ANXIETY

Levels of Anxiety
Levels Perceptual Field Other signs

Mild Widens (observes Diaphoresis

more) Fidgeting
Alert Senses Tapping
Moderate Narrows (Selective Nausea and
inattention; (focus vomiting
on immediate task Restlessness
only) Tremors
Severe Greatly reduced has physiologic
(dissociation) symptoms of
tachycardia,
diaphoresis, and
chest pain.
Pacing
Hyperventilation
Rapid speech
Panic Reduced to a detail Loss of rational
(distortion) thought, delusions,
hallucinations, and
complete physical
immobility and
muteness
 Interventions

Mild Use energy anxiety provides

to encourage learning

Moderate Encourage patient to

talk: to focus on one
experience, to describe it
fully, then to formulate the
patient’s generalizations
about that experience.
Severe Allow relief behaviors to be used
but do not ask about them.
Encourage the patient to talk
only about the anxiety
Panic Nurse to stay with the patient.
Allow pacing and walk with the
patient.
No content inputs to the
patient’s thinking should be
made by the
nurse.
Short phrases by the nurse
Direct to the point
Do not touch the patient
O LISTEN
O STAY with the patient in a
CALM environment
O ADMINSTER MEDS
 ANXIETY
DISORDERS
 GENERALIZED ANXIETY
DISORDER
O at least 6 months of persistent and excessive worry and
anxiety
O Three of the following symptoms:
O Restlessness
O Easily fatigued
O Difficulty concentrating or mind going blank
O Irritability
O Muscle tension
O Sleep disturbance
O Agoraphobia
O Anxiety about or avoidance of places or situations from
which escape might be difficult or help might be
unavailable
O Panic Disorder
O It is characterized by recurrent, unexpected panic attacks
that cause constant concern.
O Social Phobia
O anxiety provoked by certain types of social or performance
situations, which often leads to avoidance behavior
O Acute stress disorder
O involves the development of anxiety, dissociation, and
other symptoms after a recent exposure to a traumatic
stressor. Within 4 weeks of the traumatic event and lasting
for at least 2 days
 POST-TRAUMATIC STRESS
DISORDER
O It is characterized by the re-experiencing of an
extremely traumatic event
O 3 months after the event
O Symptoms:
O fear, helplessness or horror- reliving the event
O Avoidance of memory-provoking stimuli
O Increased arousal (sleep disturbance, irritability or angry
outbursts, difficulty concentrating, hypervigilence,
exaggerated startle response)
O Significant distress or impairment
 Specific Phobia

fear of heights Acrophobia

fear of open spaces Agoraphobia
fear of cats Ailurophobia
fear of pain Algophobia
fear of spiders Arachnophobia
fear of thunder Brontophobia
fear of closed spaces Claustrophobia
fear of dogs Cynophobia
fear of insects Entomophobia
fear of blood Hematophobia
fear of germs Microphobia
fear of night or dark places Nyctophobia
fear of snakes Ophidiophobia
fear of loud noises Phonophobia
fear of light Photophobia
Fear of fire Pyrophobia
Stage fright Topophobia
Fear of strangers Xenophobia
Fear of animals Zoophobia
O Cognitive Behavioral Techniques
O Instead of thinking, “My heart is pounding. I think I
am going to die” the client thinks, “I can stand this. This
is just anxiety. It will go away.”- positive self-talk.
O Decatastrophizing
O The therapist may ask: “What is the worst thing that could
happen? Is that likely? Could you survive that? Is that as
bad as you imagine?”
O Thought Stopping
O Splashing the face with water
O Snapping a rubber band worn on the wrist
O Assertiveness Training
O “I feel angry when you turn your back while I’m talking”, “I
want to have five minutes of your time for an
uninterrupted conversation about something important
O Systematic Desensitization
O used to desensitize patients, exposes the
patient to a hierarchy of feared situations that
the patient has rated from least to most
feared.
O Flooding
O Desensitizing is done by presenting feared
objects or situations repeatedly without
session breaks until the anxiety dissipates.
 OBSESSIVE-COMPULSIVE
DISORDER
O Recurrent obsession or compulsions
O Checking rituals

Mngt:
O Electroconvulsive Therapy
O Maintaining Skin Integrity
O Tepid water and hand cream
O Time-limited washing
O Psychopharmacologic Treatment
O SSRIs and TCAs
O Nursing approach: The nurse should interact with the
patient in a calm, nonauthoritarian fashion
O Thought Stopping
O Relaxation techniques
O Cognitive Restructuring
O Cue Cards
O Psychoeducation
 Dissociative Disorders
O Dissociation is a subconscious defense mechanism that
helps a person protect his or her emotional self.
O Dissociative amnesia: The client cannot remember
important personal information usually of a traumatic or
stressful nature
O Dissociative fugue: The client has episodes of suddenly
leaving the home or place of work without any
explanation, traveling to another city, and being unable
to remember his or her past or identity. He or she may
assume a new identity.
O Dissociative identity disorder (formerly multiple
personality disorder): The client displays two or
more distinct identities or personality states
that recurrently take control of his or her
behavior.
O Depersonalization disorder: The client has a
persistent or recurrent feeling of being detached
from his or her mental processes or body. This is
accompanied by intact reality testing;
Nurse Djohn is caring for a client who is experiencing
panic attack. Anxiety is a vague uneasy feeling of
discomfort or dread accompanied by an autonomic
response and a feeling of apprehension caused by
anticipation of danger (Schultz, 56).
Which intervention would be most appropriate?
A. Tell the client he’s all right and there is no need to
panic
B. Explain to the client that there’s no need to worry
because he’s safe
C. Give the client a detailed explanation of his panic
reaction
D. Speak to client in short, simple sentences
KC reports that she often feels a choking
sensation in her throat, a racing heart,
dizziness and fearfulness. All of these
symptoms have occurred almost daily for the
past 3 months. Suspecting a psychological
component to these symptoms, what would
Nurse Djohn anticipate administering?
A. Benzodiazepines
B. Tofranil
C. Clozapine
D. Lithium carbonate
Edwin has generalized anxiety disorder. Which statement
is true about this client?
A. Nightmares and flashbacks are common in individuals
who suffer from generalized anxiety disorder
B. Generalized anxiety disorder is characterized by
anxiety that last longer than 6 months
C. The client has regular obsessions
D. Relaxation techniques and psychotherapy are
necessary for care
O The client is pacing and complains of
racing thoughts. The nurse asks the
client if something upsetting happens,
and the client response is vague and not
focused on nurse’s question. The nurse
assesses the client’s level of anxiety as:
A. Mild
B. Moderate
C. Severe
D. Panic
Which of the following is a behavior is
a manifestation of anxiety, except:
A. Tachycardia
B. Hyperventilation
C. Tachypnea
D. Panic
A 46-year old is admitted to the hospital because her
family is unable to manage her constant hand washing
rituals. Her family reports she washes her hands at least
30 times each day. The nurse noticed the client’s hands
are reddened, scaly and cracked. The main nursing goal
is to:
A. Remind the client several times of her appointment
B. Limit the number of hand washings
C. Tell her it is her responsibility to be there on time
D. Provide ample time for her to complete her rituals
Which of the following is an appropriate
treatment for this client?
A. A structured schedule of activities
B. An unstructured schedule of activities
C. Intense counseling
D. Negative reinforcement every time she
performs her rituals
The most effective way for the nurse to
intervene with her hand and face washing is
to:
A. Allow her a certain amount of time each
shift to engage in this behavior
B. Interrupt the activity briefly and frequently
C. Lock the door to her room and restrict
access to the bathroom
D. Tell her to stop each time she is observed
doing it