Generalized Anxiety Disorder

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Nichole Weaver
MSN/Ed,RN,CCRN
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Included In This Lesson

Study Tools For Generalized Anxiety Disorder

Generalized Anxiety Disorder Pathochart (Cheatsheet)
Anxiety Assessment (Picmonic)
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Outline

 Overview

  1. Definition: Daily unrealistic, excessive, uncontrollable, persistent anxiety that manifests into physical symptoms

Nursing Points

General

  1. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  2. The symptoms can’t be explained by other physiological disorders

Assessment

  1. Issues with sleeping
  2. Irritability
  3. Difficulty concentrating
  4. Muscular tension
  5. “On edge” all the time
  6. Patient is hyper-focused on physical symptoms

Therapeutic Management

  1. Interventions if patient is experiencing a panic attack (sudden intense fear and apprehension)
    1. Determine what thoughts initiated/ triggered the attack
    2. Reorient them or rationalize thoughts
    3. Help to restructure distorted thoughts
    4. Treat/medicate for anxiety first
    5. Address physical symptoms

Nursing Concepts

  1. Safety
  2. Coping
  3. Mood Affect

Patient Education

  1. Identify and avoid triggers
  2. 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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Concepts Covered:

  • Gastrointestinal
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  • Oncology Disorders
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Study Plan Lessons

