Generalized anxiety disorder is diagnosed by a mental health clinician who can help determine whether the symptoms your child is experiencing is related to an anxiety disorder or another medical condition. The mental health clinician (such as a child and adolescent psychiatrist, child psychologist, psychiatric social worker, or psychiatric nurse practitioner) will make the diagnosis following a comprehensive assessment, which includes a
diagnostic with you and your child. During the assessment, parents are asked to talk about their child’s anxiety symptoms and related behavior. You will also be asked to give an overview of your child’s family history, medical history, social history, and social interactions. Sometimes parent or child questionnaires are used to help clarify the diagnosis. After the comprehensive assessment, a mental health clinician will help
explain your child’s condition and answer any questions you or your child may have. The next step is developing a mutually agreed-upon treatment plan that works for you, your child, and your family. If you suspect your child may have GAD, it is essential to speak with a qualified mental health professional as soon as possible. Children with GAD respond well to treatment that is administered by trained mental health clinicians. By closely
working with the treatment team, you can help your child go on to enjoy an active and fulfilling life. Evidence-based treatments for GAD in children and adolescents includes cognitive behavioral therapy, medication, or a combination of medication and therapy. Here at Boston Children’s Hospital, medication is used in conjunction with therapy for treatment of GAD. Selective serotonin reuptake inhibitor (SSRI) antidepressants are currently first-line medications in the pharmacotherapy of
anxiety disorders in children. These antidepressants are powerful anxiolytics with a broader spectrum that may improve comorbid affective disorders and symptoms of anxiety. If left untreated, studies show that GAD is often a chronic illness with symptoms that tend to wax and wane across the lifespan. Earlier age of onset is also associated with greater risk for development of other anxiety and depressive disorders later in life. People with anxiety disorders rarely require hospitalization unless they are suicidal, although anxiety can occur with other mental disorders requiring hospitalization. As a nurse working with individuals with diagnosed anxiety disorders, be aware of your self-reaction. It is not uncommon to have feelings of frustration, especially if you feel as if the symptoms are a matter of choice or under the client’s control. The client often acknowledges the fear is unrealistic or exaggerated but continues to engage in avoidant behavior. Recall that avoidant behavior is a symptom, and behavioral changes are accomplished slowly with treatment.[1] It is also important to be aware that hospitalized patients may develop anxiety in association with other medical conditions (i.e., chronic obstructive pulmonary disease [COPD], angina, or hyperthyroidism) or medical procedures. Anxiety is a nursing diagnosis, as well as a potential mental health disorder. While implementing interventions that address medical conditions, often the nurse must also implement interventions that address associated anxiety. AssessmentWhen assessing clients with anxiety, assess for the symptoms associated with the “fight or flight” stress response including the following[2]:
Determine the client’s current level of anxiety (mild, moderate, severe, or panic) and assess for risk of suicide or self-harm. Perform a psychosocial assessment and focus on what factors could be contributing to the anxiety. For example, the client may identify a problem such as a relationship issue, stressful job, or school challenges that could be addressed by counseling.[3] Screening ToolsThe Severity Measure for Generalized Anxiety Disorder in Adults is a common tool for measuring anxiety. High scores may indicate generalized anxiety disorder or panic disorder, although it can also be associated with major depressive disorder. Diagnostic and Lab WorkWhen assessing for anxiety disorders, the provider will typically order lab work to rule out common medical causes of anxiety, such as hyperthyroidism, hypoglycemia, hypercalcemia, hyperkalemia, hyponatremia, or hypoxia. Review and/or monitor the results of these tests as part of the nursing assessment. Cultural ConsiderationsCultural beliefs can affect an individual’s expression of their feelings of anxiety. An example of a culture-mediated response related to anxiety and panic disorder is ataque de nervios (ADN) or “attack of the nerves” that may be exhibited in Hispanic populations. Symptoms of ADNs can vary widely but are typically described as an experience of distress characterized by a general sense of being out of control. The most common symptoms include uncontrollable shouting, attacks of crying, trembling, and heat in the chest rising into the head. Suicidal gestures, seizures, or fainting episodes may be observed. These symptoms are reported to typically occur following a distressing event such as an interpersonal conflict or the death of a loved one.