Anxiety Disorders

ANXIETY

Nursing Diagnoses:

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Vague sense of impending doom

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Ineffective individual coping

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Subjective response to stress

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Anxiety

Is a state of apprehension, uneasiness, uncertainty or tension experienced by an individual in response to an unknown object or situation.

Nursing Management:

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Signs and symptoms:

Mild

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Physical - ↑PR, RR, BP, pupillary dilatation, sweating

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Cognitive - Attentive and alert

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Emotional - Minimal use of defenses

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Calm

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Administer medications

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Listen

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Minimize environmental stimuli

ANXIETY DISORDERS

Panic Disorder Moderate

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An individual may suddenly experience frightening and uncomfortable symptoms

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Physical - Nausea, Anorexia, Vomiting, Diarrhea, Constipation, Restlessness

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May include terror, sense of unreality or fear of loosing control

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Cognitive - narrowed perceptual field & selective inattention

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Attack: 1 minute and 1 hour

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Emotional - use of any defense mechanism available Phobic Disorder

SEVERE

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Phobia is an irrational fear of an object, place, activity or situation. Avoidance will allow the individual to be free from anxiety.

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Physical - s/sx becomes the flow of attention

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Cognitive – perceptual field is greatly narrowed, focus of attention is trivial events

Examples:

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Emotional – defense mechanism operate

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Agoraphobia - fear of open places and of being alone in public places.

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Social phobia - irrational fear of criticism, humiliation or embarrassment.

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Acrophobia - fear of heights

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Algophobia - fear of pain

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Claustrophobia - fear of enclosed place

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Thanatophobia - fear of crowds

PANIC

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Physical – s/sx of exhaustion ignored

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Cognitive – personality disorganized

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Emotional – defense mechanism fail

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Pathophobia - fear of disease

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Monophobia - fear of being alone

Generalized Anxiety Disorder (GAD) ⊗

Unrealistic, excessive anxiety and is unable to control worry.

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Clients may experience: fatigue, irritability, restlessness, muscle tension, sleep disturbance

Obsessive Compulsive Disorder ⊗

Is characterized by recurrent obsessions and compulsions that interfere with normal life.

Nursing Interventions ⊗

Calm and nonjudgmental approach to convey acceptance.

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Use short and simple sentences or words.

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Help the client develop an increase tolerance to anxiety.

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Help the client to:

Refers to persistent, painful intrusive thought, emotion or urge that one is unable to suppress or ignore.

develop a problem-solving and coping skills of the client.

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develop the ability to remain calm in anxiety-producing situations.

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Approach: kind-firmness

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Systematic desensitization (phobic disorders)

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Clients with ritualistic behavior (obsessive-compulsive disorder) should not be prohibited or reprimanded.

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Biofeedback, change of the scenery, therapeutic touch, hypnosis, massage or relaxation exercises.

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Administer medications, as ordered.

Obsession ⊗

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Compulsion ⊗

Refers to repetitious uncontrollable act and sometimes a purposeful act to prevent a certain mistake in an event or situation.

ANXIETY RELATED DISORDERS Somatization Disorder

Post-Traumatic Stress Disorder (PTSD)

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Is the delayed reaction of the person who has been involved or exposed to a traumatic events.

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Free floating anxiety disorder

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Clients:

Symptoms of this disorder are:

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express emotional turmoil or conflict through physical symptoms.

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intense psychological distress

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usually seek for repeated medical attention.

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feeling of detachment or estrangement from others

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may exhibit antisocial behavior and may attempt suicide.

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insomnia

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decreased concentration

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avoidance of thoughts and feelings

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recurrent distressing dreams

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inability to recall an important aspect of the trauma

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Associated with anxiety and depression

Conversion Disorder ⊗

A condition in which an anxiety-provoking impulse is converted unconsciously into functional symptoms.

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Conscious counterpart of malingering

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Examples: Paralysis, blindness, loss of touch or pain sensation, dyspnea, seizures or convulsions

Hypochondriasis

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Types of Personality Disorders: Eccentric Personality Disorder (Type A)

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Paranoid (Suspicious and distrustful) 

Persons who display pervasive and long stand suspiciousness

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More common in men

Schizoid (Socially distant and detached)

An individual presents an unrealistic or exaggerated physical complaints.

