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Anxiety is defined as...
a vague feeling of dread
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Anxiety also is...
Unwarranted by this situation
Accompanied by feelings of uneasiness and apprehension.
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Anxiety vs. Fear
With fear there is omething or somemone that is dangerous.
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General Adaptation Syndrome
Alarm reaction stage:
Adrenalin, norepinephrine release of glycogn stores.
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General Adaptation Syndrome
Resistance stage:
Blood is shunted AWAY from GI to heart, lungs, and muscles resulting in INCREASE oxygen and preparation for fight, flight or freeze.
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Possible outcomes of General Adaptation Syndrome:
If a person adapts to stress, their body's responses..
return back to normal
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Possible outcomes of General Adaptation Syndrome:
If a person fails to adapt to stress they will experience...
exhaustion, where the body's stores are depleted and the client has little or no reserve.
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Nursing considerations with mild anxiety:
Client very susceptible to learning and solving problems, they are "eager for information".
Educate, educate, educate!
Teach stress management
Emphasize problem-solving.
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What type of anxiety?
The client is able to focus on task at hand but forget multi-tasking.
Moderate anxiety
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What type of anxiety?
They are selectively attentive and their perceptual field is decreased.
Moderate anxiety
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What type of anxiety?
Able to learn but not to their full potential.
Moderate anxiety
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What type of anxiety?
Nurse's role is more assistive, hands on and facilitative.
Moderate anxiety
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What type of anxiety?
Feedback from the client is useful
Moderate anxiety
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Moderate Anxiety:
- The client is able to focus on task at hand but forget multitasking.
- They are selectively attentive and their perceptual field is decreased.
- Able to learn but not to their full potential.
- Nurse's role is more assistive, hands on and facilitative.
- Feedback from the client is useful.
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Nursing considerations for moderately anxious client:
- Are they following what you are saying?
- Speak in short simply and eat to understand sentences.
- Teach relaxation and coping skills
- Redirect client PRN based on feedback.
- Focus on coping and problem solving.
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Nursing goal when dealing with anxiety:
To prevent client's anxiety from worsening or progressing.
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What type of anxiety?
Perceptual field is further reduced - sees one detail or scattered details.
Severe anxiety
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What type of anxiety?
Cannot complete tasks, solve problems or learn new material.
Severe anxiety
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Snapshot of a person dealing with severe anxiety:
- Cannot relieve their anxiety
- Sense of awe, dread or horror
- Ritualistic behavior
- Headache
- Trembling, pale, crying
- Vertigo
- Chest pain
- N/V/D
- Tachycardia
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Nursing considerations for clients with severe anxiety:
- The person with severe anxiety cannot focus or solve problems.
- Remain with the person!
- Talk in a low, calm and soothing voice.
- I they cannot sit still, walk with them
- Encourage deep even breathing.
- Provide structure - consider exercise.
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What type of anxiety?
Perceptual field focuses on self.
Cannot process information
Panic
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What type of anxiety?
May be mute
Distorted perceptions could result in delusions or hallucinations
Panic
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What type of anxiety?
May bolt or run
Could be suicidal
Panic
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Symptoms of panic:
- Perceptual field focuses on self
- Cannot process information
- May be mute
- Distorted perceptions could result in delusions or hallucinations
- May bolt or run
- Could be suicidal
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Overview of panic:
- Can involve the loss of rational thought.
- Can result in loss of touch with reality
- At risk for fight or flight.
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Nursing care for the client experiencing panic:
- The person's safety is your primary concern!
- Prevent harm.
- Select a safe, quiet, and non stimulating environment.
- Reassure the client that they are safe and the anxiety will pass.
- Remain with them at all times until the panic has passed (5-30 minutes)
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Which level of anxiety?
Slight physical arousal, sharp perceptions and able to learn/cognate.
Mild
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Which level of anxiety?
Physical changes noted narrowed perceptual field, less attentive.
Moderate
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Which level of anxiety?
Physical symptoms increased, poor concentration, apprehensive.
Severe
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Which level of anxiety?
Terror, have shut down, mentally but in adrenaline overload
Dangerous and unpredictable behavior.
Panic
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Act like a "nurse".
- Therapeutic verbal tone
- Role model with relaxation and breathing techniques.
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Who identified the four levels of anxiety and nursing considerations of each level?
Hildegard Peplau
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Medications for short term anxiety disorders - anxiolytic drugs
- Benzodiazepines:
- Diazepam (valium)
- Chlorazepate (tranxene)
- Alprazolam (xanax)
- Chlordiazepoxide (librium)
- Clonazepam (klonopin)
- Lorazepam (ativan)
- Oxazepam (serex)
- Nonbenzodiazepines:
- Buspirone (Buspar)
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Chronic anxiety disorders:
- Symptoms no longer serve as a signal of danger
- Condition has become chronic
- Adversely affects the client's functioning - socially and occupationally
- Maladaptive behavior
- Represents an emotions disability
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Anxiety disorders:
- Panic, with or without agoraphobia
- Phobia (social or specific)
- OCD
- Generalized anxiety disorder
- PTSD and Acute stress disorder
- Dissociative disorder
- Anxiety due to a medical condition
- Substance induce anxiety disorder
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Biological Theories:
Genetic, inherited tendencies, moderate in heritability
- Chemical:
- GABA deficient
- Excess norepinephrine
- Serotonin imbalances
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Psychodynamic theories:
- Overuse of defense mechanisms
- Learned behavioral responses
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Treatment of anxiety disorders:
Medications (anxiolytic, antidepressants, and or beta blocker drugs)
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Uses treatment and methods such as positive reframing to assist in changing one's maladaptive behavior.
Cognitive behavior therapy
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In cognitive behavior therapy
The therapist initially works with the client making them aware of their negative thinking and how it affects personal feelings and behaviors.
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Methods used in cognitive behavioral therapy:
- Positive reframing
- Positive coping statements
- Decatastrophizing
- Assertiveness training
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"This is anxiety, it will go away"
"It's gunna be ok, just gotta stay calm"
Positive reframing
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"I've done this before (passed tests), I can do it again"
- Positive coping statements
- Positive self-talk
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What's the worst thing that could happen?
Thought stopping
Distraction to stop the negative thoughts or actions.
Decatastrophizing
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"I feel angry when you do not listen to me and leave the room when I am speaking"
Assertiveness training
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Assertiveness training:
Helps the client assume control over life and situations.
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Uses "I" to frame their concerns, needs and feelings to others.
Assertiveness training
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Goals for stress management:
- Manage your symptoms - do not allow them to manage you
- Be pro-active to decrease stressors
- Consider use or medications short term.
- Become proficient with non pharmacologic strategies.
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Mental health promotion for nurses and nursing students:
Anxiety is a warning sign that you are not dealing with stress effectively.
- Heed warning
- Change coping skills
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