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Anxiety DisordersPsychiatric Nursing: Contemporary Practice

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What are risk factors for developing panic disorders?
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Family hx, substance abuse, stimulant use/abuse, smoking, severe stressors, being female, separation anxiety during childhood, early life traumas, hx of physical or sexual abuse during childhood, socioeconomic or personal disadvantages, and behavioral inhibition by adults.
Certain medical conditions have been correlated with panic disorders, what are they? (7)
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Vertigo, cardiac disease, GI disorders, asthma, mitral valve, migraines and HTN.
What is the priority care issue for people with panic disorders?
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Suicide risk
What factors place a person especially at risk for suicide when they also have a panic disorder?
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Being female and having either depression or substance abuse problems along with the panic disorder
What are the priorities during an acute panic attacks?
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Rule out cardiac and neuro issues, then assess for panic attack
What are some common panicogenic substances?
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Caffeine, OTC medications, pseudoephedrine, amphetamines, cocaine and tobacco.
Withdrawal from ________ may produce symptoms of panic.
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CNS depressants like alcohol, benzodiazepines
Interventions that focus on the ________ aspecst of anxiety and panic are helpful in reducing the number and severity of attacks giving patients a rapid sense of accomplishment.
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physical
Describe the technique for abdominal breathing:
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Breathe deeply and slowly through the nose, while placing a hand on the abdomen. Watch the hand rise. Inhale for 5 seconds, pause, exhale slowly through pursed lips. While exhaling, focus on letting go. Repeat for 10 breaths. Pause for 30 seconds, repeat for 3-5 minutes. Light-headedness is normal.
What are the therapeutic uses for abdominal breathing?
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It is used in patients with panic disorders to interrupt a panic episode as it begins or when they notice their breathing is rapid and shallow.
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Describe four-square breathing:
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Inhale slowly through the nose, counting four. Hold for a count of four, breathe out for a count of four and then rest (no breath) for a count of four). Take two normal breaths and repeat
When is four-square method of breathing recommended?
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After a patient has learned to identify early signs of panic, they use the four-square breathing pattern to divert or decrease the severity of an attack.
What are some teaching points for patients who experience panic disorders?
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Eliminate caffeine, food coloring, MSG. After ingesting substances, determine whether anxiety occurs, if so, avoid those substances. Use isometric exercises and progressive muscle relaxation (helpful when a patient cannot clear their mind for visualizing scenes), exercise (10-20 minutes three times a week).
What class of drugs are the first-line option for treating panic disorders?
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SSRIs
What are common SE of SSRIs?
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Nausea, anorexia, tremors, anxiety, sexual dysfunction, jitteriness, insomnia.
How often are SSRIs titrated when treating panic disorders?
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Every 5-7 days.
What is important to teach a client with panic disorders about SSRIs?
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They can temporarily increase panic symptoms or trigger panic attacks, and take 4-6 weeks to work. Don't abruptly discontinue.
What relief do SSRIs provide to people with panic disorders?
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They lessen anxiety, reduce BP and symptoms of tachycardia.
What are the benefits of benzodiazepines in the treatment of panic disorders?
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They provides relief in hours, not weeks like the SSRIs or SNRIs.
What are the drawbacks of benzodiazepines in the treatment of panic disorders?
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They have a risk for withdrawal symptoms including rebound anxiety, apprehenision, irritability, insomnia, vertigo, sweating, muscle spasms, metallic taste and sensory hypersensitivity.
What class of medication should patients with sleep apnea and panic disorders not be prescribed?
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Benzodiazepines
  
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