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with others, making it a basic concept in the study of psychiatric nursing. Most common psyc disorder in the US., it impairs QOL and Funx. SXS include: CP, Palpitations, dizziness, SOB Vague in nature it encompasses uncertainty and helplessness. The person believes there is a threat to his personality. Experiences begin as early as Infancy, ending with the biggest fear: DEATH. Anxiety is an emotion w/o specific object.: It is provoked by the unknown and precedes all new experiences, (starting school, new job, ) it is different from fear. Fear: has a specific orgin that person can describe. FEAR INVOLVES THE INTELECTUAL APPRAISAIL OF A THREATENING STIMULI, ANXIETY INVOLVES AN EMOTIONAL RESPONSE TO THAT APPRAISAIAL. ANXIETY IS COMMUNICATED INTERPERSONALLY, nurse talks to anxious patient, nurse will feel types of anxiety and vice versa. Mirror effect of anxiety, may help or hinder therapeutic relationship, does provide valuable feeling of warning and assists in survival. The Crux of anxiety is self-preservation. Occurs as a threat to a person s self-help, esteem, id. A thereat to ones existence and personality. Maybe from fear of punishment, disapproval, disruptions, isolation of loss of body functioning Culture relates to anxiety as an influence. (We get anxious about our values) Underlying fear ALWAYS has anxiety of losing ones own being.<-- Frightening element. Person should use opportunity to grow ) GROW-CONFRONT-MOVE THROUGH- == OVERCOME ANXIETY. LEVELS OF ANXIETY MILD: tension of everyday living. Person alert and perceptual field increases. Senses are sensitive-hear better, see clearer. GOOD anxiety because it motivate and produce growth and creativity.
MODERATE ANXIETY: PERSON FOCUSES ONLY ON IMMEDIATE CONCERS-NARROWS THE PERCEPTUAL FIELD Senses; hearing grasp vision- diminishes Although the person blocks a lot of things going on, they can be persuaded to function and do other things.
restless. DREAD. Person is unable to communicate or function correctly. and has loss of rational thoughts. Words used are: tense. Cannot persist. Motor activity INCREASES.SEVERE ANXIETY: SIGNIFIGANT REDUCTION IN PERCEPTUAL FIELD. TON of direction is needed to focus on something else. worried. Blood is shunted from stomach and intestines to the heart. Person is distorted. Most behaviors are a response from the ANS. Can also trigger General Adaption Syndrome (SEYLE) Cortex receives threat-sends stimulus down sympathetic branch of ANS to adrenal glands . but severe anxiety and panic paralyze with exhaustion. Such disorganization can be life threatening. Epinephrine releases. Might say that they are having a bad Feeling. responsiveness. Glycogenesis is acclerated-Gluclose levels RISE. Cognitive: affects mental and intellectual function. subjectively they share the same descriptions. Behavioral: effects coordination and invol movements. ANS Reactions: Parasympathetic: Conserve the body s responses. Person focuses specific details and not think about anything else. The relationship of hostility and anxiety are VERY CLOSE! Anger and resentment toward those thought to be responsible. 15-1 page 221 Responses are Behavioral. TERROR-PERSON UNABLE TO DO THINGS EVEN WITH DIRECTION. CNS. Affective. MOST ADAPTIVE RESPONSE: ANTICIPATION MOST MALADAPTIVE RESPONSE: PANIC. PANIC AWE. There is effective TREATMENT. PATIENTS LEVEL OF ANXIETY AND POSITION ON CONTINUM OF COPING RESPONSES ARE RELEVANT TO NURSING DX. The heart beats faster and arterial pressure rises. and muscles. jumpy. Prolonged period would result in exhaustion and DEATH. Internal adjustment without a conscious or voluntary effort. Ability to relate to others DECREASES. as it is usually combined with other emotions. PANIC is FRIGHTENING and can be PARALYZING. Cognitive. Affective: by subjective narration of experience. One feeling can exemplify another. ALL behavior is aimed at relieving anxiety. Sympathetic: activate body processes. which deepens respiration. All words express apprehension and over alertness. BEHAVIORS: Mild to moderate can be helpful. Person interprets anxiety as a kind of warning sign. AND INFLUENCES OUR INTERVENTIONS. On edge. . prepares for Flight/Fight. It is hard to distinguish anxiety from depression. Pure anxiety is rarely seen. jittery. Discomfort is anticipated which causes social isolation. at this level it is incompatible with life. turning hostility into anxiety.
