ANXIETY Nursing Diagnoses:

⊗ Vague sense of impending doom ⊗ Ineffective individual coping

⊗ Subjective response to stress ⊗ Anxiety

⊗ Is a state of apprehension, uneasiness, uncertainty or tension experienced by an individual

in response to an unknown object or situation. Nursing Management:

⊗ Calm

Signs and symptoms: ⊗ Administer medications

⊗ Listen

Mild ⊗ Minimize environmental stimuli

⊗ Physical - ↑PR, RR, BP, pupillary dilatation, sweating

⊗ Cognitive - Attentive and alert ANXIETY DISORDERS

⊗ Emotional - Minimal use of defenses

Panic Disorder

Moderate ⊗ An individual may suddenly experience frightening and uncomfortable symptoms

⊗ Physical - Nausea, Anorexia, Vomiting, Diarrhea, Constipation, Restlessness ⊗ May include terror, sense of unreality or fear of loosing control

⊗ Cognitive - narrowed perceptual field & selective inattention ⊗ Attack: 1 minute and 1 hour

⊗ Emotional - use of any defense mechanism available

Phobic Disorder

SEVERE
⊗ Phobia is an irrational fear of an object, place, activity or situation.

⊗ Physical - s/sx becomes the flow of attention ⊗ Avoidance will allow the individual to be free from anxiety.

⊗ Cognitive – perceptual field is greatly narrowed, focus of attention is trivial events Examples:

⊗ Emotional – defense mechanism operate

 Agoraphobia - fear of open places and of being alone in public places.

 Social phobia - irrational fear of criticism, humiliation or embarrassment.

PANIC
 Acrophobia - fear of heights
⊗ Physical – s/sx of exhaustion ignored
 Algophobia - fear of pain
⊗ Cognitive – personality disorganized

⊗ Emotional – defense mechanism fail

 Claustrophobia - fear of enclosed place

 Thanatophobia - fear of crowds

 Pathophobia - fear of disease

Nursing Interventions
 Monophobia - fear of being alone
⊗ Calm and nonjudgmental approach to convey acceptance.

⊗ Use short and simple sentences or words.

Generalized Anxiety Disorder
(GAD) ⊗ Help the client develop an increase tolerance to anxiety.

⊗ Unrealistic, excessive anxiety and is unable to control worry. ⊗ Help the client to:

⊗ Clients may experience: fatigue, irritability, restlessness, muscle tension, sleep disturbance
 develop a problem-solving and coping skills of the client.

 develop the ability to remain calm in anxiety-producing situations.

Obsessive Compulsive Disorder
⊗ Approach: kind-firmness
⊗ Is characterized by recurrent obsessions and compulsions that interfere with normal life.
⊗ Systematic desensitization (phobic disorders)

⊗ Clients with ritualistic behavior (obsessive-compulsive disorder) should not be prohibited or

Obsession reprimanded.

⊗ Refers to persistent, painful intrusive thought, emotion or urge that one is unable to ⊗ Biofeedback, change of the scenery, therapeutic touch, hypnosis, massage or relaxation
suppress or ignore. exercises.

⊗ Administer medications, as ordered.

Compulsion

⊗ Refers to repetitious uncontrollable act and sometimes a purposeful act to prevent a certain
mistake in an event or situation.
ANXIETY RELATED DISORDERS

Somatization Disorder
Post-Traumatic Stress Disorder (PTSD)
⊗ Free floating anxiety disorder
⊗ Is the delayed reaction of the person who has been involved or exposed to a traumatic
⊗ Clients:
events.

⊗ Symptoms of this disorder are:  express emotional turmoil or conflict through physical symptoms.

 intense psychological distress  usually seek for repeated medical attention.

 feeling of detachment or estrangement from others  may exhibit antisocial behavior and may attempt suicide.
 insomnia
⊗ Associated with anxiety and depression
 decreased concentration

 avoidance of thoughts and feelings

 recurrent distressing dreams

 inability to recall an important aspect of the trauma

Conversion Disorder

⊗ A condition in which an anxiety-provoking impulse is converted unconsciously into Types of Personality Disorders:
functional symptoms.
Eccentric Personality Disorder (Type A)
⊗ Conscious counterpart of malingering
⊗ Paranoid (Suspicious and distrustful)
⊗ Examples: Paralysis, blindness, loss of touch or pain sensation, dyspnea, seizures or
convulsions  Persons who display pervasive and long stand suspiciousness

