Highest priority nurs diagnosis when client is anxious is: 

Nurse taught an anxious client a relaxation technique....evaluate the effect on the following client goal:

"The client will experience anxiety w/o feeling overwhelmed."

"The client will work through problems w/o being devastated."

Disabling Anxiety

• Personality and mood changes
• Distorted Perceptions
• Inability to concentrate
• Memory Impairment
• Maladaptive defense mechanisms

Remain w/ client to promote safety

Clients are frantic; extremely disordered cognitively.  Judgment is impaired, unable to make sound decisions, and at high risk for injury if left alone.

Palpitations and Rapid Heart Rate

Effective in reducing cardiovascular symptoms - increased pulse, blood pressure, & possible palpitations

target the beta-adrenergic receptors in SNS

What are symptoms associated with abrupt withdrawal from benzodiazepines? 

example - clonazepam (Klonopin)

• Severe Drowsiness
• Ataxia
• Impaired Coordination

What is the most common mental illness among adolescents?

Anti-depressants

• effective for multiple symptoms
• have minimal abuse potential as benzos have.

1. Predominant disturbance (as in Generalized Anxiety Disorder)
2. Anxiety experienced as an "avoidance behavior"

1. Panic D/O
2. Phobic D/O
3. Generalized Anxiety D/O
4. Obsessive-Compulsive D/O (OCD)
5. Post-Traumatic Stress D/O (PTSD)
6. Acute Stress D/O

• Feelings of impending doom
• Extreme apprehension or fear
• Feelings of terror; severe that perceptual field is severely limited
• Severe personality disorganization evident
• May think they are losing their mind or having a heart attack
• Typically "come out of the blue" -not necessarily provoked by stress
• Last for a few minutes

Fear of being in environment or situation from which escape might be difficult/embarrassing 

Example: alone outside, home alone, traveling in car/bus/plane or on a bridge or in elevator

Agoraphobia without the panic disorder

(occurs rarely and early in person's hx; over time will develop into panic attacks)

1. Stay w/ client
2. Maintain a calm, serene manner
3. Use short, simple sentences
4. Use a firm and authoritiative voice
5. Move client to quieter, smaller, less stimulating environment
6. Focus the client's diffuse energy on a repetitive task
7. Administer antianxiety (anxiolytic) medications if ordered

Persistent irrational fears of a specific object, activity, or social situation

Examples: snakes, swimming, or performing on stage

Leads to a desire of avoidance

High levels of anxiety or fear provoked by a specific object or situation

Examples: dogs, snakes, spiders, tunnels, bridges, sight of blood, etc.

Provoked by exposure to a social situation or a performance situation;

can cause great difficulty

1. Paroxetine (Paxil) - An SSRI used in severe cases that limit occupational function
2. Levetiracetam (Kepra) - An anticonvulsant
3. Others meds treat the cardiovascular symptoms are: propranolol (Inderal) and atenolol (Tenormin)

1. Presence of excessive anxiety or worry lasting 6 mths +
2. Symptoms of Anxiety (restlessness, fatigue, poor concentration and poor decision making)
3. Worry that is out of proportion to the true impact of event or situation

1. Restlessness
2. Fatigue
3. Poor Concentration
4. Poor Decision Making (dread of making a mistake)

1. Inadequacy in interpersonal relationships
2. Job responsibilities
3. Finances
4. Health of self or family members
5. Household Chores
6. Lateness for appointments

1. Escitalopram (Lexapro) - SSRI approved for GAD
2. Venlafaxine (Effexor) - SNRI approved for GAD
3. Olanzapine (Zyprexa) - antipsychotic
4. Buspirone (Buspar) - specific for anxiety
5. Benzodiazepines - antianxiety
6. Imipramine (Tofranil) - TCA 

• Uncontrollable, persistent urges to perform ritualistic acts or behaviors
•  Individual feels driven to reduce the unbearable tension and anxiety
•  An attempt to control or modify the obsessions.  Only a temporary fix to reduce the anxiety so must be repeated again and again.

What medications are appropriate treatment of OCD?

• fluoxetine (Prozac)
• sertraline (Zoloft)
• fluvoxamine (Luvox)
• citalopram (Celexa)
• paroxetine (Paxil)

What is Post Traumatic Stress D/O?

repeated re-experiencing of a traumatic event or significant stressor

(must be trauma outside the usual human experience)

• Military combat
• Criminal attack
• Child abuse
• Natural or manmade disasters
• Violence in home/school/community, etc 

• Intrusive recollection of event through dreams or flashbacks
• Dissociative experiences when event is relived, but emotions are blocked (feeling of numbness/detachment - "isolation of affect")
• Hyperarousal when re-experiencing the traumatic event
• Persistent avoidance of the event by not talking about it or avoiding the triggering stimuli (person, places)

For example- woman raped in elevator avoids elevators

1. sertraline (Zoloft), paroxetine (Paxil) - SSRIs
2. propanolol (Inderal), Atenolol (Tenormin) - Beta Blockers

These relieve depressive symptoms, improve sleep and suppress intrusive thoughts, jumpiness, and explosive anger