Anxiety

Definition:

• Is a subjective, individual experience characterized by a feeling of apprehension, uneasiness, uncertainty, or dread.
• It occurs as a result of threats that may be actual or imagined, misperceived or misinterpreted, or from a threat to identity or self-esteem.
• It often precedes new experiences.
• May be treated by therapy, counselling. Some trials say CBD seems to have a positive effect on anxiety.

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.

Levels of Anxiety:

1.Mild/ Alertness Level (+1)

• This is the type of anxiety associated with the normal tension of everyday life.
• The individual is alert
• Perceptual field is increased
• Produce growth and creativity, as it increases learning
• The person uses adaptive coping mechanisms to solve problems and alleviate anxiety.

Nursing Interventions:

1. Recognize the anxiety by statements such as “I notice you being restless today”.
2. Explore causes of anxiety and ways to solve problems that cause anxiety by statements such as “Let’s discuss ways to…”

2. Moderate/ Apprehension Level (+2)

• The response of the body to immediate danger and focus is directed to immediate concerns.
• Narrows the perceptual field to pay attention to particular details.
• Selective inattentiveness occurs
• The increased tension makes this the optimal time for learning
• The person uses palliative coping mechanisms.

Nursing Interventions:

1. Provide outlets for anxiety such as crying or talking.
2. Tell client “It’s all right to cry”.
3. Encourage in motor activity to reduce tension.
4. Make client be aware of his behavior and feelings by statements such as “ I know you feel scare…”
5. Encourage client to move from affecting (feeling) to cognitive mode (thinking).
6. Refocus attention
7. Encourage the client to talk about felings and concerns.
8. Help the client identify thoughts and feelings that occurred prior to the onset of anxiety.
9. Provide anti-anxiety oral medications.

3. Severe/ Free-floating Level (+3)

• Creates a feeling that something bad is about to happen, or feeling of an impending doom.
• Fight and flight response sets in
• Narrow perceptual field occurs and focus is on specific details or scaterred details so that learning and problem-solving is not possible.
• All behaviors are directed at alternative the anxiety
• The individual needs direction to focus
• Dilated pupils, fixed vision
• The person uses maladaptive coping mechanisms.

Nursing Interventions:

1. Do not focus on coping mechanisms
2. Stay calm and stay with the client
3. Give short and explicit direction
4. Modify the environment by setting limits or seclusion, limit interaction with others, and reduce environmental stimuli to calm client.
5. Provide IM antianxiety medications.

4. Panic Level (+4)

• Feelings of helplessness and terror
• The personality and behavior is disorganized
• The individual lessens perception of the environment to protect the ego from awareness and anxiety causing distorted perceptions and loss of rational thoughts.
• Is unable to communicate or function effectively
• Inability to concentrate
• If prolonged, panic can lead to exhaustion and death
• The person uses dysfunctional coping mechanisms.

Nursing Interventions:

1. Guide patient step by step to action
2. Restrain if necessary.

image courtesy of: www.nlm.nih.gov, healthpapa.com