Week 1 learning guide:
Anxiety / Panic ch14
Anxiety: vague feeling of dread or apprehension. A response to external or internal stimuli that
can have behavioral, emotional, cognitive, and physical symptoms. Distinguished from fear.
Unavoidable. Has positive and negative side effects.
positive: produce growth and adaptive change
negative: produce poor self-esteem, fear, inhibition, anxiety disorders
Anxiety disorders: comprise a group of conditions that share a key feature of excessive anxiety
with ensuing behavioral, emotional, cognitive, and physiological responses.
4 Stages of anxiety:
1-Mild: helps people learn, grow, change
2- Moderate: increases focus on alarm and learning is still possible
3- severe: greatly decreases cognitive function, increases prep for physical
response, increases space needs)
4- Panic: flight/fight/freeze response (alarm,resistance,exhaustion), no
learning possible, person is attempting to free self from discomfort of this high stage)
Panic disorder: composed of discrete episodes of panic attacks
Panic attacks: 15-30 minutes of rapid, intense, escalating anxiety in which the person
experiences great emotional fear as well as physiological discomfort. Displays 4+ symptoms:
palpitations, sweating, tremors, SOB, sense of suffocation, chest pain, nausea, abdominal
distress, dizzy, chills, hot flashes, paresthesia.
Defense mechanisms: intrapsychic distortions that a person uses to feel more in control. Anxiety
disorder= defense mechanisms overused.
Neurochemical theories:
*GABA, Serotonin, norepinephrine*
GABA- inhibitory neurotransmitter, amino acid. Functions as the body’s natural antianxiety
agent by reducing cells excitability – thus decreasing rate of neuronal firing. Believed to be
dysfunctional in anxiety disorders due to regulation problem between GABA and
norepinephrine.
Serotonin- subtypes play a role in anxiety, aggression, and mood. Serotonin play direct role in
OCD, panic disorder, GAD.
*Excess of Norepinephrine is suspected in panic disorder, GAD, PTSD.
Anxious behavior care plan:
interventions: safety, calm/quiet area/voice, relaxation techniques, supportive sources, identify
anxiety – no avoiding/self awareness.
, Drugs used to treat anxiety disorders (p.230)
benzodiazepines, SSRI, antidepressants – see med list
Applying nursing process- panic disorder
appearance/mood/behavior: speech increase; rate, pitch, volume, difficultly staying still – tap
finger, play w/ hair. *could also be normal
mood/affect: appears worried, anxious, worried, tense, depressed, serious, sad. Tearful when
discussing attacks.
thought process/sensory/intellect/judgement/insight: sense of losing control, overwhelmed,
disorganized, suicidal thoughts*, confused/disoriented, judgement/insight=suspended.
self-concept/roles&relationships: patient evaluates self negatively, consumed with worry.
Altercations on personal life (social, occupational, family). Avoids people/places in fear of panic
arising. May even quit job and never leave house over fear of having panic attack.
Nursing interventions:
SAFETY. Provide safe environment, maintain patient privacy, stay with patient, help focus on
deep breathing, talk to client in calm voice, teach patient relaxation techniques, use cognitive
restructuring techniques, explore how to decrease stressors and anxiety provoking situations
Client/family education:
review breathing and relaxation techniques, positive coping strategies, regular exercise, stay on
medications and do follow up MD visits, time management techniques (to-do list, realistic daily
goals), support groups and community contact.
Self-awareness:
avoid getting emotionally involved, client needs are #1 priority. SAFETY.
Considerations:
do not try to fix clients problems, don’t allow own life stressors/anxiety to interfere with client
care, discuss uncomfortable feelings w/ team and ask for help, practice stress relieving
techniques for own life.
Anxiety / Panic ch14
Anxiety: vague feeling of dread or apprehension. A response to external or internal stimuli that
can have behavioral, emotional, cognitive, and physical symptoms. Distinguished from fear.
Unavoidable. Has positive and negative side effects.
positive: produce growth and adaptive change
negative: produce poor self-esteem, fear, inhibition, anxiety disorders
Anxiety disorders: comprise a group of conditions that share a key feature of excessive anxiety
with ensuing behavioral, emotional, cognitive, and physiological responses.
4 Stages of anxiety:
1-Mild: helps people learn, grow, change
2- Moderate: increases focus on alarm and learning is still possible
3- severe: greatly decreases cognitive function, increases prep for physical
response, increases space needs)
4- Panic: flight/fight/freeze response (alarm,resistance,exhaustion), no
learning possible, person is attempting to free self from discomfort of this high stage)
Panic disorder: composed of discrete episodes of panic attacks
Panic attacks: 15-30 minutes of rapid, intense, escalating anxiety in which the person
experiences great emotional fear as well as physiological discomfort. Displays 4+ symptoms:
palpitations, sweating, tremors, SOB, sense of suffocation, chest pain, nausea, abdominal
distress, dizzy, chills, hot flashes, paresthesia.
Defense mechanisms: intrapsychic distortions that a person uses to feel more in control. Anxiety
disorder= defense mechanisms overused.
Neurochemical theories:
*GABA, Serotonin, norepinephrine*
GABA- inhibitory neurotransmitter, amino acid. Functions as the body’s natural antianxiety
agent by reducing cells excitability – thus decreasing rate of neuronal firing. Believed to be
dysfunctional in anxiety disorders due to regulation problem between GABA and
norepinephrine.
Serotonin- subtypes play a role in anxiety, aggression, and mood. Serotonin play direct role in
OCD, panic disorder, GAD.
*Excess of Norepinephrine is suspected in panic disorder, GAD, PTSD.
Anxious behavior care plan:
interventions: safety, calm/quiet area/voice, relaxation techniques, supportive sources, identify
anxiety – no avoiding/self awareness.
, Drugs used to treat anxiety disorders (p.230)
benzodiazepines, SSRI, antidepressants – see med list
Applying nursing process- panic disorder
appearance/mood/behavior: speech increase; rate, pitch, volume, difficultly staying still – tap
finger, play w/ hair. *could also be normal
mood/affect: appears worried, anxious, worried, tense, depressed, serious, sad. Tearful when
discussing attacks.
thought process/sensory/intellect/judgement/insight: sense of losing control, overwhelmed,
disorganized, suicidal thoughts*, confused/disoriented, judgement/insight=suspended.
self-concept/roles&relationships: patient evaluates self negatively, consumed with worry.
Altercations on personal life (social, occupational, family). Avoids people/places in fear of panic
arising. May even quit job and never leave house over fear of having panic attack.
Nursing interventions:
SAFETY. Provide safe environment, maintain patient privacy, stay with patient, help focus on
deep breathing, talk to client in calm voice, teach patient relaxation techniques, use cognitive
restructuring techniques, explore how to decrease stressors and anxiety provoking situations
Client/family education:
review breathing and relaxation techniques, positive coping strategies, regular exercise, stay on
medications and do follow up MD visits, time management techniques (to-do list, realistic daily
goals), support groups and community contact.
Self-awareness:
avoid getting emotionally involved, client needs are #1 priority. SAFETY.
Considerations:
do not try to fix clients problems, don’t allow own life stressors/anxiety to interfere with client
care, discuss uncomfortable feelings w/ team and ask for help, practice stress relieving
techniques for own life.
