Generalized Anxiety Disorder
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Outline
Overview
- Definition: Daily unrealistic, excessive, uncontrollable, persistent anxiety that manifests into physical symptoms
Nursing Points
General
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The symptoms can’t be explained by other physiological disorders
Assessment
- Issues with sleeping
- Irritability
- Difficulty concentrating
- Muscular tension
- “On edge” all the time
- Patient is hyper-focused on physical symptoms
Therapeutic Management
- Interventions if patient is experiencing a panic attack (sudden intense fear and apprehension)
- Determine what thoughts initiated/ triggered the attack
- Reorient them or rationalize thoughts
- Help to restructure distorted thoughts
- Treat/medicate for anxiety first
- Address physical symptoms
Nursing Concepts
- Safety
- Coping
- Mood Affect
Patient Education
- Identify and avoid triggers
- Have a resource for who to call or what to do when the anxiety gets too difficult to handle
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Transcript
So, in this lesson we’re going to talk about Generalized Anxiety Disorder, sometimes abbreviated GAD. We want to help you differentiate this from the anxiety we talked about in the last lesson.
This isn’t just the occasional anxiety, this is daily, unrealistic, excessive, uncontrollable, persistent anxiety. These people live their everyday lives, day in and day out, up here in the moderate to severe anxiety range. They absolutely cannot turn it off, they cannot release it, and it begins to manifest into physical symptoms. The other way we differentiate between GAD and anxiety is that with GAD there is a clinically significant impact on their daily functioning – it keeps them from being able to do normal daily tasks like going to the grocery store, or even getting out of bed. And for diagnostic purposes, there is no other way we can explain these thoughts and feelings they’re having.
So, like I said, GAD tends to manifest regularly into physical symptoms. They’ll have sleeping troubles – trouble falling asleep, trouble staying asleep. Think about the worst anxiety you’ve ever felt, let’s say before a test, or the night before a big game, or before your wedding – could you sleep? Didn’t you wake up throughout the night? Now, imagine feeling that way every single night. You can see how sleep becomes an issue, right? And of course – when you’re anxious and not sleeping – you’re going to be irritable and struggle to concentrate. There’s just too much on your mind. Then, this anxiety starts to manifest itself as muscle tension…Usually it can be in the head, neck, and shoulders, but I’ve actually been known to carry a lot of anxious tension in my lower back and hips, so it’s different for everyone. These patients are on edge all the time and may become hyper-focused on their physical symptoms. It’s hard for them to understand that the physical symptoms are only there because of the mental health issue – so their anxiety may get worse thinking that there’s something physically wrong with them.
So, when someone starts to spiral into panic mode, we want to make sure we address the anxiety first – what’s causing it, how can we help them calm down – and then look at addressing the physical symptoms. Think about it this way – if I’m in so much pain that I’m nauseated…you can give me medication for the nausea, but it’s going to just keep coming back, right? BUT – if you address my pain, chances are the nausea will be taken care of as well, right? Or how about someone who has a bad headache because their blood pressure is too high? Get that blood pressure down and their headache will probably go away. So, we do want to deal with the anxiety first. We can help them identify what triggered the panic attack, help reorient them to reality. We also want to try to help them restructure any disorganized thinking and bring some rational thought back. Remember we talked in the last lesson that during a panic attack, the patient loses their ability for rational thought – so we can help do that for them. Okay? So address the anxiety first, possibly even with medication, and then worry about the physical symptoms.
When it comes to nursing priority concepts, safety will always be first. We want to protect them from hurting themselves or others and make sure they’re in a calm, safe environment. We help them identify their triggers and provide them with resources on what to do if their symptoms return or how to have a plan when they’re spiraling up to the panic level. And then we want to monitor their mood and affect, especially to look for any risks of self-harm.
So let’s recap quickly. Generalized Anxiety Disorder is a persistent, daily, excessive anxiety that is pervasive and impacts their daily life. It usually manifests in physical symptoms like muscle tension and trouble sleeping. We want to help reorient and rationalize and disorganized thoughts while we address the anxiety before the physical symptoms. And we always put safety as our number one priority.
So that’s it for Generalized Anxiety Disorder – make sure you check out the care plan and patient story attached to this lesson to learn more and to see this condition from multiple angles. We love you guys. Go out and be your best selves today. And, as always, happy nursing!
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