Which would be the primary nursing intervention for a client with anxiety or panic?
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Anxiety disorders are the most common of mental disorders, affecting nearly 30 percent of adults at some point in their lives. But anxiety disorders are treatable and there are several effective treatments available. This article focuses on anxiety disorders in general and their nursing management. Background Anxiety disorders are the most common mental health disorders. Despite the high prevalence rates of these anxiety disorders, they often are under recognized and undertreated. It is important to diagnose and treat an anxiety disorder that develops or worsens during the childhood and early adulthood to help prevent the problem from becoming chronic and continuing into later life. DefinitionAnxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. (DSM-5) *. These disorders include:
Obsessive-compulsive disorder (OCD), acute stress disorder, and posttraumatic stress (PTSD) are no longer considered as anxiety disorders as in the previous version of the DSM. However, these disorders are closely related to anxiety disorders. Anxiety disorders can cause a great deal of distress, interferes with the ability to relax and experience a sense of enjoyment and well-being. It often affects job performance, school work and personal relationships. People will to try to avoid situations that trigger or worsen their symptoms. Anxiety may be defined as apprehension, tension, or uneasiness from anticipation of danger, and is more associated with muscle tension and avoidance behavior. Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger. *Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition In general, for a patient to be diagnosed with an anxiety disorder, the fear or anxiety must:
Type of Anxiety Disorders and Clinical PresentationGeneralized Anxiety Disorder Generalized anxiety disorder is characterized by persistent, unrealistic and excessive anxiety and worry, occurring more days than not for at least six months, about a number of events and activities. The symptoms can cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. WHAT IF mnemonic to assess whether the person has GAD
The anxiety and worry may be accompanied by physical symptoms, such as restlessness, feeling on edge or easily fatigued, difficulty in concentrating, muscle tension or trouble sleeping. Panic Disorder Panic disorder is characterized by recurrent, unexpected panic attacks, the onset of which are sudden, unpredictable, and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom, and accompanied by intense physical discomfort. A panic attack is an abrupt period of intense fear or discomfort accompanied by 4 or more of the following symptoms:
DSM 5 criteria for panic disorder: recurrent panic attacks, with 1 or more attacks followed by at least 1 month of fear of another panic attack or significant maladaptive behavior related to the attacks. Other symptoms may include headache, cold hands, diarrhea, insomnia, fatigue, intrusive thoughts, and ruminations. The attacks usually last for minutes, or more rarely, hours. The individual often experiences varying degrees of nervousness and apprehension between attacks. Symptoms of depression are common. Phobias, Specific Phobia A specific phobia is marked and persistent fear of a specific object, situation or activity that is generally not harmful (e.g., flying, heights, animals, receiving an injection, seeing blood). The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation. The fear cause significant distress and people go extreme lengths to avoid what they fear. This can result in impairment in social, occupational, or other important areas of functioning Agoraphobia Agoraphobia is the fear of being in places or situations from which escape might be difficult or in which help might not be available in the event that panic symptoms should occur. A person with agoraphobia experiences marked fear or anxiety in two or more of the following situations:
The individuals may have experienced the symptoms in the past and is preoccupied with fears of their recurrence. The fear is out of proportion to the actual danger posed by the situation and typically lasts six months or more. The fear can cause significant impairment in social, occupational, or other important areas of functioning. In severe cases, the individual is unable to leave his or her home without being accompanied by a friend or relative whom he trusts. Social Anxiety Disorder (social phobia) A person with social phobia will typically report a marked and persistent fear of social or performance situations in which the individual is exposed to possible judgment and scrutiny by others, to the extent that his or her ability to function is impaired. The social situations are avoided or endurd with great anxiety. Examples are social interactions, speaking or performing in front of others. The fear, anxiety and avoidance typically last at least six months and causes problems with daily functioning. Separation Anxiety Disorder Separation anxiety disorder is characterized by excessive fear or anxiety about separation from those with whom he or she is attached. The feeling is beyond what is appropriate for the person’s age, persists (at least four weeks in children and six months in adults) and causes problem with functioning. Selective Mutism A rare disorder associated with anxiety is selective mutism. Selective mutism is characterized by failure to speak in specific social situations despite having normal language skills. Usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, withdrawal, compulsive traits, clinging behavior, and temper tantrums. Anxiety Disorder Due to Another Medical Condition The symptoms of this disorder are considered to be the direct physiological consequence of another medical condition. Symptoms may include prominent generalized anxiety symptoms, panic attacks, or obsessions or compulsions. Medical conditions known to cause anxiety disorders include endocrine, cardiovascular, respiratory, metabolic, and neurological disorders. Substance/Medication-Induced Anxiety Disorder The essential features of this disorder is prominent anxiety symptoms that are considered to be caused by the direct physiological effects of a substance (substance intoxication or withdrawal from alcohol, amphetamines, cocaine, hallucinogens, sedatives, hypnotics, anxiolytics, caffeine, cannabis, or other substances) EtiologyPhysiological
Related Anatomy and PathophysiologyAnatomyThe brain amygdala seems key to modulating fear and anxiety. Patients with anxiety disorders often show increased amygdala response to anxiety cues. The amygdala and other structures of the limbic system are connected to the regions of the prefrontal cortex. Hyper responsiveness of the amygdala may be associated with low activation thresholds in responding to perceived social threat. Abnormalities in prefrontal-limbic activation have been shown to reverse with clinical response to psychologic or pharmacologic interventions. PathophysiologyIn the central nervous system, the major mediators of the anxiety disorders symptoms appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. Positron emission tomography (PET) scanning has demonstrated increased flow in the right Para hippocampal region and reduced serotonin type 1A receptor binding in the anterior and posterior cingulate and raphe of patients with panic disorder. Magnetic resonance imaging has shown a smaller temporal lobe volume despite normal hippocampal volume in these patients. The CSF studies in humans shows elevated levels of hypocretin, which is believed to play an important role in the pathogenesis of panic episodes. EpidemiologyUnited States statistics
International statistics The prevalence of specific anxiety disorders seems to vary between countries and cultures. An international study of the prevalence of panic disorder found lifetime prevalence rates ranging from 0.4% in Taiwan to 2.9% in Italy. The average prevalence of social anxiety disorder in Europe is 2.3%. Gender Women are more affected than men (female-to-male ratio for any lifetime anxiety disorder is 3:2). Age distribution Most anxiety disorders begin in childhood, adolescence, and early adulthood. New-onset symptoms in older adults may be due to general medical condition, a substance abuse disorder, or major depression with secondary anxiety symptoms. Prognosis
DiagnosisHistory
Physical Examination: Patients with new onset anxiety symptoms should have a physical examination and basic laboratory workup to rule out medical conditions that might present with anxiety like symptoms Mental status Examination: A complete mental status examination should be obtained for each patient with anxiety symptoms.
