ANXIET

Anxiety is a
subjective
emotional state
occurring when
ego is
threatened and
provoked by
the unknown.
It is fear of the
unknown.

Causes of
Anxiety

1.

Genetic Theory.
Chromosome 9 is
linked to
development of panic
disorder,
chromosome 13q is
linked to potential
subtype of panic
disorder called panic
syndrome and
chromosome 14 is
linked to simple
phobia, social phobia,
panic disorder and

agoraphobia.

2.

Biologic
Theory.
Neurotransmi
tter studies
have revealed
that serotonin
plays a role in
causing
anxiety.

3. Psychoanalytic
Theory. Anxiety is
the result of
unresolved,
unconscious conflicts
between impulses
for aggressive or
libidinal gratification
and the egos
recognition of the
external damage
that could result
from gratification.

4. Interpersonal Theory.
Sullivan (1953)
considered
interpersonal relations
and the socialization
process important to
how individuals feel
about themselves.
Sullivan saw
individuals striving for
security and relief
from anxiety to protect
their self-esteems.

1. Normal healthy
type.
2. Acute
precipitated by
imminent loss or
change that
threatens the
sense of security.
3. Chronic the
individual lived for
it for a long time.

Levels of
Anxiety

1. Mild Anxiety
Characteristics
include wide
perceptual field,
sharpened senses
(attentive and
alert), motivation
is increased,
effective problem
solving, increased
learning ability,
irritability.
Tensions of
everyday life.

Physical
Characteristi
cs include:
Restlessness,
Fidgeting, GI
problems,
difficulty
sleeping,
hypersensitiv
ity

Management To assist
client to
tolerate some
anxiety.

2. Moderate Anxiety
Characterized
by narrowed
perceptual field:
immediate tasks,
selectively
attentive, cant
connect thoughts
and events
independently,
increased use of
automatisms.

Physical
Characteristics
include the
following: Muscle
tension,
diaphoresis,
bounding pulse,
headaches, dry
mouth, high pitch
of voice, faster
rate of speech, GI
problems, and
frequent urination

Management To reduce
anxiety by
helping client
understand
its cause and
by identifying
a way of
controlling it.

3. Severe Anxiety
characterized by
perceptual field: one
detail or scattered
details (cannot establish
connection of details),
cannot complete tasks
and solve problems or
learn effectively,
behavior geared towards
anxiety relief (usually
ineffective), doesnt
respond to redirection,
feels awe, dread, or
horror, cries.

Physical
Characteristics
include the
following: Severe
headache,
nausea/vomiting,
diarrhea,
trembling, rigid
stance, vertigo,
pallor, tachycardia,
chest pain

Management
- To help the
client
channel
anxiety and
lower it to a
moderate or
mild level.

4. Panic Anxiety Perceptual field:

focus on self, cannot
process
environmental
stimuli, distorted
perceptions, loss of
rational thought,
doesnt recognize
potential danger,
cant communicate
verbally, possible
delusions and
hallucinations.

Physical
Characteristics
include the
following: May
bolt or run,
totally
immobile and
mute, dilated
pupils,
increased BP
and PR, Flight,
fight, or freeze

Manageme
nt - To be
supportiv
e and
protectiv
e

Coping with Anxiety

1. Adaptive - Solves
the problem that
is causing anxiety,
so the anxiety is
decreased. The
patient is
objective, rational
and productive.

Common Use
Anxiety about
an upcoming
exam is
reduced by
studying
effectively
and passing
the exam with
a very high
grade

2. Palliative
Temporarily
decreases the
anxiety but does
not solve the
problem, so the
anxiety
eventually
returns.
Temporary relief
allows the
patient to
return to
problem solving.

Common Use Anxiety about

the exam is
temporarily
reduced by
jogging for an
hour. Effective
studying is
then possible
and a very high
grade is still
achievable.

3. Maladaptive Unsuccessful
attempts to
decrease
anxiety
without
attempting to
solve problem.
The anxiety
remains.

Common Use
Anxiety about the
exam is first
ignored by going
to the movie and
then handled by
frantically
cramming for a
few hours.
Getting a passing
grade is obtained

4. Dysfunctional Is
not successful in
reducing anxiety
or solving the
problem. Even
minimal
functioning
becomes difficult,
and new
problems begin
to develop.

Common Use Anxiety about the

exam is first ignored by going out
drinking with friends and then
escaped by passing out for the
night. A failing grade is obtained
and the course has to be repeated.

AnxietyRelated
Disorde
rs

A. Generalized Anxiety
Disorders it is
manifested by excessive
worry and anxiety, there
is difficulty in controlling
the worry. There is
impairment in
interpersonal, social and
occupational functioning.
Feelings of depression,
helplessness,
restlessness, fatigue,
irritability, muscle
tension and disturbed
sleep.

Nursing Management
1.Recreational
activities, stress
management, selfesteem,
assertiveness
2.Provide calm and
quiet environment
3.Ask patients to
identify what and
how they feel

4. Listen to patients expressions of

helplessness and hopelessness.
5. Ask patient if they are suicidal
6. Plan and involve patient in
activities
7. Encourage problem solving.

