Buy a Nursing essay from nursingessays.us

Left your Nursing Assignment to the last minute? Let a qualified expert do your Nursing essay for you and deliver it before your deadline!

9.8
Buy Nursing essay Papers
Calculate your paper price
Pages (550 words)
Approximate price: -

Anxiety Disorders and Panic Disorders

Anxiety disorders involve disorders that contain characteristics of excessive fear and anxiety and linked behavioral disturbances. There are several types of anxiety disorders including generalized anxiety disorder, agoraphobia, separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder or social phobia, panic disorder, substance/medication-induced anxiety disorder, and anxiety disorder due to another medical condition. Review this study guide and learn more about anxiety disorders, its nursing care management, interventions, and assessment.

Types of Anxiety Disorders

The characteristic features of this group of disorders are symptoms of anxiety and avoidance behavior. Anxiety disorders are categorized in the following manner:
  • Panic disorder (with or without agoraphobia). Panic disorder is characterized by by recurrent panic attacks, the onset of which are unpredictable, and manifested by intense apprehension, fear or terror, often associated with feelings of impending doom, and accompanied by intense physical discomfort.
  • Agoraphobia without history of panic disorder. The APA 2000 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) identifies the essential feature of this disorder as fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of suddenly developing a symptoms(s) that could be incapacitating or extremely embarrassing.
  • Social phobia. Social phobia is characterized by a persistent fear of behaving or performing in the presence of others in a way that will be humiliating or embarrassing to the individual.
  • Specific phobia. Formerly called simple phobia, this disorder is characterized by persistent fears of specific objects or situations.
  • Obsessive-compulsive disorder. This disorder is characterized by involuntary recurring thoughts or images that the individual is unable to ignore and by recurring impulse to perform a seemingly purposeless activity.
  • Posttraumatic stress disorder. Posttraumatic stress disorder is characterized by the development of physiological and behavioral symptoms following a psychologically traumatic event that is generally outside the range of usual human experience.
  • Acute stress disorder. Acute stress disorder is characterized by the development of physiological and behavioral symptoms similar to those of PTSD; the major difference in the diagnosis lies in the length of time the symptoms exist; with acute stress disorder, the symptoms must subside within 4 weeks of occurrence of the stressor.
  • Anxiety disorder due to a general medical condition. The symptoms of this disorder are judged to be the direct physiological consequence of a general medical condition.
  • Substance-induced anxiety disorder. The DSM-IV-TR (APA, 2000) describes the essential features of this disorder as prominent anxiety symptoms that are judged to be caused by the direct physiological effects of a substance.
Obsessive-compulsive disorder (included in the obsessive-compulsive and related disorders), posttraumatic stress disorder (included in the trauma and stress-related disorders), and acute stress disorder, are no longer considered anxiety disorders as they were in the previous version of the DSM. Nonetheless, these disorders are closely linked to anxiety disorders and the sequential order of these chapters in the DSM-5 reflects this close connection.

Pathophysiology

The brain circuits and regions associated with anxiety disorders are beginning to be understood with the development of functional and structural imaging.
  • In the central nervous system (CNS) the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA).
  • Other neurotrasmitters and peptides, such as corticotropin-releasing factor, may be involved.
  • Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms.

Statistics and Incidences

Anxiety disorders are the most common type of psychiatric disorders in the Unites States.
  • The lifetime prevalence of anxiety disorders among American adults is 28.8%.
  • Social anxiety disorder is the most common anxiety disorder; it has an early age of onset-by age 11 years in about 50%, and by age 20 years in about 80% of individuals that have the diagnosis- and it is a risk factor for subsequent depressive illness and substance abuse.
  • The prevalence of specific anxiety disorders appears to vary between countries and cultures.
  • The median prevalence of social anxiety disorder in Europe is 2.3%.
  • The female-to-male ratio for any lifetime anxiety disorder is 3:2.