05.02 Liver Overview and Disease for CCRN Review
Airway Suctioning
Antidiabetic Agents
Cirrhosis Case Study (45 min)
Colonoscopy
Encephalopathies
Enteral & Parenteral Nutrition (Diet, TPN)
Gastrointestinal (GI) Bleed Concept Map
Insulin
Insulin Mnemonic (Ready, Set, Inject, Love)
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Pancreatitis
Nursing Case Study for Hepatitis
08.01 Psychological Review for CCRN Review
Addiction – Behavioral Problems Nursing Mnemonic (The 5 D’s)
Albumin Lab Values
Alcohol Withdrawal (Addiction)
Alcohol Withdrawal Case Study (45 min)
Alcoholism – Outcomes Nursing Mnemonic (BAD)
Alprazolam (Xanax) Nursing Considerations
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Alzheimer – Diagnosis Nursing Mnemonic (The 5 A’s)
Ammonia (NH3) Lab Values
Anorexia – Signs and Symptoms Nursing Mnemonic (ANOREXIA)
Antianxiety Meds
Antianxiety Meds
Antidepressants
Antidepressants
Antipsychotics
Antipsychotics
Anxiety
Anxiety Disorders (PTSD, Anxiety, Panic Attack) for Certified Emergency Nursing (CEN)
Atypical Antipsychotics
Benzodiazepines
Benzodiazepines Nursing Mnemonic (Donuts and TLC)
Blood Urea Nitrogen (BUN) Lab Values
Bulimia – Signs and Symptoms 1 Nursing Mnemonic (BULIMIA)
Bulimia – Signs and Symptoms 2 Nursing Mnemonic (WASHED)
Buspirone (Buspar) Nursing Considerations
Calcium-Ca (Hypercalcemia, Hypocalcemia)
Carbamazepine (Tegretol) Nursing Considerations
Chloride-Cl (Hyperchloremia, Hypochloremia)
Chlorpromazine (Thorazine) Nursing Considerations
Cholesterol (Chol) Lab Values
Cognitive Impairment Disorders
Creatinine (Cr) Lab Values
Day in the Life of a Hospice, Palliative Care Nurse
Day in the Life of a Mental Health Nurse
Defense Mechanisms
Defense Mechanisms
Dementia Nursing Mnemonic (DEMENTIA)
Depression
Depression Assessment Nursing Mnemonic (SIGNS)
Depression Concept Map
Diazepam (Valium) Nursing Considerations
Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)
Dissociative Disorders
Divalproex (Depakote) Nursing Considerations
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Encephalopathy Case Study (45 min)
End of Life for Progressive Care Certified Nurse (PCCN)
End-of-Life and Palliative Care (Organ and Tissue Donation, Advance Directives, Care Withholding, Family Presence) for Certified Emergency Nursing (CEN)
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Generalized Anxiety Disorder
Glomerular Filtration Rate (GFR)
Grief and Loss
Grief and Loss
Haloperidol (Haldol) Nursing Considerations
Handling Death and Dying
Head to Toe Nursing Assessment (Physical Exam)
Homicidal and Suicidal Ideation for Certified Emergency Nursing (CEN)
Hypochondriasis (Hypochondriac)
Lamotrigine (Lamictal) Nursing Considerations
Lithium (Lithonate) Nursing Considerations
Lithium Lab Values
Liver Function Tests
Lorazepam (Ativan) Nursing Considerations
Magnesium-Mg (Hypomagnesemia, Hypermagnesemia)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
MAOIs
Meds for Alzheimers
Mental Health Course Introduction
Metabolic Alkalosis
Methadone (Methadose) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Mood Disorders (Bipolar)
Mood Stabilizers
Mood Stabilizers
Nurse-Patient Relationship
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Anxiety
Nursing Care Plan (NCP) for Depression
Nursing Care Plan (NCP) for Dissociative Disorders
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Paranoid Disorders
Nursing Care Plan (NCP) for Personality Disorders
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Somatic Symptom Disorder (SSD)
Nursing Care Plan (NCP) for Suicidal Behavior Disorder
Nursing Case Study for (PTSD) Post Traumatic Stress Disorder
Nursing Case Study for Bipolar Disorder
Nursing Case Study for Mania (Manic Syndrome)
Olanzapine (Zyprexa) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
Palliative Care for Progressive Care Certified Nurse (PCCN)
Paranoid Disorders
Paroxetine (Paxil) Nursing Considerations
Personality Disorders
Phases of Nurse-Client Relationship
Phosphorus-Phos
Post-Traumatic Stress Disorder (PTSD)
Postmortem Care
Potassium-K (Hyperkalemia, Hypokalemia)
Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)
Quetiapine (Seroquel) Nursing Considerations
Schizophrenia
Schizophrenia Case Study (45 min)
Self Concept
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Sertraline (Zoloft) Nursing Considerations
Sodium-Na (Hypernatremia, Hyponatremia)
Somatoform
Somatoform Disorder Case Study (30 min)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
SSRIs
Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)
Suicidal Behavior
TCAs
Therapeutic Communication
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Thought Disorders (Psychosis, Schizophrenia) for Certified Emergency Nursing (CEN)
Total Bilirubin (T. Billi) Lab Values
Types of Schizophrenia
Urinalysis (UA)
Vitamin B12 Lab Values
12 Points to Answering Pharmacology Questions
6 Rights of Medication Administration
ACLS (Advanced cardiac life support) Drugs
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Anesthetic Agents
Anti-Infective – Antifungals
Anti-Platelet Aggregate
Antianxiety Meds
Antidepressants
Atenolol (Tenormin) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Barbiturates
Bariatric: IV Insertion
Basics of Calculations
Benztropine (Cogentin) Nursing Considerations
Bisacodyl (Dulcolax) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Combative: IV Insertion
