Nursing care of the patient with anxiety disorder
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This article discusses nursing care for patients with anxiety disorder, including generalized anxiety disorder and panic disorder. It emphasizes the importance of empathy and effective communication skills in building a therapeutic relationship with the patient. The article also provides patient education on Paroxetine 20mg PO daily.
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Nursing care of the patient with anxiety disorder
Generalized Anxiety disorder
Anxiety is the common feeling that is experienced by most of the people. But an
anxiety disorder is the mental illness that causes persistent anxiety thoughts.
Persistent anxiety thoughts cause distress which significantly affects the normal life
of the person. Generalized anxiety disorder is said to be a constant anxiety feeling
which makes a person think and worry about various things of life for a duration of
six months or more. The person suffering from generalized anxiety disorder will be
expecting some problem that is related to health, family, job, relationship, financial
status, and various other problems. The person with a generalized anxiety disorder
finds it hard to manage their meaningless worry. Most of the time the person worries
without any rationale (Tuma, 2016). An individual is diagnosed to have generalized
anxiety disorder when he/ she are unable to control his worries. Common signs and
symptoms of generalized anxiety disorder are constant worries without any rationale,
make plans that are impossible and trying to find solution for the problems,
misperception of situations as a frightening, unable to handle the simple problems
and situations, persistent wavering mind and fear of making a incorrect decision,
unable to relax, rest, sleep and always feeling like on the edge and lack of
concentration in any work.
Panic disorder is one type of anxiety disorder. Panic disorder is said to be an
overwhelmed fear and anxiety which causes recurrent episodes of panic attacks. It is
the sudden onset of uncontrollable fear that causes discomfort and various other
related symptoms. A person suffering from the panic disorder will have a persistent
fear of panic attacks (Thibaut,2017).The feeling of fear is overwhelmed which is not
Generalized Anxiety disorder
Anxiety is the common feeling that is experienced by most of the people. But an
anxiety disorder is the mental illness that causes persistent anxiety thoughts.
Persistent anxiety thoughts cause distress which significantly affects the normal life
of the person. Generalized anxiety disorder is said to be a constant anxiety feeling
which makes a person think and worry about various things of life for a duration of
six months or more. The person suffering from generalized anxiety disorder will be
expecting some problem that is related to health, family, job, relationship, financial
status, and various other problems. The person with a generalized anxiety disorder
finds it hard to manage their meaningless worry. Most of the time the person worries
without any rationale (Tuma, 2016). An individual is diagnosed to have generalized
anxiety disorder when he/ she are unable to control his worries. Common signs and
symptoms of generalized anxiety disorder are constant worries without any rationale,
make plans that are impossible and trying to find solution for the problems,
misperception of situations as a frightening, unable to handle the simple problems
and situations, persistent wavering mind and fear of making a incorrect decision,
unable to relax, rest, sleep and always feeling like on the edge and lack of
concentration in any work.
Panic disorder is one type of anxiety disorder. Panic disorder is said to be an
overwhelmed fear and anxiety which causes recurrent episodes of panic attacks. It is
the sudden onset of uncontrollable fear that causes discomfort and various other
related symptoms. A person suffering from the panic disorder will have a persistent
fear of panic attacks (Thibaut,2017).The feeling of fear is overwhelmed which is not
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controlled by a person or any other means. Signs and symptoms associated with the
panic disorder are increased heart rate, rapid breathing, and profuse sweating, feel
like choking, giddiness, nausea, chilled extremities, altered mental status, tingling
sensation in the extremities, chest pain and fear of death. The cause for the panic
disorder is unknown. Panic attacks are generally experienced by most of the people,
as it happens when a person experiences an important transition in their life. Anxiety
and panic attacks are a common psychological issue that is experienced by all the
people. But generalized anxiety disorder and panic disorders are a mental illness
that needs medical intervention (Cui, 2016). Both panic disorder and generalized
anxiety disorder have diverse signs and symptoms and both the mental illness
significantly affects the normal life of a person.
Empathy in the therapeutic relationship
Empathy is an essential tool to build a therapeutic relationship with the patient
suffering from a mental illness. The therapeutic relationship is building a relationship
for the therapeutic purpose with help of mutual trust, hope, and respect. Especially
the relationship between the nurse and the patient is essential for a better outcome.