Causes

Predisposing factors to anxiety disorder include the following:
  • Biochemical. Increased levels of norepinephrine have been noted in panic and generalized anxiety disorders; abnormal elevations of blood lactate have also been noted in patients with panic disorder.
  • Genetic. Studies suggest that anxiety disorders are prevalent within the general population; it has been shown that they are more common among first-degree biological relatives of people with the disorders than among the general population.
  • Medical or substance-induced. Anxiety disorders may be caused by a variety of medical conditions or the ingestion of various substances.
  • Psychodynamic theory. The psychodynamic view focuses on the inability of the ego to intervene when conflict occurs between the superego and the id, producing anxiety.
  • Cognitive theory. The main thesis of the cognitive view is that faulty, distorted, or counterproductive thinking patterns accompany or precede maladaptive behaviors and emotional disorders.

Clinical Manifestations

Signs and symptoms of anxiety disorders may include the following:
  • Pounding, rapid heart rate.
  • Feeling of choking or smothering.
  • Difficulty breathing.
  • Pain in the chest.
  • Feeling dizzy or faint.
  • Increased perspiration.
  • Feeling of numbness or tingling in the extremities.
  • Trembling.
  • Fear that one is dying or going crazy.
  • Sense of impending doom.
  • Feelings of unreality (derealization and/or depersonalization).

Assessment and Diagnostic Findings

For presentations with a higher index of suspicion for other medical causes of anxiety, more detailed evaluations may be indicated to identify or exclude underlying medical disorders.
  • EEG, lumbar puncture, and head/brain imaging. Rule out CNS disorder using EEG, lumbar puncture, brain computed tomography scan, as indicated by history and associated clinical findings.
  • Electrocardiography. Rule out cardiac disorders using electrocardiography or treadmill ECG.
  • Tests for infection. Rule out infectious causes using rapid plasma reagent test, lumbar puncture, or HIV testing.
  • Arterial blood gas analysis. Arterial blood gas analysis is useful in confirming hyperventilation and excluding hypoxemia or metabolic acidosis.
  • Chest radiography. Chest radiography is useful in excluding other causes of dyspnea with chest pain.
  • Thyroid function. Hyperthyroidism is one of the most common medical causes for anxiety related to a medical condition.

Medical Management

Treatment usually consists of a combination of pharmacotherapy and/or psychotherapy.
  • Cognitive therapy. Cognitive therapy helps patients understand how automatic thoughts and false beliefs/distortions lead to exaggerated emotional responses, such as anxiety, and can lead to secondary behavioral consequences.
  • Behavioral therapy. Behavioral therapy involves sequentially greater exposure of the patient to anxiety-provoking stimuli; over time, the patient becomes desensitized to the experience.
  • Diet. Caffeine containing products, such as coffee, tea, and colas, should be discontinued.

Pharmacologic Management

Antidepressant agents are the drugs of choice in the treatment of anxiety disorders, particularly the newer agents that have a safer adverse effect profile and higher ease of use than the older tricyclic antidepressants.
  • Selective serotonin reuptake inhibitors. The SSRIs are first-line agents for long-term management of anxiety disorders, with control gradually achieved over a 2-to 4-wk course, depending on required dosage increases.
  • Serotonin and norepinephrine reuptake inhibitors. Pharmacologic agents with reuptake inhibition of serotonin and norepinephrine may be helpful in a variety of mood and anxiety disorders.
  • Atypical antidepressants. Antidepressants that are not FDA-approved  for the treatment of a given anxiety disorder still may be beneficial for the treatment of anxiety disorders; mirtazapine acts distinctly as an alpha-2 antagonist, consequently increasing synaptic norepinephrine and serotonin, while also blocking some postsynaptic serotonergic receptors that conceptually mediate excessive anxiety when stimulated with serotonin.
  • Tricyclic antidepressants. The tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects.
  • Benzodiazepines. Benzodiazepines often are used with antidepressants as adjunct treatment; they are especially useful in the management of acute situational anxiety disorder and adjustment disorder where the duration of pharmacotherapy is anticipated to be 6 weeks or less and for the rapid control of anxiety attacks.
  • Antianxiety agents. Buspirone is a non-sedating antipsychotic drug unrelated to benzodiazepines, barbiturates, and other sedative hypnotics; it has fewer cognitive and psychomotor adverse effects, which makes its use preferable in elderly patients.
  • Anticonvulsant. The drug of choice in this category is the gamma-aminobutyric acid derivative pregabalin (Lyrica).
  • Antihypertensive agent. Agents in this class may have a positive effect on the physiological symptoms of anxiety; beta-blockers may be useful for the circumscribed treatment of situational/performance anxiety on an as-needed basis.
  • Monoamine oxidase inhibitor (MAOI). MAOIs are most commonly prescribed for patients with social phobia.
  • Antipsychotic agent. Atypical and typical antipsychotic medications are generally used  more as augmentation strategies and are second-line treatment options in generalized anxiety disorder.

