'enta# acts.

Recurrent, !ersistent, un/anted t&oug&tsi'!u#ses or i'ages

Atte'!ts to ignore,su!!ress,or neutra#iCesobsessions /it& co'!u#sions @are 'ost#yine""ecti e$


26/47

O(D inter entionsIdenti"y t&e situation t&at !reci!itates t&e be&a ior Do not interru!t co'!u#si e be&a iors

A##o/ ti'e "or co'!u#si e ritua#s

ro ide sa"ety re#ated to be&a iorsro ide sc&edu#e to distract be&a iors

Set #i'its on ritua#s t&at 'ay inter"ere /it& c#ient/e##)beingEstab#is& /ritten contract)decrease "re uency o"co'!u#si e be&a iors


27/47

De e#o!'enta# considerations(&i#d

Ado#escent

Adu#t

E#der

( ( d


28/47

(u#tura# (onsiderations "or Anxiety disorders in?

6is!anic A"rican @A'erican

AsianEuro!ean) A'erican3idd#e Eastern


29/47


30/47

A c#ient dis!#ays iso#ation, biCarrebe&a iors, unsa"e actions and !oor&ygiene$ 4&ic& /i## be t&e "irst !riority i

t&e nursing care !#an A$. Sa"ety+$.6ygiene

($.Iso#ationD$. +iCarre be&a iors


31/47

T&e nurse /ou#d ana#yCe t&e sy'!to'so" 'usc#e rigidity, I u!set, ra!ids!eec&,and need to urinate as /&ice e# o" anxiety

A$. 3i#d+$. 3oderate($. Se ere

D$. anic


32/47

A c#ient &as recent#y been in o# ed in assisting /it& t&ec#ean)u! "ro' a "#ood t&at /as&ed a/ay 'any

&o'es in &is area and caused #oss o" #i"e$4&ic& o"t&ese inter entions /ou#d assist t&e c#ient in dea#ing/it& t&e trau'atic ex!erience$

A$ ro ide t&e o!!ortunity to ta#1 about t&e ex!erience$+$ Encourage t&e c#ient to #ea e t&e area in order to

"orget t&e ex!erience$($ Suggest ad'ission to a 'enta# &ea#t& "aci#ity$D$ Arrange "or a 'inister to s!ea1 /it& t&e c#ient$


33/47

A!!ro!riate disc&arge criteria "or a c#ient /it&c&ronic anxiety disorder is t&e c#ient /i##)))

A$. ex!erience no 'ore anxiety+$. su!!ress t&e anxiety sy'!to's and

"ocus on t&e "uture($. Identi"y situations and e ents t&at trigger

anxietyD$. recogniCe t&e need to ta1e 'edications

"or t&e rest o" &is2&er #i"e to contro# anxiet


34/47

T&e nurse is /or1ing /it& a c#ient /it& c&ronic anxiety$T&e goa# is t&at t&e c#ient /i## identi"y ear#y /arningsy'!to's o" anxiety$T&e nurse /ou#d ana#yCe t&e

c#ient as 'o ing to/ards t&is goa# /&en t&e c#ient? A$. begins to connect !anic sy'!to's /it& t&oug&tsabout a recent brea1)u! in a re#ations&i!$

+$. is "ree o" anxiety "or one /ee1

($.!ractices re#axation tec&ni ues dai#y and /&enanxiety increasesD$.recogniCes t&at ot&ers a#so ex!erience anxiety in

arying situations


35/47

A c#ient is to recei e 'edication t&era!y "or ananxiety disorder$ To reduce t&e ris1 o" de!endenceand !rob#e's re#ated /it& /it&dra/a#, /&ic& o" t&e"o##o/ing agents /ou#d t&e nurse 'ost #i1e#yantici!ate as being !rescribed - select all thatapply)

A$ aroxetine - axi#.

+$ Serta#ine - o#o"t.($ 0oraCe!a' -Ati an.D$ Ven#a"axine -E""exor.E$ (#onaCe!a' -L#ono!in.


36/47

T&e nurse assesses a c#ient /it& adiagnosis o" enera#iCed Anxiety disorder

"or /&ic& o" t&e "o##o/ing sy'!to's A$ 5ear and a oidance o" s!eci"ic situations or!#aces$

+$ ersistent obsessi e t&oug&ts($ Re)ex!erience o" "ee#ings associated /it&trau'atic e entsD$ Bnrea#istic /orry about a nu'ber o" e ents

in one*s #i"e$


37/47

A H year)o#d gir# /&o is a icti' o" a bo'b b#ast t&atde'o#is&ed t&e bui#ding /&ic& &oused &er daycare constant#ybui#ds b#oc1 &ouses and b#o/s t&e' u!$ S&e a#so &asnig&t'ares "re uent#y$ 4&ic& one o" t&e "o##o/ing diagnosesis a!!ro!riate "or t&e nurse to 'a1e regarding t&is c&i#d

A$ ost)trau'a res!onse re#ated to terrorist attac1 as e idencedby destructi e be&a iors and s#ee! disturbance$

+$ Ex!#osi e disorder re#ated to dys"unctiona# !ersona#ity ase idenced by destructi e be&a iors$

($ S#ee! disturbance re#ated to e'otiona# trau'a as e idenced

by nig&t'ares$D$ Ine""ecti e indi idua# co!ing re#ated to interna# stressors ase idenced by destructi e be&a iors and nig&t'ares$


38/47

Nursing (are #an? Anxiety Assess'ent data?

