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Hmmm... I see my trafic blog is quite high. But without any comments left. So.. i will change my blog from anxiety topic to health topic.. It may seems like tips, what is... And how to... And i hope it will be more usefull for you.. :) Thank you...

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The Nursing Process for Client with Anxiety

The Generalist’s Role
Understanding the basis of anxiety disorders and the interventions uses to treat them enables the generalist psychiatric-mental health nurse to identify the mental health needs of the anxious client and intervene to reduce the frequency and severity of the symptoms of anxiety. Major nursing interventions include enhancing present coping skills, assessing maladaptive responses, and minimizing the deleterious effects of anxiety. Case management and psychoeducation can be used to:
·    Enhance coping skills and self care
·    Identify physical and cognitive symptoms that suggest an impending panic attack and administer medications that minimize the severity and frequency of attacks
·    Monitor the client’s responses to medication and other treatment modalities
·    Coordinate and mobilize various resources
·    Teach progressive relaxation, cognitive techniques and other anxiety-reducing measures
·    Provide crisis intervention
·    Participate in comprehensive care planning (American nurses Association [ANA], 1994)

Role of The Advanced-Practice Nurse

The advanced psychiatric-mental health nurse incorporates the role of the generalist and autonomously applies advanced clinical skills, knowledge, and experience to complex client needs (ANA, 1994). Psychotherapy, prescription of medication, case management, and researching the effectiveness of treatment are major measures used by the advanced nurse. Psychotherapy enables the nurse to asses the impact of underlying psychodynamic issues, such as early childhood traumas and abuse, on current symptoms and behaviors.

Understanding pharmacokinetics and pharmacodynamics and the neurobiological aspects of anxiety disorders permits the nurse to prescribe psychotropic medication that reduces the deleterious effects of anxiety disorders and to monitor the clients responses to the medication. Case management and research enable the advanced nurse to collaborate with the client to develop a comprehensive plan of care. A comprehensive plan of care facilitates identification of positive and negative outcomes and continuous monitoring of the client’s complex needs.

Regardless of the nurse’s level of practice, clients can expect a comprehensive plan of care that promotes health and minimizes and deleterious effects of anxiety disorders.

The Nursing Process

Anxiety disorder represents a continuum of symptoms that affect psychosocial, biological, and vocational wellbeing. Its comorbidity with other disorders such as depression underscores te need for health care professionals to understand the complexity of the human response to internal and external demands and develop effective interventions. The nursing process has critical roles in the assessment, intervention, and evaluation of client’s responses to stressful and traumatic situations. Establishing rapport, facilitating adaptive coping behaviors, individualizing teaching, encouraging active client participation, and administering psychotropics are major treatment strategies for various anxiety disorders.
-    Assessment
During the initial assessment, the nurse reassures client that his/her symptoms are real and distressful, even though he/she feels like he/she is losing touch with reality. The sense of losing touch with reality is associated with depersonalization, paresthesias, lightheadedness, and a negative physical examination. We can explore the clients with interview and assessment about client’s history.
-    Nursing diagnoses
We can conclude the diagnoses after we assess the client and then analyze the data from client and match it with criteria of anxiety disorder from DSM-IV.

Anxiety Disorder / Condition  with  DSM-IV Criteria      
Acute Stress Disorder   

a.    Person exposed to a traumatic event that posed threat to self or others physical integrity; impact on person involves profound fear, powerlessness, or terror
b.    During exposure or after exposure to trauma event, three or more of the following dissociative manifestations are present
-    Numbness, void of emotional responsiveness
-    “being daze”
-    Derealization
-    Depersonalization
-    Dissociative amnesia
c.    The traumatic event is persistently re-experienced in one of the following: recurrent vivid memories, nightmare, flashbacks, and distress (neurobiological arousal) arising from memory of the event
d.    Marked avoidance of stimuli behaviors
e.    Profound anxiety or autonomic arousal
f.    Interference with optimal level of function
g.    Duration of symptoms persists for at last 2 days and no longer than a month and occurs within a month of traumatic exposure
h.    Not due to a substance or medical condition
-    Differs from posttraumatic stress disorder because manifestations of this disorder must evolve within 1 motnh and resolve within this 1-month period.      
Anxiety Due to a General Medical Condition    