Nursing Management

Nursing management of a patient with anxiety disorder include the following:

Nursing Assessment

Nursing assessment of a patient with anxiety disorder include:
  • History. The client usually seeks treatment for panic disorder after he or she has experienced several panic attacks; usually, the client cannot identify any trigger for these events.
  • General appearance and motor behavior. The client may appear entirely “normal” or may have signs of anxiety if he or she is apprehensive about having a panic attack in the next few moments.
  • Mood and affect. Assessment of mood and affect may reveal that the client is anxious, worried, tense, depressed, serious, or sad.
  • Thought processes and content. During a panic attack, the client is overwhelmed, believing that he or she is dying, losing control, or “going insane”; the client may even consider suicide.
  • Sensorium and intellectual process. During a panic attack, the client may be confused and disoriented; he or she cannot take in environmental cues and respond appropriately.

Nursing Diagnosis

Based on the assessment data, the major nursing diagnosis are:
  • Anxiety related to unconscious conflict about essential values and goals of life; situational or maturational crises.
  • Fear related to phobic stimulus.
  • Ineffective coping related to underdeveloped ego; punitive superego.
  • Powerlessness related to fear of disapproval from others.
  • Social isolation related to panic level of anxiety.

Nursing Care Planning and Goals

The major nursing care planning goals for patients with Anxiety Disorders are:
  • Client will verbalize ways to intervene in escalating anxiety within 1 week.
  • Client will be able to recognize symptoms of onset of anxiety and intervene before reaching the panic stage by time of discharge from treatment.

Nursing Interventions

The nursing interventions for anxiety disorders are:
  • Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa.
  • Assure client of safety. Reassure client of his or her safety and security; this can be conveyed by physical presence of the nurse; do not leave client alone at this time.
  • Be clear and concise with words. Use simple words and brief messages, speak calmly and clearly, to explain hospital experiences to client; in an intensely anxious situation, client is unable to comprehend anything but the most elementary communication.
  • Provide a non-stimulating environment. Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor); a stimulating environment may increase level of anxiety.
  • Administer medications as prescribed. Administer tranquilizing medication, as ordered by physician; assess medication for effectiveness and for adverse side effects.
  • Recognize precipitating factors. When level of anxiety has been reduced, explore with client possible reasons for occurrence; recognition of precipitating factors is the first step in teaching client to interrupt escalation of anxiety.
  • Encourage client to verbalize feelings. Encourage client to talk about traumatic experience under nonthreatening conditions; help client work through feelings of guilt related to the traumatic event; help client understand that this was an event to which most people would have responded in like manner.

Evaluation

The outcome criteria for Anxiety Disorders include:
  • Client is able to maintain anxiety at level in which problem solving can be accomplished.
  • Client is able to verbalize signs and symptoms of escalating anxiety.
  • Client is able to demonstrate techniques for interrupting the progression of anxiety to the panic level.

Documentation Guidelines

Documentation guidelines include the following:
  • Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
  • Cultural and religious beliefs, and expectations.
  • Plan of care.
  • Teaching plan.
  • Responses to interventions, teaching, and actions performed.
  • Attainment or progress toward the desired outcome.

