Anxiety and Panic Disorders

Anxiety Disorders Overview

• The main characteristics are anxiety symptoms and avoidance behavior.

Panic Disorder (with or without Agoraphobia)

• Panic disorder involves recurrent, unpredictable panic attacks with intense apprehension, fear, or terror.
• Feelings of impending doom and physical discomfort accompany the attacks.
• Attacks usually last minutes or hours.
• Agoraphobia can co-occur, involving fear of situations where escape is difficult or help might not be available if a panic attack occurs.
• Common agoraphobic situations: being outside alone, in a crowd, standing in line, on a bridge, or traveling.

Agoraphobia Without History of Panic Disorder

• Main feature of this disorder identified in the DSM-IV-TR is the fear of being in situations where escape is difficult or help might be unavailable if distressing symptoms develop.
• Travel is restricted, or the individual needs a companion when away from home; intense anxiety is endured if situational pressures are unavoidable.

Social Phobia

• Social phobia involves a persistent fear of behaving or performing in front of others in a way that could be humiliating or embarrassing.
• Individuals are highly concerned about scrutiny by others and fear social or performance situations where embarrassment may occur.
• Exposure to phobic situations is avoided or endured with intense anxiety.
• Common social phobias: speaking or writing in front of people, eating in the presence of others, and using public restrooms.

Specific Phobia

• Formerly called simple phobia.
• Includes persistent fears of specific objects or situations.
• Fairly widespread in the general population.
• Common specific phobias include:
  • Fear of animals (zoophobia)
  • Fear of closed places (claustrophobia)
  • Fear of heights (acrophobia)
• Exposure to the phobic stimulus is avoided or endured with intense anxiety.

Obsessive-Compulsive Disorder

• Involves involuntary recurring thoughts or images that the individual cannot ignore, and recurring impulses to perform seemingly purposeless actions.
• Obsessions and compulsions help prevent extreme anxiety.

Posttraumatic Stress Disorder

• Characterized by physiological and behavioral symptoms which follow a psychologically traumatic event.
• Traumatic events are generally outside the range of usual human experience.
• The stressor is markedly distressing, experiences with intense fear, terror, and helplessness.

Acute Stress Disorder

• Features physiological and behavioral symptoms similar to PTSD.
• Symptoms must subside within 4 weeks of the stressor's occurrence
• If symptoms last longer than 4 weeks, it is considered PTSD.

Generalized Anxiety Disorder

• This disorder involves chronic, unrealistic, and excessive anxiety and worry.
• Symptoms must occur more days than not for at least 6 months.
• Clinically significant distress or impairment in social, occupational, or other important aspects of functioning must be present.
• Symptoms include:
  • Restlessness
  • Feeling "on edge"
  • Becoming easily fatigued
  • Difficulty concentrating
  • Irritability

Anxiety Disorder Due to a General Medical Condition

• Symptoms are the direct physiological consequence of a general medical condition.
• Symptoms may include:
  • Generalized anxiety
  • Panic attacks
  • Obsessions or compulsions
• Medical conditions: endocrine, cardiovascular, respiratory, metabolic, and neurological disorders.

Substance-Induced Anxiety Disorder

• Prominent anxiety symptoms are caused by the direct physiological effects of a substance.
• Could be a drug of abuse, medication, or toxin exposure.
• Symptoms occur during substance intoxication or withdrawal.
• Can involve:
  • Intense anxiety
  • Panic attacks
  • Phobias
  • Obsessions or compulsions

Symptomatology (Subjective and Objective Data)