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Pattern of detachment from social relationship

The person becomes, preoccupied with the fear of developing or having already a disease or illness in spite of medical reassurance.

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Chooses solitary activities

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Topics are inanimate objects and ideas

Body Dysmorphic Disorder ⊗

Preoccupation with an imagined defect in his or her appearance.

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Slight physical abnormality = excessive concern / anxiety

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Schizotypal (Odd and eccentric) 

“mild schizophrenia”

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Acute discomfort in close relationships

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Cognitive or perceptual distortion

Dissociative Amnesia ⊗

Inability to recall extensive amount of important information

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Caused by trauma

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Characterized by:

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Disorientation

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Purposeless wandering

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Impairment in ability to perform ADL

Rapid recovery generally occur

Dramatic-Erratic Personality Disorder (Type B) ⊗

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PERSONALITY DISORDERS

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Are pervasive and inflexible patterns of functioning that is stable overtime, and leads to distress or impairment.

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Antisocial (aggressive and manipulative) 

Pattern of disregard for the violation of the rights of others

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Low self-esteem

Borderline (destructive and unstable) 

Characterized by patterns of instability in relationships, self image and mood

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Self-mutilating behavior

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Affective instability

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More common in women

Narcissistic (boastful / superiority complex)

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Grandiosity and need for constant admiration

EATING DISORDERS

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Exploitation of others for fulfillment of own desire

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More common among females.

Anxious or Fearful Personality Disorder (Type C)

Causes:

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Avoidant (inferiority complex)

Psychological factors

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Social inhibition

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Parental factors (domineering parents)

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Feelings of inadequacy and sensitivity

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Individual factors (conflict about growing up)

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Low self-esteem

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Sociocultural factors

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Social withdrawal in spite of a desire for affection and acceptance

Dependent (submissive) 

Submissive clinging behavior related to excessive need to be cared for by others

Anorexia Nervosa

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Lack of self-confidence

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Main sign: Morbid fear of gaining weight

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Perceive self as helpless and stupid

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Other signs:

Obsessive-Compulsive (perfectionist)

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Sensitivity to cold temperatures

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Preoccupied with orderliness, perfectionism, inflexibility, need to be in control

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Amenorrhea

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Formal and serious interpersonal relationship

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Deliberate self-starvation with weight loss

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Judgmental of self and others

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Denial of hunger

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Obvious thinness but feels fat

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Lanugo all over the body

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Loss of scalp hair

Passive-Aggressive 

Intentional inefficiency

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Passive resistance to demands for adequate performance in both occupational and social functioning

Nursing Diagnosis: •

Ineffective individual coping

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Self-esteem disturbance

DISORDERS COMMONLY DIAGNOSED TO ADULTS

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Depression / distorted body image

Bulimia Nervosa ⊗

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Extreme measures to lose weight 

uses diet pills, diuretics or laxatives

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purges after eating

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extreme exercise

Signs of purging 

swelling of the cheeks or jaw area

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cuts and calluses on the back of the hands and knuckles

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teeth that look clear

Nursing Diagnosis: ⊗

Body image disturbance

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Ineffective individual coping

Nursing Interventions: ⊗

Establish a trusting relationship

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Monitor vital signs

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Reinforce:

Peculiar signs 

depression

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loss of interests in activities

Findings: (for both)

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Weight loss of 15% or more of original body weight

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Amenorrhea

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Social withdrawal and poor family and individual coping

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History of high activity and achievement in academics, athletics

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Electrolyte imbalance

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dietician’s prescription to accomplish realistic weight gain

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treatment plan that establishes privileges and restrictions based on compliance

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Decrease emphasis on foods, eating, weight loss or gain

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Weigh client daily at the same time

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Remain with the client after meal and for 1st four hours

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Set limit on time allotted for eating

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Encourage client to express feelings

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Promote feeling of control by 

participation in treatment

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independent decision making