- a particular relationship between the persona and the environment that is appraised by the person as taxing and/or exceeding his resources and endangering his well-being

- wear and tear that life causes on the body

- occurs when a person has difficulty dealing with life situations, problems, and goals

- subjective emotional response to a stressor

- vague feeling of dread that is unwarrented by the situation; in response to external or internal stimuli

- always part of the stress response

- unavoidable in life and can serve many positive functions

- alarm reaction stage

- resistance stage

- exhaustion stage

- norma reaction to a realistic danger or threat to biological integrity or self-concept

- dissipates when the danger or threat is no longer present

- determined by society

- mild +1

- moderate +2

- severe +3

- panic +4

- sensation that something is different and warrants special attention

- sensory stimulation increases

- attention is focused to lear, solve problems, think, act, feel and protect self

- motivated

- feeling that something is definitely wrong

- nervousness or agitation

- can still process information, solve problems, and learn new things with assistance from others

- concentration difficult but can be redirected

- trouble thinking and reasoning

- muscles tighten, vital signs increase, pacing, restlessness, irritability and anger

- use of ther emotional-psychomotor means to release tension

- flight, flight, or freeze response

- cognitive process focus on the person's defense

- response is greatly disproportionate to the risk and severity of the danger or threat

- response continues beyond the existence of a potential danger or threat

- intellectual, social, or occuptional functioning is impaired

- individual suffers from a psychosomatic effect

women

people younger than 45

divorced or seperated persons

persons of lower socioeconomic status

- anxiety disorder due to a general medical condition

- substance induced anxiety disorder

- seperation anxiety disorder

- adjustment disorder

- genetic: anxiety may have inherited component

- nuerochemical theories: neurotransmitters may be dysfunctional in persons with anxiety disorders

- intrapsychic/psychoanalytic theories: overuse of defense mechanisms

- interpersonal theory: results from problems in interpersonal relationships

- behavioral therapy: "learned" behavioral response

- Be aware of own anxiety level

- Assess anxiety level

- Speak in short, simple, easy to understand sentances, and talk in a low, calm, soothing voice

- Lower anxiety level to moderate or mild before proceeding with anything else

- Walk while talking if patient cannot sit still

- Ensure safety during panic level anxiety

- Remain with client until the panic recedes

- Short term use of anxiolytics

-

Positive reframing - turning negative messages into positive ones

Decatastrophizing - making a more realistic appraisel of the situation

 Assertiveness training - learning to negotiate interpersonal situations

panic attack: 15-30 minutes episodes of intense, escalating anxiety with emotional fear and physiological discomfort

diagnosed: when person has recurrent, unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks

Primary: relief of anxiety

Secondary: attention received from others as a result of behavior

- CBT

- Deep breathing and relaxation

- Medications: benzos, SSRIs, tricylic antidepressents, antihypertensives

- Hamilton rating scale for anxiety

- reports of several panic attacks

- may appear normal or may have signs of anxiety

- anxious, worried, tense, depresses, serious or sad

- fears losing control or going insane

- confused and disoriented

- judgment is poor during an attack

- self-blaming statements

- alterations in his or her social, occupational, or family life

- problems sleeping and eating

- be free from injury

- verbalize feelings

- use effective coping techniques

- manage own anxiety response

- verbalize sense of personal control

- re-establish adequate nutrtional intake

- sleep at least 6 hours per night

- promoting safety and comfort

- using therapeautic communication

- managing anxiety

- providing client and family education

- Does the client understand the prescribed medication regiment, and is he or she commited to adhering to it?

- Have the client's episodes of anxiety decreased in frequency or intensity?

- Does the client understand various coping methods and when to use them?

- Does the client beleive that his or her quality of life is satisfactory?

uneasiness

irritability

muscle tension

fatiue

difficulty thinking

sleep alterations

- family physicians

- SSRI and buspirone

Meds: anxiolytics, SSRIs, beta blockers

Behavioral therapies: systematic desensitization, flooding

- Yale-Brown OC Scale

- reports of obsessions becoming too overwhelming; compulsions interfere with daily life

- tense, anxious, worried and fretful

- ongoing, overwhelming feelings of anxiety

- intact intellectual functions with difficulty concentrating

- recognizes that the obsessions are irrational but he or she cannot stop them

- powerlessness

- relationships suffer

-trouble sleeping or loss of appetite

- anxiety

- ineffective coping

- fatigue

- situational low self-esteem

- impaired skin integrity (if scrubbing/washing rituals)

- complete daily routine within realistic time frame

- demonstrate effective use of relaxation techniques

- discuss feelings with others

- demonstrate effective use of behavior therapy techniques

- spend less time performing rituals

- using therapeutic communication

- teaching relaxation and behavioral techniques

- completing a daily routine

- proving client and family education

- Do the symptoms no longer interfere with the client's ability to carry out responsibilities

- When obsessions occur, does the client manage resulting anxiety without engaging in complicated or time-consuming rituals?

- Does the client report regained control over his or her life?

- Does the client report ability to tolerate and manage anxiety with minimal disruption?

- sleep difficulties

- hypervigilance

- thinking difficulties

- sever startle response

- agitation

- distrubing behavior from a trumatic event at least 3 months after trauma occured

- 3 clusters of symptoms: reliving the event, avoiding reminders of the event, being on guard or experiencing hyperarousal

- hx of trauma or abuse

- pt appears hyperalert, anxious, or agitated

- mood and affect: client is fearful and anxious, needs large personal space, has a wide range of emotions

- though processes and content: nightmares, flashbacks, and destructive thoughts or impulses

- sensorium and intellectual processes: disorientation, memory gaps

- judgement and insight: impaired decision-making and problem solving abilities

- self concept: client has low self esteem

- roles and relationships: problems with relationships, works, authority figures

- physiologic considerations: difficulty sleeping, under or over eating, use of alcohol or drugs for self-medication

- risk for self-mutiliation

- ineffective coping

- post-trauma response

- chronic low self-esteem

-powerlessness

- persistent nightmares

-memories

-flashbacks

-emotional numbness

-insomnia

-irritability

- hypervigilance

-angry outbursts

somatic symptoms, such as:

- headaches

-backaches

-fatigue

- dizziness

-stomach problems

- sadness

- agitation

- weight loss

- weakness

- HR changes

- symptoms beleived to occur bc supernatural spirits or bad air from dangerous places and cemetaries invade the body

another condition, such as:

- depression

-dementia

- physical illness

- medication toxicity or withdrawel

- phobias, particularly agoraphobia

- GAD

- family practice or advanced practice nurse

- physician office

- psychiatric clinical specialists

- physchologists or other mental health counselors

- referally to community resources such as anxiety disorder groups or self-help groups

- keep a positive attitude and believe in yourself

- accept there are events you cannot control

- communicate assertively with others: talk about your feelings, express your emotions

- learn to relax

- exercise regularly

- eat well balanced meals

- limit intake of caffeine and alcohol

- get enough rest and sleep

- set realistic goals and expectations

- learn stress managment techniques