• A panic attack may occur when:
  • As the predominant disturbance, with no apparent precipitant
  • Exposed to a phobic stimulus
  • Attempts are made to curtail ritualistic behavior
  • Following a psychologically traumatic event
• Symptoms (APA, 2000) may include:
  • Pounding, rapid heart rate
  • Feeling of choking or smothering
  • Difficulty breathing
  • Pain in the chest
  • Feeling dizzy or faint
  • Increased perspiration
  • Feeling of numbness or tingling in the extremities
  • Trembling
  • Fear that one is dying or going crazy
  • Sense of impending doom
  • Feelings of unreality (derealization and/or depersonalization)
• Other symptoms include:
  • Restlessness, feeling "on edge," excessive worry, being easily fatigued, difficulty concentrating, irritability, and sleep disturbances (generalized anxiety disorder)
  • Recurrent and intrusive recollections or dreams about the traumatic event, feeling of reliving the trauma (flashback episodes), difficulty feeling emotion (a “numbing" affect), insomnia, irritability or outbursts of anger (PTSD)
  • Repetitive, obsessive thoughts related to violence, contamination, and doubt; repetitive, compulsive performance of purposeless activity, such as handwashing, counting, checking, touching (obsessive-compulsive disorder)
  • Marked and persistent fears of specific objects or situations (specific phobia), social or performance situations (social phobia), or being in a situation from which one has difficulty escaping (agoraphobia)

Nursing Diagnoses and Interventions: Anxiety (Panic)

• Definition: Vague uneasy feeling, of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger.
• An alerting signal that warns of impending danger and enables the individual to take measures to deal with threat.
• Possible Etiologies ("related to") include:
  • Unconscious conflict about essential values and goals of life
  • Situational and maturational crises
  • [Real or perceived] threat to self-concept
  • [Real or perceived] threat of death
  • Unmet needs
  • [Being exposed to a phobic stimulus]
  • [Attempts at interference with ritualistic behaviors]
  • [Traumatic experience]
• Defining Characteristics ("evidenced by") include:
  • Increased respiration
  • Increased pulse
  • Decreased or increased blood pressure
  • Nausea
  • Confusion
  • Increased perspiration
  • Faintness
  • Trembling or shaking
  • Restlessness
  • Insomnia
  • [Nightmares or visual perceptions of traumatic event]
  • [Fear of dying, going crazy, or doing something uncontrolled during an attack]
• Goals/Objectives include:
  • Short-Term Goal :Client will verbalize ways to intervene in escalating anxiety within 1 week.
  • Long-Term Goal: Client will be able to recognize symptoms of onset of anxiety and intervene before reaching panic stage by time of discharge from treatment.
• Interventions with Selected Rationales:
  • Maintain a calm, nonthreatening manner which working with client. Anxiety spreads between staff and client. Client develops a feeling of security through a calm staff
  • Reassure the client of safety and security through physical presence. Do not leave the client alone, the may fear death. A trusted presence provides security.
• Use simple works and brief messages. In an anxious state, the client is unable to comprehend anything but the most elementary communication.
  • Keep immediate surrounding low in stimuli. A stimulating environment may increase the anxiety.
  • Administer prescribed medication and access the medication.
  • when their anxiety is reduced, explore with client for reasons for the occurrence. Recognition of factors is the first step in interrupt escalation of the anxiety.
  • Encourage the client to talk about the traumatic experience. Provide support during flashbacks.
• Teach sings and symptoms of escalating anxiety, the techniques to interrupt escalation of anxiety.
  • Relaxation techniques
  • Deep breathing
  • Physical exercises
  • Brisk walks
  • Jogging, and or meditation
• Outcome Criteria:
  • The client is able to remain anxiety is at a level which problem-solving can be accomplished
  • The Client is able to verbalize the signs and symptoms of escalating anxiety.
  • The client is able to demonstrate techniques for anxiety at the panic level.

Fear

• Definiton- Response to perceived threat that is consciously recognized as a danger
• Possible Etiologies ("related to"):
  • Phobic stimulus
  • Being in place or situation from which escape might be difficult
  • Causing embarrassment to self in front of others
• Defining Characteristics ("evidenced by")
  • [Refuses to leave own home alone]
  • [Refuses to eat in public]
  • [Refuses to speak or perform in public]
  • [Refuses to expose self to (specify phobic object or situation)]
• Identifies object of fear.
  • [Symptoms of apprehension or sympathetic stimulation in the presence of phobic object or situation]
• Goals/Objectives include:
  • Short-Term Goal :Client will discuss phobic object or situation with nurse or therapist within 5 days.
  • Long-Term Goal: Client will be able to function in presence of phobic object or situation without experiencing panic anxiety by time of discharge from treatment.
• Interventions with Selected Rationales:
  • Reassure the client of safety and security at a level where panic occurs on life.
  • Explore the client’s physical integrity or threats to self-concept is important to understand the client’s perception of a phobic situation.
  • Discuss the reality of the situation between the client in order to recognize aspects of the situation that cannot be changed. The client must also believe in this before they can have this before fear can be reduced.
  • Include clients in making decisions related to selection of coping strategies, so it will allow the client to have control of the serves of self-worth.
  • If the client selects to work on elimination techniques of desensitization may be employed the systematic plan will expose the individual gradually to situations until fear is no longer experienced, the physical sensation should diminish in response to exposure to phobic situations. Encourage client to have explore underlying feelings of the irrational fears, the adaptive coping abilities.
• Outcome Criteria:
  • The Client does not experience disabling fear when exposed to the phobic object
  • The Client is able to verbalize ways in which he or she will be able to avoid the exposure to the phobic object

