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Vicki Notes

• The initial response to a psychic threat.
• Feelings such as discomfort, uncertainty, self-doubt, diffuse apprehension, dread, restlessness, jumpiness, jitteriness, helplessness, powerlessness & irrationality.
• Type r/t degrees include mild, moderate, severe & panic.

• The effects of anxiety can be seen in verbal & nonverbal behaviors & physiological response.
• Physiological effects include: the release of epinephrine, norepinephrine, cortisone, with an allover increase in heart rate, BP, rate & depth of respirations, increased perspiration, muscle tension, changes in menstrual cycle, sexual dysfunction, change in clotting time, release of glycogen by the liver (think about diabetics here too– this could r/t BS going up while in hospital).
• Perceptual effects - the ways a person perceives & processes. Mild anxiety increases sensory awareness while all others decrease sensory input r/t the degree i.e. moderate, severe or panic.
• Cognition effects – anxiety decreases the ability to concentrate, learn & solve. Mild & moderate levels may promote cognition. Severe & panic decrease function.
• Behavioral effects – nonverbal: involves fine & gross motor tremors, facial grimaces, pacing, purposeless handwriting. Verbal: speech rate may increase, as well as volume, frequent change of topic, repetitive questioning, joking, wordiness, blocking, loss of train of thought. May tend to hesitate & procrastinate. Symptoms worsen with degree of anxiety.

• Refers to a psychiatric condition characterized by the emotion of intense terror. Accompanied by thoughts of impending catastrophe & can prevail over substantial time periods.
• Disorders include – phobic, panic, generalized anxiety, obsessive-compulsive & stress disorders.
• Common to all the disorders is:
• A person distressed by symptom(s) that make them extremely uncomfortable.
• The ability to perceive reality is grossly intact.
• Without tx the disorder will endure & recur.
• The disorders are not due to organic factors or causes.
• May receive primary & secondary gains from disorders.
• Primary gain – is the defense against & reduction of the emotional pain r/t the anxiety.
• Secondary gain – may be relief from responsibilities, extra attention & money from others.
• These tend to reinforce symptoms & maladaptive behavior.

Anxiety disorders effects twice as many women as men & tend to run in families.

• Phobia – is a persistent, irrational fear attached to an object or situation that objectively does not pose a significant threat or danger. Phobias are anticipated & person usually recognizes the fear is unreasonable.

• Agoraphobia – is a marked fear of being alone or in public places or enclosed places (stores, theaters) without easy escape & the most severe & pervasive disorder. This person is excessively dependent on others & feels embarrassment & humiliation about being unable to bear a situation easily tolerated by others.

• Social Phobia – is the persistent irrational fear of & compelling desire to avoid situations where the person may be exposed to scrutiny of others. Harbors fear of behaving in some wrong manner. S/S include: thought pattern may become disturbed or blocked AEB: garbled speech, inability to speak or write. May avoid friendships or other close associations. Social phobias include: fear of public speaking, using public restrooms, writing in the presence of others.

• Specific Phobia – a.k.a. Simple Phobia is r/t a specific circumstance or thing. Examples include: fear of heights (acrophobia), fear of closed spaces (claustrophobia), also fear of flying, animals, seeing blood etc.

Panic Disorder involves recurrent panic attacks that occur unexpectedly.

Panic Attack – is the sudden onset of tense apprehension or terror & often associated with feelings of doom – it is an over-response to stressors. S/S include: dyspnea, chest pain, palpitations, choking, feeling of smothering, dizziness, vertigo, paresthesias, hot & cold flashes, sweating & fainting. Attacks usually last several minutes & reach a peak within 10 minutes.

Is characterized by chronic anxiety that is uncomfortable to the patient to the point of interfering with daily life. Seldom experience eruptions of acute anxiety. S/S include: inability to concentrate, chronic fatigue & sleep pattern disturbance & may lead to depression.

• Is the development of characteristic symptoms after exposure to a severe or extraordinary stressor – occurs in response to a traumatic life experience & occur within 6 months of the trauma.
• S/S include: psychic numbing & denial, reexperiencing the event by dreams, recollections, etc., hallucinations, memory impairment r/t the trauma, somatic symptoms (fatigue, headache, muscle pain).
• If symptoms occur within 4 weeks of the trauma – it is called Acute Stress Disorder & usually lasts < 3 months.
• If symptoms occur after the standard 6-month period – it is called Delayed Posttraumatic Stress Disorder – of the 3 types prognosis is worst with this one.
• Examples of trauma:
• Natural disasters – hurricanes, floods, tornadoes.
• Accidental human-man – auto or plane crash.
• Intentional human-made – military combat, rape, muggings, armed robbery, assault, stalking, hazing, abuse of all kinds such as verbal, physical, sexual & emotional.

• Many apply here – Review page 463 or and Nursing Diagnosis book.

Goals for the patient include:

• Accept the experience of anxiety as natural & inevitable.
• Increase self-awareness with regard to fluctuations & causes of anxiety.
• Decrease shame about s/s of anxiety.
• Learn & apply self-help techniques.
• Learn to remain calm in anxiety producing situations.
• Increase problem-solving & coping skills.

Clarifying the issues

• To defuse an emotionally charged state: the nurse remains calm, sits central to patient’s vision field (because perceptual & cognitive processes are decreased with anxiety), speaks clearly with low voice volume & tone, using short simple questions to get to the specifics of the symptoms of anxiety. Then nurse & patient can work toward coping/problem-solving.

• Emphasize that all people feel anxious from time to time – this can decrease patient fears by ‘normalizing’ the experience to some degree & may decrease the shame r/t losing control of emotions.

• To increase self-awareness encourage the patient maintain a diary to record when they feel anxious, what they are doing & thinking at the time, and who they are with. This may help them to recognize what triggers their anxiety. Also encourage keeping a graph to measure anxiety in a 24-hour period. Monitor degrees of anxiety r/t family members/significant other – this helps all concerned identify how they affect each other.

• Identify ways of decreasing anxiety to a tolerable level.
• Learn assertiveness skills – practice expressing feelings (positive & negative) & practice making behavior change requests.
• Use positive coping statements – here the patient composes reassuring statements that they can say aloud or silently to themselves when feeling anxiety or self-doubt until relief is experienced.
• Practice covert rehearsal – three times per day – imagine the (anxiety-producing) situation, then image self as calm, alert, relaxed & successful.
• Relaxation therapy – involves progressive muscle relaxation & deep breathing.
• Bibliotherapy – reading literature of those who have overcome the same disorder a.k.a. success stories.
• Emotions Anonymous – self-help group.

• Drugs – antianxiety agents are given in the initial phase – but are usually short-term r/t possible abuse or dependence. Antidepressant agents may be used for a longer term. These drugs do not cure anxiety disorders but calm patients so they can engage in therapies.
• Biofeedback – is where the patient learns to remain relaxed to prevent the hyperarousal physiological state produced by anxiety.

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