ELDER TIP A benzodiazepine with a long half-life tends to accumulate in an older patient’s system and may cause oversedation. Benzodiazepines are sometimes given along with opioids to add to the analgesic effect or as a preanesthetic. Remember, if the elderly psychiatric patient is scheduled for surgery, he may take longer to recover from anesthesia if these combinations are used.
Tricyclic antidepressants or higher doses of short-acting benzodiazepines may relieve severe anxiety and panic attacks. Buspirone, an antianxiety drug, causes the patient less sedation and poses less risk of physical and psychological dependence than the benzodiazepines.
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the cause of the anxiety and eliminating environmental factors that precipitate an anxious reaction. In addition, the patient can learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Panic disorder:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Panic disorder may respond to behavioral therapy, supportive psychotherapy, or drug therapy, alone or in combination. Behavioral therapy works best when agoraphobia accompanies panic disorder because the identification of anxiety-inducing situations is easier.
Psychotherapy commonly uses cognitive techniques to enable the patient to view anxiety-provoking situations more realistically and to recognize panic symptoms as a misinterpretation of essentially harmless physical sensations.
Drug therapy includes antianxiety drugs, such as diazepam, alprazolam, and clonazepam, and beta blockers, such as propranolol, to provide symptomatic relief. Antidepressants, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors, are also effective.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Chest pain:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when his chest pain began. Did it develop suddenly or gradually? Is it more severe or frequent now than when it first started? Does anything relieve the pain? Does anything aggravate it? Ask the patient about associated symptoms. Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 162 and 163.)
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Anxiety disorder, generalized:
Treatment
(Handbook of Diseases)
A combination of drug therapy and psychotherapy may help a patient with generalized anxiety disorder. Benzodiazepine anxiolytics relieve mild anxiety and improve the patient’s ability to cope. They should be used cautiously, however, because they can be addictive. Buspirone, a nonbenzodiazepine anxiolytic, is an alternative to the benzodiazepines because it causes less sedation and poses less risk of physical and psychological dependence.
Psychotherapy for generalized anxiety disorder has two goals: helping the patient identify and deal with the underlying emotional and psychological issues and eliminating environmental factors that precipitate an anxious reaction. In addition, the patient can learn relaxation techniques, such as deep breathing, progressive muscle relaxation, focused relaxation, and visualization.
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Source: Handbook of Diseases, 2003
Panic disorder:
Treatment
(Handbook of Diseases)
Panic disorder may respond to behavioral therapy, supportive psychotherapy, or drug therapy, singly or in combination. Behavioral therapy works best when agoraphobia accompanies panic disorder because the identification of anxiety-inducing situations is easier.
Psychotherapy commonly uses cognitive techniques to enable the patient to view anxiety-provoking situations more realistically and to recognize panic symptoms as a misinterpretation of essentially harmless physical sensations.
Anxiolytics and antidepressants have been used successfully to treat panic disorders.
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Source: Handbook of Diseases, 2003
Chest pain:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
As needed, prepare the patient for cardiopulmonary studies, such as an ECG and a lung scan. Perform a venipuncture to collect a serum sample for cardiac enzyme and other studies. Assess the cardiovascular system frequently. Interpret changes in cardiac rhythm. Be prepared for emergency procedures.
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.
Patient teaching
Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Prepare him if cardiac catheterization or fibrinolytic therapy is indicated. Explain the purpose of any prescribed drugs and make sure that he understands the dosage, schedule, and possible adverse effects. Teach the patient with coronary artery disease to recognize the typical features of cardiac ischemia as well as symptoms that require prompt medical attention. Teach him how to administer sublingual nitroglycerin and advise him to seek medical attention if the pain lasts more than 20 minutes, fails to respond to nitroglycerin, or has a different pattern than the usual angina.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Skin, clammy:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Take the patient’s vital signs frequently and monitor urine output. If clammy skin occurs with an anxiety reaction or pain, offer the patient emotional support, administer pain medication, and provide a quiet environment.
Patient teaching
If an underlying illness is related to the patient’s clammy skin, provide information on the condition. If the condition is related to an alteration in the patient’s blood glucose level, provide information on management of hypoglycemia and early signs of a falling blood glucose level. Provide information on the importance of nutrition and hydration.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Agitation:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Orient the patient with agitation to the unit and its procedures and routines. Provide reassurance and emotional support. Explain the need to reduce stressors and maintain a quiet environment.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Anxiety:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient relaxation techniques and practice them with him. Encourage the patient to verbalize his anxiety and listen to him attentively. Help the patient identify and explore coping mechanisms that he used in the past. Work with the patient to identify stressors and guide him in effective coping skills.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Chest pain:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach patients with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt them to seek medical attention. If the pain fails to disappear after sublingual nitroglycerin, lasts more than 20 minutes, or has a different pattern from the usual angina, the patient must be evaluated immediately.
Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Also explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Skin, clammy:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Because the patient with cool, clammy skin may be acutely ill, provide emotional support to him and his family. Explain what’s happening using short, simple sentences. Orient them to the intensive care unit, if applicable, explaining the equipment and the unit’s routines.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Agitation:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Because agitation can be an early sign of many different disorders, monitor the patient's vital signs and neurologic status while the cause is being determined.
▪ Eliminate stressors, which can increase agitation.
▪ Provide adequate lighting, maintain a calm environment, and allow the patient ample time to sleep.
▪ Ensure a balanced diet, and provide vitamin supplements and hydration.
▪ Remain calm, nonjudgmental, and nonargumentative.
▪ Avoid using restraints, unless absolutely necessary, because they tend to increase agitation.
▪ If appropriate, prepare the patient for diagnostic tests, such as a computed tomography scan, skull X-rays, magnetic resonance imaging, and blood studies.
Patient teaching
▪ Orient the patient to the unit and its procedures and routines.
▪ Explain stress-reduction measures.
▪ Offer reassurance and emotional support.
▪ Explain all tests and procedures, the underlying cause, and treatment plan.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Anxiety:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Provide supportive care, as indicated by the patient's signs and symptoms.
▪ Provide a calm, quiet atmosphere.
▪ Administer medications, as ordered, to reduce anxiety.
▪ Treat the underlying cause of the patient's anxiety, if known.
▪ Encourage the patient to express his feelings and concerns.
Patient teaching
▪ Teach the patient anxiety-reducing measures, such as distraction, relaxation techniques, or biofeedback.
▪ Teach the patient coping mechanisms to help control his anxiety.
▪ Explain the underlying causes of his anxiety, if known.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Chest pain:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for cardiopulmonary studies, such as an electrocardiogram, chest X-ray, magnetic resonance imaging, and a lung perfusion scan.
▪ Collect a serum sample for cardiac enzyme and electrolyte levels.
▪ Provide emotional support because chest pain produces increased anxiety.
Patient teaching
▪ Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety.
▪ Teach the patient about the cause of his chest pain once a diagnosis is established.
▪ Explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.
▪ Stress the importance of reporting symptoms to allow for the adjustment of treatment.
▪ Teach the patient with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt him to seek immediate medical attention.
▪ Discuss lifestyle changes that can reduce the risk of coronary artery disease.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Skin, clammy:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Take the patient's vital signs frequently.
▪ Monitor the patient's intake and output.
▪ Provide measures to correct the underlying condition. For example, if clammy skin occurs with an anxiety reaction or pain, offer the patient emotional support, administer pain medication, and provide a quiet environment.
Patient teaching
▪ Explain the underlying disorder and its treatment.
▪ Orient the patient to the intensive care unit.
▪ Explain any diagnostic tests or procedures.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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