Ineffective Coping

• Definition : Inability to form a valid appraisal of the stressors
• defining Characteristics ("evidenced by") -[ underdevelopment ego; punitive superego] Situational Crisis [personal vulnerability] [Inadequate support systems] Defining Characteristics ("evidenced by")
• [Ritualistic behavior]
• [Obsessive thoughts]
• Inability to meet basic needs
• Inability to meet role expectations
• Goals/Objectives
• Short-Term Goal: within one week a client will decrease participation in their behavior.
• Long-Term Goal: discharge after one week the client will display the ability to cope without resorting to obsessive or compulsive behavior.
• Intervention and Selected Rationales Recognition must occur for client the change, A client’s treatment the doctor is allowed to deny any behavior, and support for to is need to be explore there can be issues that. Providing a client where the support is with the time of rituals where the client becomes anxious the client should be able replace that behavior with adaptive ones. Give positive reinforcement to non-ritualist clients. positive reinforcement can enhance self-esteem, encourage repetition of design. The client should be able to the type of behavior, if they aren’t using thought shopping techniques and and their is a lot anxiety. Client recognizes signs and symptoms that are easy Interments obsessive thoughts and refrain from ritualistic behaviors

Powerlessness

• The client cannot perceive one person and has a perceived lack of control over immediate happenings.
• Possible Etiologies ("related to")
  • Lifestyle of helplessness
  • Disapproval from others
  • Need dependency
  • Consistent negative feedback
• Defining Characteristics ("evidenced by")
  • Verbal expressions of having no control
  • Care will be to take the most care
• Goals/Objectives
  • Short-term goal
  • The is involved making their own decision making
• Intervention - Provide a client with the choice of control and set up realistic goals. With the client on the emotional client and that we can provide benefits and the best advice for for all options. Identify areas of what client likes. identify ways in which the client can achieve certain actives that have enhance the self-esteem. Outcome criteria:
• the client can have verbal honest feelings what clients do have control over, and when they don’t

Isolation

• Definition Experience when the individual feels alone or is perceived to be impose others.
• Possible Etiologies ("related to")
  • Panic with that has has difficult speaking to others.
  • The clients needs to engage with others to keep with anxiety a person is feared
• The individual is alway aloneness is a group is the most important thing.
• Goals/Objectives:
  • The client will attend the activity support will from the week for the long trem goals. Inventions accept the attitude to give self-worth and you will be show unconditional positive regard.
• You are a nice person
• Dependability for them will be easy to talk to from there get their space if they are to nervous.
• The medication can ease their interactions with others; help their anxiety through thought exercises.

Self-Care-Deficit

• A person cannot fully provide life skills and is not independent alone

• Possible Etiologies ("related to")

  • Some are withdrawn with other
  • They are in need of certain dependency

• They need rituals with certain

• If they have irrrational fears

• The client should be taking the proper care, food, and clothing. And will is like a lack level of clothing to maintain the body .

• The short term The client it is the to want to take the care

• Long-term to take control of what they have done, to be willingly in the future

• The client will able to do their best, but to have the best for their client during their the client and is not going to want to perform. Is it always good to stay on top or good to leave them with what skills is the time .

• The high level of anxietiy

• It is necessy to strict recorrds

• You provide the client a healthy option from there. In order has

• It is important to the client for the needs will be. Outcome Criteria: The end result you will see is a perfect