Physiologic responses

Flight or fight responses Sympathetic fibers increase the vital signs Adrenal glands release adrenalin which causes the body to:

Take in more oxygen

Dilate the pupils (brings more light into eyes; better vision) Increase the arterial blood pressure and heart rate Constrict peripheral vessels (makes skin cool and pale) Increase glycogenolysis to free glucose for fuel (glycogen is

being broken down in the liver) Shunt blood from GI and reproductive organs

Psychological response

Difficulty with logical thought Increased agitation with motor activity Increased vital signs Client will try to change the feelings of discomfort by:
Changing behavior by adaptation Changing behavior with defense mechanisms

Panic disorder Phobic disorder Agoraphobia Obsessive-compulsive PTSD Generalized anxiety Anxiety related to medical conditions Substance-induced anxiety disorder

Predisposing factors

Onset: Acute or insidious (builds up) Precipitating event Chronic stressors Unusual behavior Fears disproportionate to reality

Mild:

Psychological: Wide perceptional field, sharpened senses, increased motivation, effective problem solving, increased learning ability, irritability. Physiologic: Restlessness, fidgeting, butterflies, difficulty sleeping, hypersensitivity to noise.

Moderate:

Psychological: perceptual field narrowed to immediate task, selectively attentive, cannot connect thoughts or events independently, increased use of automatisms Physiologic: Muscle tension, diaphoresis, pounding pulse, HA, dry mouth, high voice pitch, faster rate of speech, GI upset, frequent urination

Severe:

Psychological: Perceptual field narrowed to one detail or scattered details; cannot complete tasks; cannot solve problems or learn effectively; behavior geared toward anxiety relief and is usually ineffective; doesnt respond to redirection; feels awe, dread, or horror; cries; ritualistic behavior. Physiologic: Severe HA, N/V, diarrhea, rigid stance, vertigo, pale, tachycardia, chest pain.

Panic:

Psychological: Perceptual field reduced to focus on self; cannot process any environmental stimuli; distorted perceptions; loss of rational thought; doesnt recognize potential danger; cant communicate verbally; possible delusions or hallucinations; may be suicidal. Physiologic: May bolt and run OR totally immobile and mute; dilated pupils, increased blood pressure and pulse; flight, fright, or freeze.

Alarm reaction

Physiologic response Body prepares to defend itself Body will defend by flight or fight If the stress is gone; body relaxes Negative response to anxiety and stress Body stores are depleted

Resistance stage

Exhaustion stage

An episode lasting 15-30 minutes in which a client experiences rapid, intense, escalating anxiety; great emotional discomfort; and physiologic discomfort. Defined as recurrent, unexpected panic attacks followed by a month of persistent concern or worry about having another attack. 75% with panic disorder have spontaneous attacks with no triggers Others have attacks stimulated by phobias or chemical changes within the body.

Treatment Psychotherapy Positive reframing Assertiveness training Psychopharmacology SSRIs Anxiolytics Antidepressants MAOIs

An illogical, intense, persistent fear of a specific object or social situation that causes extreme distress and interferes with having a normal life. Treatment for phobias:
Psychopharmacology Anxiolytics Benzodiazepines SSRIs Beta Blockers Psychotherapy Behavioral therapy Systemic desensitization

Flooding Getting rid of fear all at one time

Obsessions: Recurrent thoughts, ideas, visualizations, or inappropriate impulses that disturb a persons life; has no control over them. Compulsions: Behaviors or rituals continuously carried out to get rid of the obsessive thoughts and reduce anxiety. Higher incidence with groups in higher economic status and with more education

Nursing interventions:
Remember, a lot of the time people feel guilty about their thoughts and behaviors. Do not try to stop the act unless the act is harmful (dangerous) Talk to them! Use I statements If they are too down on themselveslimit your time with them. For instance, I hate myself. No one cares about me. Im fat and ugly. The nurse would then say, I am going to come back in 30 minutes. In that time frame, I want you to think of your good qualities.

Nursing interventions:

Do not argue with OCD person. Inject reality. If a teenager thinks she is pregnant despite a negative pregnancy test, tell her the TEST IS NEGATIVE. Take them back into reality. If they repetitively do an act over and over again; help them set a goal. For instance, Lets try to only wash your hands once every ten minutes.

Treatment

Psychotropic drugs SSRIs (Fluvoxamine, Paroxetine, Setraline, Fluoxetine) Antidepressants (TCA Clomipramine) Anxiolytics (Buspirone BuSpar) Psyhotherapy

SSRIs cannot be given concurrently with MAO inhibitors. MAOIs should be discontinued 3 to 5 weeks before starting therapy with SSRIs to avoid HYPERTENSIVE CRISIS.

Three clusters if symptoms are present

Reliving the event Memories, dreams, or flashbacks Avoiding reminders of the event Staying away from any stimuli that could be associated with the trauma. Being on guard (hyper-arousal) Less responsive to stimuli Insomnia, irritability, or angry outbursts

At risk people include:

Combat veterans Victims of violence Abused victims Children in traffic accident (and the parents) Only 46% of parents sought help for their children. KIDS NEED HELP.

Symptoms of PTSD occur 3 months or more after the trauma.

Some more signs of PTSD:

Have issues with authority figures Their first emotions are anger, rage, and guilt Their guilt comes out as anger (violent behavior) Isolate themselves Cry Dont want to talk about it Drug and alcohol abuse Nightmares Manifests in physiological symptoms (HA, GI distress) Irritable Insomnia

Nursing interventions:

Have specific staff members assigned to client to facilitate building trust Consistency is the key Be non-judgmental; encourage client to talk Help them acknowledge where grief is coming from Involve family Give positive feedback

Goals for PTSD:

Short term: Safety, decrease insomnia, identify source, grieve! Long term: Accept the fact that the experience happened and live healthy.

Luis has become increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling, has high-pitched random speech, and seems preoccupied with his thoughts. He is pounding his fist into his other hand as he agitatedly paces. Diagnose his level of anxiety.

SEVERE Anxiety

Luis has become increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling, has high-pitched random speech, and seems preoccupied with his thoughts. He is pounding his fist into his other hand as he agitatedly paces. Diagnose his level of anxiety.

SEVERE Anxiety