The therapeutic relationship helps the nurse to understand both the physical and
psychological need of the patient and ensure holistic nursing care. Empathy is also a
vital tool which helps the nurse to communicate and build the rapport that
complements the recovery of the patient (Conoley, 2015). Nursing care with empathy
communication encourages the patient to participate in the nursing care and
treatment. In the case of Mr. Peter, he was suffering from uncontrollable fear which
has no rationale and meaning. His family may not listen to his fearful words or
respond to him (Wiechula,2016). The nurse has to implement communication
panic disorder are increased heart rate, rapid breathing, and profuse sweating, feel
like choking, giddiness, nausea, chilled extremities, altered mental status, tingling
sensation in the extremities, chest pain and fear of death. The cause for the panic
disorder is unknown. Panic attacks are generally experienced by most of the people,
as it happens when a person experiences an important transition in their life. Anxiety
and panic attacks are a common psychological issue that is experienced by all the
people. But generalized anxiety disorder and panic disorders are a mental illness
that needs medical intervention (Cui, 2016). Both panic disorder and generalized
anxiety disorder have diverse signs and symptoms and both the mental illness
significantly affects the normal life of a person.
Empathy in the therapeutic relationship
Empathy is an essential tool to build a therapeutic relationship with the patient
suffering from a mental illness. The therapeutic relationship is building a relationship
for the therapeutic purpose with help of mutual trust, hope, and respect. Especially
the relationship between the nurse and the patient is essential for a better outcome.
The therapeutic relationship helps the nurse to understand both the physical and
psychological need of the patient and ensure holistic nursing care. Empathy is also a
vital tool which helps the nurse to communicate and build the rapport that
complements the recovery of the patient (Conoley, 2015). Nursing care with empathy
communication encourages the patient to participate in the nursing care and
treatment. In the case of Mr. Peter, he was suffering from uncontrollable fear which
has no rationale and meaning. His family may not listen to his fearful words or
respond to him (Wiechula,2016). The nurse has to implement communication
strategies to understand the fearful thoughts of peter. Understanding the patient’s
problem helps the nurse to plan the nursing care and implement for the speedy
recovery of the patient.
Anxiety disorder affects the daily routine and also family relationships. Because the
family member is unable to understand the intensity of the fearful thought of peter.
The nurse has to use empathy in communicating with peter to understand the patient
condition. Empathy and therapeutic communication implemented in the care of peter
encourages him to express his feelings of fear. The nurse has to listen to his
expression of fearful thoughts (Fischman, 2015).The nurse has to concentrate on the
most common fearful thought of peter. His most common thought is ‘what if’. The
nurse has to use a confessing statement ‘I understand’ which builds the trust in
nurse –patient relationship. The nurse has to explain peter that occurrence the
fearful thoughts are due to the disease condition. The nurse has to provide a
complete explanation to the patient regarding the mental disorder he is suffering
from and make him understand the fearful thoughts are caused by the mental
disorder. The nurse has to extend the communication to the family members and
encourage them to understand the condition of peter and co-operate with the nursing
care. The nurse caring for the anxiety patient has to implement empathy and
therapeutic relationship for a better outcome.
Effective communication skills
Communication is the essential tool which builds the patient – nurse relationship and
also aids in the treatment of the patient. It is essential to implement the effective
communication skills to meet the physical, mental and social need of the patient.
Generally, the nurse has to use therapeutic relationship strategies in nursing care.
problem helps the nurse to plan the nursing care and implement for the speedy
recovery of the patient.
Anxiety disorder affects the daily routine and also family relationships. Because the
family member is unable to understand the intensity of the fearful thought of peter.
The nurse has to use empathy in communicating with peter to understand the patient
condition. Empathy and therapeutic communication implemented in the care of peter
encourages him to express his feelings of fear. The nurse has to listen to his
expression of fearful thoughts (Fischman, 2015).The nurse has to concentrate on the
most common fearful thought of peter. His most common thought is ‘what if’. The
nurse has to use a confessing statement ‘I understand’ which builds the trust in
nurse –patient relationship. The nurse has to explain peter that occurrence the
fearful thoughts are due to the disease condition. The nurse has to provide a
complete explanation to the patient regarding the mental disorder he is suffering
from and make him understand the fearful thoughts are caused by the mental
disorder. The nurse has to extend the communication to the family members and
encourage them to understand the condition of peter and co-operate with the nursing
care. The nurse caring for the anxiety patient has to implement empathy and
therapeutic relationship for a better outcome.
