Anxiety disorders represent a spectrum of psychiatric conditions that manifest as excessive worry, fear, and panic. One of the most intense forms of anxiety is the panic attack, a sudden surge of overwhelming fear that peaks within minutes and produces both psychological and physical symptoms.
This second part of our comprehensive guide explores panic attacks, interventions for severe anxiety, pharmacological management, coping mechanisms, and exam-focused notes (NCLEX, HESI, ATI, Kaplan) for healthcare learners. By combining clinical understanding with practical nursing strategies, this article provides a complete resource for students, practitioners, and patients.
Signs and Symptoms of Panic Attacks
A panic attack is characterized by an abrupt onset of intense fear, often with no apparent trigger. The symptoms usually peak within 10 minutes and last up to 30 minutes.
Psychological Symptoms
- Fear of death (“Impending doom”)
- Detachment from reality (“Hallucination-like experiences”)
- Intense fear of losing control
Physical Symptoms
- Chest pain and palpitations
- Trembling and numbness
- Hyperventilation (rapid breathing)
- Sweating and hot flashes
- Nausea and choking sensations
These symptoms mimic life-threatening conditions such as heart attack or asthma attack, making panic attacks particularly distressing.
Interventions for Severe Anxiety and Panic Attacks
When dealing with patients experiencing severe anxiety or panic attacks, safety and reassurance are top priorities.
Nursing Interventions
1. Remain with the client
- The #1 NCLEX priority: staying with the client prevents isolation and ensures safety.
2. Place the client in a quiet room
- Reduce external stimuli.
- Encourage “sit with client” or “remain at bedside” care.
3. Use calm, simple communication
- Speak slowly and clearly.
- Avoid medical jargon or complex instructions.
HESI Question Example
Client shows spontaneous onset of hyperventilation, trembling, and inability to concentrate. What is the nurse’s priority?
Answer: Stay with the client.ATI Question Example
A client with severe anxiety paces back and forth, stating: “Something bad is going to happen.” What should the nurse do first?
Answer: Sit next to the client’s bed (ensuring presence and safety).Pharmacology for Anxiety and Panic Disorders
Pharmacological management helps control acute episodes and prevent recurrence.
1. Beta Blockers (end in -lol)
Example: Atenolol, Propranolol
Reduce physical symptoms such as palpitations and tremors.2. Antidepressants
- SSRIs (Most Commonly Used): Sertraline, Paroxetine
- TCAs: Amitriptyline, Imipramine
- MAOIs: Phenelzine, Isocarboxazid (rarely used due to dietary restrictions)
3. Anxiolytics (Most Tested in Exams)
- Benzodiazepines: Diazepam, Lorazepam (short-term relief, risk of dependence)
- Barbiturates: Rarely used due to toxicity risk
- Buspirone: Non-sedating, less risk of dependence
Effective Coping Strategies
Beyond medications, clients must learn healthy coping mechanisms to prevent relapses and build resilience.
3 NCLEX Coping Tips
- Increased comfort during exposure to phobia (gradual desensitization).
- Verbalizing feelings and insight into anxiety (encourages self-observation).
- Self-distraction techniques such as focusing on external activities.
NCLEX Resilience Tip
Encourage daily stress reduction techniques such as:
- Deep breathing exercises
- Yoga or meditation
- Progressive muscle relaxation
- Journaling
Cognitive Behavioral Therapy (CBT)
CBT is the gold standard psychotherapy for anxiety disorders. It works by:
- Helping clients reframe negative thought patterns.
- Teaching strategies to challenge catastrophic thinking.
- Encouraging gradual exposure to feared situations.
For example, a client afraid of public speaking might work with a therapist to challenge irrational beliefs and practice speaking in small, supportive groups before larger audiences.
Clinical Question Examples
HESI Example
Q: A patient reports chest pain, feelings of choking, and hot flashes. What diagnosis is most likely?
Answer: Panic Disorder.Kaplan Example
Client states: “I feel like I’m having a panic attack.” The nurse’s best response:
“I’m going to help you back to your room.”(Prioritize safety and reducing stimulation).
Top Missed NCLEX Question
Client with social anxiety is invited out by coworkers. Which coping statement indicates improvement?
“I went to a restaurant with a few coworkers to focus on conversation rather than my phobia.”Prognosis and Long-Term Management
With appropriate treatment (CBT + medications), most patients experience significant symptom reduction. However, without intervention, panic attacks may progress into agoraphobia (fear of leaving home) and severe social impairment.
Long-term management requires:
- Medication adherence
- Regular therapy sessions
- Practicing daily coping strategies
- Building a support system
Reference Table: Panic Attack vs. Severe Anxiety
| Feature | Severe Anxiety | Panic Attack |
|---|---|---|
| Onset | Gradual | Sudden |
| Peak | Minutes–hours | Within 10 min |
| Symptoms | Hyperventilation, doom | Chest pain, palpitations, sweating |
| Perception | Reduced | Nearly absent |
| Intervention | Calm presence, short instructions | Immediate reassurance, safety focus |
FAQs
Q1. How do panic attacks differ from heart attacks?
Panic attacks mimic heart attacks with chest pain and shortness of breath, but unlike heart attacks, panic attacks resolve within 30 minutes and don’t show cardiac enzyme elevation.
Q2. Can panic attacks be prevented?
Yes, through CBT, medications, and daily stress-reduction practices, frequency and severity can be minimized.
Q3. What is the first priority intervention during a panic attack?
Remain with the client, provide reassurance, and ensure a calm, safe environment.
Q4. Are benzodiazepines safe for long-term use?
No, they are effective short-term but carry risks of dependence and tolerance. SSRIs are preferred for long-term therapy.
Q5. What role does resilience play in recovery?
Resilience, developed through consistent coping strategies and lifestyle changes, helps patients adapt better to future stressors and reduces relapse risk.
