Mental Health Nursing I NURS 1300 Unit IV Anxiety Disorders and Crises

Objective 1 Define stress, stressors, and anxiety a state of bodily or mental tension resulting from factors that tend to alter an existent equilibrium necessary for growth and development Stressor anything that necessitates an adaptive response on the part of the individual

Objective 1 (cont’d) Anxiety a vague and sometimes intense sense of impending doom or apprehension that may appear to have no clearly identifiable cause often an early response to illness

Objective 2 Describe the “fight-or-flight” syndrome 1st stage of the general adaptation syndrome Body’s response to perceived threat or danger Hormones released to give body strength increases heart rate slows digestion shunts blood flow to major muscle groups

Objective 3 Define the four levels of anxiety Mild anxiety client able to focus attention motivates learning and personal growth Moderate anxiety optimal level for learning client focused on immediate concerns Severe anxiety ability to think is clouded problem solving is impaired Panic anxiety inability to communicate or function effectively misperceptions of surrounding events client may react impulsively by running or striking out

Objective 4 Describe various coping mechanisms used to deal with stress and anxiety Imagery Deep-breathing Meditation Yoga Therapeutic touch Music therapy Biofeedback

Objective 5 Describe the major defense mechanisms See Defense Mechanisms handout

Objective 6 Be able to discuss generalized anxiety, panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder

Generalized Anxiety Disorder (GAD) Characterized by chronic anxiety and unrealistic, excessive worry and tension Concurrent physical symptoms occur in the absence of organic conditions fatigue headaches muscle aches and tension difficulty swallowing trembling and twitching irritability sweating and hot flashes

Panic Disorder Characterized by recurrent panic attacks episodes of intense apprehension of variable length accompanied by feelings of impending doom often occur in familiar places, where there is seemingly nothing threatening to the individual Concurrent physical symptoms include: increased pulse elevated blood pressure trembling diaphoresis shortness of breath chest pain nausea

Phobias A phobia is an irrational, persistent fear of certain situations, objects, activities, or persons The main symptom is the excessive, unreasonable desire to avoid the feared subject Phobic fear interferes with daily life

Obsessive-Compulsive Disorder (OCD) Obsessions = recurrent, unwanted thoughts Compulsions = repetitive behaviors often performed with the hope of preventing obsessive thoughts or making them go away hand washing, counting, checking, cleaning provides only temporary relief not performing rituals results in marked increase in anxiety Time-consuming; causes distress or impairment Client aware thoughts and behaviors are irrational, but feels powerless to stop

Post-Traumatic Stress Disorder (PTSD) PTSD = a cluster of symptoms experienced following a distressing event event is outside the range of normal experiences event produced intense fear, helplessness, and/or horror Characteristic symptoms of PTSD include: dissociative flashbacks sustained high level of anxiety/arousal or a general numbing of responsiveness intrusive recollections or nightmares of the event

Objective 7 Be able to discuss somatoform disorders to include types, risk factors, signs and symptoms Somatoform disorders = physical ailments for which no medical explanation has been found Types of somatoform disorders conversion disorder pain disorder hypochondriasis body dysmorphic disorder

Conversion Disorder Disorder in which emotional distress or unconscious conflicts are expressed though physical symptoms Sudden onset of symptoms following a stressful experience Involves involuntary loss of one or more bodily functions in which diagnostic testing uncovers no physical cause Risk factors medical illness dissociative disorder personality disorder

Pain Disorder Persistent and chronic pain at one or more sites in which psychological factors are thought to play a role Suffering is so severe that it impairs client’s ability to function Risk factors underlying medical condition fibromyalgia migraines uncontrolled or inadequately managed pain depression and/or anxiety

Hypochondriasis Excessive preoccupation or worry about having a serious illness Characteristics include: fears that minor bodily symptoms may indicate serious illness constant self-examination and self-diagnosis preoccupation with one’s body Fear is persistent and disabling in spite of reassurances that no organic pathology can be found

Body Dysmorphic Disorder Exaggerated belief that body is deformed or defective in some specific way Most common complaints involve imagined or slight flaws of the face or head Risk factors chemical imbalance of the brain obsessive-compulsive disorder (OCD) eating disorder generalized anxiety disorder (GAD) higher socioeconomic status strict cultural standards

Objective 8 Describe the major types of crisis and what crisis intervention means Major types of psychiatric crisis include: 1. Suicidal thinking or behaviors 2. Homicidal thinking or behaviors 3. Acute psychotic symptoms 4. Sudden change in mental status 5. Violence resulting from a mental disorder

Objective 8 (cont’d) Crisis intervention = the provision of emergency psychological care to clients in order to restore their level of functioning and to prevent or decrease potential negative effects of the crisis Intervention consists of: preventing clients in crisis from harming themselves or others administering medications providing a supportive, therapeutic environment

Objective 9 Identify medical treatment and nursing interventions for the client with an anxiety or somatoform disorder

Nursing interventions: Medical treatment: therapies individual psychotherapy cognitive therapy behavior therapy group therapy medications anxiolytics antidepressants Nursing interventions: anxiety R/T severe stress AEB patient’s self-report/agitation/appearance ineffective coping R/T severe stress AEB development of somatic symptoms disturbed body image R/T body dysmorphic disorder AEB expression of repugnance with imagined defect or minor physical anomaly

See Medications for Clients with Anxiety/Somatoform Disorders handout Objective 10 Identify major drugs used, actions, side effects and nursing interventions for the client with an anxiety disorder or somatoform disorder See Medications for Clients with Anxiety/Somatoform Disorders handout