Anxiety And Panic Attack Disorder

Anxiety And Panic Attack Disorder

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Anxiety And Panic Attack Disorder

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Anxiety And Panic Attack Disorder

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Question:
Discuss about the Anxiety And Panic Attack Disorder.
 
 
Answer:

Engaging with Barry during the interview
Interpersonal skills are the most vital requirements for a nurse to successfully get information from their clients. The nurse should be able to utilize these skills in every situation, because nurses are the liaison between patients and medical practitioners. Nursing involves a lot of interaction with clients and their unique needs, mastering the art of communication by using interpersonal skills enables the nurse to make the most out of the interaction (Arnold, 2015). Some of the skills that the nurse would use during the interaction with Barry are; listening, communication, patience, personal stress management and sense of humor.
Listening
It is the most important aspect of a communication the nurse should be able to listen to their client. This skill is the cornerstone of every communication that takes place between a nurse and their client. The nurse should be able to listen to the clients concerns actively and passively, without judging the client this will make the client more comfortable and relaxed which allows the client to disclose details that will be very beneficial in making a diagnosis.
Communication
This is another skill that the nurse would utilize to successfully deduce information from the client. The nurse needs to understand all aspect of communication; that is verbal and non-verbal cues from the patient (Bach, 2015). Verbal communication is the exchange of words that takes place between the nurse and the client while non-verbal communication is the communication that the patient’s engages in unconsciously such as facial expressions and body language.                               
Patience
A nurse should always be patient with the client. Patience means allowing the client time to internalize information in order for them to communicate what they are actually feeling with honesty. The nurse should remaining calm at all times and allow the client time to process what they want to say accurately. Patience helps in promoting the clients trust in the nurse.
 
Personal stress management
Nurses are human and they are subjected to all forms of stress just like any other person; however a nurse should be able to manage her personal life separately from her work life. Personal stress management ensures that the nurse is able to listen and communicate with their client even when the client is not co-operating and it helps them not lash out on patients.  
A sense of humor
Nursing is a very stressful career whereby you meet all sort of people with differing beliefs and ideology. Being humorous helps the nurse cope and relieve tension that comes with the profession.
Signs and symptoms to elicit a mental health disorder
Some of the signs and symptoms that may alert the nurse about Barry experiencing a mental health disorder are, fear and worry about the future, episodes of apnea and tachycardia and sleep disturbances accompanied by digestive upset (Association., 2013).
Fear and worry about the future
Fear and worry about the future and impending doom is one of the symptoms that Barry exhibited through verbalization that would make the nurse diagnose a mental health disorder (Lissek, 2015). According to Barry’s history he has been laid off from work and his wife doesn’t make much as a teacher. Barry is also worried about the future of his children and worried about how he is going to make ends meet. All of these situations might elicit unnecessary fear and worry which can lead to anxiety and depression.
 
Apnea and tachycardia
Barry verbalizes of experiencing shortness of breath and a racing heart, clinically this indicates that he experiences apneic periods accompanied with tachycardia. These symptoms are an indicator of anxiety and panic attacks (Esler, 2017). They should cause concern and alert the nurse that he or she is dealing with a client who has a mental health issue that can lead to depression and self-harm if not mitigated early before it progresses to something can totally impair the client’s activities of daily living. These symptoms are alerting because after episodes of apnea and tachypnea, the client verbalizes about feeling completely helpless and a complete wreck. Feelings of hopelessness can lead to a major depressive episode, such a client requires urgent medical attention such as behavioral therapy, cognitive therapy and pharmacologic therapy to help them adapt. For instance if Barry does not get these symptoms under control he would have a hard time finding and sustaining a job.                             
Sleep disturbance and digestive upset
Sleep disturbance and digestive upsets are symptoms that warrant a mental health disorder diagnosis given that Barry doesn’t smoke, he is not on any medication and he doesn’t drink; therefore these symptoms cannot be a cause of any of the listed factors. Barry’s condition is psychological and such symptoms can cause debilitating side effects such as inability to perform activities of daily living. For instance Barry cannot eat because of the digestive upset this can lead to malnutrition, which will lead to impaired immunity. If his digestive upset is not managed early it can lead to physical complications such us increased susceptibility to infections.
Sleep disturbance will also alter his circadian rhythm, which can be very frustrating if not managed early. They can lead to harmful behaviors such as drug abuse as a coping mechanism to help him sleep because stimulants elicit euphoria and a relaxed state of mind (Lader, 2015). This will not only complicate the situation but it will worsen the mental health condition.
 
