References:
- Course Module
Panic disorders involve discrete episodes of panic attacks, that is, 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiological discomfort. During a panic attack, the person has overwhelmingly intense anxiety and displays four or more of the following symptoms: palpitations, sweating, tremors, shortness of breath, sense of suffocation, chest pain, nausea, abdominal distress, dizziness, paresthesias, chills, or hot flashes.
- Diagnosed when the person has recurrent, unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks or their meaning or a significant behavioral change related to them.
- Suicidal ideation and attempts is prevalent in patients with panic disorder.
- Avoidance behavior is formed from the fear of another panic attack. The person may become homebound or stay in a limited area near home— agoraphobia.
- Gratification from avoidance behaviors can be described with primary gain and secondary gain. Primary gain refers to relief of anxiety by performing the specific anxiety-driven behavior, such as staying in the house to avoid the anxiety of leaving a safe place. Secondary gain is the attention received from others as a result of these behaviors. For instance, the person with agoraphobia may receive attention and caring concern from family members who also assume all the responsibilities of family life outside the home; the compassionate significant others become enablers of the self-imprisonment of the person with agoraphobia.
Treatment
Panic disorder is treated with CBTs, deep breathing and relaxation, and medications such as benzodiazepines, SSRI antidepressants, tricyclic antidepressents, and antihypertensives such as clonidine (Catapres) and propronalol (Inderal).
- Promoting Safety and Comfort: the nurse’s first concern is to provide a safe environment and to ensure the client’s privacy during a panic attack.
- The client should be moved to a non-stimulating environment to reduce anxiety and provides privacy for the client.
- The nurse remains with the client to help calm him or her down and to assess client behaviors and concerns.
- The nurse uses a soothing, calm voice and gives brief directions to assure the client that he or she is safe. Reassurances and a calm demeanor can help reduce anxiety. When the client feels out of control, the nurse can let the client know that the nurse is in control until the client regains self-control.
- Using Therapeutic Communication:
- Clients with anxiety disorders can collaborate with the nurse in the assessment and planning of their care; thus, rapport between the nurse and the client is important.
- Communication should be simple and calm because the client with severe anxiety cannot pay attention to lengthy messages and may pace to release energy. The nurse can walk with the client who feels unable to sit and talk.
- The nurse should carefully evaluate the use of touch because clients with high anxiety may interpret touch by a strange as a threat and pull away abruptly.
- As the client’s anxiety diminishes, cognition begins to return. When anxiety has subsided to a manageable level, the nurse uses open-ended communication techniques to discuss the experience.
- Managing Anxiety: the nurse can teach the client relaxation techniques to use when he or she is experiencing stress or anxiety. All of these techniques should be practiced while the client is relatively calm.
- Deep breathing is simple; anyone can do it.
- Guided imagery: imagining a safe, enjoyable place to relax.
- Progressive relaxation: progressively tightens, holds, and then relaxes muscle groups while letting tension flow from the body through rhythmic breathing.
- Cognitive restructuring techniques may also help the client manage his or her anxiety response.