8. Discuss
present and
previous
coping
mechanism
s.

9. Discuss the meaning of

problems and conflicts
10.Assist in exploring
alternative solutions and
behaviors.

B. PANIC
DISORDER
intense fear
or discomfort
and lasts from
minutes to an
hour, peak in
10 minutes.

Etiology
1.Genetically
transmitted
2.Environmental
factors
3.Serotonin is
elevated
4.Caffeine
5.Carbon dioxide
6.Sodium lactate

Manifestations:
1.Increased heart
rate, palpitations
or chest pain
2.Chills or hot
flushes, sweating,
trembling,
dizziness, lightheadedness
3.Feeling of choking,
smothering or
shortness of
breath.

4. Nausea or abdominal
distress
5. Numbness or tingling
6. Fear of dying, going
crazy or losing
control
7. Agoraphobia fear of
being in a place or
situation in which
escape might be
difficult or
embarrassing.

Nursing
Management
1.Gross motor
activities such as
walking, jogging,
basketball,
volleyball, use of
stationary bicycle.

2. Stay with the patient

3. Maintain calm
4. Give one direction at a time
in a calm tone of voice.

5. Provide brown bag if

hyperventilating
6. Allow patient to cry
or pace.
7. Communicate to the
patient that you are
in control and will
not let anything
happen to them.
8. Dont touch patient.
9. Ask to express fears.

C. OBSESSIVE-COMPULSIVE
DISORDER
Obsessions recurrent and
persistent thought or ideas that
are intrusive and senseless.
Compulsions repetitive behaviors
in response to obsessions to
prevent discomfort or anxiety.
Etiology - Genetic transmission

Manifestations:
1.Time consuming
repetitive behaviors
such as hand
washing, counting,
which interferes
with usual daily
functioning.

Nursing Management:
1.Stress management,
recreational skills, social skills,
cognitive therapy, problemsolving, communication
training, assertiveness training
2.Ensure the basic needs of food,
rest and grooming are met.

3. Provide patient with

time for rituals
4. Explain expectations,
routines and changes
5. Assist patient in
connecting behaviors
and feeling
6. Structure simple
activities
7. Reinforce and
recognize positive
non-ritualistic
behaviors.

D. PHOBIAS intense,
irrational and unreasonable
fear responses to a freefloating anxiety.
Etiology individual,
environment, family
environment, genetic

Types of Phobias

Nursing Management
1.Behavior therapies
(desensitization, flooding,
exposure, self-exposure,
treatment), assertiveness
training, goal-setting,
social skills.
2.Accept patients and fears
3.Promote safety and
comfort
4.Identify basis of anxiety

5.
6.
7.
8.

Allow to verbalize feelings

Promote desensitization
Teach relaxation techniques
Do not force to have contact
with the phobic object.

E. ADJUSTMENT DISORDERS
Etiology divorce, moving,
marriage, retirement,
illness or disability,
financial problems,
difficulties in child rearing

Manifestations
develop in 3 6
months
a.Anxiety
b.Depression
c.Interpersonal,
social impairment
d.Work, academic
inhibition

Nursing Management
1.Recognize the
relationships
between stressful
situation and current
problems
2.Review and
reintegrate feelings
and memories of the
original situation.

SOMATOFORM
DISORDERS
physical symptoms
for which there is
no known organic
cause or
physiological
mechanism,
instead connected
to psychological
factors or
conflicts.

Etiology genetic,
personality,
socio-cultural
factors, stressful
life events

1. Somatization
disorder patient
verbalizes
recurrent, frequent
and multiple
somatic complaints
on different sites
for several years
without physiologic
cause. Patient
sees many
physicians through
the years.

2. Pain Disorder
severe pain in a
localized site with
no known organic
cause.
3. Hypochondrias
patient who is
afraid that they
have a disease and
constantly check
for re-assurance
about illness

4. Conversion disorder - deficit or

alteration in voluntary motor or
sensory function due to
psychological factors such as
blindness, paralysis and
seizures.
a. Use Primary Gain (conscious alleviation
of anxiety and Secondary Gain
(gratification received as a result of how
people in these patients environment
respond to patients illness
b. La Belle Indifference expressing little
concern about his anxiety
c. Malingering conscious or pretentious
in making a symptom to alleviate
anxiety.

General Manifestations
1.Patients are not in control of
symptoms
2.Patients repeatedly seek
medical diagnosis and
treatment even though they
have been told there is no
known cause.
3.Repression
4.Denial
5.Displacement
6.Conversion

5. Body dysmorphic
disorder
pervasive
subjective
feeling of
ugliness and are
pre-occupied
with an imagined
defect in
physical
appearance.

Medical Management
1.Anxiolytics

Nursing Management
1.Hypnosis, relaxation techniques
2.Use a caring approach
3.Ask patients how they are
feeling
4.Use positive reinforcement
5.Set limits
6.Be consistent with all patients
7.Use diversion
8.Do not push awareness into
conflicts