Anxiety

What is a stressor?

An external pressure placed on an individual

What is anxiety?

The emotional response to a stressor

How is anxiety different from fear?

Anxiety is an emotional process, while fear is a cognitive process

What are Peplau’s four levels of anxiety?

Mild, Moderate, Severe, Panic

Mild Anxiety

Seldom a problem

Moderate Anxiety

Perceptual field begins to diminish

Severe Anxiety

Perceptual field diminishes greatly

Panic Anxiety

The most intense state

What is panic disorder characterized by?

Recurrent, unpredictable panic attacks with intense fear, terror, and feelings of impending doom.

What must be ruled out before diagnosing a panic attack?

Myocardial infarction (MI)

What are panic attacks characteristic of?

Panic disorder

Key features of panic attacks

Sudden intense fear + physical symptoms + peaks in 10 min + fear of dying/losing control

What is an intervention for hyperventilation during a panic attack?

Have the pt. breathe into a paper bag to increase CO₂ & help calm breathing.

What is generalized anxiety disorder characterized by?

Chronic, excessive anxiety and worry

What is a phobia?

An irrational fear of an object, person, or situation that leads to avoidance.

What is agoraphobia?

Fear of being in places where escape is difficult or help may not be available during panic symptoms.

What is social anxiety disorder (social phobia)?

Excessive fear of embarrassment or being negatively judged by others

What is a specific phobia?

Fear of a specific object or situation that is excessive, unreasonable, and inappropriate.

How does a person with a specific phobia respond to the feared object?

With an exaggerated and irrational reaction

What is substance- or medication-induced anxiety disorder?

Anxiety caused by intoxication or withdrawal from substances or medications

What are desired patient outcomes for anxiety and phobic disorders?

Recognizes early anxiety, keeps it manageable, makes decisions independently, and functions without panic in feared situations.

Priority nursing interventions for Anxiety (Panic)?

Initially, stay with pt. to prevent harm

Give short, brief commands

What are benzodiazepines used for?

Anxiety

What is the mechanism of action of benzodiazepines?

Enhance GABA → increases inhibitory effects in the CNS

What are common benzodiazepine medications?

Alprazolam, Diazepam, Lorazepam, Clonazepam

What are key safety and patient education points for benzodiazepines?

Habit forming (PRN use), do NOT stop abruptly (withdrawal risk), take as prescribed, do not crush SR tablets, dependence can occur,

What is the antidote for benzodiazepines?

Flumazenil

What is an example of an atypical anxiolytic?

Buspirone

What is the mechanism of action of buspirone?

Binds to serotonin and dopamine receptors

Teaching points for Buspirone?

Scheduled drug, not suitable for PRN usage, low dependence risk, slow onset

What is the mechanism of action of SSRIs?

Block reuptake of serotonin → increases serotonin levels

What are SSRIs first-line treatment for?

Depression, panic disorders, stress-related disoders

What are common SSRI medications?

Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil)

Education Points For SSRI’s?

BBW: Suicidal ideations, 4wk onset, don’t abruptly stop drug

What is the first-line treatment for GAD?

SSRI’s or SNRI’s

How are beta blockers (propranolol, atenolol) used for anxiety?

Given PRN to treat physical symptoms of anxiety (e.g., tremors, tachycardia) in situational anxiety

What is the key difference between benzodiazepines and atypical anxiolytics (buspirone)?

Benzos = habit forming, PRN use; Buspirone = not habit forming, taken on a schedule.