Anxiety disorders: Nursing process (ADPIE)

Georgia Ryan is a 22-year-old female client who presents to her college campus clinic with a report of an inability to sleep and difficulty concentrating for the past 9 months. Georgia says that lately she’s been self-isolating from fellow students and that she has stopped attending her classes the past few days. After a review of Georgia’s medical history and current symptoms, the advanced practice registered nurse, or APRN, diagnoses Georgia with generalized anxiety disorder.

Anxiety is the anticipation of a future threat or stressful situation with an uncertain outcome, and is often associated with feelings of fear, worry, and nervousness, which causes avoidant behaviors. Anxiety disorders are a group of disorders in which these feelings are disproportionate to the stressful situation, and can be accompanied by physical and psychological symptoms that are so severe as to interfere with day-to-day activities. The most common anxiety disorders include generalized anxiety disorder, panic disorder, and phobia-related disorders.

Now, the underlying cause of anxiety disorders is poorly understood, but it seems to be related to an imbalance of the neurotransmitter GABA. The main risk factors for anxiety disorders include having a family history of an anxiety disorder or experiencing a personal trauma. Other risk factors include having other mental health disorders, having medical conditions like hyperthyroidism or pheochromocytoma, and using or experiencing withdrawal of substances like alcohol or cocaine.

Anxiety disorders typically present with symptoms like excessive fear, worry, and nervousness that interfere with day-to-day activities, but there are slight variations between the different anxiety disorders. Clients with generalized anxiety disorder may experience restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and trouble sleeping. These symptoms persist for at least 6 months. 

On the other hand, panic disorder is characterized by recurrent episodes of sudden panic attacks with uncontrollable fear, which may cause symptoms like palpitations, chest or abdominal pain, sweating, trembling, shortness of breath, dizziness, chills or hot flashes, paresthesia or a “pins and needles'' sensation, as well as derealization or feelings of unreality, depersonalization or detachment from self, and a feeling of impending doom.