anxiety

anxiety fefinition

feeling of apprehension,unreasiness, uncertainity due to threat

nomral anxiety

neccesay for survival reaction

procide energy to carry dait task, and prepare for challenge

persitetn diableing

interfere with personal,occupational,social function

rigid, ineffectibe habior to control anxeiyy

chronic with long term efect

biological factor

genetic:family

neuro:epinephrine, NE,dopamine,serotonin,GABA

PTSD; r/t hypothalamic piturary adrenal system

psychological factor

behavirol theory:learned experiecen through encriomental stimuli,conditoning

cognitve theroy:thought distrotyion

learning theory:maladpative learning,pattern of avoidance

sociocultural

presentation varies

somtic/cognitve symtom

environmental factor

truamatic event

childhood trauma

mild anxiety

sharp and focus perception of reality

discomfort,restlessness, irritability,tension-relieving nail bite,foot tap,fidgeting

moderate anxeity

narrow perception-selective arrentuoin

tension,tachycardia, tachyonea,perspiration,mild somatic;GI discomort,H/A,urinary urgency,voice and hand termor,increase miscle gension more muscle tension relieving

*dangerous signal

severe anxiety

greatly reduced ;erception,focus on scattered detail

H/A.nausea, dizz,insomnia,trembling,imdepending room,hyperventilation,consuion,ineffctive fx,loud rapid speech,threat

panic anxieyyr

disturbed behavior

hallucination

pacing,running,shouting,withdrawl,erratic behqvior, uncoordianted and impulse action,immobility,pupile dilation, sleepiness,unable speak

panic disorder

sudden ;anic attack, recuring severe panic

impending room

panic disorder symtom

extreme fear, thought heart attck

palpitation,CP,dyspnea,nausea, choking,chill,hot fluash,limited perception,server personality disorganization,miinterepet reality

panic disorder intervention

encourage slow, deep breathing,

help identify feeling before onset

teach abd breathing

geernalized anxiety

persistant ,excessive worry

gernerliazed anxiety symptom

peristent anxiety

wory

restlessness

fatigue

poor concetrantion

irritability

,uslce tension sleep disturbance

general anxiety tx

stay with pt

speak slow and calm,using shot sentence

antixiolytic

teach postive self talk,refrme negative situation

PTSD

trauma induced flkashback,nightmare, hypoerviligilance,irritability

PTSD sysmptom

peristent numbning genral responsivenss,

increase arousal,irritability, diffisult sleeping, diffisult concentrating, ecagreetd startle repson

PTSD onset

symtom appear within 3 mopnth of trauma

PTSD nursing intervention

provide education

encourage expression of feeling and listen empathy

monitor ofr suicidal idelation

OCD

obesession-recurrrent thought

compulsion-repetive behaviopr

distress feel humiliation, and shameful

time cosuming ritual interact with momral routine and social activity

OCD sym,tom

obesession-=recuring thought, impulses, imahes

compulsion-ritulailistic behvaior to reduce anxiety

ocd comorbidity

with othe rpsy treat with cognitve behavirol therapy

common tyope of obesession

losing control,harm , vontamination, perfectionism,sexual, religios

wahsing,chekcing repeating

anxiety assessment

-pt safety

-hamiltopn anxiety rating-anxious, tension,fear, insomnia, intellectual depresse, somatic-sensory,muscular,cardio, resp,gi,automonmic.

-yale brwon obesessive,complusibve

-psychosocial-family,freidn, spirtual,cultural, work,physical,major illness

-MSE

-VS

-rx-undertstaing,comliance,se

implemention

couseling-enhacing coping and communication

health teaching and health promotion:coping ski;;,grounding,techqiue,njournal,

mileu therapy

promotion of self care-nutrtion, fluid intake,personal hygine,e,grooming, elimination

rx

modeling

therpist act as a role model to demonstrate aprropriate behaor in feared situation and then pt imiate

systematic desensitazation

pt gradually introduced to fear objecy or expeeience, throught a series odf step, from least to most frgihteneing

flodding

prolonged exposure surivial is possibler ajd anxiety diminish spontaneously

response prventation

pt with complusive behavior are not allow to perfrom ther compulsive ritual, pt lear that anxiety,susbside when ritual is not complieted

thought stopping

negative thought or obesession is interpted,say out loud when idea come to mind or snap to rubber band

cognitve therpay

cognitve restructuring

1.identify automatic negayive belief cause anxiety

2.explore the basis for theses thought

3. reevalute the situation realisatically

4. 4.replace negative self -talk,supportive idea

cognitve behaviroal therpay

cognitve restuctring, pychoeducation ,breahing,muscle relaxation,self monitor

somatic therapy

integreat into pahse-oritented trauma tx to facilate symptom reducation and stability

intergrate traumtic memeory, resotre person ability to saty in the momment

disarm the patho defense mechanism of dissociation and replace with other resource

mileu therapoy

structuring daiky routine to offer physcial sadety

provide daily activity

provide therpaeutic interaction

nursing evlaution

meausre improvement

evalaution pof outcome

safety maintained

reduce level of anxiety /distress

display obesession,complusion,owrry

able to self care

SSRI

indication;1st line acute stress and PTSD

onset;1-4wk

Rx;celxa0-GAD,prozac-OCD,zoloft paxil-PD,SAD,OCD,GAD,PTS

SSRI se and warning

agiation,insomnia, headache, nausea, vomnintg, sexual dysfunction,hyponatermia

warning:increase suicidial ideation

not with MAOI

DC syndromw;dizz,irritability, nausea,agiataion

SNRI

common-

duloxetine-cymbalta-panic, GAD

effexor-GAD,PD<SAD

SE:HYN,insomnia,seating,headache,dry mouth, nasuea, sexual dysfunction

warning:suicidal idealtion

dc syndrome:dizz,irrtiability

monitor bpT

TCA

similar to ssrri, more side effect

amitriptiline,anafranil-OCD

MAOI

se;dry mouth,consitpation,urinary retention, blurry vision,ortho hypigension, cardiac toxicity,sedation

warning:hypertensive crissi

benzo

indication;somatic,psychological,rapid relief acute anixety

MOA;stop GABA,calming effect’

ativan-GAD,PD

diazepam-GAD

rivotril-PD

alprezolam-PD,GAD

se benzo

sedation,hypotension,ataxia,decrease LOC, resp depression

warning for dependence-short term

risk for substance use

pregancy;congential defect,withdral

benzo nursing care

vs

LOC

avid CNS depressant

gradual tape

buspar

use for GAD,OCD

affect dopamine,seortnin

safe long term

2-4wk-not for acute

beta blocker

atennol,propanol

mange physical symtom of anxiety,such as tachycardia, termor

block adrenlaine

SAD

antihistamine

hydrozyzine,benadryl

alternative for GAD

sedative

anticonvuldant

valproci acid

carzempine

mange GAD,PD,PTSD, SAD

monito liver function,mood change momnitor

abx

d-cycloserine

bind to NMDA

use inconjuction with CBT for tx OCD and SAD