Practice Quiz: Anxiety Disorders

Nursing practice questions for Anxiety Disorders. For more practice questions, visit our NCLEX practice questions page.

Exam Mode

In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.

Practice Quiz: Anxiety Disorders

Start
Congratulations - you have completed Practice Quiz: Anxiety Disorders. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Practice Mode

Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.

Practice Quiz: Anxiety Disorders

Start
Congratulations - you have completed Practice Quiz: Anxiety Disorders. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Text Mode

Text Mode: All questions and answers are given on a single page for reading and answering at your own pace. Be sure to grab a pen and paper to write down your answers.

1. After seeking help at an outpatient mental health clinic, Ruby who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby? A. Allowing the client time to heal. B. Recommending a high-protein, low-fat diet. C. Exploring the meaning of the traumatic event with the client. D. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle. 1. Answer: C Exploring the meaning of the traumatic event with the client.
  • Option C: The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse.
  • Option B: A special diet isn’t indicated unless the client also has an eating disorder or a nutritional problem.
  • Option C: The client must explore the meaning of the event and won’t heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client’s anxiety and induce sleep.
  • Option D: The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate.
2. Alfred was newly diagnosed with anxiety disorder. The physician prescribed buspirone (BuSpar). The nurse is aware that the teaching instructions for newly prescribed buspirone should include which of the following? A. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug. B. A warning about the incidence of neuroleptic malignant syndrome (NMS). C. A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days. D. A warning that immediate sedation can occur with a resultant drop in pulse. 2. Answer: C. A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days.
  • Option C: The client should be informed that the drug’s therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed.
  • Option A: Blood level checks aren’t necessary.
  • Options B and D: NMS hasn’t been reported with this drug, but tachycardia is frequently reported.
3. Patient Clint with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include: A. Severe anxiety and fear B. Withdrawal and failure to distinguish reality from fantasy C. Insomnia and an inability to concentrate D. Depression and weight loss 3. Answer: A. Severe anxiety and fear.
  • Option A: Phobias cause severe anxiety (such as a panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia, and elevated blood pressure.
  • Option B: Withdrawal and failure to distinguish reality from fantasy occur in schizophrenia.
  • Options C and D: Insomnia, an inability to concentrate, and weight loss are common in depression.
4. Which medications have been found to help reduce or eliminate panic attacks? A. Anticholinergics B. Mood stabilizers C. Antipsychotics D. Antidepressants 4. Answer: D. Antidepressants.
  • Option D: Tricyclic and monoamine oxidase (MAO) inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks isn’t clearly understood.
  • Option A: Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but don’t relieve the anxiety itself.
  • Option B: Mood stabilizers aren’t indicated because panic attacks are rarely associated with mood changes.
  • Option C: Antipsychotic drugs are inappropriate because clients who experience panic attacks aren’t psychotic.
5. The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent? A. Suspiciousness, dilated pupils, and increased blood pressure B. Emotional lability, euphoria, and impaired memory C. Agitation, hyperactivity, and grandiose ideation D. Combativeness, sweating, and confusion 5. Answer: B. Emotional lability, euphoria, and impaired memory.
  • Option B: Signs of antianxiety agent overdose include emotional lability, euphoria, and impaired memory.
  • Option A: Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure.
  • Option C: Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation.
  • Option D: Phencyclidine overdose can cause combativeness, sweating, and confusion.

Questions?

Ask our team

Want to contact us directly? No problem. We are always here for you.

Frequently Asked Buy a Nursing essay Questions

See all
Is your service confidential?

When you place an order with our company, we ask you to provide us with such personal information as your name, phone number, and email address. We need this data to keep you updated on the important things related to your order or account, and never share it with any third parties. We also don’t use your contact details for spamming you.

Please note that our support team may contact you using only the phone number(s) stated on our website, such +1 (248) 599-2414 and/+44 (151) 528-2636. In order to secure our mutual cooperation, please do not communicate with those who introduce themselves as essaypapers support staff and reach you from different phone numbers.

