GUIDED LECTURE NOTES, CHAPTER THIRTEEN
Learning Objective 1. Describe anxiety as a response to stress.
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Define stress as the wear and tear that life causes on the body (refer to PowerPoint
slide 2).
Define anxiety as a vague feeling of dread or apprehension in response to external
or internal stimuli that can have behavioral, emotional, cognitive, and physical
symptoms (refer to PowerPoint slide 2).
Differentiate anxiety from fear, which is feeling afraid or threatened by a clearly
identifiable external stimulus that represents danger to the person (refer to
PowerPoint slide 2).
Learning Objective 2. Describe the levels of anxiety with behavioral changes related to
each level.
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List the four levels of anxiety: mild, moderate, severe, and panic.
Define mild anxiety as a sensation that something is different and warrants special
attention. Discuss cognitive, affective, and behavioral experiences of the person
with mild anxiety.
Describe moderate anxiety as the disturbing feeling that something is definitely
wrong. Discuss cognitive, affective, and behavioral experiences of the person
with mild anxiety.
Discuss the primitive survival skills associated with severe anxiety and panic.
Emphasize the use of defensive responses, loss of cognitive skills, and onset of
physical responses (refer to PowerPoint slides 4-5).
Learning Objective 3. Discuss the use of defense mechanisms by people with anxiety
disorders.
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Define defense mechanisms as cognitive distortions. Explain how according to
psychodynamic theories, people use defense mechanisms unconsciously to
maintain a sense of being in control of a situation, to lessen discomfort, and to
deal with stress (refer to PowerPoint slide 10).
Learning Objective 4. Describe the current theories regarding the etiologies of major
anxiety disorders.
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Explain that biologic theories support the idea that anxiety may have an inherited
component, or there may be dysfunctions with neurotransmitters (refer to
PowerPoint slide 10).
Discuss how in the view of psychodynamic theories, anxiety disorders may be
caused by overuse of defense mechanisms and problems in interpersonal
relationships, or anxiety is a learned behavioral response (refer to PowerPoint
slide 10).
Learning Objective 5. Evaluate the effectiveness of treatment including medications for
clients with anxiety disorders.
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Explain how treatment for anxiety disorders is most effective when it involves
both medication and therapy.
Discuss drugs commonly used to treat anxiety disorders (refer to PowerPoint slide
12).
Discuss techniques of cognitive–behavioral therapy that are effective for anxiety
disorders, namely positive reframing, decatastrophizing, and assertiveness
training (refer to PowerPoint slide12).
Learning Objective 6. Apply the nursing process to the care of clients with anxiety and
anxiety disorders.
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Discuss assessment of panic disorder using the Hamilton Rating Scale for Anxiety
(refer to PowerPoint slide 20).
Discuss expected findings in the patient with panic disorder in relation to history,
general appearance and motor behavior, mood and affect, thought processes and
content, sensorium and intellectual processes, judgment and insight, self-concept,
and roles and relationships (refer to PowerPoint slide 20).
List nursing diagnoses commonly applicable for a person with panic disorder
(refer to PowerPoint slide 21).
Formulate realistic and measurable patient care outcomes for treatment of panic
disorder (refer to PowerPoint slide 22).
Discuss interventions to assist the person with panic disorder, including
promoting safety and comfort, communicating therapeutically, and managing
anxiety (refer to PowerPoint slide 23).
Discuss Assessment of OCD using the Yale-Brown Obsessive Compulsive Scale
(refer to PowerPoint slide 31).
Discuss expected findings in the patient with panic disorder in relation to history,
general appearance, and motor behavior, mood and affect, thought processes and
content, sensorium and intellectual processes, judgment and insight, self-concept,
and roles and relationships (refer to PowerPoint slide 31).
List nursing diagnoses commonly applicable for a person with OCD (refer to
PowerPoint slide 32).
Formulate realistic and measurable patient care outcomes for treatment of OCD
(refer to PowerPoint slide 33).
Discuss interventions to assist the person with OCD, including communicating
therapeutically, relaxation and behavioral techniques, and completing a daily
routine (refer to PowerPoint slide 34).
Learning Objective 7. Provide teaching to clients, families, caregivers, and
communities to increase understanding of anxiety and stress-related disorders.
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Discuss educating the patient and family with panic disorder about the efficacy of
combined psychotherapy and medication and the effects of the prescribed
medication. Educate the client and family members about the physiology of
anxiety and the merits of using combined psychotherapy and drug management.
Encourage the client to exercise regularly (refer to PowerPoint slide 23).
Discuss educating the client and family with OCD about the disorder. Teach
about the importance of medication compliance to combat OCD (refer to
PowerPoint slide 34).
Review drugs used to treat anxiety disorders (refer to PowerPoint slide 36).
Learning Objective 8. Examine your feelings, beliefs, and attitudes regarding clients
with anxiety disorders.
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Reflect on personal understandings of anxiety.
Recognize all people are equally vulnerable to stress and anxiety.
Discuss how to separate personal feelings from patient care so as to avoid
hindering effectiveness (refer to PowerPoint slide 39).