Anxiety Term used to described feelings of uncertainty, uneasiness, apprehension, or tension that person experiences to unknown object or situation.

Fingering hair continuously or other nervous habits Hypervigilance

Levels of Anxiety Normal: the client may experience periodic warnings of a threat such as uneasiness or apprehension that prompt the client to take necessary steps to prevent a threat or lessen its consequences Euphoria: The client experiences an exaggerated feeling of well-being that is not directly proportional to a specific circumstance or situation Mild Anxiety: The client has an increased alertness to inner feelings or environment. Modern anxiety: The client experiences a narrowing of the ability to concentrate, with the ability to focus or concentrate on only one specific thing at a time. Severe anxiety: The ability to perceive is further reduced, and focus is on small or scattered details. Panic state: Complete disruptions of the ability to perceive takes place.

Intellectual or Cognitive Symptoms Decreased interest Inability to concentrate Nonresponsiveness to external stimuli Decreased productivity Preoccupation Forgetfulness Orientation to past rather that present or future Rumination D. Obsessive Compulsive Disorder - is characterized by recurrent obsessions or compulsions or combination of both that interferes with normal life. - Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. Treatment: Exposure involves assisting the client to deliberately confront the situations and stimuli that he or she usually avoids Response prevention focuses on delaying or avoiding performance of rituals. Nursing Management: Assess client s appearance and behavior. Explores client s thought processes and content. Examines the client s judgment and insight. Assess the effects of OCD on client s role and relationship. Use therapeutic communication. Teaching relaxation and behavioral techniques. E. Post-Traumatic Stress Disorder - develops after an individual sees, is involved in, or hears about a traumatic experience. - The diagnosis of: - Acute onset - Chronic onset - Delayed onset Clinical Symptoms: Recurrent and intrusive distressing recollection Recurrent distressing dreams Acting or feeling as if the event were recurring Intense psychological distress to internal or external cues Symbolizing an aspect of the event Physiologic reactions on exposure to stimuli that resemble an aspect of the event Avoidance of activities, places, or people associated with the trauma Avoidance of thoughts, feelings, or conversations associated

Clinical Symptoms Physiologic Symptoms: Elevated pulse, blood pressure, and respiration Dyspnea or hyperventilation Diaphoresis Vertigo or lightheadedness Blurred vision Anorexia, nausea, and vomiting Frequency of urination Headache Insomnia or sleep disturbance Weakness or muscle tension Tightness in the chest Sweaty palms Dilated pupils Psychological or Emotional Symptoms: Withdrawal Depression Irritability Crying Lack of interest or apathy Hypercriticism Anger Feelings of worthlessness, apprehension or helplessness Behavioral Symptoms: Pacing Inability to sit still

Inability to recall an important aspect of the trauma Inability to recall an important aspect of the trauma Feeling of detachment or estrangement from others Restricted affect Insomnia Labile emotion Decreased concentration Hypervigilance Exaggerated startle response

Individual psychotherapy can be effective when the client s symptoms do not affect functioning to a significant degree.

Alternative Behavioral Therapies Visual imagery Change of pace or scenery Exercise or massage Transcendental meditation Biofeedback Systematic desensitization Reference: Vidibeck, Sheila L. (2004). Psychiatric Mental Health Nursing (2nd Edition). Philadelphia: Lippincott Williams & Wilkins. Shives, Louise Rebraca (2008). Psychiatric-Mental Health th Nursing (7 Edition). Philadelphia: Lippincott Williams & Wilkins.

Diagnostic Characteristics:

Nursing Management: Remain calm in your approach to the client Avoid asking or forcing the client to make choices Help the client to see mild anxiety as a positive catalyst for change G. Atypical Anxiety Disorder - it is a catch-all category for client who exhibit signs of an anxiety disorder, but do not meet criteria for any of the previously described conditions listed. Management: During interaction: o The nurse must maintain a calm, nonjudgmental approach to convey acceptance toward the client. He must also use short, simple sentences to reduce the client s heightened response to environmental stimuli. Assistance in Meeting Basic Needs: o Assist the client in meeting basic needs and encourage verbalization of feelings. o Attempt to channel the client s behavior be engaging the client in physical activities that provide an outlet for tension or frustration and promote sleep. Medication Management: Benzodiazepines, antidepressants, anxiolytics, beta blockers, and in some cases, neuroleptics. Antidepressants such as the selective serotonin reuptake inhibitor (SSRI) paroxetine (Paxil), and the serotonin-nonepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) have been approved by the FDA as the agents of choice. Interactive Therapies: