Question

Lauren has been diagnosed with Social Anxiety Disorder and experiences obsessive thoughts that result in compulsive behaviors. This has a major impact on her life and day to day functioning.

Describe at least three clinical signs of Anxiety

• Describe at least three Obsessive-Compulsive behaviors .
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• Explain at least three therapeutic communication techniques used by the nurse
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• Discuss at least two nursing interventions appropriate for Lauren.

Answer 1

CLINICAL SIGNS OF ANXIETY

* Common anxiety signs and symptoms include: Feeling nervous, restless or tense. Having a sense of impending danger, panic or doom. Having an increased heart rate. Breathing rapidly .

Symptoms include stress that's out of proportion to the impact of the event, inability to set aside a worry and restlessness.

People may experience,Behavioural changes like hypervigilance, irritability, or restlessness.and also Cognitive likelack of concentration, racing thoughts, or unwanted thoughts.

Whole body: fatigue or sweating

Also common: anxiety, excessive worry, fear, feeling of impending doom, insomnia, nausea, palpitations.

• Anxiety can make you feel worried or scared.
• Anxiety can cause physical symptoms such as a fast heartbeat or sweating.
• It is a normal human response to be anxious in certain situations. You may have an anxiety disorder if you feel anxious all or most of the time.
• You can recover from anxiety disorders. Treatment and support are available for you.
• Your doctor can offer you treatment. What you are given will depend on your symptoms and how severe they are.

OBSESSIVE COMPULSIVE BEHAVIOR

* Obsessive-compulsive behavior  is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.

Excessive double-checking of things, such as locks, appliances, and switches. Repeatedly checking in on loved ones to make sure they're safe. Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety. Spending a lot of time washing .

Obessive compulsive behaviour comes in many forms, but most cases fall into at least one of four general categories:

• Checking, such as locks, alarm systems, ovens, or light switches, or thinking you have a medical condition like pregnancy or schizophrenia
• Contamination, a fear of things that might be dirty or a compulsion to clean. Mental contamination involves feeling like you’ve been treated like dirt.
• Symmetry and ordering, the need to have things lined up in a certain way
• Ruminations and intrusive thoughts, an obsession with a line of thought. Some of these thoughts might be violent or

Obsessive thoughts can include:

• Worries about yourself or other people getting hurt
• Constant awareness of blinking, breathing, or other body sensations
• Suspicion that a partner is unfaithful, with no reason to believe it

Compulsive habits can include:

• Doing tasks in a specific order every time or a certain “good” number of times
• Needing to count things, like steps or bottles
• Fear of touching doorknobs, using public toilets, or shaking hands

THERAPEUTIC COMMUNICATION TECHNIQUES

* Theraputic communication techniques such as active listening, silence, focusing, using open ended questions, clarification, exploring, paraphrasing, reflecting, restating, providing leads, summarizing, acknowledgment, and the offering of self, will be described below.

• Assess verbal and nonverbal client communication needs
• Respect the client's personal values and beliefs
• Allow time to communicate with the client
• Use therapeutic communication techniques to provide client support
• Encourage the client to verbalize feelings (e.g., fear, discomfort)
• Evaluate the effectiveness of communications with the client

1).Assessing verbal and non verbal client communication needs.

Communication is a human, interactive process that sends some meaning, information, message, emotions, and/or beliefs from one human being to another person or to a group of people. Connectedness and interrelationships between and among human beings occur because communication occurs.

There are several forms of communication. Communication can occur with the spoken word, with the written word, and with body language and gestures, which are oral communication, written communication and nonverbal communication, respectively.

It is essential that the components of all types of communication are effective in order for the communication to occur and be effective. The sender of the message must be able to formulate and then express the message and the receiver of the message must be able to process the message and then effectively respond back to the message.

2).Individual values, beliefs, persepctives, and perceptions.

Individual values, perspectives, perceptions and beliefs bias communication. At times people will only hear or see what they hear or see as based on their own, rather than an objective, view and perspective. For example, a client may only hear the nonthreatening rather than the threatening and stressful aspects of their plan of care because they are biased against the negative aspects of care. Similarly, gestures and other forms of body language are interpreted very differently as based on the client's preconceived notions, as well as their values, beliefs, perspectives, and perceptions.

As a result of these factors, nurses must assess these individual values, beliefs, perspectives, and perceptions as they impact on the sending and receiving of messages. For example, the nurse will clarify and validate the client's nonverbal grimacing which could be a sign of pain or it could be a sign of disgust during the interaction.

3).Allowing time to communicate with the client.

Nurses have a daunting job. They care for a number of clients at one time and these clients have multiple needs with rapidly changing priorities. Nurses are often in a hurry to get this patient care done and complete in the proper manner but they often fail to take the time that is necessary to communicate with their clients.

A failure on the part of the nurse to allow enough time to communicate with the client is a frequently encountered barrier to communication in the health care setting.

Enough time must be allotted so that the client has the time that they need to fully tell you about all of their feelings and concerns and to ask you questions. They also need time during oral conversations and exchanges to process incoming messages, reflect on the message, and to formulate and express their feedback message to the nurse.

NURSING INTERVENTIONS

* Nurses encounter anxious clients and families in a variety of situations. The nurse must first assess the person’s anxiety level because this determines what interventions are likely to be effective. Treatment of anxiety disorders usually involves medication and therapy. A combination of both produces better results than either one alone.

When working with an anxious person, the nurse must be aware of her own anxiety level. It is easy for the nurse to become easily anxious – remaining calm and in control is essential if the nurse is going to work effectively with the client.

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

1. Limit, but do not interrupt, the compulsive acts.
2. Teach the client to use alternate coping methods to decrease anxiety.
3. Client’s behavior maybe frustrating to staff and family. Power struggles often result. Consistency to the approach to care is critical.
4. Assess the client’s needs carefully.
5. Provide an environment that has structure and predictability as a strategy to decrease anxiety.
6. Risk associated with the use of alcohol and drug abuse..