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Mental Health Nursing: Anxiety Disorders Stress Produces Anxiety

Apr 01, 2015

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Mental Health Nursing: Anxiety Disorders Stress Produces Anxiety Slide 2 Anxiety Disorders Objectives At the completion of this unit you will be able to: 1)Explain anxiety and five specific anxiety disorders 2)Identify behavioral and physical manifestations of anxiety disorders 3)Describe nursing care and treatment modalities for anxiety disorders Slide 3 Anxiety Disorders Stress and anxiety can be associated with both positive and negative situations Slide 4 Anxiety Disorders Eustress: stress associated with positive experiences. Stressor: any person or situation that produces anxiety. What is stressful to one person might be relaxing to another. Slide 5 Anxiety Disorders Anxiety is: A feeling of uneasiness or apprehension A response to extreme or prolonged periods of stress An uncomfortable feeling of dread Slide 6 Anxiety Disorders Anxiety may be influenced by ones culture: Some believe that personal problems should be kept to themselves Others believe it is therapeutic to acknowledge and discuss stress Machoism Slide 7 Anxiety Disorders Free-floating anxiety: a gut feeling that something bad may happen; feeling of impending doom. Stressor is not clear. Signal anxiety: A clear & known stressor causes stress & anxiety Slide 8 Anxiety Disorders In Children & Teenagers Stress & Anxiety Indicators: Withdrawal from friends and usual activities Changes in eating habits Changes in sleeping patterns Decline in school performance Slide 9 Anxiety Disorders In Children & Teenagers More than 50% of juveniles who are offenders of the law &/or are incarcerated also have a mental illness that is associated with anxiety and substance abuse. Slide 10 Anxiety Disorders Freuds Psychoanalytic Theory Unconscious forces act to determine personality & behavior Id: primitive drives, pleasure principle; i.e.: hunger, sex Ego: Rational & reasonable; buffer between the outside world & the id Superego: Conscious distinctions between right & wrong. Slide 11 Anxiety Disorders Freuds Psychoanalytic Theory Anxiety is caused by conflict between the id and the superego. Slide 12 Anxiety Disorders Sympathetic Nervous System Responses Initiates the fight or flight response Epinephrine & norepinephrine are released. BP, pulse, pupil dilation Slide 13 Anxiety Disorders Effects of chronic or uncompensated stress Review Table 11-1 (p. 188) Slide 14 Anxiety Disorders Effects of chronic or uncompensated stress Individuals with stress/anxiety are 2/3s more likely to develop cold and flu symptoms than those who are not. Slide 15 Anxiety Disorders Suppressed anger also has the same negative effects on general health. Chronic anger is frequently associated with chronic headaches. Slide 16 Anxiety Disorders Anxiety Types Generalized Anxiety Disorder Excessive worry or stress that is related to 2 or > things & lasts > 6 months. Must show 6 or > symptoms of anxiety Slide 17 Anxiety Disorders Anxiety Types Generalized Anxiety Disorder Symptoms: Nausea, dry mouth, muscle aches, restlessness, shakes, fatigue, polyuria, chills, hot flashes, sleep disturbances, dry mouth, nausea, vomiting, palpitations, difficulty swallowing Slide 18 Anxiety Disorders Anxiety Types Generalized Anxiety Disorder Nursing Actions: Calm milieu, open communication, explore causes & effects of anxiety, encourage enjoyed activities, suicide precautions, document behaviors. Slide 19 Anxiety Disorders Anxiety Types Panic Disorder Extreme fear that cannot be controlled. Panic Attack Agoraphobia Diagnosis requires 4 out of 12 DSM symptoms. Slide 20 Anxiety Disorders Anxiety Types Common Symptoms of Panic Disorder Fear, dissociation, nausea, diaphoresis, chest pain, shaking, Increased pulse, unsteadiness Interventions: are the same as those for anxiety disorder Slide 21 Anxiety Disorders Anxiety Types Common Symptoms of Panic Disorder Slide 22 Anxiety Disorders Anxiety Types Phobia Most common anxiety disorder Irrational fear Individuals are aware that it is an irrational fear Estimated that 700 different things cause phobias Slide 23 Anxiety Disorders Anxiety Types Phobia Arachnophobia Ophidiophobia Slide 24 Anxiety Disorders Anxiety Types Phobia Subcategories Agoraphobia: fear of being in open spaces. Social phobia: fear humiliation in social situations Simple phobia: fear of a specific thing (i.e.: claustrophobia, hematophobia, acrophobia) Slide 25 Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder (OCD) Slide 26 Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder (OCD): 2 Parts Obsession: repetitive thought, urge, or emotion Compulsion: repetitive act that may appear purposeful Behaviors are ritualistic and occur to reduce anxiety Unable to stop the thought or