Question

Maria is hospitalized as she is suffering from generalized anxiety disorder that is interfering with her ability to function in her daily life. Her provider just informed her that the treatment team is developing a care plan that includes medication and education regarding coping skills. Maria tends to ask a lot of questions, and as her nurse, you want to be fully prepared to help her with her new treatment plan. Describe this anxiety disorder and explain it including what symptoms Maria might be demonstrating. What is a possible medication for the anxiety disorder and what patient information (side effects and patient education) will you need to give Maria? What is an appropriate coping mechanism for Maria's anxiety? Why is it helpful for her disorder? What other nursing interventions are appropriate for this type of anxiety? Describe at least one. (You must explain the intervention and not just name it.)

Answer 1

1Q).

Generalized anxiety disorder (GAD) is a psychological illness characterized by unusual events of anxiety regarding different aspects of life such as personal and social relationships, workforces, financial matters, and others.

The common symptoms of GAD in the given patient are,

1. Worrying all the time about every day and everything
2. Lack of appropriate sleep
3. Difficulty in concentrating on studies and constantly worrying about school, grades, meeting her financial responsibilities, and her parents

The patient had chronic anxiety as the symptoms are continuous and the anxiety is related to almost all the situations, but not to a particular event.

Cortisol is the major glucocorticoid released from the adrenal cortex during the stress. Chronic stress increase the levels of corticosteroids, which also act as immunosuppressant, and anti-inflammatory molecules. As patients with GAD have severe stress, their cortisol levels are expected to raise. The morning cortisol levels range from 10 – 20 µg/dl, and the patient’s cortisol levels are, 10 µg/dl, which indicates that it is at the lower end.

2Q).

Treatment for GAD:

• Relaxation training (breathing exercises, reality testing exercises)
• Benzodiazepines
• Selective serotonin reuptake inhibitors (SSRIs)

Benzodiazepines (BDZs) are the commonly prescribed drugs for the treatment of anxiety disorders. Examples include diazepam, alprazolam, and clonazepam. Although these drugs cause drug dependence, they are less likely abuse than it is actually assumed. BDZs cause psychological dependence due to their rapid onset of action, which gives a sensation of intoxication.

The sudden withdrawal of BDZs causes withdrawal symptoms (physical and psychological) that include, seizures, anxiety, tremors, hallucinations, and delirium. The withdrawal symptoms occur after a few days of taking the last dose. So, the dose should be gradually reduced by 25% per week to avoid the withdrawal symptoms.