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The most common mental disorder in the United States of America is anxiety disorder, affecting over 40 million people aged 18 years and above. Anxiety disorder can affect people of different social statuses, including the young, the old, the rich, the poor, the healthy, and the sick. It can result from racing and circular thoughts, uncertainty, and fear. Anxiety disorder can make one think they are losing their mind, affecting one’s ability to function normally.
Anxiety disorder can result from psychological problems such as personality difficulty and substance abuse. Many people are struggling with anxiety disorder, and patients and healthcare providers need to understand the anxiety one suffers from and its effects on the patient. Appling cognitive strategies practically can help patients overcome anxiety.
Causes of Anxiety.
The following are the factors that cause anxiety disorder:
- Abuse of the substance. This disorder is caused by herbal medications and over-the-counter drugs
- Genetic factors. These factors play a major role in social phobias. A study on twins and family reveals that social phobia risks are heritable.
- Environmental factors. Early childhood trauma is an environmental factor that can cause late anxiety disorders.
- Panic disorder. Two theories explain the causes of panic disorder, namely, genetic and neurochemical factors. One theory suggests that anxiety is genetically inherited. This means individuals from a family with this condition history are at risk of having it. The other theory suggests that panic disorder can result from neurochemical dysfunction. Imbalances of certain brain chemicals cause the development of this condition.
Signs and symptoms of Anxiety Disorder.
- Fear of dying
- Discomfort and chest pain
- Heart palpitations
- Shortness of breath
- Heat sensation
- Fear of going crazy
Goals and outcomes.
Many people experience anxiety, and each of them has symptoms that vary. Anxiety may be underdiagnosed in some cases, and proper treatment may not be given. Anxiety can significantly affect patients’ ability to function and quality of life because it has high morbidity. Therefore it is important to let the professional team manage anxiety. The team’s goals and outcomes may include:
- Reducing the patient’s anxiety level to a manageable level where the patient will feel more relaxed.
- Ensuring the patients are aware of their emotions to help them find ways to cope with those feelings.
- Ensuring patients are aware of their situations.
- Ensuring patients can display a range of emotions appropriate with their situation.
- Ensuring patients are able to use resources effectively, and they can develop problem-solving skills.
Nursing Diagnosis for Anxiety.
This diagnosis includes,
- Anxiety associated with situational stressors has symptoms like sweating, increased heart rate, and restlessness.
- Anxiety associated with side effects of medicine, such as nausea and dizziness, is evidenced by fear and worry about taking medicines.
- Anxiety associated with the fear of the unknown and medical diagnosis made recently with symptoms like worry, fear, and restlessness.
- Anxiety associated with medical procedures and hospitalization stress as demonstrated by Panic attacks, fear, and nervousness.
Anxiety Nursing Assessment.
The importance of this assessment is to differentiate feasible problems that lead to anxiety. Nursing assessment includes:
|The existence of a culture-bound anxiety state should be assessed.||Mediate culturally the meaning, responses, and the situation in which anxiety is established.|
|The four levels of a patient’s anxiety should be assessed. (Mild, moderate, severe, and panic).||Mild anxiety patients experience zero/minimal physiological anxiety symptoms, and their vital signs are usually within the normal ranges. Patients in this stage may have a calm appearance but may report nervousness.
Patients experiencing moderate anxiety have a tone of voice, animated facial expressions, feel tense, and have an energized appearance. Patients with severe anxiety experience the urge to urinate frequently, elevated vital signs, dry mouth, diaphoresis, and muscle tension.
At this stage, the patient gets more irritable and agitated, and the new stimuli may overwhelm them. Pain in the chest and heart palpitations are also experienced at this stage. In the last level of anxiety disorder, called panic level, the automatic nervous system of the patient rises to sympathetic neurotransmitter release.