action. Slide 27 Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder The thought or action is a substitute for the source of anxiety. Individuals with this disorder tend to be rule-oriented and perfectionistic Slide 28 Anxiety Disorders Anxiety Types Obsessive-Compulsive Disorder If the individual is prevented from performing the act, the anxiety converts into somatic symptoms. Slide 29 Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Develops in response to a emotional or physical trauma that could not be controlled. Slide 30 Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Common Causes Solders in war Rape victims Witnessed suffering Experienced the effects of violent acts or storms Slide 31 Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder World Trade Center Slide 32 Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Survivor Guilt Guilt experienced by survivors of a traumatic event. Slide 33 Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Symptoms May appear immediately or be repressed for years. Flashbacks: reliving or acting out the traumatic event. Social Withdrawal Low self-esteem Slide 34 Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Symptoms (continued) Changes in relationships & difficulty forming new relationships Irritability and outbursts of anger with seemingly no obvious reason Depression Chemical dependency: self-medicating Slide 35 Anxiety Disorders Anxiety Types Post-Traumatic Stress Disorder Nursing Interventions Communication & listening skills Develop a working rapport First step is important: encourage the patient to express thoughts & feelings about the traumatic event Help to identify the source Validate the patients feelings Slide 36 Anxiety Disorders Medical Treatment Psychopharmacology Antianxiety Medications Benzodiazepines Strong potential for dependency Antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Slide 37 Anxiety Disorders Antianxiety/Anxiolytic Medications Uses: Treatment of anxiety, stress, mild depression, ETOH withdrawal, muscle relaxation Action: Depress activities of the cerebral cortex (CNS Depressant) Benzodiazepines: largest sub- category of anxiolytics Slide 38 Anxiety Disorders Anixolytics Benzodiazepines: 1) Chlordiazepoxide (Librium) 2) Lorazepam (Ativan) 3) Diazepam (Valium) 4) Alprazolam (Xanax) Slide 39 Anxiety Disorders Benzodiazepines: Side effects & Precautions: Fatigue, drowsiness, postural hypotension & ataxia Potential for physical & psychological dependence Confusion in the elderly Sleep pattern disturbance Potentiates ETOH and other narcotics Slide 40 Anxiety Disorders Medical Treatment Psychotherapy Individual treatment Group therapy Systematic desensitization Counseling: concentrate esteem needs & reality Slide 41 Anxiety Disorders Alternative Interventions Biofeedback Form of behavior modification Promotes relaxation Slide 42 Anxiety Disorders Alternative Interventions Hypnosis Is a licensed profession Needs to be done routinely to be effective Slide 43 Anxiety Disorders Alternative Interventions Aromatherapy Essential oils: aid in relaxation Slide 44 Anxiety Disorders Alternative Interventions Teaching deep breathing and other relaxation techniques provides an avenue for individuals with an opportunity to manage their anxiety independently Slide 45 Anxiety Disorders Nursing Interventions I.Maintain a calm milieu Minimizing stimuli helps the individual to focus and find their center. II. Encourage activities: should be of interest, enjoyable, and have meaning to the individual. Should not cause stress. Provide diversion; individual will think about something else. Slide 46 Anxiety Disorders Nursing Interventions III: Maintain open communication: Encourage individual to verbalize feelings and thoughts. Show respect and encourage reflection to facilitate understanding themselves. Individuals need to feel that they have value. IV.Observe affect & body language: reveal more about thoughts, esteem, attitudes, & feelings. Slide 47 Anxiety Disorders Nursing Interventions V.Observe for suicidal thoughts: risk of suicide results from feelings of decreased self-worth and low self-esteem. Any statements made in relation to suicide need to be reported. Ask if they have a plan. VI.Document changes in behavior: i.e.: they ways in which the individual responds to the nurse, to other people, to treatments, or in interactions. Slide 48 Anxiety Disorders Concluding Statements Trust & communication techniques are important skills for the nurse. Interventions that facilitate a calm milieu are also important. Therapies and psychopharmacology should be individualized to the individual. Slide 49 Anxiety Disorders Closure Table 11-2 (p. 194): Review common anxiety disorders Test Questions (p. 197-199) What is a therapeutic Milieu? (p. 126: lets read together)

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