Anxiety, OCD and Trauma Disorders
Levels of anxiety and nursing care
Levels of anxiety
| Level | What you see | Nursing approach |
|---|---|---|
| Mild | Alert, sharper focus; learning is easy | Teach, problem-solve |
| Moderate | Narrower focus; can learn with direction; some physical symptoms | Guide; help focus |
| Severe | Very narrow focus; can't learn or solve problems; headache, nausea, trembling | Calm, simple directions; reduce stimuli |
| Panic | Can't think or communicate clearly; may be a danger to self | Stay with the patient, short simple sentences, quiet room, safety, PRN medication. Teach later |
Anxiety disorders
- Generalized anxiety disorder: excessive worry on most days for ≥6 months. CBT; SSRIs/SNRIs; buspirone.
- Panic disorder: sudden attacks peaking within minutes (chest pain, pounding heart, fear of dying) + worry about future attacks. Rule out medical causes first. CBT, SSRIs; benzodiazepines short-term only.
- Phobias and social anxiety: gradual exposure therapy.
- Coping: slow breathing, grounding, muscle relaxation, exercise, limiting caffeine.
Obsessive-compulsive disorder
- Obsessions (intrusive thoughts) → compulsions (rituals) that reduce anxiety for a while.
- Don't stop rituals abruptly at first (anxiety will spike): allow time, build a schedule, then gradually limit.
- Exposure and response prevention (therapy); SSRIs (often higher doses), clomipramine.
- Watch skin (handwashing), nutrition, sleep.
PTSD
- After trauma, lasting >1 month: intrusions (flashbacks, nightmares), avoidance, negative mood and thoughts, hyperarousal (startle, irritability, poor sleep). (3 days–1 month = acute stress disorder.)
- Trauma-focused therapy (prolonged exposure, cognitive processing, EMDR); SSRIs (sertraline, paroxetine) or venlafaxine.
- Screen for substance use and suicide risk.
Trauma-informed care
Assume anyone may have trauma history: explain before touching, offer choices and control, provide privacy, avoid re-traumatizing procedures and restraints, stay calm and predictable.
Somatic and functional disorders
Somatic symptom disorder: real distress focused on physical symptoms. Functional neurological disorder (formerly "conversion disorder"): genuine neurologic symptoms (weakness, seizures) without structural disease. The patient isn't faking: acknowledge symptoms, focus on function, avoid unneeded tests.