Anxiety/GAD

EMOTIONAL RESPONSE to stressor (internal)

Anxiety

EXTERNAL stimuli/pressure

Stressor

Cognitive/Intellectual Process → appraisal of stimulus perceived to be threatening

Fear

How much is too much?

1. OUT OF PROPORTION

2. interferes with FUNCTIONING

Excessive and persistent

SUDDEN, overwhelming feeling of terror/IMPENDING DOOM

Panic (most severe)

Panic Disorder characterizations

RECURRENT panic attacks → unpredictable

Physical sensations associated with panic attack

Believe they are having a heart attack

S/S of panic attack

• Palpitation

• SWEATING/diaphoresis

• Trembling

• SOB/Choking

• Chest pain

• Nausea

• Dizzy, lightheaded, faint (hyperventilation & CO2)

• Chills

• Paresthesias

• Derealization

• Fear of going crazy/dying

Panic Attack interventions

• STAY WITH THEM

• risk of diagnostic overshadowing (rule out heart attack)

• Not time to work on coping mechanisms

• Low stimuli

• Calm voice, simple statements

• Give anxiolytics as prescribed

Hyperventilation Interventions

LOW CO2

• lightheaded, tachycardic, SOB, numb/tingle, syncope

DIAPHRAGMATIC BREATHING (Stimulates vagus nerve/PNS)

Interventions once the panic attack have been reduced

• Explore reasons for occurrence

• Teach s/s of escalating anxiety and ways to interrupt its progression (deep breathing)

GAD

CHRONIC, unrealistic and excessive anxiety & worry

MORE DAYS THAN NOT

How long does the individual have symptoms to be dx with GAD

MORE DAYS THAN NOT

At least 6 months

Symptoms associated with GAD anxiety

restless/feeling keyed up

On age

Fatigue

difficulty concentrating

irritable

muscle tension

sleep disturbance

Other factors that may cause symptoms

Caffeine

HYPERthyroidism

in GAD anxiety and worry result in…

avoiding activities

spending considerable time preparing for activities

PROCRASTINATION

Psychodynamic theory

weak ego, can’t intervene when conflict occurs between ID and superego → anxiety

Weak ego results in use of…

EGO defense mechanisms instead of coping and management skills

Cognitive theory

Thinking patterns/neuropathways distorted 

• dysfunctional appraisal of situation

Neurochemical imbalances

INCREASE norepinephrine (panic)

DECREASE serotonin and GABA

Nursing Dx

Panic Anxiety

Powerlessness

Outcome

Recognize signs of escalating anxiety and intervene before panic

Anxiety at manageable level