CARE OF CLIENTS WITH MALADAPTIVE Normal Anxiety Borderline Psychosis

PATTERNS OF BEHAVIOR
Within the With same Resolution of Reality
world of reality amount of stress crisis is outside of disregarded
so there but resolution of reality & within (disorganized)
Anxiety and Other Related Disorders is resolution of crisis markedly the reality of
crisis prolonged world

Definition: there is a high level of apprehension and Restored to Can return to Does not go back Deteriorating
homeostasis equilibrium to normal
development of behavioral pattern to avoid anxiety (BQ) equilibrium
Chief Predominant Symptom = Anxiety (fear of dying) Handled by Handled as
+ depression (prone to suicide) psychiatrist as inpatient
Behavioral Pattern = Rituals & Phobia outpatient
Mild symptoms Severe
symptoms
Psychopathology of Anxiety:
Aware of reality Ignores reality Denies reality,
1. Psychobiologic aspect of stress & anxiety: (Role of substitute a
nature) fantastic world

a. GABA – an inhibitory neurotransmitter Builds castle in Resides in the

the air castle in the air
associated with relaxation response
Defense Pathological
b. ↓ Serotonin mechanism: defenses:
c. ↑ Norepinephrine – an excitatory Displacement
Undoing
Projection
Introjection
neurotransmitter responsible for cardiovascular Obsessive-
changes during stress & anxiety and prepares compulsive
body for fight or flight response Psychotherapy ECT
Anxiolytics Neuroleptic
2. Psychodynamic of Anxiety: (Role of nurture)
a. According to Otto Rank: anxiety is due to birth Subtypes of Anxiety Disorder:
trauma where intrauterine environment is the
1. Generalized Anxiety Disorder (GAD):
most favorable place to prevent anxiety; put baby
in mother’s chest after birth & breastfeeding to ↓  Excessive generalized nonspecific fear,
birth trauma constant worry & apprehension occurring for
more than 6 months
b. According to Sigmund Freud: anxiety is due to
 There is feeling of impending doom, danger or
repressed ID → repressed anger & unreleased
catastrophe
sexual drive → anxiety
 ➢ Symptoms:
c. Defense mechanism: Repression & Symbolism
a. restlessness, feeling keyed up or on edge
Levels of Anxiety based on Keltner’s Definition: b. being easily fatigued
1. Mild: +1 or + c. difficulty concentrating, irritability
 There’s total focus, ↑ attention, ↑ motivation, ↑ d. sleep disturbance, muscle tension ➢ Nursing
perceptual field Interventions:
 No need for defense mechanism but only a. Assist patient in developing adaptive coping
adaptive coping responses-ultimate nurse goal
2. Moderate: +2 or ++ b. Teach the client to:
 There’s partial focus, selective inattention, 1) Be kind to self & appreciate self
physical pain, keeps on complaining 2) Be less critical of self
 Can be therapeutic with supervision & used
3) Maintain high self esteem
palliative coping (watching TV)
4) Share feelings when upset or restore self-
3. Severe: +3 or +++
esteem when lowered
 There’s scattered focus, mental block,
psychological pain, decision making & 5) Identify physiological symptoms of
anxiety
problem solving are hard to do
 Uses defense mechanism like conversion & 6) Manage stress with diet, exercise, rest,
make use of maladaptive coping sleep & relaxation
4. Panic: +4 or ++++ 7) Realize that some anxiety is part of living
 There’s wild (homicide) & desperate (Suicide)
behavior
 Dysfunctional coping is used
 BQ: During panic level, do the following except:
a. Be alert
b. Stay calm
c. Encourage problem solving
Answer: C
 Types of Description Normal Use 3. Panic Disorder
Coping  Panic attacks:
Adaptive Solves the problem that Anxiety about the a. usually occur suddenly, unexpected & with
is causing the anxiety. upcoming examination
The client is objective, no obvious precipitating factor
is reduced by studying
rational and productive effectively & passing b. accompanied by intense fear or discomfort
the examination with a c. lasting for hours after an attack
grade A
Palliative Temporarily decreases Anxiety is temporarily
d. it may be severe, frightening & incapacitating
the anxiety but does not reduced by jogging. e. may occur in anticipation of or upon exposure
solve the problem and Effective studying is to a trigger ➢ is an attack that lasts for an
anxiety eventually then possible and a
returns. hour, reaching a peak in approximately 10
grade of a is still
Temporary relief allows achievable minutes accompanied by:
the client to return to
a. physiologic symptoms: racing heart, chest
problem solving
pain, dizziness & nausea, DOB, choking
Maladaptive Unsuccessful Anxiety is being
sensations, numbness & tingling
attempts to decrease ignored by going to a
the anxiety without movie and then sensations, trembling & diaphoresis
attempting to solve the handled by frantically b. feeling that one is having a heart attack
