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Learning Objective

Describe the continuum of adaptive


and maladaptive anxiety responses
(Level of Anxiety)
Identity behaviors associated with
anxiety responses
Analyze predisposing factors,
presipitating stressors, appraisal of
stressor related to anxiety responses
Describe coping resources and
coping mechanisms

Learning Objective
Formulate nursing diagnoses
Identify expected outcomes and
short term nursing goals
Develop a patient education plan to
promote the relaxation responses
Analyze nursing intervention related
to anxiety responses
Evaluate nursing care

Introduction
Anxiety is part of everyday life
Its basic to the human condition and
provides a valuable warning system to
the individual
Its necessary for survival
Its preservationof self anxiety
occurs as a result of a threat to a
persons selfhood, selfesteem or
identity

Define
Anxiety is an emotion and a
subjective individual experience
Cannot be observed directly A
nurse infers the patient is anxiety
based on behavior
Anxiety communicated
interpersonally
(Stuart & Laraia, 2001 dan Stuart & sundeen, 1998)

Contd
Anxiety is an emotion without a specific
object.
Its provoked by the unknown and
precedes all new experiance (Ex:
entering school, starting a new job, ect)
Anxiety is experienced when the values
a person identifies with existance are
threatened
(Stuart & Laraia, 2001 dan Stuart & sundeen,
1998)

Anxiety vs Fear
The caracteristic of anxiety
differentiated it from FEAR.
Fear is an individual ideation with
a specific source or object that a
person can identify and describe

Deferentiate
Anxiety

Fear

the intelectual
the emotional
appraisal of a
responseto that
threatening
appraisal
stimulus
Caused by fear
Caused by physical
Fear produced
or psychological
exposure to a
anxiety
threatening
situation

(Stuart & Laraia, 2001 dan Stuart &


sundeen, 1998)

Level of Anxiety
Peplau (1963) identify 4 levels of
anxiety

1.Mild Anxiety
2.Moderate Anxiety
3.Severe Anxiety
4.Panic
(Stuart & Laraia, 2001 dan Stuart &
sundeen, 1998)

Associated with the tension of day to


day living
The person is alert and the
perceptual field is incrased
The person sees, hears, and grasps
more than before
This anxiety can motivate learning
and produce growth and creativity

The person focuses only on


immadiate concerns involve the
narrowing of the perceptual field as
the person sees, hears, and prasps
less.
The person blocks selected areas but
can attend to more if directed to do so

Severe Anxiety
Is Marked by significant reduction in
the perceptual field

The person tends to focus on a


specific detail and not think about
anything else

Panic
Is associated with awe,dread and terror.
This stage details are blown out of proportion
Complete loss of control the person is
unable to do things even with direction
Involve the disorganization of the personality
Characteristic:
Increased motor activity
decreased ability to relate to others
distorted perceptions and loss of rational
thought

Contd
Panic is frightening and paralyzing
experiance
The person is unable to communicate
or function effectively
The person is incompatible with life
A prolonged periode of panic result
in exhaustion and death

Panic Attack Criteria

is discrete periode of intense fear or


discomfort
in which at least 4 of
1. Palpitations, pounding herat, accelerated
folowing
.... Within 10 mnt
HR

2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or
smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress

8. Feeling dizzy, unsteady, lighteaded,


9. Derealization (feeling of unreality) or
depersonalization
10. Fear of losing control or going
crazy
11. Fear of dying
12. Parasthesias
13. Chills or hot flushes

Environment
Perceptual
field

Mild

Perceptual
Field

Moderate

Environment

Illustration
Perceptual
Field

Environment

Mild

Severe

Environment

Perceptual
Field

Panic

Continuum of Anxiety Responses


Continuum of Anxiety Responses

Adaptive Response
Response
Anticipation
Severe

Mild
Panic

Maladaptive

Moderate

Stuart & Laraia, 2001 dan Stuart &


sundeen, 1998)

The Stuart Stress Adaptation Model Related to


Anxiety Responses
Predisposing Factor
Precipitating Stressor
Appraisal of Stressor
Coping Resources
Coping Mechanism
Task Oriented

Ego Oriented

Constructive

Destructive

Continuum Of Anxiety Responses


Adaptive Response
Maladaptive Response

Anticipation

Mild

Moderate

Severe

Panic

Nursing Care Plan


1. Assessment

2.
3.
4.
5.

Behaviors
Predisposing Factors
Pracipitating Stressors
Coping Resources
Coping Mechanisms

Nursing Diagnoses
Planning
Implementation
Evaluation

Behaviors
Physiological responses Autonomic
nervous systems
1. The Sympathic
2. The parasympathetic
(effect: Cardiovascular, respiratory,
gastrointestinal, neuromuscular, urinary,
skin.)
Behavioral psychomotors manifestation
Cognitif
Affective

Predisposing Factors
Psychoanalytic view Traumatic
stage, with increase age and ego
development, a new kind of anxiety
arises, emitional conflict: id and
superego
Interpersonal view
Behavioral view frustration, conflict
(there are two opposing interest
choose between them)
Family study
Biological basis

Precipitating
Threat to phusical integrity
Threat to self-system (identity, selfesteem, integrated social functional)

Coping Resource Coping Mechanisms


Task-oriented reaction solve problem,
resolve conflict, gratify need.
Ego orientes reaction compensation,
denial, displacement, dissociation,
intellectualization, isolation, identification

Nursing Diagnoses
1. Anxiety
Panic level of anxiety related to ...
severe anxiety related to ...
moderate anxiety related to ...

2. Ineffective individual coping


3. Fear

Implementing of severe and panic


level of anxiety:
1.
2.
3.
4.
5.
6.

Establishing a trusting relationship


Self awareness
Protecting the client
Modifying the environment
Encourageing activity
Medication

Implementing of moderate
level of anxiety
1.
2.
3.
4.

Recognition of anxiety
Insight into the anxiety
Coping with the threat
Promote the relaxation the
relaxation response
Evaluation
1. Deduced of anxiety level
2. Not harm and injury