Patients at this level have extreme behavior, get pale, are uncontrollable, have poor muscle coordination, and are reported to be hypotensive.
|The influence of cultural beliefs, norms, and values should be assessed when evaluating a patient’s perspective of a stressful situation.||Individuals’ interpretation and stress response is greatly impacted by culture.|
|The patient’s physical reaction to anxiety should be assessed.||Somatoform disorders can be caused by anxiety and have symptoms such as weakness, pain, and nausea.|
|Observations should be verified by asking the patient if they are feeling anxious at the moment.||Anxiety is a natural and normal response to life events that different people experience differently. Different people experience anxiety differently and for different reasons.|
|With the help of the State-Trait Anxiety Inventory (STAI), differentiate the two individual anxiety levels (temporary response state, long-standing personality trait.||State-Trait Anxiety Inventory is a psychological assessment tool used to measure a patient’s anxiety levels. The development of this tool was done by Spielberger. It is designed in a way that is easy to understand and use.
People of different regions and cultures can easily access it since it is available in over 40 languages. People of different educational backgrounds can use it with ease since it has a reading level of a six-grade.
|Observe how the patient uses defense mechanisms and coping techniques to deal with anxiety.||Defense mechanisms are important in helping patients manage anxiety levels and preserve their pride. Sublimation, suppression, and humor are highly adaptive defense mechanisms in dealing with anxiety.
Other defense mechanisms that can lead to less adaptive behavior include; denial, displacement, projection, repression, and splitting of self-image.
Patients should give informative answers to questions asked to evaluate whether coping techniques are effective. These coping techniques include physical exercises such as walking, journaling, and reading.
|Homicidal and suicidal risks should be evaluated.||This assessment can be done by asking the patient if they ever had thoughts of committing suicide, their thoughts about death, have plans to harm themselves, and death desires.|
Anxiety Nursing interventions.
Regardless of contributing and the causing factors, anxiety nursing interventions can be applied to all persons with anxiety. These interventions are as follows:
|Awareness of the patient’s anxiety should be recognized||Anxiety causes are not always identified, and this can make the person experiencing it feel like the feelings are unreal. It is important to validate and acknowledge the client’s feelings, and this will help them accept and deal with reality, which will help reduce fear and anxiety.
To resume a normal life, the patients must accept the responsibility to participate in their recovery. They must actively work towards positive change and address their anxiety.
|With the client’s permission, use demeanor, touch, presence, and verbalization to encourage the clients and assure them they are not alone. Questions, clarifications, unknowns, concerns, and expressions should be encouraged.||Nurses can promote Therapeutic communication with patients by being approachable and by them being supportive. Interaction between nurses and patients will help patients eliminate feeling alone. Utilizing interview techniques will help in building rapport.
Therapeutic communication techniques have helped the clients easily understand their needs, find ways to meet them, and express their feelings.
|Clients should be familiar with people, the environment, and new experiences.||The anxiety that a client is experiencing could be reduced by them being aware of the environment. If clients cannot control environmental stimuli and feel threatened, their anxiety level may increase to a panic level.
For a patient to feel comfortable, safe, and relaxed, it is important to consider environmental factors such as lighting, smells, sounds, color palette, and temperature. Managing conflicts, indirect communication, and unreliable people can be very difficult.
|Have peaceful interaction with the client.||Healthcare providers should have calm and peaceful interactions with their clients because some clients with hypersensitivity can easily pick up stress and anxiety from people around them, worsening their anxiety.
The client’s feeling of calmness and stability can increase when a calm and non-threatening environment is created, making it easier for the clients to receive care and treatment. The nurse’s interaction and approaches with the client greatly impact the effectiveness of the care and treatment.
|The client’s defenses should be accepted. Avoid debating, arguing, and daring the patient||Healthcare providers should avoid challenging clients’ defenses because it will make the client feel less secure, making them less willing to engage with care. Healthcare providers should accept the defense without judgment.
