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Anxiety (Diagnosis (-Ineffective coping related to anxiety (mild, moderate…
Anxiety
Diagnosis
-Ineffective coping related to anxiety (mild, moderate, severe, or panic)
Interventions
-Stay with the patient to provide support
-Provide therapeutic communication with the patient to allow openness
-Assure the patient you are there to help and assist with control of the situation
-Administer antianxiolytic medications as prescribed
-Give simple directions for the client to follow
-Allow the patient to openly express feelings of anxiety
-Encourage the patient to speak about possible preciptating factors of anxiety
-Ask patient to question illogical thinking
-Identify what has helped them relieve anxiety in the past
-Discuss the patient's strengths
-Refreame the situation in ways that are positive
-Promote self-care acitivities for the patient to partcipate in
-Maintain a safe environment for the patient
-Practice breathing techniques to ease the level of anxiety the patient is currently feeling
-Refer the patient to counseling
-Use firm, short, simple statements
Planning
-The nurse should include the patient in the planning of care
-Ask the patient what goals they'd like to achieve in their care
-In more severe cases of anxiety, the patient may be unable to participate in planning. In this scenario, the nurse should take a more directive role.
-Collaborate with the healthcare team to provide multiple entities of care
DSM Criteria
A. Excessive anxiety and worry (apprehensive expectation),
occurring more days than not for at least 6 months, about a
number of events or activities (such as work or school
performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of
the following six symptoms (with at least some symptoms
having been present for more days than not for the past 6
months):
Note: Only one item is required for children.
- Restlessness or feeling keyed up or on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Irritability.
- Muscle tension.
- Sleep disturbance (difficulty falling or staying asleep, or
restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically
significant distress or impairment in social, occupational, or
other important areas of functioning.
E. The disturbance is not attributable to the physiological effects
of a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental
disorder (e.g., anxiety or worry about having panic attacks in
panic disorder, negative evaluation in social anxiety disorder,
contamination or other obsessions in obsessive-compulsive
disorder, separation from attachment figures in separation
anxiety disorder, reminders of traumatic events in
posttraumatic stress disorder, gaining weight in anorexia
nervosa, physical complaints in somatic symptom disorder,
perceived appearance flaws in body dysmorphic disorder,
having a serious illness in illness anxiety disorder, or the
content of delusional beliefs in schizophrenia or delusional
disorder.
Assessment
-Identify factors that have successfully helped reduce anxiety in the past
-Ask if the client has recently used any drugs or alcohol
-Identify how agreeable the client is to participating in their care and the family's desire to participate in their care
-Assess for specific cultural, ethnic, and social backgrounds that may affect the plan of care
-Determine current level of anxiety
-Asess for self-harming behaviors (cutting, burning, skin picking)
-Assess for suicidal or homocidal ideations
-Assess for somatic symptoms of anxiety
-Assess thought process
-Identify factors that may precipitate anxiety
-The Severity Measure for Generalized Anxiety Disorder in Adults (FIG 15.2) can be used to assess symptoms on anxiety
-Assess the patient's goals for treatment
Outcomes
-The patient will state three coping mechanisms to help them through their anxiety before discharge
-Patient will be able to identify factors that precipitate anxiety before discharge
-Patient will experience less anxiety by the end of the interaction with the nurse
Signs & Symptoms
Levels of Anxiety
Moderate Anxiety
-Narrowed perceptual field
-Less present in the situation
-Focuses on the source of anxiety
-Shorter attention span
-Able to solve problems, but much less able than without anxiety
-Voice tremors
-Change in pitch of voice
-Poor concentration
-Shakiness
-Urinary frequency
-Headache
-Backache
-Insomnia
-Increased respirations, pulse, and muscle tension
-Tension-relieving behaviors such as pacing and banging hands on table
Severe Anxiety
-Very limited perceptual field
-Focuses on certain specific details
-Inability to pay attention
-Very difficult to solve problems
-Has difficulty understanding cause and effect of events
-Feelings of dread
-Restlessness
-Sense of impending doom
-Sweating
-Chest discomfort
-Dizziness
-Nausea
-Sleeplessness
-Social withdrawal
-Loud and rapid speech
-Threats and demands
Mild anxiety
-Heightened perceptual field
-Aware of the anxiety
-Ability to maintain some focus
-Able to weigh options and work towards goals
-Can feel more alert and aware
-Slightly uncomfortable
-Restless
-Attention-seeking behavior
-Irritability or impatience
-Easily startled
-Tension-relieving behaviors such as foot or finger tapping, lip chewing, or fidgeting)
Panic
-inability to withstand the environment
-Inability to focus
-Feeling of unrealness
-Inability to process what's happening
-Irrational reasoning
-Feelings of terror
-Immobility or sever hyperactivity
-Numbness or tingling
-Shortness of breath
-Dizzness
-Chest pain
-Nausea
-Trembling
-Chills
-Overheating
-Palpitations
-Severe withdrawal
-Hallucinations or delusions
-Out of touch with reality
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References:
Halter, M. J. (2018). Varcarolis' foundations of psychiatric mental health nursing: A clinical approach (8th ed.). Elsevier.
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