1. Anxiety
Jenny Vacek RN MSN

3. Becks Rating Scale
Self assessment

4. Definition
 Unsettled feeling from an unknown or
nonspecific threat – core of personality
is threatened
 May be real or imagined
 A universal response to stress
 An alerting response
 Crux of anxiety is self preservation

5. Anxiety –
Normal
Response

6. Anxiety
A state of tension, dread, or
impending doom
Motivates one to action:
-flee (fight or flight)
-control dangerous impulses

7. Anxiety
-In some cases the person may
become immobilized, freeze

8. Signs and Symptoms of Anxiety
 Should usually have insight (some
conditions, no insight)
 Mood (affective)
 Cognitive
 Behavioral
 Physiological
 Sometimes suicide attempts

9. Anxiety
-Consequence of ignoring anxiety
signals is the threat of being
destroyed, no longer existing

10. Defense Mechanisms
Hydrochondiasis
Obsessions
Compulsions
Phobias
Projection
Fantasy
Idealization
Somatization

11. Levels of Anxiety
 Hildegard Peplau 1952
moderate severe panic
mild
maladaptive
adaptive

12. Scope of Anxiety
 MILD – facilitates learning, creativity,
personal growth
 MODERATE – a little higher, manage,
GET pt. to move back on continuum
 SEVERE – can be acute or chronic –
focus to deal with pain, discomfort

13. Scope of Anxiety
SEVERE ANXIETY –
Since focus is not on coping with
environment, function is impaired.
Person needs help to reverse
situation

14. Levels of Anxiety
PANIC
Person is disorganized, increased
motor activity, distorted visual
perceptual field, loss of rational
thought, decreased ability to
related

15. Nursing Care - First
 Pay attention to patient cues (behavior)
 Assess for, rule out emergent needs
 Assess level of anxiety
 Administer psychotrophics prn
 Use therapeutic communication
 If severe: tell patient to calm down, slow
deep breaths, check vital signs
 Relaxation techniques

16. Anxiety as Contagious-explore own
awareness

17. Nursing Care- general
 Anxiety can increase perception of pain, treat
pain
 What is root cause
 If moderate anxiety, help patient stabilize to
lower anxiety level
 Listen to patient’s stories
 Decrease environmental stimuli
 Give information- knowledge is power

18. Nursing Care
 Assess for signs/symptoms of depression
(anxiety is a symptom)
 Patient may need consult
 Spiritual counseling
 Suicide screening

19. Anxiety in Children

20. Primary Prevention
 Foster healthy relationships
 Parental education
 Realistic Goals
 Developmentally appropriate

21. Anxiety – Healthy Responses
 Stranger Anxiety – at about 6 months
Infants may cry or protest when another person
holds them –due to cognitive development
and parental attachment
• Separation Anxiety - second half of first
year – inconsolable crying and other signs of
stress when parent is gone

22. Stages of Separation Anxiety-
Hospitalized Child
 Protest – crying, clinging
 Despair- depression, withdrawal
 Denial- appearance of being happy, close
relationships can be impaired, developmental
delay possible

23. Nursing Care - Children
Reduce stress of hospitalization
 Developmentally appropriate stimulation
 Rest
 Relationships – family, family life specialist,
volunteers
 Maintain routines- e.g. belongings from home

24. Assignment # 1
8 year old male is
-admitted to pediatric oncology unit
-diagnosis leukemia
-3rd bout of chemo – consider invasive
procedures
-reverse isolation precautions
-parents rarely visit

25. Nursing Process
 Assess
 Plan
 Implement
 Evaluate

26. Secondary Anxiety Disorders
Many people have
disorders/diseases that mimic or
cause anxiety or have symptoms of
anxiety – needs to be
assessed/ruled out

27. Secondary
Anxiety
Disorders –
Medical
Conditions,
Medications,
illicit drugs

28. Anxiety
Angina, MI, shock, hyperthyroidism,
hypothyroidism, pediatric neuropsychiatric
disorders: strep (mimics OC disorder), Drug
abuse (psychostimulants, benzo’s, barb),
theophylline, albuterol, SSRI’s,TCA’s,
antipsychotics, epinephrine, thyroid
supplements, levodopa, gastritis

