Nursing Care Generalized Anxiety Disorder
Anxiety is a broad term used to describe feelings of worry, discomfort, or fear. Feeling anxious during stressful periods is an ordinary emotion. Although this term is used as a general description of an emotional state, it is crucial that nurses and other health professionals distinguish those who are feeling anxious from those with Generalized Anxiety Disorder (GAD). Assessments are key when dealing with anxious patients in order to determine their level of functioning. GAD is often a comorbidity to certain illness and diseases, which can effect treatments. Understanding the differences between GAD and anxiousness will allow nurses to develop appropriate interventions that will be most effective physiologically and psychologically for patients.
Generalized Anxiety Disorder (GAD) is a mental illness that is characterized by frequent and extreme worry and tension with little to no underlying cause (Frey, Odle, & Waun, 2015). Individuals with GAD have difficulty controlling their emotions, which may interfere with one’s activities of daily living and psychosocial functioning. Symptoms of GAD include insomnia, sweating, lightheadedness, frequent urination, and feeling out of breath (Frey et al., 2015). These symptoms also occur in those feeling anxious; but, according to the American Psychiatric Association (2013) in order to be diagnosed with GAD, these symptoms must be chronic and present more days than not for over six months.
As nurses, it is important to recognize the signs and symptoms of anxiety when interacting with patients. These indicators may be psychological findings, as well as physiological. While assessing a patient, it is important to ask open ended questions in order to allow the patient to express their individual emotions and concerns. Patients may verbalize their anxieties through repetitive statements or by expressing feelings of discomfort. Though some patients can easily verbalize their current state of mind, some may find it difficult. Nurses can pick up on nonverbal cues or physiological signs that can suggest feelings of anxiousness.
There are different levels of anxiety nurses need to be aware of while completing an assessment in order to prepare appropriate goals and interventions; these levels are: mild, moderate, severe, and panic. Mild anxiety consists of every day worry that most individuals’ encounter. During this period, one may have an upset stomach or an increased heart rate. Most patients who are hospitalized may have mild anxiety because they are in an unfamiliar setting and might be worried about their current illness. Moderate anxiety develops when a thought or fear becomes one’s main focus and hinders an individual’s ability to attend to other thoughts. A patient with moderate anxiety may exhibit more physical symptoms including: perspiration, back pain, or changes in sleeping patterns. Severe anxiety occurs when one starts to feel a loss of control and the ability to form coping strategies weakens. Patients with severe anxiety may present with elevations in heart rate and blood pressure, along with a decrease in appetite. Prolonged severe anxiety can cause one to enter the panic stage. Patients experiencing panic lose all control of their emotions and they feel helpless in their current mental state. These disorganized emotions can cause one to become angry, which puts the patient and others around them at risk to harmful behaviors and injury. Recognizing these signs and symptoms during early stages are crucial in helping prevent a patient’s anxiety from intensifying.
Certain illnesses and diseases can coexist with Generalized Anxiety Disorder in which one may exacerbate the other. One illness that is often associated to GAD is alcoholism. Often, those with anxiety turn towards alcohol as a way to relax or escape from their obsessive thoughts and reality. Though alcohol can temporarily “eliminate” the feeling of anxiety, one can later develop a dependency. Alcohol can generate substance-induced anxiety, which then exacerbates GAD or causes one without GAD to develop the mental illness. Chronic Obstructive Pulmonary Disease (COPD) is also associated with GAD. A patient with COPD tends to develop higher levels of anxiety because they have difficulty breathing causing them to feel a loss of control. Other patients with COPD may develop symptoms of anxiety as they begin smoking cessation. Similar to alcohol, smoking may serve as a negative coping strategy used to relieve anxiety. Patients withdrawing from alcohol and nicotine can develop higher levels of anxiety.
Hospitalizations and acute care facilities can cause patients to develop a feeling of anxiousness. Patients may feel isolated, worried about a new diagnosis, apprehensive about an upcoming surgery, or pain. These anxieties can be considered “normal” or “mild”. These patients might exhibit an elevated heart rate at times and frequently ask questions about medications, procedures, or other relevant information regarding their stay. Patients with GAD will often exhibit the same behaviors, but may require more attention and care. Individualized care plans and goals are important when addressing concerns about anxiety because all patients respond differently to interventions
Interventions and treatments are used to decrease or eliminate a patient’s anxiety and help them feel comfortable. One intervention that is commonly used by nurses is educating patients about deep breathing exercises. This intervention may be helpful when caring for patients with mild levels of anxiety. Though deep breathing exercises can help minimize anxiety, another intervention that is essential for patients exhibiting anxiousness is helping the patient identify the source of their anxiety and encouraging them to express their feelings and emotions. Expressing emotion will help decrease the feeling of isolation and will help the patient identify strategies for coping. Patients with GAD often receive medication. A nurse is responsible for following the medication administration record and teaching patients about the medication they are taking. Administering a patient’s medication as ordered will help relieve the symptoms of anxiety and it is important to monitor these patients to ensure that the medication is working properly. When working with a patient experiencing panic level anxiety, it is imperative to decrease any surrounding stimuli, as that can worsen one’s anxiety.
Nurses play a very large role in patient care. Nurses spend the most time with patients and understand how important it is to complete a full assessment by observing a patients’ physical, emotional, and psychological state in order to provide optimal care. The outcome for every patient experiencing anxiety should be safety and comfort. These outcomes can be achieved by developing an empathetic and trusting relationship. Before discharging patients, it is important to refer patients as needed to local community mental health services. This will ensure that the patient will continue to receive treatment for their anxiety or GAD when returning to their everyday life.
GAD and feelings of anxiousness are very common in our population. Anxiety should always be assessed, and it is important for nurses to help these patients express feelings and emotions in order to develop and individualized care plan promoting comfort and safety. Through education and a deep understanding of GAD and anxiety, nurses will provide compassionate and therapeutic care for all patients.