MH exam 3: Chapters 11, 13-16, 21, 25
❖ Anxiety
➢ Most common form of psychiatric disorder
➢ Fear is not the same as an anxiety
➢ Anxiety - Normal, helps you survive
■ Needed for survival
■ Motivates us to change
■ Leads to constructive behaviors
➢ Mild: everyday anxiety
■ Mild fidgeting
➢ Moderate: impairs function
■ Tremors
■ Tension relieving behaviors (pacing, banging, etc.)
➢ Severe: Severe impairment
■ May be dangerous
■ Often have chest pain and SOB
■ May go to ED
■ Somatic s/s (headache, nausea, dizziness, insomnia)
■ Might feel like a heart attack
➢ Panic - incapacitates, risk for injury to self or others
■ Perceptual field
● Lost/unattended
● Unable to attend to environment
■ Problem solving ability
● Completely unable to process
● Disorganized, irrational thinking
■ Physical symptoms
● Experience tremors
● Immobility, severe hyperactivity, or flight
● Unintelligible, overwhelmed
● Psychotic, unable to process reality; Impulsivity
● Running, shouting, screaming pacing
● Safety is important - stay with patient
➢ All types of anxiety have an effect on perceptions, problem solving abilities,
physical s/s
■ If you can identify a general level, you can select an appropriate
intervention based on the degree of anxiety
■ Fear is not the same as anxiety
, ➢ Rule out medical etiologies: Anxiety may mimic an MI or PE, be caused by
hyperthyroidism, medication side-effects, substance intoxication, asthma, CHF,
delirium, metabolic imbalance, may present with a somatic complaint/concern
(“my stomach hurts”)
■ Symptoms of anxiety are a direct physiological result of a medical
condition
● Resp: COPD, hypoxia, severe allergic reaction, PE
● CV: angina, CHF, BP, mitral valve prolapse, arrhythmia
● Endo: hypoglycemia, hyperthyroid
● Neuro: delirium, seizures, Parkinson’s
● Metabolic: electrolytes, hyper, hypo
➢ Medications include: Benzodiazepines, SSRIs, SNRIs, beta blockers,
antihistamines, anticonvulsants
➢ RN Interventions:
■ help patient calm him/herself
■ remain with, stay with, walk with, talk with, be with, do with, KEEP
SAFE
■ validate feelings
■ collaborate care with patient
■ role-model calm appropriate behavior
■ meds PRN
■ short & simple directions/instructions
■ decrease stimuli
■ NOT the time to teach when patient is highly anxious or emotional
➢ Generalized anxiety disorder (GAD)
■ Uncontrollable, excessive worry for +6 months
■ Decreased concentration, decision making
■ Worried about everything, cannot make decisions
■ Stay with them and role model desired behavior during an episode
■ Walk with, talk with, stay with, etc.
➢ Defense mechanisms
■ Automatic coping styles
■ Protect people from anxiety
■ Maintain self image by blocking
● Felling
● Conflicts
● Memories
■ Can be healthy or unhealthy (adaptive, maladaptive) generally based on
frequency, intensity, duration
❖ Anxiety
➢ Most common form of psychiatric disorder
➢ Fear is not the same as an anxiety
➢ Anxiety - Normal, helps you survive
■ Needed for survival
■ Motivates us to change
■ Leads to constructive behaviors
➢ Mild: everyday anxiety
■ Mild fidgeting
➢ Moderate: impairs function
■ Tremors
■ Tension relieving behaviors (pacing, banging, etc.)
➢ Severe: Severe impairment
■ May be dangerous
■ Often have chest pain and SOB
■ May go to ED
■ Somatic s/s (headache, nausea, dizziness, insomnia)
■ Might feel like a heart attack
➢ Panic - incapacitates, risk for injury to self or others
■ Perceptual field
● Lost/unattended
● Unable to attend to environment
■ Problem solving ability
● Completely unable to process
● Disorganized, irrational thinking
■ Physical symptoms
● Experience tremors
● Immobility, severe hyperactivity, or flight
● Unintelligible, overwhelmed
● Psychotic, unable to process reality; Impulsivity
● Running, shouting, screaming pacing
● Safety is important - stay with patient
➢ All types of anxiety have an effect on perceptions, problem solving abilities,
physical s/s
■ If you can identify a general level, you can select an appropriate
intervention based on the degree of anxiety
■ Fear is not the same as anxiety
, ➢ Rule out medical etiologies: Anxiety may mimic an MI or PE, be caused by
hyperthyroidism, medication side-effects, substance intoxication, asthma, CHF,
delirium, metabolic imbalance, may present with a somatic complaint/concern
(“my stomach hurts”)
■ Symptoms of anxiety are a direct physiological result of a medical
condition
● Resp: COPD, hypoxia, severe allergic reaction, PE
● CV: angina, CHF, BP, mitral valve prolapse, arrhythmia
● Endo: hypoglycemia, hyperthyroid
● Neuro: delirium, seizures, Parkinson’s
● Metabolic: electrolytes, hyper, hypo
➢ Medications include: Benzodiazepines, SSRIs, SNRIs, beta blockers,
antihistamines, anticonvulsants
➢ RN Interventions:
■ help patient calm him/herself
■ remain with, stay with, walk with, talk with, be with, do with, KEEP
SAFE
■ validate feelings
■ collaborate care with patient
■ role-model calm appropriate behavior
■ meds PRN
■ short & simple directions/instructions
■ decrease stimuli
■ NOT the time to teach when patient is highly anxious or emotional
➢ Generalized anxiety disorder (GAD)
■ Uncontrollable, excessive worry for +6 months
■ Decreased concentration, decision making
■ Worried about everything, cannot make decisions
■ Stay with them and role model desired behavior during an episode
■ Walk with, talk with, stay with, etc.
➢ Defense mechanisms
■ Automatic coping styles
■ Protect people from anxiety
■ Maintain self image by blocking
● Felling
● Conflicts
● Memories
■ Can be healthy or unhealthy (adaptive, maladaptive) generally based on
frequency, intensity, duration
