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Mental Health Nursing I
NURS 1300
Unit IV
Anxiety Disorders and Crises
Objective 1
Define stress, stressors, and anxiety
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Stress
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a state of bodily or mental tension resulting
from factors that tend to alter an existent
equilibrium
necessary for growth and development
Stressor
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anything that necessitates an adaptive
response on the part of the individual
Objective 1 (cont’d)
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Anxiety
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a vague and sometimes intense sense of
impending doom or apprehension that may
appear to have no clearly identifiable cause
often an early response to illness
Objective 2
Describe the “fight-or-flight”
syndrome
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1st stage of the general adaptation
syndrome
Body’s response to perceived threat or
danger
Hormones released to give body strength
increases heart rate
 slows digestion
 shunts blood flow to major muscle groups
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Objective 3
Define the four levels of anxiety
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Mild anxiety
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Moderate anxiety
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optimal level for learning
client focused on immediate concerns
Severe anxiety
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client able to focus attention
motivates learning and personal growth
ability to think is clouded
problem solving is impaired
Panic anxiety
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inability to communicate or function effectively
misperceptions of surrounding events
client may react impulsively by running or striking
out
Objective 4
Describe various coping mechanisms
used to deal with stress and anxiety
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Imagery
Deep-breathing
Meditation
Yoga
Therapeutic touch
Music therapy
Biofeedback
Objective 5
Describe the major defense
mechanisms
See Defense Mechanisms handout
Objective 6
Be able to discuss generalized anxiety,
panic disorder, phobias, obsessivecompulsive disorder, and posttraumatic stress disorder
Generalized Anxiety Disorder (GAD)
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Characterized by chronic anxiety and
unrealistic, excessive worry and tension
Concurrent physical symptoms occur in
the absence of organic conditions
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fatigue
headaches
muscle aches and tension
difficulty swallowing
trembling and twitching
irritability
sweating and hot flashes
Panic Disorder
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Characterized by recurrent panic attacks
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episodes of intense apprehension of variable length
accompanied by feelings of impending doom
often occur in familiar places, where there is
seemingly nothing threatening to the individual
Concurrent physical symptoms include:
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increased pulse
elevated blood pressure
trembling
diaphoresis
shortness of breath
chest pain
nausea
Phobias
A phobia is an irrational, persistent fear
of certain situations, objects, activities,
or persons
The main symptom is the excessive,
unreasonable desire to avoid the feared
subject
Phobic fear interferes with daily life
Obsessive-Compulsive Disorder (OCD)
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Obsessions = recurrent, unwanted thoughts
Compulsions = repetitive behaviors
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often performed with the hope of preventing
obsessive thoughts or making them go away
hand washing, counting, checking, cleaning
provides only temporary relief
not performing rituals results in marked increase in
anxiety
Time-consuming; causes distress or impairment
Client aware thoughts and behaviors are
irrational, but feels powerless to stop
Post-Traumatic Stress Disorder (PTSD)
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PTSD = a cluster of symptoms
experienced following a distressing event
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event is outside the range of normal
experiences
event produced intense fear, helplessness,
and/or horror
Characteristic symptoms of PTSD include:
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dissociative flashbacks
sustained high level of anxiety/arousal or a
general numbing of responsiveness
intrusive recollections or nightmares of the
event
Objective 7
Be able to discuss somatoform
disorders to include types, risk
factors, signs and symptoms
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Somatoform disorders = physical ailments for
which no medical explanation has been found
Types of somatoform disorders
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conversion disorder
pain disorder
hypochondriasis
body dysmorphic disorder
Conversion Disorder
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Disorder in which emotional distress or
unconscious conflicts are expressed
though physical symptoms
Sudden onset of symptoms following a
stressful experience
Involves involuntary loss of one or more
bodily functions in which diagnostic
testing uncovers no physical cause
Risk factors
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medical illness
dissociative disorder
personality disorder
Pain Disorder
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Persistent and chronic pain at one or
more sites in which psychological factors
are thought to play a role
Suffering is so severe that it impairs
client’s ability to function
Risk factors
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underlying medical condition
fibromyalgia
 migraines
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uncontrolled or inadequately managed pain
depression and/or anxiety
Hypochondriasis
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Excessive preoccupation or worry about
having a serious illness
Characteristics include:
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fears that minor bodily symptoms may
indicate serious illness
constant self-examination and self-diagnosis
preoccupation with one’s body
Fear is persistent and disabling in spite of
reassurances that no organic pathology
can be found
Body Dysmorphic Disorder
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Exaggerated belief that body is deformed
or defective in some specific way
Most common complaints involve
imagined or slight flaws of the face or
head
Risk factors
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chemical imbalance of the brain
obsessive-compulsive disorder (OCD)
eating disorder
generalized anxiety disorder (GAD)
higher socioeconomic status
strict cultural standards
Objective 8
Describe the major types of crisis and
what crisis intervention means
Major types of psychiatric crisis include:
1. Suicidal thinking or behaviors
2. Homicidal thinking or behaviors
3. Acute psychotic symptoms
4. Sudden change in mental status
5. Violence resulting from a mental
disorder
Objective 8 (cont’d)
Crisis intervention = the provision of
emergency psychological care to clients
in order to restore their level of
functioning and to prevent or decrease
potential negative effects of the crisis
Intervention consists of:
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preventing clients in crisis from harming
themselves or others
administering medications
providing a supportive, therapeutic
environment
Objective 9
Identify medical treatment and
nursing interventions for the client
with an anxiety or somatoform
disorder
Medical treatment:
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therapies
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individual psychotherapy
cognitive therapy
behavior therapy
group therapy
medications
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anxiolytics
antidepressants
Nursing interventions:
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anxiety R/T severe stress AEB patient’s selfreport/agitation/appearance
ineffective coping R/T severe stress AEB
development of somatic symptoms
disturbed body image R/T body dysmorphic disorder
AEB expression of repugnance with imagined defect
or minor physical anomaly
Objective 10
Identify major drugs used, actions,
side effects and nursing interventions
for the client with an anxiety disorder
or somatoform disorder
See Medications for Clients with
Anxiety/Somatoform Disorders handout