Stats: panic disorder heredity is 40% Families that have a HX of psyc illness are 3x likely to develop PTSD. especially physical disorders. both structures of the Limbic System. they are more likely to be anxious later in life. If exposed early in life to intense fears. Coping mechanisms can be affected by: toxic influence. PTS with nervous fatigue and sleep problems may already be experiencing moderate anxiety and are more susceptible to future stress. Meds that decrease activity of the locus (antidepressents. hormones. it binds to a place on the GABA receptor next to GABA. IT IS THE MOST COMMON INHIBITORY NEUROTRANSMITTER IN THE BRAIN. People with anxiety d/o can have other ones overlap. reduced blood supply. In addition. . (Relates to depression and anxiety) Traumatic experiences: alternates many regions of the brain. and memory! Norepinephrine: NE for fight or flight. hippocampus. Limbic: rage. If children see their parents respond to every little stress. fear. and are more likely To develop major depression later in life. When a person takes a benzo. The hypothalamic-pituitary-adrenal (HPA) axis is a major response system. Familiar: Anxiety D/o run in the family-are common and of different types. which can be modified by trauma. manufactured in the locus ceruleus. Based upon hypersensitive 5-ht receptors. GABA receptors are amygdala. Psychological. Uses same highway as GABA. they soon will develop the Same pattern. center of emotion. physical disorders can also may mimic or exacerbate anxiety. Fatigue: increases irritability and feelings of anxiety. trycylics) effectively treat anxiety disorders! (Shehen) Serotonin: deregulation plays role in etiology of anxiety by neurotransmitters. No specific gene has been found to mark susceptibility. dietary deficiency. arousal. The post-synaptic receptor becomes more sensitive to GABA effects enhancing neurotransmission and further causing more inhibition of cell activity. particularly the limbic System. Uses the neurotransmitter Gammaaminobutyric controlling the anxiety and firing rates that produce anxiety. and also the cerebral cortex.Predisposing factors: BIOLOGICAL GABA SYSTEM: regulates anxiety. General Health: coping and anxiety go hand in hand when other illness are present. If nervous factors person CAUSES fatigue will have a greater degree of anxiety.
Anxiety is high because the doubt they can succeed.) they feel failure Insignificance. Double approach-avoidance: Person can see both desirable and undesirable aspects of both alternatives. Goals blocked would be financial stability. APPROACE is the tendency to do something or move towards something. Conflict derived from two tendencies: APPROACH AND AVOIDANCE. which produces feeling of helplessness. Internal frustration: a young college kid who sets unrealistic high goals who is frustrated by entry-level job offers.SELF ESTEEM: easily threatened people have low self-esteem and are more susceptible to anxiety. and mounting anxiety. External frustration would be the loss of a job. pride in work. role models and cognitive flexibility. person that wants to exhibit anger and express feelings but has anxiety because he knows there will be conflict. distort and block out previous studying. conflict. which increased the perception of conflict. anxiety will reduce their perceptual field greatly! Students misinterpret. The alternative is to seek psychiatric help and expose one self to the threat and potential pain of the therapy . only to perception of his or her ability! Although they have studied and are well prepared. Ex: students with test anxiety. Example: A person living with the pain of an unsatisfying Social and emotional life. but worries about the loss of friends that might result from the reporting the violation. This results in a poor grade adding to their low self-esteem Resilience: the ability to maintain normal function despite adversity. Conflict creates anxiety. moral compass. (View of self-threated by unrealistic goals. Avoidance-Avoidance: Person must choose between to undesirable goals. interpersonal readiness. If a child experiences trauma or significant stress in like the will be more vulnerable to future stressors. positive outlook. perception of self. Example is witnessing a friend cheating and feels the need to report the act. coupled with destructive coping patterns. AVOIDANCE: is the opposite tendency-not to do something/not to more forward. It is considered a protective psychosocial factor-includes coping style. social support. Example: Having to choose between two great job offers. a reciprocal relationship. Approach-Avoidance: person wants to pursue AND avoid goal. Two competing drives. Behavioral: Belief that anxiety is a product of frustration caused by anything that interferes with attaining a desired goal. Creates 4 types of conflict! Approach-Approach: Person wants to pursue two equally desirable but incompatible goals. Difficult As both goals seem beneficial. No relation to time studied.
