The Client Experiencing Anxiety Chapter 12 The Client Experiencing Anxiety

Anxiety Universal human experience Autonomic response Includes subjective feelings of dread Physical symptoms: Increased heart rate Increased blood pressure No specific source or reason State when person feels strong sense of dread, accompanied by physical symptoms of Increased heart rate, elevated blood pressure without having source or reason for emotion

Fear Like anxiety: Focused on specific object or event Autonomic response Includes subjective feelings of dread May include same physical symptoms Focused on specific object or event

Stages of Anxiety Mild anxiety-day to day tensions and is alert, with increased perceptual field May be useful. Motivational Moderate anxiety-narrowed perceptual field Focuses on immediate concerns Severe anxiety focuses on specific detail Reduced perceptual field Panic-feelings of dread or terror Causes disorganization of personality (continued)

Anxiety Disorders Distinct from normal anxiety Interfere with ability to function in daily life Six are particularly important p 215 (12.2) General anxiety disorder, panic disorder, agroaphobia, phobia, obsessive compulsive disorder, PTSD

Generalized Anxiety Disorder Anxiety focused on variety of life events or activities; excessive when occurs more days than not for more than 6 months; DX of exclusion Symptoms:primary-excessive dread or anxiety (3 or more of symptoms. Restlessness Fatigue Difficulty concentrating Irritability Muscle tension Sleep disturbance DSM difficult to control and causes significant distress or impairment in functioning

Panic Disorder Episodes of intense anxiety that begins abruptly and peaks within 10 minutes Symptomsat least 4 of these Palpitations Trembling Shortness of breath Fear of losing control Fear of dying; numbing/tingling, chills, altered reality. Strong association between panic disorder and major depressive disorder; commonly in young people with onset common between adolescence and mid-thirties; could be genetic component. Have a higher risk of suicide than does non-affected population

Agoraphobia Acute anxiety and fear in any setting from which individual may have trouble escaping; fear of crowds (or being home alone) Symptoms: Avoidance of anxiety-provoking situations Avoidance of going out therefore they become homebound Linked with panic disorder

Phobia Persistent, irrational, excessive fear of specific object or situation (social phobias are referred to social anxiety disorder) Symptom: experiences severe anxiety when under social stress ie: speaking or performing in public Interference with life activities Intervention: social skills training and exposure to social situations DSM –fear must be excessive or unreasonable; must be recognized as such by phobic individual and must result in significant social, occupational or academic disruption. Repeated exposure leads to diminishing of anxiety.; common stereotypes show women are twice as likely to have symptoms of specific phobia than men

Obsessive-Compulsive Disorder Recurrent thoughts coupled with repetitive actions or behaviors Cannot stop thoughts or behaviors Symptoms: Repetition of behaviors that individual recognizes as unreasonable, intrusive and inappropriate and cause marked anxiety and distress Use of compulsive behavior relieve the anxiety Begin in young people during adulthood or before; for people resistant to drugs, neurosurgical procedures include reversible deep brain stimulation using implanted electrodes and a pacemaker like device

Post-Traumatic Stress Disorder Re-experience of significant, life-threatening event; anxiety disorder that occurs after a frightening event, most often an accident, crime or battle Symptoms: Dreams Hallucinatory-like flashbacks Impairment of social functioning; persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (APA,2000) Commonly seen in military situations Half recover within 3 months but others continue for a year or more Pts exposed to provoking stimuli have greater activation of the amygdala and DECREASED activation of cortical brain centers that normally suppress amygdala activity

Causes of Anxiety Disorders Infantile conflicts involving sexual development Adversity- a measure of how strong a given stimulus for anxiety is. Trait anxiety- is an abstract but measurable personality characteristic based on the everyday observtion that some quite normal individuals appear to experience more anxiety than others. Occur in response to environmental stimuli

Treatment of Anxiety Disorders Psychotherapy Insight-based or behaviorally based treatment for pts highly motivated and symptoms are not crippling; psychoanalysis is best known insight therapy; behaviorally the clients can learn to identify the common stimuli that cause anxiety, develop plan to respond to stimuli and problem solve when situations arise.Emergency TX is help person cope and prevent PTSD Pharmacotherapy p 229 and NIH booklet—know meds Combination therapy- meds and psychotherapy

Nursing the Anxious Client Build trust Model client’s world Be accepting of client’s world and assure along the way

Assessment Begin with objective information E.g., increased pulse, increased blood pressure, respiratory rate, etc. Ask about cognitive responses E.g., ability to concentrate, disorientation, etc.

Nursing Diagnosis Will address human response to disorder See pg 234 and forward to read care plans.

Outcome Identification Based on realistic outcomes Set goals in collaboration with client May take weeks or months for improvement

Planning/Interventions Establish trust Use therapeutic listening Establish positive nurse-client relationship Understand and accept symptoms as real Implement specific interventions directed toward alleviating symptoms

Evaluation Ask: Have expected outcomes been achieved? Are expectations realistic?