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Anxiety and Somatoform Disorders
Terms in this set (17)
June is a 40 year old woman who comes to the emergency department (ED). She appears anxious, is crying and holds herself tightly as she sits in the chair of the waiting room, rocking slightly. She tell the triage nurse that can't get her breath and she doesn't know what's wrong. "It just started this morning when I woke up. I've never felt like this. I feel like I might die. My heart is pounding out of my chest, and I'm so scared."
What is happening with this patient?
They are experiencing anxiety
What is anxiety?
an emotional response to
of danger, the source of which is largely unknown or unrecognized
What is stress?
Differences between normal anxiety and abnormal anxiety?
Normal - dissipates when danger is gone
Abnormal - disproportionate to the threat and continues beyond threat, impairment of function and existence of psychosomatic effects
What is mild anxiety?
Something is different and warrants attention
What is moderate anxiety?
Physical symptoms are occurring. Goes to ER. Something is definitely wrong; nervous or agitated
What is severe anxiety?
Trouble thinking and reasoning
What is panic anxiety?
Fight, flight or freeze
For someone who is experincing anxiety, what else should be assessed?
2. EKG changes
3. cardiac enzymes
4. Thyroid panel
6. caffeine intake
7. Sleep patterns
8. Current stressors?
9. Illegal drugs?? - meth, cocaine, adderall, CNS stimulants
R/O other illness
Health promotion for anxiety
Goal of treatment?
Goal is effective management, NOT total elimination of anxiety
Keep a positive attitude, talk about their feelings, accept that you cannot control everything, learn to relax, get 6-8 hours of sleep, limit caffeine, exercise, eat a well-balanced diet, set realistic goals and stress management
June returns to the clinic the next week feeling like she is having a heart attack and that she is going to die....
She reports she was at the grocery store when this feeling occurred. This feeling lasted several minutes.
What is possibly happening to June now?
She is in a panic attack
S/S of panic attacks
Sweating, trembling, feeling of chest discomfort and nausea
Feeling of impending doom (going to die), intense physical discomfort
What is agoraphobia?
a fear of being in places or situations in which escape may be difficult or embarrassing or in which help might not be available if a panic attack occurs
How would you care for a pt at the immediate time while they were having a panic attack?
1. Move pt to a quiet area to minimize stimulus
2. Use short, simple, clear instructions
3. Tell pt what to do, avoid giving choices
4. Encourage relaxation exercises
5. give prn anxiety meds if ordered
What are some non-pharmacological tx for anxiety disorders?
Combination of: Cognitive-behavioral therapy
1. Positive re-framing (think positive)
3. Assertive training (needs to take control to ask for help)
What are some medications that can be prescribed for anxiety?
Antiolytics and antidepressants
Alprazolam, clonazepam, lorazepam, diazepam, paroexetine and sertraline
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