a.    Pronounced anxiety, specific anxiety disorder (e.g panic attacks) is chief complaint
b.    Physiological symptoms directly parallel a general medical condition (e.g., hypoglycemia, hyperthyroidism)
c.    Symptoms are not associated with another mental disorder
d.    Symptoms are not part of the course of delirium
e.    Symptoms interfere with optimal level of functioning      
Substance-induced Anxiety Disorder    

a.    Pronounced anxiety, specific anxiety disorder (e.g., panic attacks) is chief complaint
b.    Anxiety symptoms evolved during or within the past month of substance intoxication or withdrawal;  medication use is directly associated with presenting symptoms
c.    Symptoms are not directly caused by a specific anxiety disorder
d.    Manifestations are not part of the course of delirium
e.    Symptoms interfere with optimal level of function   

-    Planning
Nursing Care Plan identifies the desired outcomes for client’s nursing diagnoses and delineates the nursing actions needed to achieve these outcomes, along with the rationales for these actions.

Outcome Identification                    Nursing Actions    Rationales    Evaluation      
ð    Nursing Diagnosis I: ………..      
By [date] [client’s name] will….                                                     Goal Met: [Client’s name]is able to…      
ð    Nursing Diagnosis II :      
By [date] [client’s name] will …                                                     Goal Met: [Client’s name]  is able to …   

-    Implementation
The initial intervention is the establishment of a therapeutic relationship with the client and spouse. Coping with anxiety is a two part endeavor that consists of the client’s assessing his or her perception of threat and using specific coping behaviors to reduce or eliminate distorted cognitions (Andrew & Crino, 1991)
Anxiety-Reducing Techniques

Cognitive-Behavioral Techniques      
Cognitive Therapy
Therapy is based on principle of internal dialogue or self-talk and it’s impact on thoughts and feelings or emotions and behaviors.
Major goals are to
-    Assess the clients belief systems and cognitive distortions
-    Challenge and alter the clients distorted/negative thoughts and self-defeating behaviors
-    Enhance the clients copin skills
Homework assignments are used to test cognitions (e.g., stimulus à thoughts à feelings). Various behavioral techniques can be used.
Behavioral role rehearsal
The client role-plays anticipated dtressful situations. The therapist assess the client’s reactions and provides feedback to the client as a teaching modality. The client can use modeling to shape behavior      
Systemic Desensitzation      
The client is taught to maintain relaxation while imaging various stages of ranked anxiety-evoking situations. For example, for an agoraphobic client, situations that evoke an anxiety reaction are ranked from least to most
1.    Going outside
2.    Being alone
3.    Driving
4.    Going to a shoping mall
The client neutralizes anxiety by using deep-muscle relaxation techniques and visual imagery, while the nurse assesses the client’s subjective responses.      
Progressive Relaxation      
Visual imagery is the basis of the this technique. Directions to the client are as follows:
-    Choose a dark, quiet area
-    Close your eyes
-    Focus on all muscle group of muscles and maintain tension for 4 to 8 seconds
-    Tell yourself to relax and immediately release tension
-    Progress until you have tensed and relaxed all muscles.
Progressive relaxation can also be done using deep-breathing exercises: the client lies on his or her back and inhales through the nose and exhales through the mouth.   

-    Evaluation
The evaluation process begins with the initial assessment and continues throughout treatment. Criteria for effectiveness are based on outcome identification, the clients feedback, and the observations of the nurse and other mental health professionals regarding the client’s response to interventions.

SUMMARY
Anxiety is an integral aspect of the human experience. It is associated with arousal, the body’s mobilization of its neurobiological resources. Clients tend to seek treatment when their anxiety becomes overwhelming and interferes with their psychosocial and biological functioning. Symptoms of anxiety range from mild to severe forms of distress,
Psychiatric nurses are challenged to assess client’s adaptive and maladaptive responses and to provide them with adequate and effective treatment. The nursing process is an effective mechanism that identifies disabling symptoms and effective interventions that promote adaptive responses. In addition, education of the client and his or her significant others regarding anxiety and their active participation intreatment are critical to successful treatment outcomes.