A!!earance,+e&a ior,(on ersation i$e$?4ringing &ands,decreasedco''unication,rest#essness,irritabi#ity,!acing,decreased attn, !oori'!u#se contro#

Identi"y stressors) intra,inter, extra!ersona#Identi"y #ines o" de"ense


39/47

oa#s2ex!ected outco'es?S&ort ter'?T&e c#ient /i##? be @"ree o" injury

Discuss "ee#ings o" dread or anxietyRes!ond to re#axation tec&ni uesDe'onstrate abi#ity to !er"or' re#axation


40/47

I'!#e'entation? anxietyRe'ain /it& c#ient at a## ti'es i" #e e# is se ereor !anic-sa"ety i'!ortant.Re'o e c#ient to Puiet area- c#ient is not ab#e to

dea# /it& excessi e sti'u#i.Re'ain ca#' u!on a!!roac&ing c#ient-c#ient /i##"ee# 'ore secure i" you are in contro# o" situation.Bse s&ort si'!#e c#ear state'ents-i'!aired

abi#ity to dea# /it& abstractions2co'!#exities.Bse RN 'eds as indicated


41/47

Nursing inter entions?Educate c#ient re use o" ca""eine, nicotine etc$-!re ents2'ini'iCes cardio ascu#arres!onses i$e$ Inc &eart rate and jitteriness.

ro ide instruction regarding anxietyreduction stretagies

rogression re#axation tec&ni ues0istening to s'oot&ing 'usic or re#axation ta!es


42/47

4&en !#anning disc&arge "or a c#ient /it&c&ronic anxiety t&e nurse directs t&e goa# o"!ro'oting a sa"e en iron'ent at &o'e$T&e'ost a!!ro!riate 'aintenance goa# s&ou#d"ocus on /&ic& o" t&e "o##o/ing?

A$(ontinues contract /it& a crisis counse#or +$Identi"ying anxiety !roducing situations($Ignoring "ee#ings o" anxietyD$E#i'inating a## anxiety "ro' dai#y situations


43/47

A c#ient /it& O(D is ad'itted to t&e !syc&iatricunit "or &and /as&ing ritua#s$ T&e day a"terad'ission s&e is sc&edu#ed "or #ab tests$ Toassure t&at &e c#ient is t&ere on ti'e, t&e nurses&ou#d?

A$ Re'ind t&e c#ient se era# ti'es o" &era!!oint'ent$

+$ 0i'it t&e nu'ber o" &and /as&ings($ Te## &er it is &er res!onsibi#ity to be t&ere on ti'eD$ ro ide a'!#e ti'e "or &er to co'!#ete &er ritua#s$


44/47

A c#ient ad'itted "or ritua#istic be&a iors isconsti!ated and de&ydrated$ 4&ic& nursinginter ention /ou#d t&is c#ient 'ost #i1e#y co'!#y/it&

A$ Drin1ing Ensure bet/een 'ea#s+$ Drin1ing extra "#uids /it& 'ea#s($ Drin1ing F oC$ O" /ater e ery &our bet/een

'ea#sD$ Drin1ing ade uate a'ounts o" "#uid during t&e

day


45/47

A /o'an co'es into t&e e'ergency roo' in a se ere state o" anxiety

"o##o/ing a car accident$ T&e 'osta!!ro!riate nursing inter ention is to? A$ Re'ain /it& t&e c#ient+$ ut t&e c#ient in a uiet roo'($ Teac& t&e c#ient dee! breat&ingD$ Encourage t&e c#ient to ta#1 about &er

"ee#ings and concerns


46/47

A c#ient is un/i##ing to go out o" t&e &ouse "or 7"earo" doing so'et&ing craCy in !ub#ic


47/47

A c#ient is ad'itted to a !syc& unit a"ter &a ing'any test "or acute b#indness "or /&ic& t&ere isno organic cause$T&e nurse #earns t&e c#ientbeca'e b#ind a"ter /itnessing a &it and runaccident, /&en a "a'i#y o" t&ree /as 1i##ed$ T&e

nurse sus!ects t&e c#ient 'ay be ex!eriencing? A$ syc&osis+$ (on ersion Disorder ($ Dissociati e Disorder D$ Re!ression

7 Anxiety Disorders2

Documents

Transcript of 7 Anxiety Disorders2