Also, remember that we never ask you to provide your credit card information via phone conversations. You should enter this information only on PayPal or Gate2Shop billing forms when making an online payment on our website. The essaypapers support administrator will send a confirmation letter to your personal order page when your payment is received.

We also use a secure encrypted connection and do not store your private data if we do not need it anymore. For more details about how we ensure your confidentiality, check our Privacy Policy, which completely complies with the GDPR.

We offer original model papers that can be used legally in a number of ways if properly referenced:

  • As a source of arguments or ideas for your own research
  • As a source of additional understanding of the subject
  • Direct citing

Nonetheless, check your college’s/university’s policies, including their definition of plagiarism and paraphrasing before using our services. Make conscious decisions in regards to your education.

How do I order a paper from essaypapers?

We take care not only of your academic success, but also of your experience with us. That’s why we have made the process of placing your order as easy and fast as possible—usually, it takes no more than 2-3 minutes.

Let’s have a closer look at the simple steps you need to go through for submitting your order:

Fill in the order form.

Be sure to include specific instructions regarding your paper and to upload any of the required materials. If you have any questions while specifying your paper’s information, just click on the info sign at the end of every field name and you will see a detailed tip on what exact information is required.

Proceed with the payment.

After you are through with the order form, you will need to make a payment via a preferable system. Right after that, you will be automatically provided with your personal order page where you can track your order’s progress, provide additional requirements, and send messages to your writer or support manager.

A personal writer is assigned to your order.

Our qualified staff will choose the most suitable writer whose skills and experience match your field of study and paper’s details. In case the writer must have any particular software or literature in order to get the Nursing Assignment done, please do not forget to mention this in your initial instructions.

Your paper is completed and delivered to your personal order page.

When the writer finishes your paper, it is delivered to your personal order page as a PDF document, available for preview only. You will be able to download an editable MS Word version of the order right after you click the “Approve” button in the “Files” tab of your personal order page. If any changes are to be applied to the paper, you are always welcome to request a free revision with a new deadline for the writer (be sure to check more information about this in our revision policy).

You can check how easy the process is by going to the order page and submitting your paper details right now.

Is there a money-back guarantee? If yes, how can I receive a refund?

You can get more details about possible types and terms of refunds on our official money-back guarantee page.

How will I receive a completed paper?

You will get the first version of your paper in a non-editable PDF format within the deadline. You are welcome to check it and inform us if any changes are needed. If everything is okay, and no amendments are necessary, you can approve the order and download the .doc file. If there are any issues you want to change, you can apply for a free revision and the writer will amend the paper according to your instructions.

If there happen to be any problems with downloading your paper, please contact our support team.

What if I’m not satisfied with my order?

If your paper needs some changes, you can apply for a free revision that is available for 7 days after your paper is approved. To use this option, you have a “Revision” button on your personal page.

After the 7-day period, you cannot apply for a free revision, though you still can use a paid revision option. The price of such a revision will differ depending on the number of amendments needed to be done. Please contact our support team to find out how we can help you with the amendments to your paper.

If you think our writer didn’t manage to follow your instructions, and as a result, your paper is of poor quality, please contact us and we will do our best to solve the problem.

If the revisions didn’t give the desired result, you can apply for a refund. Our dispute department will process your inquiry to find out what kind of refund we can give you. To find out more, please visit our money-back guarantee page.

How do I request a refund?

You can’t apply for a refund on certain stages of your order, like when the order is not finished by the writer yet.

When the paper is delivered, the “Refund” button on your personal order page becomes clickable.

On the relevant tab of your personal order page, you will also be able to choose the type of refund you’re demanding and the reason why you applying for it. As soon as you do that, our dispute department will start working on your inquiry. All kinds of refunds concerning the quality or the lateness of your paper should be requested within 14 days from the time the paper was delivered, as in 14 days your paper, will be automatically approved.

Your inquiry should be submitted by clicking the “Refund” button on your personal order page only.

Order your essay today and save 15% with the discount code NURSINGHELP