[4] DiagnosesAnxiety is a NANDA-I nursing diagnosis and described as “vague, uneasy feeling of discomfort or dread accompanied by an autonomic response; a feeling of apprehension caused by anticipation of danger. It is an alerting sign that warns of impending danger and enables the individual to take measures to deal with the threat.”[5] Read selected defining characteristics of anxiety in the preceding “Assessment” subsection or consult an evidence-based nursing care plan resource. Outcome IdentificationThe overall goal for anyone experiencing anxiety is to reduce the frequency and intensity of the anxiety symptoms. SMART outcomes are individualized to the client’s diagnosed conditions, situational factors, and current status. Planning outcomes in small, attainable steps can help a client gain a sense of control over their anxiety.[6] Examples of SMART outcomes include:
Planning InterventionsThe client should be encouraged to participate in planning outcomes and interventions tailored to their situation and needs. This will increase the likelihood that the interventions will be successful. Keep in mind that clients with severe anxiety or panic may not be able to participate in planning and rely on the nurse to take a directive role.[7] Implementing InterventionsSafetyIf a client is diagnosed with risk for suicide, interventions to maintain their safety receive priority. Review interventions for clients with a risk for suicide in the “Application of the Nursing Process in Mental Health Care” chapter. If a client’s anxiety continues to escalate and they become agitated, measures must be taken to keep them and others safe. The nurse may find that administering prescribed medications, initiating time in a quiet room, seclusion, or restraints is required. Review crisis intervention in the “Stress, Coping, and Crisis Intervention” chapter. Review information regarding the use of seclusion and restraints in the “Psychosis and Schizophrenia” chapter. Mild to Moderate AnxietyThe nurse can reduce a client’s anxiety level and prevent escalation by providing a calm presence in a quiet environment, acknowledging their feelings of distress, and actively listening. Using therapeutic techniques like open-ended questions, distraction, exploring, and seeking clarification can be used to relieve the client’s feelings of tension and focus on previously successful coping strategies.[8] Review therapeutic communication techniques in the “Therapeutic Communication and the Nurse-Client Relationship” chapter. It may be helpful to encourage the client to participate in physical activities that may provide relief from tension and increase endorphin levels. For example, the nurse can encourage the mildly anxious client to walk or play ping-pong.[9] Severe Anxiety to PanicA person experiencing severe anxiety to panic is often unable to solve problems or grasp what is going on in the environment. The nurse should also remain with a client experiencing acute, severe, or panic levels of anxiety. Therapeutic communication should focus on helping the client feel safe. Firm, short, simple statements using a slow, low-pitched voice are helpful.[10] In addition to keeping the client and others safe, priority nursing interventions for a client experiencing severe anxiety focus on the client’s physical needs, such as fluids to prevent dehydration, blankets for warmth, and rest to prevent exhaustion. If a person continues to constantly move or pace despite interventions, high-calorie finger foods may be offered to maintain their nutrition.[11] Read additional interventions related to crisis intervention in the “Stress, Coping, and Crisis Intervention” chapter. EvaluationRefer to the individualized SMART outcomes established for each client when evaluating the effectiveness of interventions in the care plan. In general, evaluation of outcomes with clients with anxiety disorders includes the following questions[12]:
Which approach can be used while caring for a patient diagnosed with anxiety?Psychotherapy. Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. It can be an effective treatment for anxiety. Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders.
What are nursing interventions for generalized anxiety disorder?The nursing interventions for anxiety disorders are: Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa. Assure client of safety.
Which treatment should a nurse identify as most appropriate for patients diagnosed with generalized anxiety disorder GAD )?Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.
How do you treat generalized anxiety disorder?Generalized anxiety disorder self-help tip 1: Connect with others. Build a strong support system. ... . Talk it out when your worries start spiraling. ... . Know who to avoid when you're feeling anxious. ... . Be aware that having GAD can get in the way of your ability to connect with others.. |
Which approach would the nurse use when managing the care of a client diagnosed with generalized anxiety disorder?
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