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PANIC DISORDER - Coggle Diagram
PANIC DISORDER
PATHOPHYSIOLOGY
The brain circuits and regions associated with anxiety disorders are beginning to be understood with the development of functional and structural imaging.
In the central nervous system (CNS) the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA).
Other neurotrasmitters and peptides, such as corticotropin-releasing factor, may be involved.
Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms.
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IMPORTANT ASSESSMENTS
History. The client usually seeks treatment for panic disorder after he or she has experienced several panic attacks; usually, the client cannot identify any trigger for these events.
General appearance and motor behavior. The client may appear entirely “normal” or may have signs of anxiety if he or she is apprehensive about having a panic attack in the next few moments.
Mood and affect. Assessment of mood and affect may reveal that the client is anxious, worried, tense, depressed, serious, or sad.
Thought processes and content. During a panic attack, the client is overwhelmed, believing that he or she is dying, losing control, or “going insane”; the client may even consider suicide.
Sensorium and intellectual process. During a panic attack, the client may be confused and disoriented; he or she cannot take in environmental cues and respond appropriately.
NURSING INTERVENTIONS
Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa.
Assure client of safety. Reassure client of his or her safety and security; this can be conveyed by physical presence of the nurse; do not leave client alone at this time.
Be clear and concise with words. Use simple words and brief messages, speak calmly and clearly, to explain hospital experiences to client; in an intensely anxious situation, client is unable to comprehend anything but the most elementary communication.
Provide a non-stimulating environment. Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor); a stimulating environment may increase level of anxiety.
Administer medications as prescribed. Administer tranquilizing medication, as ordered by physician; assess medication for effectiveness and for adverse side effects.
Recognize precipitating factors. When level of anxiety has been reduced, explore with client possible reasons for occurrence; recognition of precipitating factors is the first step in teaching client to interrupt escalation of anxiety.
Encourage client to verbalize feelings. Encourage client to talk about traumatic experience under nonthreatening conditions; help client work through feelings of guilt related to the traumatic event; help client understand that this was an event to which most people would have responded in like manner.
BEHAVIORAL INTERVENTIONS
Assess client’s level of anxiety. Investigate the types of situations that increase anxiety and result in ritualistic behaviors. Helping the client recognize the precipitating factors is the first step in teaching the client to interrupt the escalating anxiety.
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During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior.
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Gradually limit the amount of time allotted for ritualistic behavior as client becomes more involved in unit activities.
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PATIENT EDUCATION
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Teach the client or family to identify stressors and situations that promote or exacerbate anxiety and to avoid them as much as possible
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Teach the client and family simple anxiety reduction strategies to help prevent escalation of symptoms
Instruct the client to avoid foods and beverages containing caffeine to prevent exacerbation of anxiety symptoms.