Laboratory InvestigationsWhen anxiety is thought to be not due to an underlying medical disorder (lack of physical findings, younger age, typical anxiety disorder presentation), initial laboratory studies might be limited to the following:
Studies to Exclude Medical DisordersFor patients with a higher index of suspicion for other medical causes of anxiety (ie, atypical anxiety disorder presentation, older age, specific physical examination abnormalities), more detailed evaluations to be done to identify or exclude underlying medical disorders.
TreatmentsTreatment usually consists of a combination of pharmacotherapy and/or psychotherapy.
The outcome of treatment is determined by several factors, including the following:
Psychotherapy
The goal is for patient to “expose” themselves to that which they fear, in an attempt to experience less anxiety over time and develop effective coping tools. [su_note note_color=”#f5e87d”]Desensitization: This is a systematic plan of behavior modification, designed to expose the individual gradually to the situation or object until the fear is no longer experienced. The individual is “flooded” with stimuli related to the phobic situation or object (rather than in gradual steps) until anxiety is no longer experienced in relation to the object or situation. Fear is decreased as the physical and psychological sensations diminish due repeated exposure to the phobic stimulus under nonthreatening conditions. [/su_note] Medications
Complementary Health ApproachesComplementary and alternative treatments can be used along with conventional treatment to help with recovery. These include:
Nursing Assessment
Nursing Diagnosis
Nursing Priorities
Planning and Goals
Nursing care plan of Anxiety
1Nursing diagnosis: AnxietyRelated to
As evidenced by
Goal: The client will experience a reduction with anxiety and fear and can be evidenced by verbalization concerning the feeling of being less anxious, regaining usual sleep pattern, relaxed facial expressions and stable vital signs. Nursing Interventions
2Nursing diagnosis: FearRelated to
As evidenced by
Goal: Client will be able to function in the presence of the phobic object or situation without experiencing panic anxiety. Nursing Interventions
3Nursing diagnosis: Disturbed sleep patternRelated to
As evidenced by
Goal: Client will have adequate sleep hours, feel less exhausted Interventions
4Nursing diagnosis: Impaired communicationRelated to
As evidenced by
Goal: client will overcome fear and will communicate freely. Interventions
5Nursing diagnosis: Ineffective copingRelated to
As evidenced by
Goal: Client will demonstrate ability to cope effectively and will be able to manage a stressful situation in future without an anxiety episode. Interventions
6Nursing diagnosis: PowerlessnessRelated to
As evidenced by
Goal: Client will be able to effectively problem solve ways to take control of life situation, thereby decreasing feelings of powerlessness and anxiety Nursing Interventions
7Nursing diagnosis: Social isolationRelated to
As evidenced by
Goals: Short-term Goal: Client will attend therapy activities accompanied by trusted support person. Long-term Goal: Client will voluntarily spend time with other clients and staff members in group activities by time of discharge from treatment. Interventions
8Nursing diagnosis: Self-care deficitRelated to
As evidenced by
Goals: Client will be able to take care of own ADLs and demonstrate a willingness to do so. Interventions
EvaluationThe patient:
References
What is the primary nursing intervention for a person in panic anxiety?The nursing interventions for anxiety disorders are: Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa. Assure client of safety.
Which is the primary concern for a client with panic level anxiety?During panic-level anxiety, the person's safety is the primary concern. He or she cannot perceive potential harm and may have no capacity for rational thought. The nurse must keep talking to the person in a comforting manner, even though the client cannot process what the nurse is saying.
Which nursing interventions would help decrease anxiety?Nurses can help reduce patient anxiety through many methods including effective communication, active listening, personal visits, medication, music, and aromatherapy. Each nurse develops ways to recognize signs that patients feel anxious or in distress.
What is the best way to deal with anxiety?Things you can try to help with anxiety, fear and panic. try talking about your feelings to a friend, family member, health professional or counsellor. ... . use calming breathing exercises.. exercise – activities such as running, walking, swimming and yoga can help you relax.. |
