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Anxiety Disorders 2

Anxiety Disorders 2

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Published by nursekatie

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Published by: nursekatie on Oct 12, 2009
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05/27/2012

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Anxiety DisordersPanic Disorder 
1.The patient experiences
recurrent panicattacks
2. Episodes typically last 15-30 minutes3. Four or more of the following symptoms arepresent:-
Palpitations, SOB,
Choking or SmotheringSensation,
Chest Pain,
Nausea, Feelings of Depersonalization,
Fear of Dying
, Chills or Hot Flashes, Fear of going crazy, Decreasedperceptual and cognitive abilities4. Pt may experience Changes in Behavior and/or Persistent Worries about when the nextattack will occur 5. May experience Agoraphobia due to fear of being in places where previous panic attacksoccurred.*MAY BE CONFUSED WITH A HEARTATTACK*DOES NOT NECESSARILY FOLLOWS ANSTRESSFUL, IDENTIFIABLE EVENT
Generalized Anxiety Disorder (GAD)
1. More than 6 months of uncontrollable,excessive, unrealistic worries (inadequacy ininterpersonal relationships, job responsibilities,finances, health of family members, householdchores, and lateness for appointments)2. GAD causes significant impairment in one or more areas of functioning.3. At least 3 of the following symptoms arepresent:-Fatigue-Restlessness-Inability to Concentrate-Irritability-Muscle Tension-Sleep Disturbances4. Characterized by Remissions andexacerbations (no acute anxiety attack)
Phobias
1. The client fears a specific object or situationto an unreasonable level. Phobias include:-SOCIAL PHOBIA-AGORAPHOBIA-SPECIFIC PHOBIAS:-Fear of specific objects (snakes, spiders,strangers)-Fear of specific experiences (flying, being inthe dark, riding an elevator, being in anenclosed space)
Obsessive Compulsive Disorder 
1. The client has intrusive thoughts of unrealistic obsessions and tries tocontrol these thoughts with compulsive behaviors, which are repetitive –ritualistic--Clients who engage in constant ritualistic behaviors may have difficultymeeting self-care needs-If rituals include constant hand washing or cleaning, skin damage and infection may occur.
Post-Traumatic Stress Disorder (PTSD)
1. Exposure to a traumatic event causes intense fear, horror,flashbacks, feelings of detachment and foreboding, restricted affect,and impairment for longer than 1 month after the event. Symptoms maylast for years.-ACUTE PTSD: Symptoms last less than 3 months-CHRONIC PTSD:Symptoms last more than 3 monthsSYMPTOMS:-Recurrent, intrusive recollection of event-Dreams or images-Reliving through flashbacks, illusions, or hallucinations-Irritability, difficulty with concentration, sleep disturbances, avoidanceof stimuli associated with trauma, inability to show feelings.(it differs from Acute Stress Disorder in that ASD occurs after exposureto a traumatic event, causing numbing, detachment and amnesia aboutthe event for NOT MORE than 4 weeks following the event, withsymptoms lasting from 2 days to 4 weeks)
 
Assessment
1.Perform a thorough Physical and Neurological examination to help determine if anxiety is primary or is secondary to another psychiatric disorder, amedical condition, or substance use.2.Assess Risk for Suicide3.Perform psychosocial assessment (To help client identify the problem to be addressed by counseling (stressful marriage, recent loss, stressful job or school situation)4.Assess coping mechanisms5. Use a standardized assessment scale, such as Hamilton Rating Scale for Anxiety.
Expected Outcomes
1.Client uses coping mechanisms to prevent panic anxiety when stressful situations occur.2.Client verbalizes acceptance of life situations over which he or she has no control3. The client is able to recognize signs of anxiety and intervene to prevent panic levels
Nursing Interventions
1.Ensure Safety2.Stay with the client and provide support (Provide reassurance, use therapeutic communication skills, use open-ended questions, encourage client toverbalize feelings)3.Use relaxation breathing techniques as needed4.Reduce environmental stimuli5.Encourage physical activity like walking
6.
Administer medications as prescribed (SSRIs, TCAs, MAOIs, Benzodiazepines (anxiolytics), Beta Blockers, Mood stabilizers)7.Instill hope (but avoid false reassurance)8.Enhance Self Esteem by encouraging positive statements about self and discussion of past achievements.
9.
Postpone teaching until acute anxiety subsides: clients with panic attack or severe anxiety are unable to concentrate or learn.In General, Interventions for Anxiety disorders attempt to:1.Reduce Anxiety2.Increase Self Esteem3.Increase Reality Testing4.Enhance Coping Mechanisms5.Instill Hope6. Relaxation Therapy
Anxiety Medications

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