ANXIETY
Definition:
Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often non-specific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impeding danger and enables the individual to take measures to deal with threat
Related factors:
- • Threat to self-concept
- • Situational crises
- • Maturational crises
- • Stress
- • Unmet needs
- • Role change
- • Familial association
- • Substance abuse
- • Unconscious conflict about goals or values
Defining Characteristics:
Subjective
Behavioral
Expressed concerns due to change in life events
Affective
Regretful; scared; rattled; distressed; apprehension; uncertainty; fearful; feeling inadequate; anxious; jittery; [sense of impending doom]; [hopelessness]
Cognitive
Fear of unspecific consequences; awareness of physiological symptoms
Physiological
Shakiness; worried; regretful; dry mouth (s); tingling in extremities (p); heart pounding (s); nausea (p); abdominal pain (p); diarrhea (p); urinary hesitancy (p); urinary frequency (p); faintness (p); weakness (s); decreased pulse (p); respiratory difficulties (s); fatigue (p); sleep disturbance (p); [chest, back, neck pain]
Objective
Behavioral
Poor eye contact; glancing about; scanning and vigilance; extraneous movement (e.g., foot shuffling, hand/arm movements); fidgeting; restlessness; diminished productivity; [crying/tearfulness]; [pacing/purposeless activity]; [immobility]
Affective
Increased wariness; focus on self; irritability; overexcited; anguish; painful and persistent increased helplessness
Physiological
Voice quivering; trembling/hand tremors; increased tension; facial tension; increased pulse; increased perspiration; cardiovascular excitation (s); facial flushing (s); superficial vasoconstriction (s); increased blood pressure (s); twitching (s); increased reflexes (s); urinary urgency (p); decreased blood pressure (p); insomnia; anorexia (s); increased respiration (s)
Cognitive
Preoccupation; impaired attention; difficulty concentrating; forgetfulness; diminished ability to problem-solve; diminished learning ability; rumination; tendency to blame others; blocking of thought; confusion; decreased perceptual field
Expected outcomes:
The patient will
- • Identify factors that elicit anxious behaviors.
- • Participate in activities that decrease feelings of anxious behaviors.
- • Practice relaxation techniques at specific intervals each day.
- • Cope with current medical situation without demonstrating severe signs of anxiety.
- • Demonstrate observable signs of reduced anxiety.
- • State that the level of anxiety has decreased.
Interventions and Rationales:
Determine:
Listen attentively to patient to determine exactly what he or she is feeling. Listening on the part of the nurse helps the patient identify anxious behaviors more easily and discover the source of anxiety.
Assess types of activities that help reduce patient’s stress levels.
Monitor physiologic responses including respirations, heart rate and rhythm, and blood pressure.
Perform:
Reduce environmental stressors (including people), and remain with patient during severe anxiety. Anxiety often results from lack of trust in the environment and/or fear of being alone.
Offer relaxing types of music for quiet listening periods. Listening to relaxing music may have a calming effect.
Promote proper body alignment to avoid contractures and maintain optimal musculoskeletal balance and physiologic function. Encourage active exercise to promote a sense of well-being.
Inform:
Teach patient relaxation techniques (guided imagery, progressive muscle relaxation, and meditation) to be performed at least every 4 hr to restore psychological and physical equilibrium by decreasing autonomic response to anxiety.
Attend:
Provide emotional support and encouragement to improve self-concept and encourage frequent use of relaxation techniques.
Allow extra visiting times with family if this seems to allay patient’s anxiety about activities of daily living.
Involve patient in planning and decision making to encourage interest and compliance. Encourage patient to talk about the kinds of activities that promote feelings of comfort. Assist patient to create a plan to try engaging in at least one of these activities each day. This gives the patient a sense of control.
Make sure that patient has clear explanations for everything that will happen to him or her. Ask for feedback to ensure that the patient understands. Anxiety may impair patient’s cognitive abilities.
Manage:
Refer to case manager/social worker or professional mental health caretaker to provide mental health assistance. Encouraging the use of community mental health resources reinforces the fact that anxiety reduction is a long-term process.
Reference:
Buffin, M. D., et al. (2006, September). A music intervention to reduce anxiety before vascular angiography procedures. Journal of Vascular Nursing, 24(3), 68–73.
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