Question

Anxiety disorders: caring for a client during a panic attack

Do all 14 boxes please.

ACTIVE LEARNING TEMPLATE System Disorder Alterations in Health (Diagnosis) Pathophysiology Related to Client Problem Health Promotion and Disease Prevention ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Expected Findings Laboratory Tests Diagnostic Procedures PATIENT CENTERED CARE Complications Nursing Care Medications Client Education Therapeutic Procedures Interprofessional Care

Answer 1

Risk factors

• Family history of panic attacks or panic disorder.
• Major life stress, such as the death or serious illness of a loved one.
• A traumatic event, such as sexual assault or a serious accident.
• Major changes in your life, such as a divorce or the addition of a baby.
• Smoking or excessive caffeine intake.

expected findings

• Palpitations, pounding heart, or accelerated heart rate
• Sweating
• Trembling or shaking

no laboratory tests to specifically diagnose panic disorder

To diagnose a panic attack, your doctor will likely ask you about your symptoms and medical history. They may also conduct a physical exam. They may need to conduct tests to rule out a heart attack. The will likely use an electrocardiogram (EKG) to measure the electric function of your heart

Nursing Interventions	Rationale
Maintain a calm, non threatening manner while working with the client.	Anxiety is contagious and may be transferred from health care provider to client or vice versa. Client develops feeling of security in presence of calm staff person.
Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions directly, offering unconditional acceptance; being available and respecting the client’s use of personal space.	Therapeutic skills need to be directed toward putting the client at ease, because the nurse who is a stranger may pose a threat to the highly anxious client.
Remain with the client at all times when levels of anxiety are high (severe or panic); reassure client of his or her safety and security.	The client’s safety is utmost priority. A highly anxious client should not be left alone as his anxiety will escalate.
Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.)	Anxious behavior escalates by external stimuli. A smaller or secluded area enhances a sense of security as compared to a large area which can make the client feel lost and panicked.
Maintain calmness in your approach to the client.	The client will feel more secure if you are calm and inf the client feels you are in control of the situation.
Provide reassurance and comfort measures.	Helps relieve anxiety.
Educate the patient and/or SO that anxiety disorders are treatable.	Pharmacological therapy is an effective treatment for anxiety disorders; treatment regimen may include antidepressants and anxiolytics.
Support the client’s defenses initially.	The client uses defenses in an attempt to deal with an unconscious conflict, and giving up these defenses prematurely may cause increased anxiety.
Maintain awareness of your own feelings and level of discomfort.	Anxiety is communicated interpersonally. Being with an anxious client can raise your own anxiety level. Discussion of these feelings can provide a role model for the client and show a different way of dealing with them.
Stay with the patient during panic attacks. Use short, simple directions.	During a panic attack, the patient needs reassurance that he is not dying and the symptoms will resolve spontaneously. In anxiety, the client’s ability to deal with abstractions or complexity is impaired.
Avoid asking or forcing the client to make choices.	The client may not make sound and appropriate decisions or may unable to make decisions at all.
Observe for increasing anxiety. Assume a calm manner, decrease environmental stimulation, and provide temporary isolation as indicated.	Early detection and intervention facilitate modifying client’s behavior by changing the environment and the client’s interaction with it, to minimize the spread of anxiety.
PRN medications may be indicated for high levels of anxiety. Watch out for adverse side effects.	Medication may be necessary to decrease anxiety to a level at which the client can feel safe.
Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth.	Relaxation exercises are effective nonchemical ways to reduce anxiety.
Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep- breathing exercises, physical exercises, brisk walks, jogging, meditation).	So the client can start using relaxation techniques; gives the client confidence in having control over his anxiety.
Administer SSRIs as ordered.	Panic attacks are caused by neuropsychiatric disorder that responds to SSRI antidepressants.
Help the client see that mild anxiety can be a positive catalyst for change and does not need to be avoided.	The client may feel that all anxiety is bad and not useful.
Cognitive-behavioral therapy (further discussed here)
Positive reframing	Turning negative messages into positive ones.
Decatastrophizing	It involves the therapist’s use of questions to more realistically appraise the situation. It is also called the “what if” technique because the worst case scenario is confronted by asking a “what if” question.
Assertiveness training	Helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance.
When level of anxiety has been reduced, explore with the client the possible reasons for occurrence.	Recognition of precipitating factors is the first step in teaching client to interrupt escalation of anxiety.
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. Support client during flashbacks of the experience.	Verbalization of feelings in a nonthreatening environment may help client come to terms with unresolved issues.

Some SSRIs commonly prescribed to treat panic disorder include:

• citalopram (Celexa)
• escitalopram (Lexapro)
• fluvoxamine (Luvox)
• paroxetine (Paxil)
• fluoxetine (Prozac)
• sertraline (Zoloft)

But you can take some steps to enhance your overall well-being and lower your risk of panic attacks. For example, it’s important to lead an overall healthy lifestyle by:

• eating a well-balanced diet
• exercising regularly
• getting enough sleep
• taking steps to reduce stress

It’s also important to seek help from your doctor if you experience a panic attack. Getting treatment may help you avoid more panic attacks in the future.