threat to selfsystem. Double approach-avoidance conflict feelings are often referred to a ambivalence. BOX 15-3 PG 224 has screening tool. Illness can develop when a person is in constant anxiety. and employee.process. immune system. Pain is often the first indication that physical integrity is being threatened. When dealing with others. divorce. relocation. Can be both external and internal. a change in job status and ethical dilemma social or cultural group practices or pressure. physical exercise and daydreaming. . use of clichés. cursing. eating. temp. FACTORS AND TYPES OF ANXIETY. including excessive workload and extreme time pressures has been found to precipitate anxiety and depression in previously healthy young workers. safety hazards lack of adequate housing. yawning. Protection from others by limiting friendship and protecting themselves in comfortable roles. social support and cultural belief can integrate stressful situations into learning and adopting positive coping strategies. External: loss of a valued friend to death. limited self-disclosure. Coping Mechanisms: Anxiety that increases from severe to pain displays more intense. Internal: failure of physiological mechanisms: heart. Additionally. low levels exist superficiality: lack of eye contact. Work stress. Internal: difficulties at home. Pal seek to avoid anxiety and circumstances that produce it. Coping Mechanisms used: For everyday living. Threats to Self-System: Implies harm to a persons ID. the many threats to the physical integrity threaten self-esteem because of the mind-body relationship. Precipitating stressors are grouped into 2 categories: threat to physical integrity. new role as student. BOX 15-4 INTEGRATES ALL TYPES OF CAUSES. parent. Pregnancy Failure to participate in preventive care. THE STUART STRESS ADAPTION MODEL PAGE 225. injurious behavior and QOL decreases. Can help extract meaning and foster suggestions. self-esteem. laughing. It does however create an anxiety that often motivates a person to seek care. food. and integrated social function. Threats to physical integrity: impending a physiological disability or decreased ability to perform ADL s Both external and internal External: bacteria. clothing And traumatic injury. Inability to cope with anxiety constructively is a primary cause of pathological behavior. economic assists. (mild): Crying sleeping. Precipitating stressors: Experiencing or witnessing trauma: anxiety disorder of PTSD. pollutants. Coping Resources: need to mobilize resources found internally an in environment? Resources: problem solving abilities. After each position of Trauma experiences the risk of PTSD increases.
Withdrawal Behavior: may be expressed physically or psychosocially. Compromise: when situations cannot be resolved with attack or withdrawal. Degree to which the defense mechanism is used. 4. First. Emotion or Ego-Focused Coping. or emotion or ego focused. Maladaptive responses are seen with severe and panic levels of anxiety. Os there a high degree of personality disorganization? Is the person open to the facts about the life situation? 3. Psychologically: admitting defeat. . rights. The accurate recognition of the patient s use of the defense mechanism by the Nurse. The aim is realistically meeting the demands of a stress situation that has been objectively appraised. The degree in which the use of the defense mechanism interferes with the patient s funx. Usually in approach-approach and avoidance-avoidance. and COMPROMISE. deliberate attempts to solve problems and resole conflicts to satisfy needs. Little awareness of what is happening and little control over events. Time may make compromise unacceptable. Destructive patterns are usually accompanied by great feelings of anger and hostility. . First line of psychic defense. indicating that the patients cognitive appraisal of the threat is unrealistic. Help against feeling of inadequacy. WITHDRAWL. additional anxiety can occur. adaptive: 1. coping mechanism can be categorized as problem or task specific.greater threat to EGO. Evaluating coping mechanism: Maladaptive vs. Nursing DX can be assessed after use of the Stuart Stress Adaption Model based upon the pts position on the continuum of anxiety responses. There is also a certain degree of self-deception and reality distortion. : Used to protect self. and are directed and action oriented. The reason the patient used the ego defense mechanism. Change usual ways of operating. Like attract this can be constructive or destructive. Ego Mechaninisims operate on an unconscious level. Better care can be planned after analyzing these points. Is the patients response to the perceived threat appropriate? Is it adaptive or Irrational? A problem may exist if the response if the response is not proportional to the threat. and well being of others. Problem or task focused coping mechanisms are thoughtful. worthlessness. When it isolates a person and interferes with a person s ability to work. Takes more energy to deal with. When overused can distort reality. Physically: removing self from a smoke filled room. THESE include: ATTACK. AKA DEFENSE MECHANISIM.Moderate to severe panic levels. the nurse determines the quality and quantity of the anxiety experienced by the patient. this was being destructive or constructive. This prevents realistic coping. Used by everyone. 2. becoming apathetic or lowering aspirations. Used effectively for mild-moderate anxiety. Attack Behavior: attempt to remove or overcome obstacles to satisfy a need. There are many possible ways of attacking problems. Destruction of property.
