NUR 304 Notes on Crises & Anxiety

Types of Crises:
• Situational
• Maturational
• Cultural
• Community

Phases of the Crisis Experience:

• First Phase: Threat
• Second Phase: Increased Anxiety-- Decreased Coping
• Third Phase: Escalating Anxiety
• Fourth Phase: Panic

Some Crisis Nursing Interventions

• Listening

• Sincerity

• Unconditional acceptance

• Understanding the subjective experience

• Assisting client to recognize themes and meaning of crisis event

Cultural Facets of Crisis Care

• Crises are culturally determined.

• Insensitive cross-cultural experiences can worsen the crisis experience.

• Nurses must be cognizant of cultural conflict.

• Culture shock is crisis.

• Belief systems are often shaken in crisis.

Stages of Anxiety :
Panic : Dread, terror, belief of impending death, loss of control, disorganization,
personality disintegration

Severe: Focus on specific detail, greatly reduced perception, exaggerated use of defenses

Moderate: Focus on immediate, narrowed perception, selective attention

Mild: Day to day tension, alert,

Major Anxiety Disorders

Types of Anxiety Disorders:
• Generalized Anxiety Disorder
• Panic Disorder
• Agoraphobia
• Phobias
• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)

Symptoms of Generalized Anxiety Disorder

• restlessness
• fatigue
• difficulty concentrating
• irritability
• muscle tension
• sleep disturbances

Symptoms of Panic Disorder

• palpitations
• sweating
• trembling
• shortness of breath
• choking sensation
• chest pain
• fear of losing control
• fear of dying
• altered sense of reality

Symptoms of Agoraphobia
• intense anxiety
• acute anxiety in crowds
• fear of losing control
• fear of inability to escape or find secure place
• avoiding situations
• fear of being alone

Symptoms of Phobia
• persistent, excessive fear of object, situation, or social performance
• inability to carry out life functions

Symptoms of OCD

• obsessive recurrent, intrusive thoughts

• uncontrollable compulsive impulses or actions

• recognition of unreasonable nature of thoughts and behaviors

• anxiety related to OCD yet repetitive compulsive behaviors are effort to reduce anxiety,

behaviors are a defense and need to be respected until new coping patterns can be

developed

Symptoms of PTSD
• recurrent, intrusive recollections, and memories
• dreams
• nightmares
• flashbacks
• "relive" traumatic experience
• anxiety, panic, despair
• impaired social functioning

Treatments for Anxiety Disorders

• Psychotherapy
- Insight-based treatments—understanding source of anxiety
- Behaviorally based treatments—i.e., desensitization

• Pharmacotherapy
- Anxiolytics--especially benzodiazepines
- Hypnotics—help to sleep and rest