anxiety disorders nursing 201. introduction –anxiety provides the motivation for achievement, a...
TRANSCRIPT
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Anxiety Disorders
Nursing 201
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Introduction
– Anxiety provides the motivation for achievement, a necessary force for survival.
– Anxiety is often used interchangeably with the word stress; however, they are not the same.
– Anxiety may be differentiated from fear in that the former is an emotional process, whereas fear is cognitive.
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Epidemiological statistics
– Anxiety disorders are the most common of all psychiatric illnesses
– More common in women than men
– Minority children and children from low socioeconomic environments at risk
– A familial predisposition probably exists
• How much is too much?– When anxiety is out of proportion to the situation that is
creating it.– When anxiety interferes with social, occupational, or other
important areas of functioning.
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Assessment
Panic disorder
• Generalized anxiety disorder
• Panic disorder with agoraphobia
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Predisposing Factors
• Psychodynamic theory
• Cognitive Theory
• Biological aspects• Transactional Model of Stress
Adaptation
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Nursing Diagnosis
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Outcomes
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Planning/Implementation
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PhobiasAssessment• Agoraphobia without history of panic disorder
– Fear of being in places or situations from which escape might be difficult or in which help might not be available if a limited-symptom attack or panic-like symptoms should occur
• Social phobia– Excessive fear of situations in which the affected person might do
something embarrassing or be evaluated negatively by other• Specific phobia
– Marked, persistent, and excessive or unreasonable fear when in the presence of, or when anticipating an encounter with, a specific
object or situation, Animal type, Natural environment type, Blood-injection-injury type, Situational type
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Predisposing Factors
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Nursing Diagnosis
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Outcomes
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Planning/Implementation
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Evaluation
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Obsessive-Compulsive Disorder (OCD)
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Assessment
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• Obsessions: Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause marked anxiety or distress
• Compulsions: Unwanted repetitive behavior patterns or mental acts that are intended to reduce anxiety, not to provide pleasure or gratification
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Predisposing Factors
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Nursing Diagnosis
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Outcomes
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Planning/Implementation
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Post-traumatic Stress Disorder (PTSD)
– Development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical
integrity of others – Characteristic symptoms include reexperiencing the
traumatic event, a sustained high level of anxiety or arousal, or a general numbing of responsiveness. Intrusive recollections or nightmares of the event are common.
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• Psychosocial theory– The traumatic experience
• Severity and duration of the stressor• Extent of anticipatory preparation before onset• Exposure to death• Numbers affected by life threat• Extent of control over recurrence• Location where trauma was experienced
– The individual• Degree of ego-strength• Effectiveness of coping resources• Presence of preexisting psychopathology
– Outcomes of previous experiences with stress/trauma– Behavioral tendencies– Current psychosocial developmental stage– Demographic factors
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– The recovery environment• Availability of social supports
• Cohesiveness and protectiveness of family and friends
• Attitudes of society regarding the experience
• Cultural and subcultural influences
• Learning theory– Negative reinforcement as behavior that leads to a reduction in an
aversive experience, thereby reinforcing and resulting in repetition of the behavior
– Avoidance behaviors– Psychic numbing
• Cognitive theory– A person is vulnerable to post-traumatic stress disorder when
fundamental beliefs are invalidated by experiencing trauma that cannot be comprehended and when a sense of helplessness and hopelessness prevails.
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• Biological aspects– It has been suggested that a person who has experienced
previous trauma is more likely to develop symptoms after a stressful life event.
– Disregulation of the opioid, glutamatergic, noradrenergic, serotonergic, and neuroendocrine pathways may be involved in the pathophysiology of PTSD.
• Transactional Model of Stress Adaptation– The etiology of PTSD is most likely influenced by multiple
factors
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Nursing Diagnosis
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Outcomes
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Planning/Implementation
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Client/Family Education
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Treatment Modalities
• Psychopharmacology – PTSD
• Antidepressants
• Anxiolytics
• Antihypertensives
• Others