ineffective coping. The Four Primary NANDA DX concerned with anxiety responses are anxiety. Neurotic disorders are maladaptive anxiety responses associated with mod and severe levels of anxiety. fatigue and lack of energy. GAD. 15-3 shows the difference. Acute stress disorder. PTSD.The nurse needs to explore if the person is coping and able to stimulate growth. depression and Alcohol abuse can be overlapping. people feel they are breaking into pieces and failures. Where the signs and symptoms can be a war against identity and existence: maladaptive behavior means that the struggle has been lost. Anxiety. Psychosis is disintegrative and involves SIGNIFIGANT DISTORTION LEVELS OF REALITY. obsessive compulsive disorder. Anxious and depressed patients share the same sxs: Sleep disturbance: appetite changes. Behaviors recognized in anxiety levels need to be decreased. SEVERE AND PANIC LEVELS OF ANXIETY Establish a trusting relationship . difficulty concentrating. and fear. Short-term goals can break this expected outcome down into readily attainable steps. Short Term goals can continue to be implemented until the anxiety is reduced. Constructive approach would be a win by person s values. Irritability. Because anxiety is SUBJECTIVE it should be useful to utilize a number scale (1-10) Obtaining a rating of 2 or 3 can be another goal. Is it depolarizing? Patient should be included in identifying problem areas. The person will become stronger and more integrated. Do not free a patient totally-they need to develop the capacity to deal with minor anxiety and use it consciously and constructively. including panic d/o w or w/o agorphobia. THE EXPECTED OUTCOME FOR PATIENTS WITH MALADAPTIVE ANXIETY IS: THE PATIENT WILL DEMONSTRATE ADAPTIVE WAYS OF DEALING WITH STRESS. The nurse helps the patient identify his or her own values. At panic level the highest-priority in short term goals should be SAFETY AND DECREASING THE ANXIETY LEVEL. cardiopulmonary and gastro complaints. Neurotic disorders that fall under the category of anxiety dx exist. It can emerge in panic level of anxiety. Neurosis: mental d/o characterized by anxiety that involves NO DISTORTION of REALITY. This identification of steps allows the patient and nurse to see progress even if the ultimate foal appears distant. OUTCOME IDENTIFICATION Goals like decrease anxiety and minimize anxiety lack specific behaviors and evaluation criteria! Goals need to guide nursing care and have evaluation process. specify phobia. The patient needs to be included to actively participate treatment strategies. agoraphobia. readiness for enhanced coping. Participation reinforces patient s ability for his or her own growth and personal development.