 More common in men

Hypochondriasis ⊗ Schizoid (Socially distant and detached)

⊗ An individual presents an unrealistic or exaggerated physical complaints.  Pattern of detachment from social relationship

⊗ The person becomes, preoccupied with the fear of developing or having already a disease  Chooses solitary activities
or illness in spite of medical reassurance.
 Topics are inanimate objects and ideas

⊗ Schizotypal (Odd and eccentric)

Body Dysmorphic Disorder
 “mild schizophrenia”
⊗ Preoccupation with an imagined defect in his or her appearance.
 Acute discomfort in close relationships
⊗ Slight physical abnormality = excessive concern / anxiety
 Cognitive or perceptual distortion

Dissociative Amnesia

⊗ Inability to recall extensive amount of important information

Dramatic-Erratic Personality Disorder (Type B)
⊗ Caused by trauma
⊗ Antisocial (aggressive and manipulative)
⊗ Characterized by:
 Pattern of disregard for the violation of the rights of others
 Disorientation
 Low self-esteem
 Purposeless wandering

 Impairment in ability to perform ADL

⊗ Borderline (destructive and unstable)
⊗ Rapid recovery generally occur
 Characterized by patterns of instability in relationships, self image and mood

 Self-mutilating behavior

 Affective instability
PERSONALITY DISORDERS
 More common in women
⊗ Are pervasive and inflexible patterns of functioning that is stable overtime, and leads to
distress or impairment. ⊗ Narcissistic (boastful / superiority complex)
  Grandiosity and need for constant admiration EATING DISORDERS

 Exploitation of others for fulfillment of own desire ⊗ More common among females.

Anxious or Fearful Personality Disorder (Type C) Causes:

⊗ Avoidant (inferiority complex) ⊗ Psychological factors

 Social inhibition  Parental factors (domineering parents)

 Feelings of inadequacy and sensitivity  Individual factors (conflict about growing up)

 Low self-esteem  Sociocultural factors

 Social withdrawal in spite of a desire for affection and acceptance

⊗ Dependent (submissive)

 Submissive clinging behavior related to excessive need to be cared for by others Anorexia Nervosa

 Lack of self-confidence ⊗ Main sign: Morbid fear of gaining weight

 Perceive self as helpless and stupid ⊗ Other signs:

⊗ Obsessive-Compulsive (perfectionist)  Sensitivity to cold temperatures

 Preoccupied with orderliness, perfectionism, inflexibility, need to be in control  Amenorrhea

 Formal and serious interpersonal relationship  Deliberate self-starvation with weight loss

 Judgmental of self and others

⊗ Passive-Aggressive
 Denial of hunger
 Intentional inefficiency
 Obvious thinness but feels fat
 Passive resistance to demands for adequate performance in both occupational and
social functioning  Lanugo all over the body

 Loss of scalp hair

Nursing Diagnosis:

• Ineffective individual coping

• Self-esteem disturbance

DISORDERS COMMONLY DIAGNOSED TO ADULTS

 ⊗ Depression / distorted body image

Bulimia Nervosa
Nursing Diagnosis:
⊗ Extreme measures to lose weight
⊗ Body image disturbance
 uses diet pills, diuretics or laxatives
⊗ Ineffective individual coping
 purges after eating

 extreme exercise
Nursing Interventions:
⊗ Signs of purging
⊗ Establish a trusting relationship
 swelling of the cheeks or jaw area
⊗ Monitor vital signs
 cuts and calluses on the back of the hands and knuckles
⊗ Reinforce:
 teeth that look clear
 dietician’s prescription to accomplish realistic weight gain
⊗ Peculiar signs
 treatment plan that establishes privileges and restrictions based on compliance
 depression
⊗ Decrease emphasis on foods, eating, weight loss or gain
 loss of interests in activities
⊗ Weigh client daily at the same time

⊗ Remain with the client after meal and for 1st four hours

⊗ Set limit on time allotted for eating

Findings: (for both)
⊗ Encourage client to express feelings
⊗ Weight loss of 15% or more of original body weight
⊗ Promote feeling of control by
⊗ Amenorrhea
 participation in treatment
⊗ Social withdrawal and poor family and individual coping
 independent decision making

⊗ History of high activity and achievement in academics, athletics

⊗ Electrolyte imbalance