Healthcare providers build trust and rapport by accepting their clients’ defenses and making them feel heard. This helps them be more receptive to following treatment plans and receiving care.
|Brief statements and simple language should be used while conversing.||Patients with severe and moderate anxiety have problems understanding instructions that are not clear, brief, and simple. Initial shock trauma makes patients forget important information given at the moment.|
|The patient’s personal reaction to discomfort, pain, and threats to well-being should be reinforced. (Walking, talking, crying)||Anxiety can be reduced by talking. You can encourage patients to continue talking using non-verbal cues. Engage with your client through a conversation, listen and understand them and show them your interest in what they are saying.|
|Sensory stimuli should be lessened by maintaining a peaceful and quiet environment. Threatening equipment should be kept away.||Excessive noise, conversation, and equipment kept near the patient may intensify anxiety and panic.|
|Situations that provoke anxiety should be examined to see if they are traceable, and the patient should be allowed to talk about the feelings that make them anxious.||Factors that make a patient feel anxious may be identified by conversing with the patient about the situations that cause the anxious feeling.|
|Empathy should be used to encourage patients to interpret anxiety symptoms as normal if the circumstantial response is rational.||Anxiety is a natural reaction to an either perceived or actual threat. While dealing with patients and their families, it is important to be nonjudgmental and empathetic. Anxiety can cause split relationships between family members, affects their lifestyle and finance, and this may cause them to have different reactions.|
|Records of anxiety episodes should be kept. Circumstances that led to these episodes and what was experienced should be described. What happened after anxiety dissipated should also be noted.||Recognizing and exploring factors that alleviate and contribute to feeling anxious is important. Understanding these factors will help develop alternative responses to manage anxiety effectively. Some patients may not understand the connection between anxiety and emotional concerns.
In this case, keeping records of their trigger and symptoms will give an insight into what is causing their anxiety. If comfortable, patients can share this log with healthcare providers, which will help develop a more effective coping strategy.
Healthcare providers can use information from the log to understand the anxiety degree a patient is experiencing and the appropriate treatment to be provided.
|Patients should be encouraged to have positive self-talk. These talks include “I can’t be harmed by anxiety,” “right now I need to stretch, and breath,” “step by step, I can take this,” and “I don’t have to be perfect.” These talks help in reducing the patient’s anxiousness and help them remain calm.||Cognitive therapy is a type of psychotherapy that aims at changing emotions and behaviors through a change of thoughts. Positive self-talk help in reducing anxiety because the counteract negative statement, which leads to stress.
Patients will learn to be more confident and feel in control if they can recognize and challenge negative thoughts. Client-centered therapy is an approach that insists on the importance of understanding each individual and their unique experiences. When patients and therapists work together, they feel more satisfied because they are involved in making treatment decisions.
|Apply coping strategies that a client used in the past and were effective should be considered.||Coping strategies help a patient become more confident and improve their mastery. Patients should be encouraged to focus on their abilities so that they don’t get overwhelmed or feel helpless. Monitoring the patient’s anxiety level during stressful life events is important. Coping mechanisms should be used in mitigating high anxiety effects.|
|Unnecessary reassurance that could increase unwarranted worry should be avoided.||Giving assurance to people experiencing anxiety is an inappropriate approach to helping them manage their anxiety. Reassurance may not help patients manage their anxiety in the long run because it doesn’t address the underlying causes. Healthcare providers should therefore be very cautious when approaching and communicating with someone experiencing anxiety.|
|Help a patient develop new skills that reduce anxiety. For example, positive visualization, relaxation, self-reassuring statements, and deep breathing.||Healthcare providers can help patients explore new coping strategies that will help them manage their anxiety in different ways. When patients practice relaxation techniques, they can control their thinking, have a positive mindset, divert their attention to things that make them comfortable, and easily manage their emotions, such as sadness, fear, and overthinking.|
|Interventions should be made to eliminate anxiety sources.||Anxiety is the body’s natural response to a perceived or real threat, and eliminating the threat will stop the response. Researchers in an experimental setting have been able to elicit anxiety symptoms
in patients with the panic disorder through the following triggers; caffeine consumption, hyperventilation, inhaling carbon dioxide, and saline hypertonic infusion. Eliminating these triggers will reduce panic in patients experiencing panic attacks and anxiety.
|Help the patient strengthen their abilities to solve problems. Logical strategies that anxious patients can use should be highlighted.||Identifying a problem and evaluating different ways of solving that problem help patients develop a coping strategy. Coping strategies that focus on solving problems help patients eliminate the threat.|
|All procedures, activities, and issues involving a patient should be explained. Calm, non-medical terms and slow speech should be used. The client’s understanding should be validated.||Patients who receive education about their upcoming medical procedures are not emotionally distressed and are less anxious because they are mentally and emotionally prepared since they know what to expect.
