Stress from a positive experience----Wedding, Job
Can produce a great deal of anxiety even though is
originated from a positive experience
Uncomfortable feeling of dread
Occurs in response to stress that is extreme or over a long
period of time.
Stressors are different for everyone.
What may be extremely stressful for one person may be
relaxing to someone else.
Anxiety is also influenced by culture. Some admit to it
others keep it to themselves based on their culture.
Higher levels of anxiety may result in behavioral changes.
All anxiety disorders except OCD occur more in woman
Mild anxiety is somewhat normal and healthy for an
individual for cooping with stress.
Nurses working with children and teen need to be aware
that they experience anxiety and stress as well, but
sometimes are unable to verbalize their feelings therefore
display symptoms differently.
For example, decrease in grades, eating habits change,
sleeping patterns, withdrawal from friends and activities.
Nurses can be instrumental in screening children for
signs of anxiety.
Anxiety is different from fear-fear is a response to a
4 Levels of Anxiety
Anxiety is ranked as mild, moderate, severe and panic.
Mild-able to recognize anxiety
Moderate-able to sustain attention on a focal point, may
talk faster, vital signs increase, able to express and
Severe-attention is focused on a small part of a specific
area, may be unaware of anxiety, vitals increase, coping
and relief measures used.
Panic-feelings of unreality, confusion, terror, self
absorption, may use violence towards self, others. Loss
of control, may run away-can result in exhaustion
Definition-the ability to withstand and recover from
A study on resilience was done on 750 servicemen who
were held captive during the Vietnam War.
They were held prisoners for 6-8 years
Some of these men did not develop depression or post
traumatic stress disorder (PTSD)
What protected these men?????
10 Characteristics of These
Faith and Spirituality
Having a Role Model
Having a Mission
Types of Anxiety Disorders
Generalized anxiety disorder
Obsessive Compulsive Disorder
Acute stress disorder
Posttraumatic stress disorder (PTSD)
Anxiety disorder due to a general medical condition
Substance induced anxiety disorder
Generalized Anxiety Disorder
Anxiety itself is the expressed symptom/ these are the
Generally requires that excessive worry be related to 2 or
more things that last 6 months or longer
These people worry excessively about money, health,
family, being late, or work---even when there are no
signs of trouble.
Physical symptoms- fatigue, HA’s, muscle tension,
muscle pain, irritability, sweating, nausea, difficulty
swallowing, trembling, etc….
People with this disorder usually avoid situations that
produce their anxiety.
Characterized by anxiety about being in places or
situations where escape may be difficult
Situations include-being alone away from home in a
crowd or standing in line; on a bridge or traveling in on
a plane, train, bus etc…
Severely impairs social and occupational functioning
when the individual avoids multiple anxiety producing
It is important to know that not everyone that stays in
the home has this….In some cultures its customary for
the woman to stay in the home.
Characterized by a marked and persistent fear of social performance
situations in which embarrassment may occur.
Phobia-definition- a persistent and irrational fear.
Social phobia only exists if the fear, avoidance, or anxiety about
encountering the social situation interferes significantly with daily
Physical symptoms include-blushing, excessive sweating, nausea, GI
distress, tremors, difficulty talking, etc….
Even after people with social phobia did the dreaded deed, they still
have anxiety about how people are still judging them and how they
repetitive thought urge or emotion
repetitive act that may appear purposeful
People with this disorder are unable to stop the thought
or action/behaviors become rituals.
It is doing the action or having the thought that reduces
Some are such strict rituals that if interrupted, requires
them to start over from beginning.
If person is prevented from performing obsession or
compulsion, anxiety converts to body related symptoms.
Examples of OCD
Check several times that doors are locked before
able to sleep. This actually can lead to inability to
Washing hands nonstop to the point of chapped
Counting and cleaning are also examples.
Performing rituals only provide temporary relief though.
People with this disease also realize that obsession are
excessive or unreasonable.
Obsessions usually take more than one hour a day and
interfere with normal healthy lifestyle, socially, work
OCD is sometimes accompanied by depression, eating
disorder, substance abuse, ADHD, or other anxiety
Treatments which combine medications and behavioral
therapy are often effective.
Nursing Interventions For OCD
Limit, but do not interrupt, the compulsive acts.
Teach the client to use alternate coping methods to
Client’s behavior maybe frustrating to staff and family.
Power struggles often result. Consistency to the
approach to care is critical.
Assess the client’s needs carefully.
Provide an environment that has structure and
predictability as a strategy to decrease anxiety.
Risk associated with the use of alcohol and drug abuse.
Acute Stress Disorder
Exposure to traumatic event causes numbing,
detachment, amnesia about event for no more than 4
weeks following event.
Is developed in response to unexpected emotional or
physical trauma that could not be controlled.
Can be actual or threatened.
Can develop after exposure to a terrifying event or
ordeal in which grave physical harm occurred or was
Events may include—violent personal assaults, natural
or human caused disaster accidents or military combat.
Family members of victims also can develop the
Can occur in people of any age, including children and
Symptoms of PTSD
Nightmares or frightening thoughts
Depression anxiety and irritability or outbursts of anger
for no apparent reason
Social withdrawal, feelings of low self esteem,
changes in relationships with significant other
and difficulty starting new relationships,
chemical dependency as a physical or behavioral
response to traumatic experience.
Anniversaries of events can trigger symptoms.
Treatment for PTSD
Cognitive behavioral therapy, group therapy and
exposure therapy in which the person is gradually and
repeatedly re-lives the frightening experience under
controlled setting. Suggest giving people opportunity to
talk about their experiences very soon after a
catastrophic event may reduce symptoms of PTSD.
Trust and communication and listening skills are very
important tools for nurses.
Encouraging points to express thoughts and feelings
surrounding the experience.
A feeling of guilt expressed by survivors of a traumatic
Why me? Or why not me?
Treat similar to PTSD.
It is important to validate the patients feelings regarding
Honesty and genuineness in communication with these
patients will help build a working rapport.
Interventions For the Client
With an Anxiety Disorder
Maintain calm milieu-minimizing stimuli helps patient keep
centered and focused.
Maintain open communication.
Encourage patient to verbalize all thoughts and feelings with
honesty helps with trust observe nonverbal communication.
Observe for signs of suicidal ideations. If suspect; observe and
confront and document any suspicions or statements
Document changes in behavior any change no matter how
Encourage activities provide diversion and concentration on
something other than stress and anxiety producing situation.
Should be purposeful and not busy work not competitive
Interventions for anxiety cont’d
Psychopharmacology-ant anxiety meds valium. Xanax.
Short term due to dependency.
Systematic desensitization-slowly reintroducing anxiety
Safety and comfort during crisis period
Remain with patient during acute attack
List nursing interventions for
the client with anxiety
Assist patient to identify precipitants and patterns to anxiety
Encourage use of positive self talk
Encourage problem solving and assist to develop alternative
When anxiety has passed help patient to identify and evaluate
coping mechanisms that did work and those that have not worked
Assess your own level of anxiety
Open ended questions to assess patients feelings