29. Assessment
-History and Physical –
medical/psych
-Time, course of symptoms
-Chronic, intermittent
-Related to exposure/trauma
-Any previous episodes

30. Assessment
Drug or alcohol use/abuse
Medications
Social support structure
Current stressors
When applicable:
Mental Status Exam

31. Nursing Assessment
 VitalSigns
 O2 saturations
 Blood gases
 Blood glucose
 EKG
 Electrolytes

32. Anxiety
Disorders:
DSM IV

33. ANXIETY DISORDERS
 Separation anxiety disorders
 Acute stress disorders
 Panic Disorders
 Agoraphobia
 Social phobia
 Specific phobia
 Obsessive Compulsive Disorder

34. Exemplars of Anxiety Disorders
Generalized Anxiety Disorder
Panic Attack
Post Traumatic Stress Disorder

35. Generalized Anxiety
Disorder
Risk factors: genetic, precipitating stressors
Assessment Findings:
Excessive worry or anxiety
Difficult controlling the worry
Restlessness
Easily Fatigued

36. Assessment Findings
 Difficulty concentrating
 Mind going blank
 Muscle tension
 Sleep disturbance
 Irritability

37. Treatment/Nursing Care
 Treat symptoms: relaxation techniques,
antidepressants (SSRI’s, paroxetine),
anxiolytics, buspirone, psycho education
 Referrals for short term/long term counseling
 Group therapy

38. Panic Attacks
A specific period of discomfort or fear that is
developed abruptly and reaches a peak
within 10 minutes – occur in a variety of
anxiety disorders

39. Assessment Findings
 Palpitations,accelerated heart beat,
pounding heart
 Sweating
 Trembling or shaking
 Feelings of SOB, smothering
 Feeling of choking

40. Assessment Findings
 Chest pain
 Abdominal stress, nausea
 Dizzy, lightheaded, faint
 Derealization
 Fear of going crazy, losing control or dying
 Paresthesia
 Chills or hot flashes

41. Treatment/Nursing Care
 Assessment
 Rule out other problems
 Pharmacological interventions: anxiolytics
 Treat underlying disorders
 CBT

42. Activity # 2
 Case study page 315
 -What are risk factors
 -What symptoms is she having?
 -Potential differential diagnosis? -why
 -Diagnostics to rule out medical problems
 -What can nurse do to keep her safe?
 -Why is silence sometimes therapeutic
 -Client education – see sheet on panic

43. PTSD

44. Then and Now
History Malingering

45. Posttraumatic Stress
Disorder
 Person has been exposed to traumatic event
That had actual or threatened serious injury or
threatened death
Domestic violence, Rape, Natural Disasters,
Combat, Hospitalization
-Secondary PTSD

46. Primary Prevention
 Psychological First Aid
Calmness
Promotion safety
Self and Community
Social connectedness
Optimism

47. Mental Status Exam

48. Activity # 3-case study page 318
What are his risk factors
Identify signs and symptoms-behavioral,
cognitive, physiological
What needs to be done?
Priority nursing intervention?
Explain 3 the following treatment (therapy:
CBT
Prolonged exposure therapy
EMDR

49. Signs and Symptoms
 Recurrent/intrusive thoughts
 Recurrent distressing dreams
 Reliving experience (delusions,
hallucinations) - psychosis
 Intense psychological distress related to
event
 Physiological reactivity on exposure

50. Signs and Symptoms
 Persistentavoidance of trauma
 Generalized numbing related to trauma
 Feelings of detachment
 Hyper arousal***
 Causes significant distress in social,
occupational, important areas of function

51. Treatment/Nursing Care
 Assess for suicidal ideation
 Psychopharmacology
 Cognitive Behavioral Therapy
 Prolonged exposure therapy
 EMDR
 Mindfulness
 Support groups
 Peer Support Groups
 Psychosocial Rehab
 Vocational Rehab
 Animal Therapy

52. Activity # 4
Mindfulness
Take turns doing a mindfulness activity with
your peer