problem→ the anxiety cramming for a few c. feeling that one is going crazy
remains hours.
A passing grade of C is d. fear of loss of control
obtained e. decreased perceptual ability
Dysfunctional Is not successful in Anxiety about the f. decreased cognitive abilities
reducing anxiety or examination is ignored
solving the problem. by going out, drinking ➢ Etiology:
Even minimal and then escaped by a. Genetically transmitted
passing out.
functioning becomes
difficult and new A grade of F resulted b. Induced by caffeine, carbon dioxide or
problems begin to Na lactate
develop c. Biologic vulnerability – irregularities in
synthesis & release of Ne, receptor
2. Phobic Disorder hypersensitivity to serotonin or GABA
 Irrational fear of a specific object, activity or ➢ Nursing Interventions:
event a. Stay with the patient during the attack
 Anxiety detached from original source & b. Maintain calm demeanor
attached to specific object
c. Speak in short simple sentences
 Patient knows it is irrational & abnormal but if
d. Provide brown bag for hyperventilation
not entertained produces anxiety
 ➢ Types: e. Do not touch the patient during the attack
a. Agoraphobia – fear of being in public or
open spaces or situations where escape could 4. Post-Traumatic Stress Disorder (PTSD)
be difficult or impossible; worst among the  re-experiencing a traumatic event through
phobias because it results to house bound flashback, nightmares & depression occurring
syndrome for more than 6 months
b. Social phobia – fear of being  ➢ Differentiated from:
humiliated, scrutinized or a. Normal Stress Reaction – last for a whole
embarrassed in public day then function is resolved
c. Simple phobia – fear of specific object or b. Acute Stress Disorder (ASD) – resolves
situation like fear of animals, flying or within 4 weeks or a month
heights c. Adjustment Disorder – symptoms occur
• Example: School phobia – the most within 3 months but not more than 6
common among all phobias; fear is due months after an identifiable event like
to separation anxiety from leaving the separation, retirement, sudden marriage,
mother; type of phobia wherein parents child rearing demands; more severe than
can be legally implicated (USA)→ bring normal stress & grief process but less severe
the child to school immediately to avoid than ASD & PTSD
fixation (behavior therapy)  Normal grief process→ cannot adjust→
d. Coitophobia – fear of coitus Adjustment Disorder→ cannot adjust→ PTSD→
e. Misophobia – fear of dirt cannot adjust→ Psychosis: Schizophrenia or
 Defense Mechanism used: Displacement Depression
 Treatment: Behavior Therapy  ➢ Symptoms:
a. Systematic desensitization (BQ) – gradual a. Exaggerated startle response
introduction of the feared object b. Sleep disturbances
b. Flooding (Exposure/Implosive by D. Wolfe)- c. Guilt
sudden introduction of the feared object d. Nightmares & flashbacks
c. Self-exposure treatment e. Anger with numbing of other emotions
f. Patients often use drugs, alcohol or self-
medicate for distressful symptoms
5. Obsessive Compulsive Disorder (OCD)
 Obsessions are recurrent & persistent thoughts,
ideas, impulses or images that are experienced as
intrusive & senseless
 Compulsions are repetitive behaviors that are
performed in a particular manner in response to
an obsession & performed to prevent discomfort
& neutralize anxiety
 OCD patients recognize that the thoughts are
products of their own minds & they know that
they are ridiculous or morbid but cannot stop
or control them therefore the thoughts become
distressful & anxiety provoking
 OCD patients perform rituals which are coming
from guilt laden conscience to relieve anxiety
 ➢ Defense Mechanism used: undoing
 ➢ Nursing Interventions:
a. Allow patients to do their rituals
b. Set limits if it is already affecting physical
integrity
c. Provide alternative that will entail perfections
like folding linens
d. Behavior therapy: also known as exposure
treatment where OCD patients are exposed to
feared stimuli & then resist the urge to
perform rituals

Nursing Interventions:
A. Assess
B. Analysis or Nursing Diagnosis:
1. Anxiety
2. IneffectiveCoping
C. Implementation:
1. Determine if it is really anxiety
2. Determine the level of anxiety
3. Determine the source of anxiety
4. Determine own anxiety (on the part of the nurse)
5. Provide an outlet like relaxation techniques,
stress reduction techniques, deep breathing
exercises, fun & humor
6. Show empathy like “It must be difficult on your
part”
7. Provide a non-stimulating environment
8. Provide assertiveness technique due to low self-
esteem making him responsible for his actions &
decisions
9. Anger Management

The trained Nurse has become the greatest blessings

of humanity, taking a
place beside the Physician and Priest