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ANXIETY- is a subjective ,individual experience characterized by a feeling of apprehension, uneasiness, uncertainty, or dread.

Types of ANXIETY:

1.) normal- a healthy type of anxiety that mobilizes a person to action. 2.) acute- precipitated by imminent loss or change that threatens the sense of security.

3.) chronic- anxiety that the individual has lived with for a long time.

Coping with ANXIETY:

1.) Adaptive- solves the problem that is causing the anxiety, so the anxiety is decreased. 2.) Palliative- temporarily decreases the anxiety but does not solve the problem, so the anxiety eventually returns. 3.) Maladaptive- unsuccessful attempts to decrease the anxiety without attempting to solve the problem. 4.) Dysfunctional- is not successful in reducing the anxiety or solving the problem. Even minimal functioning becomes difficult, a new problem begins to develop.

> MILD high degree of awareness, mild uneasiness, alert

> MODERATE- poor comprehension, narrowed perceptual field

> SEVERE- signs and symptoms becomes the focus of attention, no problem solving technique > PANIC- inability to function, personality disorganized

What am I going to do?!!!!!!!!!

Nursing intervention for each level of anxiety:

a.) mild/ alertness level - recognize the anxiety by statements such as I notice you being restless today.. - explore causes of anxiety and ways to solve the problems that cause anxiety by statements such as lets discuss ways to.. b.) moderate/ apprehension level - provide outlets for anxiety : crying, talking - tell patient its alright to cry. - engage in motor activity to reduce tension. - make patient be aware of his behaviors and feelings by statements such as I know you feel scared whenever you talk about that incident in your life. - refocus attention. - encourage the client to talk about feelings and concern. - help the client identify thoughts and feelings that occurred prior to the onset of anxiety. - provide anti- anxiety medications.

c. Severe/ free-floating level - stay calm and stay with client. - give short and explicit explanation: Look at me. Sit down on the chair. I will sit next to you. - modify the environment d.) Panic level - guide patient step by step to action. - restrain if necessary.

Classification of anxiety disorders:

1.) Panic disorder- accompanied by intense fear or discomfort that last minutes to more rarely hours, attacks occurs out of the blue with no apparent cause or stimulus. ASSESSMENT: - dyspnea, palpitations, chest pain, sensation of smothering, faintness, dizziness, sweating, trembling, shaking, nausea or abdominal pain, dizziness or lightheadedness. - fear of dying - feeling unreal or disconnected - fear of losing control, going crazy - numbness

Side effects if untreated:

a.) Avoidance- in an efforts to avoid activities, places, people or situations that he thinks triggers the attack.
b.) Agoraphobia- soon the person fears and avoids public places where he has no escape when panic attacks occurs. Some people lives becomes restricted that they avoid normal, everyday activities. c.) Anticipatory anxiety- develop intense anxiety between episodes, worrying when and where the next one will strike.

Nursing intervention:

1.) Main treatment options are medication and cognitive behavioral therapy. 2.) Cognitive behavioral therapy consists of five key elements: > Learning- in the first stage, the therapists explains the illness, teaches the patient to identify the symptoms, and outlines the treatment plan. > Monitoring- the patient keeps the diary to monitor panic attacks and record anxiety-inducing situations. > Breathing- the therapist teaches breathing relaxation techniques to combat the physical reactions of a panic attack. > Rethinking- the therapist helps the patient change his or her interpretation of physical symptoms from catastrophic to realistic. > Exposing- the therapist helps the patient encounter situations that evoke frightening physical sensations at level of gradually increasing intensity.

Phobic disorder- refers to an uncontrollable, persistent and

irrational fear of an object or situation that impairs normal functioning of the person affected.

Types of phobia: 1.) Social phobia- ( social anxiety disorder) refers to the fear of being watched, scorned or humiliated in social situation, while doing something in front of an audience or while simply interacting with other people.

2.) Agoraphobia- fear of being alone or in public places where help is minimal.
3.) Specific phobia- an extreme or excessive fear of a particular object or situation that the person could not overcome.

Other types of PHOBIA:

> acrophobia- heights > androphobia- men > astraphobia- storm, lighting > ceraunophobia- thunder > claustrophobia- closed places > hematophobia- blood > hydrophobia- water > latrophobia- doctor > nyctophobia- night > ochlophobia- crowd > pyrophobia- fire > zoophobia- animals

Nursing interventions:

1.) recognize clients feelings about phobic object or situation. 2.) provide constant support if exposure to phobic object or situation cannot be avoided. 3.) assist with relaxation techniques to control or diminish anxiety level. 4) behavior modification is a counter conditioning to overcome fears by gradually increasing exposure to the feared object, situation or animal (desensitization) 5.) videotaping with review and feedback and role playing are two therapeutic strategies that can help a person with social phobia. 6.) monitoring medication for effectiveness and adverse reactions, reinforcing concepts presented in therapy, and educating patients and their families on the significance of the phobia as debilitating problem and not just a character flaw to be overcome.

7.) nurses can also teach patients to recognize the signs of increasing anxiety and to select anxietyreduction measures appropriate for them. One of the most important things for nurses to remember when caring for a patient experiencing phobia is to refrain from confronting or humiliating them. 8.) be sure to carefully screen for suicidal ideation among people with phobia because environmental factors that predispose to phobias also contribute to the risk factors for suicide.

Generalized anxiety disorder- recognize clients

feelings about phobic object or situation.
Nursing intervention: 1.) recognize early signs of anxious behavior. 2.) encourages verbalization of feelings. 3.) provide alternative outlets such as walking and listening to music. 4.) teach techniques like feedback, relaxation, guidedimaginery, diaphragmatic breathing and assertiveness. 5.) reduce caffeine to reduce anxiety.

Obsessive- compulsive disorder

- the person attempts to ignore or suppress such thoughts or impulses or to neutralize them with some other thoughts and actions. Compulsion- is an uncontrollable urge to do repetitive acts that are recognized by patient as unnecessary and unreasonable. Rituals- are the behaviors or repetitive acts in which people engage in response to a compulsion..

Remember: there is no pleasure in carrying out the rituals, only temporary relief from the anxiety that grows when the rituals are not performed. During stressful times, the ritualistic behavior increases.

Common rituals:
a.) cleaning- provoked by the fear that real or imagined germs , dirt or chemicals will contaminate them, the fear is relieved by hours and hours of washing or cleaning the surroundings. b.) repeating- the urge to utter name, phrase or behavior repeatedly to dispel anxiety. c.) completing- people with this compulsion must perform a series of complicated behaviors in an exact order or repeat them again and again until they are done perfectly. d.) checking- the fear of harming oneself or others by forgetting to lock the door or turn of the gas stove develops into the ritual of checking.

e.) being meticulous- while neatness and tidiness dont signify a disorder, some individuals with OCD develops an overwhelming concern on how things should be arranged. f.) avoiding- compulsive avoiders stay away from the cause of their anxiety and anything related to it. g.) hoarding- involves constant collection of useless items. H.) slowness- strikes mostly on men, this compulsion causes people to do certain tasks very, very slowly.

Nursing interventions:

1.) accept rituals permissively. 2.) avoid criticisms or punishment, making demands, or showing impatience to clients. 3.) Protect from rejections by others. 4.) engage in nursing therapy after rituals is over, when client is most comfortable. 5.) protect from self-inflicted harmful acts. 6.) redirect clients actions into substitute outlets. 7.) health teaching: teach how to prevent health problems related to rituals, ie. Rubber gloves, hand lotion

Post- Traumatic Stress Disorder (PTSD)- follows

a devastating event both made man-made and God-made (rape, tsunami, assault), experience recurrent and intrusive recollection of traumatic events.

3 stages of recovery after trauma: A.) The victim stage- consist of 3 phases: > prediscovery of the traum- the person begins to experience symptoms of PTSD such as: forgetfulness or amnesia of the traumatic events, low self-esteem or feel physically, emotionally or financially vulnerable

> early awareness- the person begins to sense that he has been under a traumatic event in the past. This realization cause him to experience increased anxiety, depression, irritability and dissatisfaction with himself and others. > discovery- finally, the traumatic event is brought to awareness and as an expected response to any crises, the initial reaction is disbelief, shock, denial. As the person finally confirms that he has been under trauma, flashbacks and nightmares may occur.

B.) survivor stage- the person confronts his traumatic past and takes constructive steps such as a commitment to therapy to be able to take control again of his inner self and environment. C.) thriver stage- the person finally gains control of his self has found renewed focus and direction in life. The traumatic past no longer controls his behavior.


1.) Strengthen survivors sense of control over their lives. 2.) Create a sense of security. 3.) Assist in forming meaningful goals and connections with other people. 4.) identify how current life struggles have been affected by the trauma. Comparing life before and after the trauma in proper perspective in their lives.

Interventions for ANXIETY:

ANXIETY! Welcome to nursing school! Would you agree? Perhaps we should say, welcome to life!
C- Calm A- Awareness of anxiety L- Listen M- Medications E- Environment R- Reassurance

General treatment for ANXIETY DISORDER:

1.) Psychotherapy ( TALK THERAPY) 2.) Medications

health professional to learn how to deal with anxiety disorders

a.) behavior therapy-uses relaxation techniques and carefully planned exposure to feared object or situation. b.) cognitive- behavioral therapy (CBT) - helps patient understand their pattern of thinking so that they can react differently to situations that cause anxiety.

Psychotherapy- involves talking to a trained mental


T- Try expression R- Reflection of words U-Use of silence S- Setting limits T- Time with client
ANTI-ANXIETY MEDICATIONS: L- Librium E- Equanil A- Atarax V- Valium S- Serax