Clinical interventions to signs and symptoms of mental health disorder
All of the symptoms exhibited by the client can be clinically managed, which helps the client get control over his life and improve the disease outcome. Clinically these symptoms can be managed by use of pharmacological agents, behavioral therapy, group therapy and cognitive therapy. These therapies are instituted at different stages of the therapy. They can be used all at once or they can be used separately one after the other, the aggressiveness depends with the severity of the condition.                                      
Cognitive therapy
This form of therapy deals with the thinking processes of the client. Cognitive therapy helps identify both the negative and positive thoughts, with the aim of replacing the negative thoughts with positive thoughts (Baer, 2015). For instance when Barry feels hopeless and thinks that everything is over he can try to think about the good time he had with his children in the past. Reminiscing on these memories will help erase the negative thoughts from his mind.
Group therapy        
The client is advised to attend group meeting of people battling similar mental health conditions like his (Goldin, 2016). This will encourage him to openly talk about his struggles and give him comfort in learning that he is not the only one with problems, group therapy will help him cope through availing him with a wide range of people to talk to. It will also help him go out more and interact with others; thereby improving the disease process.
Behavioral therapy
This involves behavior modification. The client will be asked to adopt behavior that is encouraging and behavior which makes him busy (Hofmann, 2017). Keeping the client busy ensures that he is pre-occupied with beneficial things to do; therefore reducing the chances of entertaining negative thoughts, which can come as a result of idling.
Pharmacological therapy
This involves taking of pharmacological agents such us selective serotonin reuptake inhibitors, serotonin-norepinephrine inhibitors, which are anti-depressants used to treat anxiety disorder. Tricyclic anti-depressants can also be used for panic attacks and Mono-amine oxidase inhibitors are also used in the treatment of anxiety disorder (Baldwin, 2014).
Pharmacological therapy can be used as an adjunct to the other form of therapy or it can be used as the mainstay therapy.
 
Medical information about venflaxine
When administering this drug the nurse should share its mode of action and medical uses, side effects, and contraindications to the use of this agent.
Mode of action and medical uses
This drug is an anti-depressant of the selective serotonin norepinephrine reuptake inhibitor class. Venflaxine increases the concentration of serotonin and norepinephrine in the brain and in the body. It has a wide range of action over major depressive disorder, panic attack disorder, social phobia and generalized anxiety disorder. According to the client’s subjective and objective data, he seems to be suffering from panic attack disorder and generalized anxiety disorder, which is why venflaxine is the drug of choice because it has action against these two disorders by increasing the neurotransmitter concentration within the body and brain. Another indication for its use in our client is the rate of suicidal overdose when using this drug is lower compared to the other drugs in its class. In the body venflaxine can be metabolized into another anti-depressant drug known as o-desmethylvenflaxine.
Side effects of venflaxine
The common side effects associated with the use of this drug are, suicide, discontinuation syndrome and serotonin syndrome (Coupland, 2015).
Suicide
According to the FDA the use of venflaxine increases the risk of suicide compared to use of no medication at all (Paulzen, 2018).
Discontinuation syndrome
When a client ceases to use venflaxine they experience a plethora of symptom known as the discontinuation syndrome, which occur as a result of the short half-life of its metabolite. These symptoms are; headaches, nausea, irritability, emotional lability, sleep disturbance and dysphoria (Bhat, 2017).
Serotonin syndrome
This is a life-threatening condition that may occur with the use of venflaxine. This syndrome contain the following symptoms; vomiting, diarrhea, nausea, hyperthermia, tachycardia, unstable blood pressure, incoordination, hyperflexia hallucination, coma, and agitation (Boyer, 2016).
Contraindications and drug interaction         
Venfaxine is contraindicated in pregnancy, hypertension, glaucoma, children, and adolescent. Venflaxine has drug interactions with tramadol and it can cause drug-induced akathasia (Paulzen, 2018).
The client is advised to be on the look-out for all this effects and seek medical attention if they experience any of the effects of venflaxine.
 
Bibliography
Arnold, E. C. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.
Association., A. P. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). . American Psychiatric Pub.
Bach, S. &. (2015). Communication and interpersonal skills in nursing. Learning matters.
Baer, R. A. (2015). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Elsevier.
Baldwin, D. S. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology,, 5(28), 403-439.
Bhat, V. &. (2017). Recognition and management of antidepressant discontinuation syndrome. Journal of psychiatry & neuroscience: JPN, 4(42), E7.
Boyer, E. W. (2016). Serotonin syndrome (serotonin toxicity). MA: UpToDate.(UpTo-Date, Waltham,.
Coupland, C. H.-C. (2015). Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database. bmj, 350, h517.
Esler, M. (2017). Mental stress and human cardiovascular disease. Neuroscience & Biobehavioral Reviews,, 74, 269-276.
Goldin, P. R. (2016). Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of consulting and clinical psychology, 5(84), 427.
Hofmann, S. G. (2017). Cognitive Behavioral Therapy for Social Anxiety Disorder: Evidence-Based and Disorder Specific Treatment Techniques. Routledge.
Lader, M. (2015). Generalized anxiety disorder. In Encyclopedia of Psychopharmacology. Springer Berlin Heidelberg.
Lissek, S. &. (2015). Overgeneralization of conditioned fear in the anxiety disorders. Zeitschrift für Psychologie/Journal of Psychology.
Paulzen, M. H. (2018). Antidepressant polypharmacy and the potential of pharmacokinetic interactions: Doxepin but not mirtazapine causes clinically relevant changes in venlafaxine metabolism. Journal of affective disorders,, 227, 506-511.

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