Effective communication skills
Communication is the essential tool which builds the patient – nurse relationship and
also aids in the treatment of the patient. It is essential to implement the effective
communication skills to meet the physical, mental and social need of the patient.
Generally, the nurse has to use therapeutic relationship strategies in nursing care.
Trust, respect, hope, meeting therapeutic the needs of others are the components of
the therapeutic relationship (Abdolrahimi,2017). The therapeutic relationship can be
achieved by implementing therapeutic communication which helps to provide patient
centered care. Therapeutic person centered relationship is said to be meeting the
physical, emotional and spiritual needs of the patients. It helps in meeting the
curative needs of the patient In the case of peter, the therapeutic relationship is
essential to understand the patient’s feelings, fearful thoughts, and the intensity of
the anxiety. The primary tool that has to be used for therapeutic communication is
listening. The nurse has to listen to the patient and encourage him to express his
fearful feelings. The nurse should educate and encourage the patient’s family to
listen to the patient and support him in the process of therapy.
Listening builds trust and hope which helps the nurse to understand the condition of
the patient. Verbal and non-verbal communications are the primary communication
tools commonly used for communication. The nurse has to use verbal
communication to understand the patient condition and educate the patient. The
aspects of Non-verbal communication are posture, facial expression, eye contact,
and smile. Combination of Verbal communication and non-verbal communication
together forms an effective therapeutic communication. The nurse has use non-
verbal communication while taking with peter as it builds trust in the relationship and
encourages peter to express his fearful thoughts. The nurse has to use respectful
communication skill which reduces the patient’s fearful thoughts and helps the
patient to build his confidence. The nurse has to show compassion while
communicating with peter, because he is frightened, and feeling helpless.
Compassionate communication helps the nurse to interview peter. Compassionate
communication helps the nurse to place herself in the place of the patient whereby
the therapeutic relationship (Abdolrahimi,2017). The therapeutic relationship can be
achieved by implementing therapeutic communication which helps to provide patient
centered care. Therapeutic person centered relationship is said to be meeting the
physical, emotional and spiritual needs of the patients. It helps in meeting the
curative needs of the patient In the case of peter, the therapeutic relationship is
essential to understand the patient’s feelings, fearful thoughts, and the intensity of
the anxiety. The primary tool that has to be used for therapeutic communication is
listening. The nurse has to listen to the patient and encourage him to express his
fearful feelings. The nurse should educate and encourage the patient’s family to
listen to the patient and support him in the process of therapy.
Listening builds trust and hope which helps the nurse to understand the condition of
the patient. Verbal and non-verbal communications are the primary communication
tools commonly used for communication. The nurse has to use verbal
communication to understand the patient condition and educate the patient. The
aspects of Non-verbal communication are posture, facial expression, eye contact,
and smile. Combination of Verbal communication and non-verbal communication
together forms an effective therapeutic communication. The nurse has use non-
verbal communication while taking with peter as it builds trust in the relationship and
encourages peter to express his fearful thoughts. The nurse has to use respectful
communication skill which reduces the patient’s fearful thoughts and helps the
patient to build his confidence. The nurse has to show compassion while
communicating with peter, because he is frightened, and feeling helpless.
Compassionate communication helps the nurse to interview peter. Compassionate
communication helps the nurse to place herself in the place of the patient whereby
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she can understand the actual status of the patient which the the nurse to collect
needed information from the patient for the therapeutic purpose. In the case of peter,
the nurse has to implement empathy, therapeutic relationship and use effective
communication skills to understand the condition of the patient and interview him to
collect the needed information.
Paroxetine 20mg PO daily – patient education
Mr. Peter is suffering from various symptoms like distresse, sweating, worries
regarding his work, fears making a mistake in his work and his most common
thought is ‘what if’? Peter’s present medical condition shows that he is suffering from
various symptoms of mental disorder. Paroxetine is an antidepressant commonly
prescribed for patients suffering from depression and anxiety disorders. The main
action of the Paroxetine is, it balances the chemical present in the brain which
causes the imbalance in the people which results in the mental illnesses like
depression, panic disorder, obsessive compulsive disorder, anxiety, and various
other mental disorders (Borrelli, 2019).Patient education on the medication includes
dosage, adverse reaction, and points to be remembered on the administration of
medication. Paroxetine should not be taken with some of the specific medications
like pimozide, thioridazine or tryptophan. If the patient is taking the other medications
then he has to inform that to the nurse or a doctor. Antidepressant can cause
thoughts of suicide when consumed for the first time which is considered to be the
Common side effect of the antidepressant. So any changes in the mood have to be
informed to the nurse and doctor.