References:
1.    Otong, Deborah Antai. (1994). The Client Experiencing Anxiety. 191 – 208
2.    http://www.anxietycures.co.uk/?cat=10
3.    American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed). Washington, DC

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Introduction of Anxiety

Definition of Anxiety

 
The word anxiety stems from the Latin word anxietas, which means “to vex or trouble.” Anxiety represents uneasiness and is an integral aspect of human nature, because it plays a major role in adaptation and homeostasis. It often extends beyond adaptive importance for the individual. Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear or worry.

Anxiety is a generalized mood condition that occurs without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an observed threat. Additionally, fear is related to the specific behaviors of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable.
 

Another view is that anxiety is "a future-oriented mood state in which one is ready or prepared to attempt to cope with upcoming negative events" suggesting that it is a distinction between future vs. present dangers that divides anxiety and fear.
 

Anxiety is considered to be a normal reaction to stress. It may help a person to deal with a difficult situation, for example at work or at school, by prompting one to cope with it. When anxiety becomes excessive, it may fall under the classification of anxiety disorder. 
 

The Effect of Anxiety
 

In description’s part, we found that anxiety has impact to a psychological and physiological state. Anxiety generates an array of autonomic, behavioral, motor, and cognitive responses. Autonomic or neurobiological responses include increased respiration, tachycardia, paresthesias, diaphoresis and dizziness. Behavioral responses include rituals, avoidance, help seeking, and increased dependency. Motor reaction often presents as muscle tension, tremors, stuttering and restlessness. Cognitive or Psychological, symptoms include a sense of doom or powerlessness, vigilance, rumination, helplessness, dissociation, distortions, and confusion.

We can see other effect of anxiety in other literature like Wikipedia. Physical effects of anxiety may include heart palpitations, fatigue, nausea, chest pain, shortness of breath, stomach aches, or headaches. Physically, the body prepares the organism to deal with a threat. Blood pressure and heart rate are increased, sweating is increased, blood-flow to the major muscle groups is increased, and immune and digestive system functions are inhibited (the fight or flight response). External signs of anxiety may include pale skin, sweating, trembling, and pupillary dilation.
Anxiety does not only consist of physical effects, there are many emotional ones as well. They include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) or danger, and, feeling like your mind's gone blank "as well as " nightmares/bad dreams, obsessions about sensations, dejavu, a trapped in your mind feeling, and feeling like everything is scary."
 

Anxiety, Fear, and Panic Attacks

Sometimes people think that anxiety and fear has a same sign and symptoms, but it’s different. Fear is a diffuse, anticipatory reaction to danger when there is no real danger. The continuum of anxiety ranges from a mild form that produces little effect to a severe form that disrupts homeostasis by activating maladaptive responses, such as avoidance or phobias (Rosenbaum & Gelenberg, 1991) Anxiety may be thought of as protective, innate form of communication that the body uses to mobilize its coping resources to maintain homeostasis, and failure to respond adaptively further compromises homeostasis (Basch, 1988)
 

Someone suffering from anxiety might also experience it as a sense of dread or panic. Although panic attacks are not experienced by every anxiety sufferer, they are a common symptom. Panic attacks usually come without warning, and although the fear is generally irrational, the perception of danger is very real. A person experiencing a panic attack will often feel as if he or she is about to die or pass out. Panic attacks may be confused with heart attacks therefore only a doctor can be the only right person to differentiate between panic attacks or the heart attack.
 

Refences:
White, F., Hayes, B., & Livesey, D. (2005). Developmental Psychology: From Infancy to Adulthood. NSW: Pearson Education Australia.

Deborah Antai. (1994). The Client Experiencing Anxiety. 191 – 208
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/9951.jpg
http://www.medicinenet.com/anxiety/page2.htm
http://en.wikipedia.org/wiki/Anxiety
http://www.anxietycures.co.uk/?cat=10

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