Question

Julia is a 18 year-old student at a local community college. On several occasions in the past 6 months she has experienced sudden, absolute, overwhelming anxiety. During these episodes, her heart pounds, she trembles, her mouth gets dry, and it feels as if the walls are caving in. The feelings only last a few minutes but, when they occur, the only thing that seems to relieve her fear is walking around her apartment and reminding herself that she is in control. She won't ride in cars now, unless she is driving, so she is sure that she can stop if necessary. She will only go to class if she can find an aisle seat in the back row so that she can leave quietly should she have another attack.

1. How do these symptoms impair the client’s functioning?

2. What nursing interventions would be helpful?

Answer 1

Answer

a. How do these symptoms impair the client’s functioning?

• This anxiety or constant fear can affect an individual's ability to concentrate and complete tasks or to get along with others in the work place.
• Anxiety disorders are often coupled with sleeplessness, depression, panic attacks, racing thoughts, headaches or other physical issues.
• Anxiety can run in families and be a lifelong challenge that spills over into all facets of life, from relationships and parenting to the workplace.
• When anxiety interferes with daily activities, you may have an anxiety disorder.

a. What nursing interventions would be helpful?

• The first step for many people who struggle with anxiety is to create awareness of their thoughts and then learn to manage those thoughts with a counselor’s help.
• Although the strategy of identifying negative self-talk and addressing one’s thoughts is old hat to most counselors, it may be an entirely new concept for some people, especially younger clients, says Pisarik, an ACA member who uses cognitive behavior therapy (CBT) in his private practice.

Clients with anxiety often polarize, exaggerate or catastrophize details in their minds as they ruminate over them.

Nursing Interventions	Rationale
Maintain a calm, non threatening manner while working with the client.	. Client develops feeling of security in presence of calm staff person.
Establish and maintain a trusting relationship by listening to the client;	Therapeutic skills need to be directed toward putting the client at ease, because the nurse who is a stranger may pose a threat to the highly anxious client.
Remain with the client at all times when levels of anxiety are high (severe or panic); reassure client of his or her safety and security.	The client’s safety is utmost priority. A highly anxious client should not be left alone as his anxiety will escalate.
Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.)	Anxious behavior escalates by external stimuli. A smaller or secluded area enhances a sense of security as compared to a large area which can make the client feel lost and panicked.
Maintain calmness in your approach to the client.	The client will feel more secure if you are calm and inf the client feels you are in control of the situation.
Provide reassurance and comfort measures.	Helps relieve anxiety.
Educate the patient and/or SO that anxiety disorders are treatable.	Pharmacological therapy is an effective treatment for anxiety disorders; treatment regimen may include antidepressants and anxiolytics.
Support the client’s defenses initially.	The client uses defenses in an attempt to deal with an unconscious conflict, and giving up these defenses prematurely may cause increased anxiety.
Maintain awareness of your own feelings and level of discomfort.	. Discussion of these feelings can provide a role model for the client and show a different way of dealing with them.
Avoid asking or forcing the client to make choices.	The client may not make sound and appropriate decisions or may unable to make decisions at all.
Observe for increasing anxiety. Assume a calm manner, decrease environmental stimulation, and provide temporary isolation as indicated.	Early detection and intervention facilitate modifying client’s behavior by changing the environment and the client’s interaction with it, to minimize the spread of anxiety.
PRN medications may be indicated for high levels of anxiety. Watch out for adverse side effects.	Medication may be necessary to decrease anxiety to a level at which the client can feel safe.
Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth.	Relaxation exercises are effective nonchemical ways to reduce anxiety.
Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep- breathing exercises, physical exercises, brisk walks, jogging, meditation).	So the client can start using relaxation techniques; gives the client confidence in having control over his anxiety.
Help the client see that mild anxiety can be a positive catalyst for change and does not need to be avoided.	The client may feel that all anxiety is bad and not useful.
Cognitive-behavioral therapy (further discussed here)
Positive reframing	Turning negative messages into positive ones.
Decatastrophizing	It involves the therapist’s use of questions to more realistically appraise the situation. It is also called the “what if” technique because the worst case scenario is confronted by asking a “what if” question.
Assertiveness training	Helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance.
When level of anxiety has been reduced, explore with the client the possible reasons for occurrence.	Recognition of precipitating factors is the first step in teaching client to interrupt escalation of anxiety.
Encourage client to talk about traumatic experience under nonthreatening conditions. Help client work through feelings of guilt related to the traumatic event..	Verbalization of feelings in a nonthreatening environment may help client come to terms with unresolved issues.