274 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
- Social phobia
- Obsessive-compulsive disorder (OCD)
- Generalized anxiety disorder
- Acute stress disorder
- Posttraumatic stress disorder
Panic disorder and OCD are the most common and
will be the focus of this chapter. Posttraumatic stress
disorder is addressed in Chapter 11. Table 13-3 sum-
marizes the major symptoms of each anxiety disorder.
INCIDENCE
Anxiety disorders have the highest prevalence rates of
all mental disorders in the United States. About 15%
of U.S. adults have an anxiety disorder over their life-
time (Mendlowicz & Stein, 2000). Anxiety disorders
are more prevalent in women, people younger than
45 years, people who are divorced or separated, and
those of lower socioeconomic status. The exception is
OCD, which is equally prevalent in men and women
but more common among boys than among girls.ONSET AND CLINICAL COURSE
The onset and clinical course of anxiety disorders
are extremely variable depending on the specific dis-
order. These aspects are discussed later in this chap-
ter within the context of each disorder.continued from page 273The client will feel more secure if you are calm
and if the client feels that you are in control of the
situation.The client’s ability to deal with abstractions or
complexity is impaired.The client’s ability to problem-solve is impaired.
The client may not make sound decisions or may
be unable to make decisions at all.Medication may be necessary to decrease the
client’s anxiety to a level at which he or she can
listen to you and feel safe.Anxiety is communicated interpersonally. Being
with the anxious client can raise your own anxi-
ety level.Relaxation exercises are effective, nonchemical
ways to reduce anxiety.Independent use of the techniques can give the
client confidence in having some conscious control
over his or her anxious behavior.A frequent misconception is that anxiety itself is
bad and not useful. The client does not need to
avoid anxiety per se.Remain calm in your approach to the client.Use short, simple, and clear statements.Avoid asking or forcing the client to make choices.Use of PRN medications may be indicated if the
client’s level of anxiety is high or if the client is
experiencing delusions, disorganized thoughts,
and so forth.Be aware of your own feelings and level of dis-
comfort or anxiety.Encourage the client’s participation in relaxation
exercises. These can include deep breathing,
progressive muscle relaxation, meditation, guided
imagery, and going (mentally) to a quiet, peaceful
place.Teach the client to use relaxation techniques
independently.Help the client to see mild anxiety as a positive
catalyst for change.Adapted from Schultz, JM & Videbeck, SD. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:
Lippincott Williams & Wilkins.