Information should be provided to the patients to empower them to participate in their care with health care providers. This will help patients feel that they are in control of their health.
|Patients should be instructed to take antianxiety medicines appropriately.||Antianxiety medicines can be used for a short period of time to reduce physical anxiety symptoms and can also help a patient cope with anxiety. Benzodiazepine and anxiolytics can be used as emergency treatment for patients experiencing severe anxiety.
Antianxiety medications include; Selective serotonin Reuptake Inhibitors (SSRI), Buspirone HCI, Benzodiazepine and nonselective beta-blockers, and alpha-2-receptor agonists.
Patients should be instructed to limit Central nervous system stimulants usage.
|Cocaine, amphetamines, nicotine theophylline, caffeine, and terbutaline sulfate increase anxiety and physical symptoms. Products containing caffeine, such as colas, coffee and tea should either be minimized to a reasonable level or stopped completely. Anxiety symptoms may be precipitated by using ephedrine and herbal compounds; therefore, herbal remedies and over-the-counter drugs should be reviewed.|
|Back scrubs and massages should be given to the patient to reduce anxiety.||Progressive muscle relaxation(PMR) is a technique used to reduce anxiety and targets physical symptoms of anxiety-related tension. This is done by tensing specific muscles for a while, then releasing the tension and focusing on the relaxation sensation. It can be practiced alone or with the help of a trained professional.|
|Patients should be provided with means of listening to their preferred music.||Music is an effective, low-cost method of reducing anxiety. Music therapy is not the same as music medicine. Health professionals recommend music therapy for therapeutic purposes. In contrast, music therapy involves using various music components such as rhythm, melody, pitch, harmony, and timbre to enhance and support psychological, physical, and social health.|
|Sedatives, smoking, and alcohol withdrawals should be ruled out as causes of anxiety before making a diagnosis.||As part of the withdrawal process, patients trying to stop smoking and those having alcohol withdrawals may experience anxiety symptoms. Testing for drug abuse, diabetes screening, and a pregnancy test should be done before starting any anxiety medication treatments.|
|Family members and patients should be educated about anxiety symptoms.||Teaching family members and patients about the signs and symptoms of anxiety can help them manage the condition before becoming severe. Information on how anxiety affects the patient’s moods, behavior, and relationships should be given to the family. Family members can collaborate with the healthcare provider and the patient to monitor the effectiveness of the treatment.|
|Train patients on visualizing pain and anxiety absence, conflict resolution, and procedure outcome.||Patients can learn to visualize a calm environment through a relaxation exercise called guided imagery. It helps patients manage their stress by distracting them from intrusive thoughts. It involves all the senses to create a deeper sense of the sensation.|
|In emergency situations (suicide thoughts), patients should be taught to appreciate community resources like judicial systems, hotlines, law enforcement, and emergency rooms.||The most effective suicide prevention method is systematic direct screening. Individuals who are at a higher risk of committing suicide are systematically identified and are provided with treatment and intensive support.
Financial disasters and divorce can trigger suicide attempts. People with underlying mood, substance abuse problems, and anxiety risk committing suicide due to acute stress.
|Patients should be educated and assisted with box breathing.||Box breathing is an important technique that helps with relaxation. It is a breathing exercise that can help patients manage their stress and can be used before, during, or after experiencing a stressful situation.|
|Psychotherapy information should be provided.||There are two types of psychotherapy, namely cognitive and behavioral therapy. The two can be used alone or combined with pharmacotherapy. Pharmacotherapy and psychotherapy combination can yield better results than either modality used alone.
Cognitive therapy helps patients understand how their thoughts and beliefs influence their emotional responses and behaviors. Conversely, behavioral therapy exposes patients gradually to situations that cause anxiety and fear.
|Consultations and referrals should be arranged with psychologists, psychiatrists and other medical professionals.||
Testing and psychology consultations should be noted if the patient is a cognitive behavioral therapy candidate. Consulting a psychiatrist is important because it provides a follow-up plan, and longer-term therapy is initiated.