Complex Calculations (Dosage Calculations/Med Math)
Cyclosporine (Sandimmune) Nursing Considerations
Dark Skin: IV Insertion
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
Drawing Blood from the IV
Drawing Up Meds
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Epoetin Alfa
Eye Prophylaxis for Newborn
Fentanyl (Duragesic) Nursing Considerations
Geriatric: IV Insertion
Giving Medication Through An IV Set Port
Glipizide (Glucotrol) Nursing Considerations
Guaifenesin (Mucinex) Nursing Considerations
Hanging an IV Piggyback
How to Remove (discontinue) an IV
How to Secure an IV (chevron, transparent dressing)
Hydralazine
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
IM Injections
Injectable Medications
Insulin
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin Drips
Insulin Mixing
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
IV Catheter Selection (gauge, color)
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
IV Drip Administration & Safety Checks
IV Drip Therapy – Medications Used for Drips
IV Infusions (Solutions)
IV Insertion Angle
IV Insertion Course Introduction
IV Placement Start To Finish (How to Start an IV)
IV Pump Management
IV Push Medications
Ketorolac (Toradol) Nursing Considerations
Labeling (Medications, Solutions, Containers) for Certified Perioperative Nurse (CNOR)
Lidocaine (Xylocaine) Nursing Considerations
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
MAOIs
Medication Errors
Medication Reconciliation Review for Certified Perioperative Nurse (CNOR)
Medications in Ampules
Meds for Postpartum Hemorrhage (PPH)
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Methylergonovine (Methergine) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Mood Stabilizers
Nalbuphine (Nubain) Nursing Considerations
Needle Safety
Neostigmine (Prostigmin) Nursing Considerations
NG Tube Med Administration (Nasogastric)
NG Tube Medication Administration
Nitro Compounds
NRSNG Live | The S.O.C.K Method for Mastering Nursing Pharmacology and Never Forgetting a Medication Again
Nystatin (Mycostatin) Nursing Considerations
OB Pharm and What Drugs You HAVE to Know – Live Tutoring Archive
Olanzapine (Zyprexa) Nursing Considerations
Opioid Analgesics in Pregnancy
Oral Medications
Oxycodone (OxyContin) Nursing Considerations
Pain Management for the Older Adult – Live Tutoring Archive
Pain Management Meds – Live Tutoring Archive
Parasympathomimetics (Cholinergics) Nursing Considerations
Patient Controlled Analgesia (PCA)
Pediatric Dosage Calculations
Pentobarbital (Nembutal) Nursing Considerations
Pharmacodynamics
Pharmacokinetics
Pharmacokinetics Nursing Mnemonic (ADME)
Pharmacology Course Introduction
Phenobarbital (Luminal) Nursing Considerations
Phytonadione (Vitamin K) for Newborn
Pill Crushing & Cutting
Positioning
Procainamide (Pronestyl) Nursing Considerations
Propofol (Diprivan) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
Rh Immune Globulin in Pregnancy
Sedatives-Hypnotics
Sedatives-Hypnotics
Selecting THE vein
Spiking & Priming IV Bags
Starting an IV
Streptokinase (Streptase) Nursing Considerations
Struggling with Dimensional Analysis? – Live Tutoring Archive
SubQ Injections
Supplies Needed
Tattoos IV Insertion
TCAs
The SOCK Method – C
The SOCK Method – K
The SOCK Method – O
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method of Pharmacology 1 – Live Tutoring Archive
The SOCK Method of Pharmacology 2 – Live Tutoring Archive
The SOCK Method of Pharmacology 3 – Live Tutoring Archive
Tips & Tricks
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
Understanding All The IV Set Ports
Using Aseptic Technique
Verapamil (Calan) Nursing Considerations
03.02 Diabetes Insipidus for CCRN Review
03.01 Syndrome of Inappropriate Antidiuretic hormone (SIADH) for CCRN Review
03.03 Hypoglycemia for CCRN Review
03.04 DKA vs HHNK for CCRN Review
05.02 Liver Overview and Disease for CCRN Review
Absolute Neutrophil Count (ANC) Lab Values
ACE (angiotensin-converting enzyme) Inhibitors
Addisons Assessment Nursing Mnemonic (STEROID)
Addisons Disease
Airway Suctioning
Anion Gap
Calcium Channel Blockers
Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Coagulation Studies (PT, PTT, INR)
Crohn’s Morphology and Symptoms Nursing Mnemonic (CHRISTMAS)
Cushings Assessment Nursing Mnemonic (STRESSED)
Diabetes Insipidus Case Study (60 min)
Diabetes Insipidus Nursing Mnemonic (DDD)
Diabetes Management
Diabetes Mellitus (DM) Module Intro
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Emergencies for Certified Emergency Nursing (CEN)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Diagnostic Criteria for Lupus Nursing Mnemonic (SOAP BRAIN MD)
DKA Treatment Nursing Mnemonic (KING UFC)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypertonic Solutions (IV solutions)
Hypoparathyroidism
Hypothermia (Thermoregulation)
Hypotonic Solutions (IV solutions)
Insulin
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin Mnemonic (Ready, Set, Inject, Love)
Intake and Output (I&O)
Iron (Fe) Lab Values
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Leukemia Case Study (60 min)
Lymphoma
Metformin (Glucophage) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Multiple Myeloma
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Hyperparathyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoglycemia
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan for Cirrhosis (Liver)
Nursing Case Study for Type 1 Diabetes