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Anxiety introduction
- anxiety is an emotional response to anticipation of danger the source of which is largely unknown or unrecognize
- anxiety is necessary for for survival. it is not the same as stress
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anxiety disorder intro 2
- a stressor is an external pressure that is borught to bear on the individual
- anxiety is a subjective emotional response to that stressor
- anxiety maybe distinguished from fear in that anxiety emotional response and fear is cognitive
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Historical aspect
- anxiety once identified by its physiological symptoms, focusing largely on the CV system
- for many yrs, anxiety disorders were viewed as purely psychological or purely biological in nature
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Epidemiological stats
- anxiety disorders are the most common of all psychiatric illnesses
- more common in women than men
- minority children and children from low socioeconomic status at risk
- a familial predisposition probably exists
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how much is too much
- when anxiety is out of proportion to the situation that is creating it
- when anxiety interfers with social, occupational and other areas of function
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response to anxiety: mild
physiologic, cognitive
- Physiologic:
- - VS norm, minimal muscle tension
- - pupil norm or constricted
- Cognitive/perceptual
- - perceptual field is broad, awareness of multiple stimuli
- thought controlled
- - sensory awareness
- relaxed, calm, attentive movitated to achieve goals
- you can see and know what is going on
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response to anxiety mild
emotiona/behavioral
- feelings of comfort and safety
- relaxed attentive calm
- optimum state for problem solving and learning
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response to anxiety: moderate
physiologic, cognitive
- physiologic:
- - VS norm or slightly elev
- - tension experienced (labeled 'tense' or 'excited')
- Cognitive "
- - alert
- - perception is narrowed
- - focused- on what is going on
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moderate
emotional/behavior
- feelings of readiness and challenge
- energized
- engaged in competitive activity
- learn new skills (need direction)
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severe anxiety
physiologic, cognitive
- physiologic:
- flight or fight response as ANS excessively stimulated
- cardio- inc HR, RR, liver is being stimulated glycogan
- cognitive/perceptual
- perceptual gravity is narrowed, distorted
- selective attention focused on detail
- selective inattention, distorted of time
- automatic behavior
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severe anxiety
dissociative tendencies
perception of unreality about self, environment or event
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panic level
physiologic
- above symptoms escalate until SNS release occurs
- - pale, BP decrease
- - muscle coordination poor
- - pain, hearing sensation minimal
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panic level
cognitive/perceptual
- scattered, distorted closed unable to take in stimuli
- problem solving and logical thinking highly improbable, irrational
- dissociation may occure
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Panic
emotional behavioral
- feels helpless, loss of control
- angry, terrifed, combative, or withdrawn, cry or run
- disorganized
- decreased ability to relate to to others
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nursing process
panic assessment
- characterized by recurrent panic attacks, the onset is unpredictable
- manifested by intense apprehension, fear or terror, often associated feelings of impending doom
- accompanied by intense physical discomfort
- may or may not agoraphobia (fear of public places-peggy)
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nursing process
symptoms of panic attack
- must have at least four of these symptoms to call it panic attack
- sweating, trembling, shaking
- shortness of breath, chest pain, or discomfort
- nausea or abd distress
- dizziness, chills, hot flashes
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more panic symptoms
- numbness, tingling sensations
- derealization (surroundings not real), depersonalization (thoughts + feelings unreal)
- fear of losing control or going crazy
- pp 463-64
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panic attack HRN for suicide
- last minutes more rarely hours, frequency and severity very greatly
- between attacks may feel nervous and apprension and depression is common
- aver age late 20's
- panic attack may occur sporidically over weeks, moments, yrs
- peeps who have more frequent attack
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panic disorder intervention
- stay with pt reassure
- stay calm, nonthreatening
- simple words, spoken calmly clear- cant cognitively procress what you are saying
- tx hyperventialtion- o2 non breather (contra asthma COPD), o2 stat
- low stimili (dim lights)
- PRN antianxiety med
- teaching
- - why do you think this occured
- - signs of panic attack
- - medication
- - using therapy to yell stop
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application of the nursing
generalized anxiety definition
characterized by chronic, unrealistic, and excessive anxiety and worry
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predisposing factors
panic and generalized anxiety
cognitive theory
- faulty, distorted or counter-productive thinking patterns result in anxiety that is maintained by mistaken or dysfunctional appraisal of a situation
- negative interpreting, environmental stimuli, worry
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predisposing factorsÂ
panic and generalized anxiety
biological aspects
- genetics- 30% of identical twins can have the same found familial tendencies
- neuroanatomical- patho that cause anxiety is found in the temporal lobe, hippocampus
- biochemical- inc in serotonin and lactate
- neurochemical- incr in norepinephrine
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Norepinephrine/GABA
- Nore
- known to mediate arousal and causes hyperarousal and anxiety
- fight or flight
- GABA
- NT which control the activity or firing rates of neurons responsible for producing anxiety
- GABA is the most inhibitory NT in the brain- slows down neuron firing
- anti-anxiety meds inc GABA and dec anxiety
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