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Understanding Anxiety Disorders in Nursing Practice

This article provides an introduction to anxiety disorders, their epidemiological statistics, assessment, and nursing interventions. Topics covered include panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder.

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Understanding Anxiety Disorders in Nursing Practice

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  1. Anxiety Disorders Nursing 201

  2. Introduction • Anxiety provides the motivation for achievement, a necessary force for survival. • Anxiety is often used interchangeably with the word stress; however, they are not the same. • Anxiety may be differentiated from fear in that the former is an emotional process, whereas fear is cognitive.

  3. Epidemiological statistics • Anxiety disorders are the most common of all psychiatric illnesses • More common in women than men • Minority children and children from low socioeconomic environments at risk • A familial predisposition probably exists • How much is too much? • When anxiety is out of proportion to the situation that is creating it. • When anxiety interferes with social, occupational, or other important areas of functioning.

  4. Assessment Panic disorder • Generalized anxiety disorder • Panic disorder with agoraphobia

  5. Predisposing Factors • Psychodynamic theory • Cognitive Theory • Biological aspects • Transactional Model of Stress Adaptation

  6. Nursing Diagnosis

  7. Outcomes

  8. Planning/Implementation

  9. Phobias Assessment • Agoraphobia without history of panic disorder • Fear of being in places or situations from which escape might be difficult or in which help might not be available if a limited-symptom attack or panic-like symptoms should occur • Social phobia • Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by other • Specific phobia • Marked, persistent, and excessive or unreasonable fear when in the presence of, or when anticipating an encounter with, a specific object or situation, Animal type, Natural environment type, Blood-injection-injury type, Situational type

  10. Predisposing Factors

  11. Nursing Diagnosis

  12. Outcomes

  13. Planning/Implementation

  14. Evaluation

  15. Obsessive-Compulsive Disorder (OCD)

  16. Assessment

  17. Obsessions: Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause marked anxiety or distress • Compulsions: Unwanted repetitive behavior patterns or mental acts that are intended to reduce anxiety, not to provide pleasure or gratification

  18. Predisposing Factors

  19. Nursing Diagnosis

  20. Outcomes

  21. Planning/Implementation

  22. Post-traumatic Stress Disorder (PTSD) • Development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical integrity of others • Characteristic symptoms include reexperiencing the traumatic event, a sustained high level of anxiety or arousal, or a general numbing of responsiveness. Intrusive recollections or nightmares of the event are common.

  23. Psychosocial theory • The traumatic experience • Severity and duration of the stressor • Extent of anticipatory preparation before onset • Exposure to death • Numbers affected by life threat • Extent of control over recurrence • Location where trauma was experienced • The individual • Degree of ego-strength • Effectiveness of coping resources • Presence of preexisting psychopathology • Outcomes of previous experiences with stress/trauma • Behavioral tendencies • Current psychosocial developmental stage • Demographic factors

  24. The recovery environment • Availability of social supports • Cohesiveness and protectiveness of family and friends • Attitudes of society regarding the experience • Cultural and subcultural influences • Learning theory • Negative reinforcement as behavior that leads to a reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior • Avoidance behaviors • Psychic numbing • Cognitive theory • A person is vulnerable to post-traumatic stress disorder when fundamental beliefs are invalidated by experiencing trauma that cannot be comprehended and when a sense of helplessness and hopelessness prevails.

  25. Biological aspects • It has been suggested that a person who has experienced previous trauma is more likely to develop symptoms after a stressful life event. • Disregulation of the opioid, glutamatergic, noradrenergic, serotonergic, and neuroendocrine pathways may be involved in the pathophysiology of PTSD. • Transactional Model of Stress Adaptation • The etiology of PTSD is most likely influenced by multiple factors

  26. Nursing Diagnosis

  27. Outcomes

  28. Planning/Implementation

  29. Client/Family Education

  30. Treatment Modalities • Psychopharmacology • PTSD • Antidepressants • Anxiolytics • Antihypertensives • Others

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