Chapter 18 Anxiety and Panic Disorder

GAD

an anxiety disorder in which a person is stress about everyday thing for 6 months or more

Benzodiazepines

drugs that lower anxiety and reduce stress and alcohol withdrawal ends in lam and pam "-lam" AlprazoLAM MidazoLAM " -pam" TemazePAM ClonazePAM

anxiety disorders treatment

effective coping mechanisms CBT-cognitive behavioral therapy pharmacology

Which medication classification has most commonly been used to treat social phobia?

Selective serotonin reuptake inhibitors (SSRIs)

Buspirone memory trick

think of a bus and bad news takes long time to kick in

implosive therapy

A method for decreasing anxiety by exposing the client to an imaginary anxiety stimulus. The method is risky because overexposure can actually increase anxiety.

Which agent would a nurse likely expect to administer as a first-line medication to a patient experiencing mild panic disorder? Select all that apply A.Fluoxetine B.Sertraline C.Paroxetine D.Alprazolam

A, B, and C. vFluoxetine, sertraline, and paroxetine are SSRIs and are used to treat panic disorder. Alprazolam is a benzodiazepine used, in combination with SSRIs, to treat a severely distressed patient.

a fear of open spaces leading to avoidance behaviors, is often seen in panic disorder.

Agoraphobia

Buspirone

Antianxiety key point is it takes 2-4 weeks for full effect no withdrawal symptoms no sedation safe for long term use

Anxiety disorders pharmacology

beta blockers- end in lol atenolol Antidepressants SSRI-sertraline& paroxetine TCA-amitriptyline and imipramine MAOI: Phenelzine and lsocarboxazid

Which term describes feelings of being disconnected from oneself as seen in a panic attack?

Depersonalization describes feelings of being disconnected from oneself as seen in a panic attack

Anxiety Disorders pathophysiology

During severe anxiety the mind goes into a state of panic & so the body goes into fight or flight mode turning on the SNS - sympathetic nervous system. The SNS tells the body to shunt blood flow away from the extremities & toward the core of the body for the vital organs & to increase the vital signs.

Nursing interventions for physical stress related illness should include what?

Establishing daily routines of meals and sleeping Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.

Severe Anxiety

Increased RR & HR "hyperventilation" Pacing back & forth Feeling of "Impending Doom" Perception is GREATLY reduced: Can NOT respond to directions

moderate anxiety

Increased RR & HR Pacing back & forth Slightly reduced perception

Benzodiazepines moa and side effects

Increases GABA and side effects Low & slow vitals & brain

An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what?

Is conducive to concentration and problem solving Mild anxiety is often helpful to individuals and can assist in maintaining concentration and problem-solving abilities. Moderate to severe anxiety can begin to inhibit an individual's coping because these levels create physiologic responses (such as tachycardia and sweating) and psychological responses (such as loss of concentration and inability to focus) that may prevent the person from functioning adequately, interfere with cognitive abilities, and become pathologic if not treated adequately.

A nursing instructor is describing the care of a client with acute anxiety to a class of nursing students. The instructor determines that more education is necessary when the students identify which intervention as appropriate?

It is important to establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Trust can be established by approaching the client in a calm and confident manner; providing a place that is quiet, safe, and private; and encouraging the client to verbalize feelings and concerns.

what diagnose is diagnosed when a patient abruptly experiences an intense fear or discomfort with at least four characteristic symptoms reaching a peak within 10 minutes.

Panic attack

Barbiturates

Phenobarbita is a type of drug good news Lasts LONGER in the body bad news Take LONGER to get out of the body Higher risk for Toxicity leading to hypotension, Respiratory depression

mild anxiety symptoms

Restlessness, increased motivation, irritability

Anxiety Disorders pathophysiology MEMORY TRICK

SNS - Sssspeeds Up the Vital Signs Increasing the HR, BP, RR, sugar levels, & dilating the pupils!

A client is currently experiencing a panic attack. Which is the most appropriate response by the nurse?

Saying "You are safe. Take a deep breath" reassures and redirects the client. Telling the client to relax is simplistic and ineffective. The nurse should follow reassurance ("There is nothing here to harm you") with redirection. Asking the client to describe his or her feelings does not provide reassurance or redirection

Barbiturates Memory Trick:

Sedation like at a bar & lasts a long time, like stuck behind bars

SAD

Social Anxiety Disorder social or publics situation like public speaking, eating or drinking in front of others

Patients who rely heavily on defense mechanisms to manage their anxiety end up not dealing with the cause of their anxiety.

TRUE

Benzodiazepines KEY POINT:

Take at bedtime Don't skip doses Stop drinking alcohol (wine) Do not operate dangerous machines Antidote Benzos: Flumazenil Antidote Opioids: Naloxone (brand: Narcan)

Benzodiazepines are

addictive and are not safe for long term use

When patients are prescribed benzodiazepines, they must be educated to avoid

alcohol

panic attack

fear of death "impending doom" feeling detachment" hallucinations: physical s/s -chest pain and heart palpitations trembling and numbness -hyperventilation -sweating and hot flashes -nausea and choking sensations

effective coping mechanisms

increasing comfort levels when expose to phobia little by little we want to let the client verbalize feeling and insight about anxiety(self observation) self distraction focusing on something other than the phobia

cognitive-behavioral therapy (CBT)

is a highly effective tool for treating individuals with panic disorder it is considered the first line of treatment for panic and other anxiety disorders in conjunction with medications like SSRI. The goals of CBT include helping the patient to manage his or her anxiety and correcting anxiety-provoking thoughts through interventions, including cognitive restructuring, breathing training, and psychoeducation.

severe anxiety and panic attacks don'ts

never say relax never discuss the reasons if there having or undergoing

Resilence

practicing stress reduction techniques daily

severe anxiety and panic attacks

remind with the client #1 priority place the client in a quiet room"sit with client" "remained at the bedside" speaking calmly with simple clear words

generalized anxiety disorder Clinical Course

vFeelings of frustration, disgust with life, demoralization, and hopelessness vSense of ill-being and uneasiness and fear of imminent disaster vInsidious onset vMany complain of being chronic worriers vIndividuals of all ages affected vTypical onset (more than half) in childhood and adolescence; onset after age 20 years also common vMay exhibit mild depressive symptoms vHighly somatic vExperience poor sleep habits, irritability, trembling, twitching, poor concentration, exaggerated startle response

biochemical theories

§Serotonin and norepinephrine §GABA §Hypothalamus-pituitary-adrenal (HPA) axis