Chapter 27:
Anxiety Disorders: Nursing Care
of Patients with Anxiety, Phobia,
and Panic
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Anxiety
 Uncomfortable feeling of apprehension or dread in response to
internal or external stimuli
 Physical, emotional, cognitive, and behavioral symptoms (refer
to Box 27.1)
 Normal vs. abnormal
 Factors that determine if anxiety is a symptom of mental
disorder:
o Intensity of anxiety relative to situation
o Trigger for anxiety
 4 degrees of anxiety (see Table 27.1)
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Overview of Anxiety Disorders
Common of psychiatric illnesses; chronic and
persistent
Women experience anxiety disorders more often
than men
Association with other mental or physical
comorbidities such as depression, heart disease, and
respiratory disease.
Anxiety disorders across the life span
o Children
o Older adults
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Anxiety Disorders
Panic disorder
Generalized anxiety disorder (GAD)
Phobias
Separation anxiety disorder
Agoraphobia
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Phobias
An irrational fear of an object, person, or situation
that leads to a compelling avoidance
May be the outcome of extreme anxiety
Are often present in anxiety disorders but may also
develop into a specific phobia disorder
o Defense mechanisms and anxiety
 Used to reduce anxiety by preventing or
diminishing unwanted thoughts and feelings
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Panic Disorder
Extreme, overwhelming form of anxiety often
experienced when an individual is placed in a real or
perceived life-threatening situation
o Clinical Course
 Panic attacks: sudden, discrete periods of
intense fear or discomfort accompanied by
significant physical and cognitive symptoms
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Panic Disorder
 Epidemiology and Risk
o A moderately high lifetime prevalence in the general
population
o Associated with being female; middle aged; of low
socioeconomic status; and widowed, separated, or
divorced
 Comorbidity
o Other anxiety disorders, depression, eating disorder,
substance use disorder, or schizophrenia
o Medical conditions, including vertigo, cardiac disease,
gastrointestinal disorders, asthma, and those related to
cigarette smoking
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Panic Disorder
Biologic theories
o Serotonin and Norepinephrine
o Gamma-Aminobutyric Acid
o Hypothalamic–Pituitary–Adrenal Axis
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Recovery-Oriented Care for Persons with
a Panic Disorder
Teamwork and Collaboration: Working toward
recovery
o Panic Control Treatment
o Systematic Desensitization
o Exposure Therapy
o Cognitive–Behavioral Therapy
Safety
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Evidence-Based Nursing Care of Persons
with Panic Disorder
Mental Health Nursing Assessment
o Panic Attack Assessment
o Physical Health
o Nutrition
o Medication
o Substance Use
o Other Physical Assessment Areas
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Evidence-Based Nursing Care of Persons
with Panic Disorder
Psychosocial Assessment
o Self-Report Scales
 See Box 27.4 and Table 27.2
o Mental Status Examination
 Cognitive Thought Patterns (see Table 27.3)
 Social Network
 Cultural Factors
o Strength Assessment
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Clinical Judgement
 Suicide prevention is the priority
o Often depressed and consequently are at high risk for
suicide
o Adolescents are at higher risk for suicidal thoughts or may
attempt suicide more often than other adolescents
 Panic symptoms in early adolescence predict high risk
for late adolescent depression and suicide ideation
 Panic attacks may be unpredictable
 Strengths should be considered in planning care
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Panic Disorder: Emergency Care
Stay with the patient
Reassure him or her that you will not leave
Give clear, concise directions
Assist the patient to an environment with minimal
stimulation
Walk or pace with the patient
Administer PRN anxiolytic medications
Afterward, allow the patient to vent his or her
feelings
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Generalized Anxiety Disorder
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Other Anxiety Disorders
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Other Anxiety Disorders
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Therapeutic Relationship
Critical aspect of helping the person work toward
recovery
The nurse should help the patient relax and be
comfortable with discussing fears and anxiety
A calm, understanding approach in a comfortable
environment will help the person relax and be
willing to engage in a therapeutic relationship
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Mental Health Nursing Interventions
Establishing Mental Health and Wellness Goals
o
Focus on:
 Developing a healthy lifestyle
 Supporting a sense of accomplishment and
control
 Reducing anxiety and panic
o All are particularly helpful in reducing the
number and severity of the attacks
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Mental Health Nursing Interventions
Physical Care
o
Teaching breathing control
 Teach calming technique
o Teaching nutritional planning
o Teaching relaxation techniques
o Promoting increased physical activity
Wellness challenges
o See Box 27.6
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Mental Health Nursing Interventions
Medication Interventions (see Table 27.4)
o Selective Serotonin Reuptake Inhibitors
o Serotonin–Norepinephrine Reuptake Inhibitors
o Benzodiazepine Therapy (see Box 27.7)
 Administering and Monitoring Benzodiazepines
Monitoring Side Effects
Management of Complications
o Teaching Points
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Mental Health Nursing Interventions
SSRI
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Benzodiazepines
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Benzodiazepines
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Benzodiazepines
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Flumazenil
Flumazenil (Romazicon) is the antidote for
benzodiazepine overdoses.
Mechanism of Action: Flumazenil is a
Benzodiazepine Antagonist. It competitively inhibits
the benzodiazepine binding site on the
GABA/benzodiazepine receptor complex.
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Mental Health Nursing Interventions
Psychosocial Interventions
o Therapeutic interactions (see Table 27.5)
o Enhancing cognitive functioning (see Box 27.8)
 Distraction
 Reframing
 Positive Self-Talk
o Psychoeducation (see Box 27.9)
 Wellness strategies
 Providing family education
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Therapeutic Procedures
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Mental Health Nursing Interventions
Convening support groups
Continuum of care
o Emergency care
o Inpatient-focused care
o Community care
o Virtual mental health care
Integration with primary care
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Nursing Interventions for Anxiety
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Nursing Interventions for Anxiety
 If the patient has mild anxiety,
you can assist the patient with
problem solving and relaxation
techniques.
 If the patient has severe anxiety,
problem solving is not realistic.
 In severe anxiety, the nurse should
provide a quiet environment with
minimal stimulation. Remain with
the patient, provide short/simple
directions, administer PRN
medication as ordered.
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Client Education
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