Withdrawal and addiction can occur Antidepressants: Used for anxiety-effective with low side effect profile. Reduce core symptoms 2. Exercise helps to relieve anxiety because it provides an emotional release and directs the Patient s attn outward. Distance of increase and decrease may affect the patient s anxiety. Am I competing myself with a peer in another profession? 4. Is the patient s area of conflict one that I have not resolved in myself? 5. Relieve co morbid symptoms 5. What is threating me? 2. Protecting the patient: assure patient safety. accept them and attempt to explore: 1. but never first. fast. Is my patients conflict really one of my own that I am projecting. inpatient and frustrates. Nurses should answer patient s questions directly and offer unconditional acceptance. Strengthen resilience 4. whirlpools. Encourage Activity Encourage pts interest in activities: limits time used in maladaptive coping. Set limits by assuming a quiet. Have I failed to live up to what I imagine to be the patients ideal? 3. or pushed upon. Encourage the patients to verbalize all of their feelings-hostility. Improve functioning 3. Nurses must be alert to the anxiety experienced and use it therapeutically. WHY QUESTIONS ARE NOT HELPFUL!!! With time. A 6-foot distance in a small room may create the optimum condition for openness and discussion of fears. BUT CAN ENHANCE THERAPEUTIC ALLIANCE. Anxiety is contagious and can effect patients and staff. Family members can assist in planning. Nurse should strive to accept their patients anxiety without reciprocal anxiety by continually clarifying own feelings and role. Prevent relapse Benzos: Effective but mixed with ETOH can results in a serious or even fatal sedative reaction. Medications can be effective Goals of Pharmacological treatment are: 1. Modify the environment: consult with others to identify anxiety-producing situations and Attempt to remove them. calm manner and decreasing Environmental stimuli. Warm Baths. MEDICATION IS NOT A SUBSITUTE FOR AN ONGOING THERAPEUTIC RELATIONSHIP. Initially nurses need to establish an open. trusting relationship. guilt. Long-term goals now focus on helping the patient understand the cause of the anxiety And learn new ways of controlling it. Moderate levels of Anxiety Nurses assist in problem solving to cope with stress. massages can be a supportive measure in anxiety decrease. most nursing actions are purposely protective and supportive. . Have patients determine the amount of stress They can handle at one time. Is my anxiety related to something that may occur in the future? 6. Never force a patient into a situation they cannot deal with.To reduce the patient s level of anxiety. Nurses may find themselves unsympathetic. limitations can be enforced on behavior.
At this point: a trusting relationship is most important.Goals include gaining recognition of and insight into anxiety and learning new coping adaptive behaviors.if not the nurse can point out the maladaptive behavior to work on. Psycho education: education is important on promoting the patients adaptive responses to anxiety. They incorporate principals and techniques of Cognitive behavioral therapy. attempts to label it. Because the patient will often avoid or deny the anxiety the patient may use resistive approaches: frustration. This assists the nurse in recognizing the values that the patient feels are threatened. Cognitive behavior therapy has been shown to BE THE MOST EFFECTIVE IN ANXIETY REDUCTION. The patient NEEDS to assume the responsibility for actions and realize that limitations have been self-imposed. confronting cause and effect relationships. This allows the nurse to acknowledge the patients feelings. encourages the patient to describe it further and relates it to a specific behavioral pattern. This information can give patients control over their anxiety. Recognizing also allows exploration of what has worked with lowering anxiety prior. take a step back and go slow. Coping with the threat If coping resources have been constructive and adaptive encourage the patient to use them further. THERE ARE THREE TYPES OF STRATEGIES: ANXIETY REDUCTION COGNITIVE RESTRUCTION LEARNING NEW BEHAVIOR INFORM THE PATIENT THAT ANXIETY IS NEEDED FOR SURVIVAL AND GROWTH! . which is important to survival. implemented anywhere. Insight into the anxiety Once the patient understand there anxiety the focus of intervention can be discussing topics and situations that cause the symptoms the patients recognize. Here. Nurses must use open questions that move from non-threatening topics and central issues of conflict. supportive confrontation can be tried to address a particular resistive conflict-if at that time the patient shows anxiety. THE nurse can help the patient in problem solving efforts using a variety of cognitive and behavioral strategies. but be vigilant-reciprocal anxiety in the nurse needs to be recognized. Recognition of anxiety: asking questions such as how are you feeling now? Are you uncomfortable? IT IS IMPORTANT FOR THE NURSE TO IDENTIFY THE PATIENTS BEHAVIOR AND LINK IT TO THE FEELING OF ANXIETY: I noticed you have been tapping your foot since you started talking about your sister . the nurse can assume an active role by interpreting. Patients can be told that anxiety disorders are a deregulation in the normal fight or flight response. In time. Patients should be told that anxiety disorders can be successfully treated by a variety of evidence based treatments. Specifically. analyzing. irritation. which can be.
.PROMOTING the relaxation response: Patient education plans It is in the scope of practice. requires no special equipment and does NOT need a physician s supervision! Patient can practice on their own and it puts them in charge of their lives. Did I accurately observe my patients behavior? Did I listen to my patient s subjective description of anxiety? Did I Fail to see the relationships between my patient s hostility or guilt and underlying anxiety? Did I assess intellectual and social functioning? Maladaptive and new adaptive skills need to be assessed and learned. Evaluation The nurse should ask.
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