Medical Surgical Nursing || Mental Health and Neurology || Anxiety ||

 

Mental Health and Neurology: Anxiety

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Definition

Anxiety is a mental health condition characterized by excessive fear, worry, or unease about perceived threats or uncertainties. It can manifest as a response to stress or persist without any identifiable cause, significantly impacting daily functioning and quality of life.

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Causes

1. Biological Factors:

   • Imbalance of neurotransmitters (e.g., serotonin, dopamine, GABA).
   • Genetic predisposition.

2. Psychological Factors:

   • Childhood trauma.
   • Cognitive distortions (e.g., catastrophizing situations).

3. Environmental Factors:

   • Chronic stress or work pressure.
   • Financial or relational challenges.

4. Medical Conditions:

   • Thyroid disorders (hyperthyroidism).
   • Cardiovascular issues.

5. Substance Use:

   • Excessive caffeine or alcohol consumption.
   • Withdrawal from drugs or medications.

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Signs and Symptoms

1. Physical Symptoms:

   • Palpitations or increased heart rate.
   • Shortness of breath or hyperventilation.
   • Sweating, trembling, or shaking.
   • Fatigue or muscle tension.
   • Nausea or gastrointestinal disturbances.

2. Emotional Symptoms:

   • Persistent worry or fear.
   • Restlessness or irritability.

3. Behavioral Symptoms:

   • Avoidance of anxiety-provoking situations.
   • Difficulty concentrating or staying focused.

4. Cognitive Symptoms:

   • Negative thought patterns.
   • Feelings of impending doom or danger.

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Investigations

1. Clinical Assessment:

   • Detailed history-taking, including medical, psychological, and family history.
   • Use of screening tools like:
     • GAD-7 (Generalized Anxiety Disorder-7 scale).
     • HAM-A (Hamilton Anxiety Rating Scale).

2. Physical Examination:

   • Rule out physical causes such as thyroid dysfunction or heart conditions.

3. Laboratory Tests:

   • Thyroid function tests (T3, T4, TSH).
   • Complete blood count (CBC).

4. Imaging and Advanced Tests:

   • Electroencephalogram (EEG) for neurological evaluation.
   • MRI or CT scan (if organic brain issues are suspected).

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Medical Treatment

1. Medications:

   • Anxiolytics: Benzodiazepines (e.g., lorazepam, alprazolam) for short-term use.
   • Antidepressants:
     • SSRIs (e.g., sertraline, escitalopram).
     • SNRIs (e.g., venlafaxine).
   • Beta-blockers: Propranolol for physical symptoms.
   • Buspirone: Non-benzodiazepine anxiolytic.

2. Psychotherapy:

   • Cognitive Behavioral Therapy (CBT): Restructures negative thought patterns.
   • Exposure Therapy: Helps desensitize anxiety triggers.
   • Mindfulness-Based Stress Reduction (MBSR): Reduces anxiety through mindfulness techniques.

3. Lifestyle Modifications:

   • Regular physical activity.
   • Adequate sleep and balanced diet.

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Nursing Interventions

1. Assessment:

   • Monitor physical symptoms like pulse rate, respiration, and blood pressure.
   • Observe emotional state, behavior, and level of anxiety.

2. Provide a Safe Environment:

   • Ensure the patient feels secure and comfortable.
   • Reduce external stimuli during acute anxiety episodes.

3. Support and Education:

   • Teach relaxation techniques (e.g., deep breathing, progressive muscle relaxation).
   • Educate on anxiety triggers and coping strategies.

4. Medication Administration:

   • Administer prescribed medications and monitor for side effects.

5. Encourage Expression:

   • Encourage patients to talk about their fears and concerns.

6. Promote Activity:

   • Encourage mild exercise, such as walking or yoga.

7. Family Involvement:

   • Involve family members in therapy sessions or support groups.

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Nursing Care Plan for Anxiety

Nursing Diagnosis	Goal	Intervention	Rationale	Evaluation
Ineffective Coping Related to Excessive Worry	To reduce anxiety levels and improve coping mechanisms	- Establish a trusting relationship. - Teach relaxation techniques. - Encourage verbalization of feelings.	Provides emotional support and equips the patient with tools to manage anxiety.	Patient verbalizes decreased anxiety levels and demonstrates effective coping strategies.
Sleep Pattern Disturbance	Patient will achieve restful sleep.	- Provide a calm environment. - Administer prescribed sleep aids. - Limit caffeine intake before bedtime.	Promotes relaxation and reduces anxiety contributing to sleep disturbance.	Patient reports improved sleep quality.
Risk for Social Isolation	Patient will engage in social activities.	- Encourage participation in group therapy. - Identify enjoyable activities. - Provide positive reinforcement.	Enhances social interaction and reduces feelings of isolation.	Patient participates in at least one social activity.
Knowledge Deficit Regarding Anxiety Management	Patient will demonstrate understanding of management techniques.	- Educate about medication usage and side effects. - Teach stress management and relaxation exercises.	Enhances self-management and empowers the patient to manage symptoms effectively.	Patient demonstrates and verbalizes understanding of anxiety management techniques.