Antidepressants s cause several side effects like disturbance, hallucination, muscle
stiffness, trembleness, loss of coordination, giddiness, nauseated feeling, vomiting,
needed information from the patient for the therapeutic purpose. In the case of peter,
the nurse has to implement empathy, therapeutic relationship and use effective
communication skills to understand the condition of the patient and interview him to
collect the needed information.
Paroxetine 20mg PO daily – patient education
Mr. Peter is suffering from various symptoms like distresse, sweating, worries
regarding his work, fears making a mistake in his work and his most common
thought is ‘what if’? Peter’s present medical condition shows that he is suffering from
various symptoms of mental disorder. Paroxetine is an antidepressant commonly
prescribed for patients suffering from depression and anxiety disorders. The main
action of the Paroxetine is, it balances the chemical present in the brain which
causes the imbalance in the people which results in the mental illnesses like
depression, panic disorder, obsessive compulsive disorder, anxiety, and various
other mental disorders (Borrelli, 2019).Patient education on the medication includes
dosage, adverse reaction, and points to be remembered on the administration of
medication. Paroxetine should not be taken with some of the specific medications
like pimozide, thioridazine or tryptophan. If the patient is taking the other medications
then he has to inform that to the nurse or a doctor. Antidepressant can cause
thoughts of suicide when consumed for the first time which is considered to be the
Common side effect of the antidepressant. So any changes in the mood have to be
informed to the nurse and doctor.
Antidepressants s cause several side effects like disturbance, hallucination, muscle
stiffness, trembleness, loss of coordination, giddiness, nauseated feeling, vomiting,
diarrhoea, fever, sweating, shivering, rapid heart rate, and seizure. The patient has
to take Paroxetine as advised by the doctor and nurse. The patient should not take
more dosage than the recommended dosage. the patient should not break or crush
the medication and also he should not chew the medication. It has to be swallowed
which improves the action and benefits of the medication. The medication is realised
slowly and the action will be long lasting. Medication has to be continued even after
the symptoms are stopped and recovery as per the directions of the doctor. The
medication should not be stopped abruptly as it may cause severe adverse reactions
(Schalet,2016).Medication has to be kept away from the sunlight, heat, and wetness.
The patient has to stop the medication gradually according to the advice of the
doctor. Overdose of this medication may be fatal so the patient has to be aware of
the prescribed dosage. The nurse has to educate the patient about the medication
administration and the family also need to be included in the patient education which
helps the family members to support peter in the treatment course.
References
Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017).
Therapeutic communication in nursing students: A Walker & Avant concept
analysis. Electronic physician, 9(8), 4968
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614280/
Borrelli Jr, J., Starr, A., Downs, D. L., & North, C. S. (2019). Prospective Study of the
Effectiveness of Paroxetine on the Onset of Posttraumatic Stress Disorder,
Depression, and Health and Functional Outcomes After Trauma. Journal of
orthopaedic trauma, 33(2), e58-e63
to take Paroxetine as advised by the doctor and nurse. The patient should not take
more dosage than the recommended dosage. the patient should not break or crush
the medication and also he should not chew the medication. It has to be swallowed
which improves the action and benefits of the medication. The medication is realised
slowly and the action will be long lasting. Medication has to be continued even after
the symptoms are stopped and recovery as per the directions of the doctor. The
medication should not be stopped abruptly as it may cause severe adverse reactions
(Schalet,2016).Medication has to be kept away from the sunlight, heat, and wetness.
The patient has to stop the medication gradually according to the advice of the
doctor. Overdose of this medication may be fatal so the patient has to be aware of
the prescribed dosage. The nurse has to educate the patient about the medication
administration and the family also need to be included in the patient education which
helps the family members to support peter in the treatment course.
References
Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017).
