VCE 5

Virtual Clinical Excursion: Lesson 5

Reading Assignment: Anxiety and Obsessive-Compulsive Related Disorders (Chapter 15)
Patient: Dorothy Grant, Obstetrics Floor, Room 201
Goal: To care for a pregnant patient who is experiencing anxiety.
Objectives:
Define anxiety and describe its essential characteristics.
Understand levels of anxiety.
Identify stressors leading to a patient's anxiety.
Describe physiological responses to anxiety.
Define cognitive, behavioral, and affective responses to anxiety.
Define defense mechanism.
Identify effective medications prescribed for patients with anxiety.
Discuss levels of anxiety as they relate to nursing interventions.
Develop treatment interventions and outcomes for a patient with anxiety.
Identify the characteristics of generalized anxiety disorder and posttraumatic stress disorder.

Exercise 1

Writing

1. ANXIETY is defined as a universal human experience that produces a diffuse, vague feeling of
apprehension, including feelings of uneasiness, uncertainty, or dread.

2. Anxiety is experienced at different levels. Match each level of anxiety with its characteristics.

Level:
Mild - Associated with tensions of daily life and may produce slight discomfort.

Moderate - The person may demonstrate selective inattention. As the perceptual field narrows, the person
focuses on
immediate concerns.
Severe - Significant reduction in the perceptual field as the person focuses on specific or scattered details
and cannot think of anything else. Learning and problem solving are not possible.
Panic - Associated with dread and terror, the person exhibits markedly disturbed behavior as the
personality becomes disorganized.

3. Identify at least two physiological responses to anxiety in each of the systems below.

Cardiovascular - pectoris ,Arrhythmias ,Congestive heart failure ,Hypertension

Respiratory - Chronic obstructive pulmonary disease, Pulmonary embolism, Asthma, Hypoxia
Gastrointestinal - Hypercalcemia, Hyperkalemia
Somatic (sensory) – Delirium, Post-concussion syndrome, Parkinson’s disease
Genitourinary tract - Pressure to urinate, Frequent Urination

Somatic (muscular) - Essential tremor, Increased reflexes, Startle reaction Eyelid twitching, Clumsy
movement
4. Match each type of anxiety disorder with its characteristics.

Type:
Generalized anxiety disorder (GAD)
Excessive worry about numerous things lasting longer than 6 months
Decision making difficult because of poor concentration and fear of making mistakes
Anxiety level out of proportion to the true impact of the event
Posttraumatic Stress Disorder (PTSD)
Symptoms beginning within 3 months after the trauma
Persistent stimuli avoidance and numbing of general responsiveness

5. cognitive restructuring are automatic coping styles that protect people from painful awareness of
feelings, conflict, etc., by blocking feelings, conflicts, and memories that can provoke overwhelming
anxiety.

6. Discuss three overall guidelines for basic nursing interventions in working with a patient with anxiety.

Maintain a calm manner, always remain with the person experiencing an acute severe to panic level of
anxiety, use a low pitched voice; speak slowly, listen for themes in communication, use clear and simple
statements and repetition,

7. For patients with moderate to severe anxiety, medication may be a necessary intervention. List the
positive aspects and the cautions associated with the use of antidepressant and anxiolytic medications in
patients with anxiety.

Antidepressants:

Anxiolytics: