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Carita Bird
Region A Nursing Consortium
NUR 112
ANXIETY
 Anxiety
is a state of apprehension, dread,
uneasiness, or uncertainty generated by
a real or perceived threat whose actual
source is unidentifiable
 ANXIETY
• An emotional, subjective response
• Involves feelings of apprehension, worry
• In an acute form, it is known as “state anxiety”
• In a chronic form, it is known as “trait anxiety”
• Primary anxiety is related to psychological
factors
• Secondary anxiety results as a reaction to a
physical health problem
 Fear
• A reaction to a specific danger
 Stress
• State of imbalance
 Stressors
• Internal or external event that causes anxiety
 Client’s internal or external environment
 Physical illness
 Perception of the stressor
 Burnout
• State of mental or physical exhaustion
 Anxiety
can be a healthy, adaptive
reaction
 Anxiety
can be pathological
 Anxiety
exists on a continuum
• Mild
• Moderate
• Severe
• Panic
 An
automatic physical reaction to stress
mediated by the sympathetic nervous
system.
A
stressor is encountered
 Stress is the initial response to the
stressor
 The “fight or flight” reaction occurs
 Increased alertness
 The body mobilizes resources
 Coping and defense mechanisms in play
 Psychosomatic symptoms
 Prolonged stress
burnout
 Several
theories have been proposed
 One’s theoretical viewpoint affects the
selection of treatment modalities
 Theory based on Biological factors,
Psychodynamic factors, Interpersonal
factors, and Behavioral factors
 Social
theorists
 Intrapersonal
 Cognitive
 Feminist
theorists
theorists
theorists
A look at clients experiencing

phobias

panic disorder

generalized anxiety disorder
 Recognize
that their fears or phobias are
irrational
 Contact with or thought of contact with
the phobia brings high anxiety
 Clients attempt to manage their phobia
by avoidance
 Avoidance leads to interference with
routine activities
 Agoraphobia
• The fear of being incapacitated by being forced
into or trapped in an unbearable situation from
which there is no escape
• Examples: crowds, standing in lines, traveling in
a vehicle
• Treatment: Cognitive therapy and graduated
exposure or desensitization; anxiolytics for short
term therapy
• Nursing care: accept but do not support the
phobia
Social Phobia
 An
excessive fear of embarrassment and
humiliation in public places
• Example: may be related to a specific situation
or generalized to several similar situation i.e.
business meetings or specific reunions
• They strain interpersonal relationships and the
individual may escalate when SOs try to help
• Treatment: benzodiazepines, beta blockers,
SSRIs and exposure therapy
• Nursing care: acceptance but not support of the
phobia
 Unrealistic
fear of a particular object or
situation
• Stimulus may be an object or a concern
• Example: spiders
• Panic level anxiety
• Consider the ethnic or cultural background of
the client during assessment
• Treatment: Cognitive therapy; desensitization,
short term anxiolytics use
• Nursing care: accept that the client has the
phobia, but do not support it.
 Difficulty
controlling unrealistic,
excessive anxiety associated with
common daily experiences
 Symptoms:
• Restlessness
• Irritability
• Fatigue
• Depression
• Difficulty concentrating
• Muscle tension
• Sleep disturbance
• Helplessness
 Symptoms
 May
interfere with ADLs
attempt to control symptoms by
becoming dependent on ETOH or other
substances
 Treatments:
• Cognitive therapy
• Relaxation therapy
• Encourage clients to rethink their perceptions of
the stressor
• Medications: Selective serotonin reuptake
inhibitors, tricyclic antidepressants and
buspirone
 Individuals
who have recurrent panic
attacks for which the source may not be
known. In between panic attacks, these
individuals worry about another attack.
The onset of the attack is sudden.
 Symptoms:
• Desire to escape
• Chest pain
• Chills/hot flashes
• Choking sensations, dizziness
• Nausea
• Palpitations
• Shortness of breath
• Sweating and trembling
• Fear of loss of control
 Clients
tend to associate their symptoms
with physical illness
 Feelings of hopelessness, helplessness
and despair
 Agorophobia may or may not be present
 Nursing
care:
• Provide calm, offer reassurance, use short clear
sentences and remain with client during the
panic attack
• When the anxiety diminishes, encourage the
client to assume care for self, reinforce
appropriate coping strategies
• Medications: SSRIs, benzodiazepines, and
valporic acid are used to treat the panic attack.
Beta blockers may reduce ANS symptoms
 Stress
affects each client differently
 Determine the level of anxiety
 Anxiety disorders are seen in all settings
 Biological, psychological and social
factors should be assessed
 Assessment
should focus on the physical,
affective, cognitive, social and spiritual
symptoms of stress
 Anxiety
 Fear
 Ineffective
individual coping
 Powerlessness
 Social isolation
 Used
by clients to manage anxiety
 Coping strategies are determined by the
individual’s intellect, emotional state,
physical health, beliefs. Values
 Coping strategies may be effective or
ineffective
 Common coping strategies include:
breathing exercises, guided imagery,
listening to music, recreational activities
 General
life management techniques can
be used to reduce stress
• Diet
• Exercise
• Time management
• Sleep
 Assessment
of facts
 Development of goal
 Determination of alternatives for coping
with the problem
 Identification of the risks and benefits
 Selection of an alternative
 Implementation of the selected
alternative
 Evaluation of the outcome
 Modification
of actions based on
evaluation
 Emotional
focused coping
 Altruism
 Conversion
 Denial
 Displacement
 Identification
 Intellectualization
 Introjection
 Isolation

Projection
Rationalization
Reaction Formation
Regression
Repression
Splitting
Sublimation
Suppression
Undoing
 It
is important to note that sublimation
and altruism are always positive!
 Anxiety
disorders are treated with
antidepressants
• Selective serotonin reuptake inhibitors
• Tricyclic antidepressants
• Beta adrenergic blockers
• Antihistamines
• Antiepileptics
• Buspirone
 SSRIs
have a more rapid onset of action
and fewer side effects
• Initially may cause nausea, loose bowel
movements, headaches and insomnia
• A rare but serious adverse reaction is serotonin
syndrome
 Benzodiazepines
– effective for anxiety
Tx
• May lead to dependency
• Absorbed well via the GI tract
• Onset of action is rapid – within an hour
• Few drugs interact with benzodiazepines
• Common side effects: ataxia, drowsiness,
impaired cognition, memory and coordination
• Don’t mix with alcohol
• Withdrawal symptoms
 Buspirone
– a serotonin partial agonist
used in the short-term treatment of
anxiety
• Well absorbed orally
• 2-3 weeks for full effectiveness
• Side effects – light-headedness, drowsiness,
headache, nausea
• Side effects generally decrease over time
• Not habit forming
• Withdrawal is not an issue
• High cost and slow onset of action preclude it
from being widely used.
• Should not be used as a PRN medication for
anxiety
 Beta
blockers – have a calming effect on
the CNS
• Propanolol – sometimes used for anxiety
• Effective in treating the physical symptoms of
anxiety such as tremors and tachycardia
 Antihistamines
– used to treat lower
levels of anxiety
• Safe and nonaddictive
• Can be purchased without a prescription
• Used to lower anxiety in clients with substance
abuse problems
• Anticholinergic effects can be a problem for
elderly clients
 Individual
and group therapy – can be
used to help anxious individuals develop
insight into the reasons for their anxious
feelings
• Individual therapy
 Insight therapy
 Psychoanalysis
 Group
therapy – effective therapy for
treatment of anxiety which provides
multiple sources of feedback
• Growth groups
• Support groups
• Task groups
• Self-help groups
• Education groups
 Cognitive
therapy – assists individuals to
identify errors in thinking and plan
responses to stressors
• Encouraged to replace positive thought for the
•
•
•
•
negative ones
Brief and time-limited
Structured and orderly
Clients appraise stressors
Questions are used by the practitioner to
encourage the client to develop their own
solutions
 Behavioral Therapy
– a variety of
activities to decrease anxiety
• Response prevention
• Systematic desensitization
• Flooding
• Thought-stopping