Therapeutic communication in nursing students: A Walker & Avant concept
analysis. Electronic physician, 9(8), 4968
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614280/
Borrelli Jr, J., Starr, A., Downs, D. L., & North, C. S. (2019). Prospective Study of the
Effectiveness of Paroxetine on the Onset of Posttraumatic Stress Disorder,
Depression, and Health and Functional Outcomes After Trauma. Journal of
orthopaedic trauma, 33(2), e58-e63
https://journals.lww.com/jorthotrauma/Abstract/2019/02000/Prospective_Stud
y_of_the_Effectiveness_of.13.aspx
Cui, H., Zhang, J., Liu, Y., Li, Q., Li, H., Zhang, L., ... & Li, W. (2016). Differential
alterations of resting‐state functional connectivity in generalized anxiety
disorder and panic disorder. Human brain mapping, 37(4), 1459-1473
https://onlinelibrary.wiley.com/doi/abs/10.1002/hbm.23113
Conoley, C. W., Pontrelli, M. E., Oromendia, M. F., Carmen Bello, B. D., & Nagata,
C. M. (2015). Positive empathy: A therapeutic skill inspired by positive
psychology. Journal of Clinical Psychology, 71(6), 575-583.
https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22175
Fischman, D. (2015). Therapeutic relationships and kinesthetic empathy. In The art
and science of dance/movement therapy (pp. 65-84). Routledge
https://www.taylorfrancis.com/books/e/9781315693477/chapters/10.4324/978
1315693477-16
Lader, M. (2015). Generalized anxiety disorder. Encyclopedia of
psychopharmacology, 699-702
https://link.springer.com/referenceworkentry/10.1007%2F978-3-642-36172-
2_317
Schalet, B. D., Tang, T. Z., DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., &
Shelton, R. C. (2016). Specific pharmacological effects of paroxetine
comprise psychological but not somatic symptoms of depression. PloS
one, 11(7), e0159647
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159647
y_of_the_Effectiveness_of.13.aspx
Cui, H., Zhang, J., Liu, Y., Li, Q., Li, H., Zhang, L., ... & Li, W. (2016). Differential
alterations of resting‐state functional connectivity in generalized anxiety
disorder and panic disorder. Human brain mapping, 37(4), 1459-1473
https://onlinelibrary.wiley.com/doi/abs/10.1002/hbm.23113
Conoley, C. W., Pontrelli, M. E., Oromendia, M. F., Carmen Bello, B. D., & Nagata,
C. M. (2015). Positive empathy: A therapeutic skill inspired by positive
psychology. Journal of Clinical Psychology, 71(6), 575-583.
https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22175
Fischman, D. (2015). Therapeutic relationships and kinesthetic empathy. In The art
and science of dance/movement therapy (pp. 65-84). Routledge
https://www.taylorfrancis.com/books/e/9781315693477/chapters/10.4324/978
1315693477-16
Lader, M. (2015). Generalized anxiety disorder. Encyclopedia of
psychopharmacology, 699-702
https://link.springer.com/referenceworkentry/10.1007%2F978-3-642-36172-
2_317
Schalet, B. D., Tang, T. Z., DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., &
Shelton, R. C. (2016). Specific pharmacological effects of paroxetine
comprise psychological but not somatic symptoms of depression. PloS
one, 11(7), e0159647
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159647
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Tuma, A. H., & Maser, J. D. (Eds.). (2016). Anxiety and the anxiety disorders.
Routledge https://books.google.co.in/books?
hl=en&lr=&id=r3t_DwAAQBAJ&oi=fnd&pg=PT11&dq=anxiety+disorders&ots=
slw7UlFFEA&sig=ho-vtml2ofN3m6OLxNiGzwA_a-
8&redir_esc=y#v=onepage&q=anxiety%20disorders&f=false
Thibaut, F. (2017). Anxiety disorders: a review of current literature. Dialogues in
clinical neuroscience, 19(2), 87.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573565/
Wiechula, R., Conroy, T., Kitson, A. L., Marshall, R. J., Whitaker, N., & Rasmussen,
P. (2016). Umbrella review of the evidence: what factors influence the caring
relationship between a nurse and patient?. Journal of Advanced
Nursing, 72(4), 723-734
https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12862
Routledge https://books.google.co.in/books?
hl=en&lr=&id=r3t_DwAAQBAJ&oi=fnd&pg=PT11&dq=anxiety+disorders&ots=
slw7UlFFEA&sig=ho-vtml2ofN3m6OLxNiGzwA_a-
8&redir_esc=y#v=onepage&q=anxiety%20disorders&f=false
Thibaut, F. (2017). Anxiety disorders: a review of current literature. Dialogues in
clinical neuroscience, 19(2), 87.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573565/
Wiechula, R., Conroy, T., Kitson, A. L., Marshall, R. J., Whitaker, N., & Rasmussen,
P. (2016). Umbrella review of the evidence: what factors influence the caring
relationship between a nurse and patient?. Journal of Advanced
Nursing, 72(4), 723-734
https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12862
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