During the period of stress everyone goes through anxiety, An individual is able to cope up with the associated symptoms of anxiety. But when the individual is not able to do so and starts developing marked symptoms, he/she requires help. Sometimes this basic factor of anxiety may turn into other neurotic disorders.
Definition of Anxiety
Anxiety is a pervasive feeling of dread, apprehension and impending disaster. It is different from FEAR
Fear is a response to a clear and present danger. For example : fear of dark, fear of a dog.
Anxiety is a response to an undefined or unknown threat which may be due to unconscious conflict or insecurity (like undergoing surgery). The psychological and physiological changes occur in fear as well as in anxiety.
Types of Anxiety Disorders
(1) PANIC DISORDERS
It is also called episodic paroxysmal anxiety. The individual has recurrent attacks of severe anxiety.
These attacks are not restricted to any particular situation or circumstance and are unpredictable. The person has an onset of palpitations, chest pain, choking sensation, dizziness and a feeling of unreality
(Depersonalization).
A fear of dying, losing control or going mad may also be present. The attack lasts for minutes or a little longer. Panic attack is often followed by a fear of having another attack.
(II) GENERALIZED ANXIETY DISORDERS
The essential feature is anxiety. It is generalized and persistent but not necessarily due to environmental
circumstances. It is also called a Free Floating anxiety.
Common symptoms are nervousness, trembling muscular tension, sweating, lightheadedness, palpitation, dizziness and epigastric discomfort. “Like a feeling that someone in the family is going to be very ill Generalised anxiety is a common disorder in women than men.
ASSOCIATED CONDITION OF ANXIETY
- Anxiety disorders
- Schizophrenia
- Delusional (Paranoid) disorders
- Psychophysiological conditions like crisis, Phobia, obesity and physical disorders.
- Dissociative disorders
ETIOLOGICAL FACTORS OF ANXIETY
- Biological factors
- Psychological factors
- Maladaptive learning
- Blocked personal growth
NURSING DIAGNOSIS FOR ANXIETY
- Exaggerated fear
- Changed physiological status
- Impaired communication
- Decreased orientation
- Lowered self-esteem
- Altered socialization
- Ineffective coping abilities
- Disturbed sleep pattern
- Disturbed eating pattern
- Increased activity
- Decreased family support
NURSING CARE PLAN FOR ANXIETY
| NURSING NEEDS | NURSING GOALS |
| 1. THERAPEUTIC NEEDS | STG: To prevent the patient from going into shock LTG :To help the patent to overcome anxiety |
| 2. PHYSICAL NEEDS i. Improve sleep pattern | STG : To reduce physical exhaustion. LTG : To help the patient to : – have adequate sleep hours. -feel less exhausted |
| ii. Decreased activity/restlessness | STG : To reduce exhaustion to the patient. LTG : To help the patient to : – find the relationship between anxiety & increased activity. -reduce the purposeless activity |
| iii. Improve appetite & weight | STG : To increase intake of food LTG : To help the patient to : – improve diet intake – improve in physical health. |
| iv. Prevent from injury | STG : To protect the patient from self injury. LTG : To help the Patient to : – protect himself/ others from injury and accidents |
| 3. PSYCHOSOCIAL NEEDS i. Reduce anxiety | STG : To help the patient to over Come anxiety. LTG : To help the patient to : – use coping mechanisms -reduce complications |
| ii. Improve perception | STG : To help the patient to be Oriented to time, place and person. LTG :To help the patient to : -develop accurate perception -improve attention and concentration |
| iii. Improve socialization | STG : To reduce irritability to others. LTG : To help the patient to : -to regain his/her socialization abilities. |
| iv. Improve family support | STG : To feel secure and have less anxiety. LTG : To help the patient to : -identify available family support -feel secure during stress. |
| 4. RECREATIONAL ACTIVITIES | STG :To divert from an anxiety situation LTG : To help the patient to : -find pleasure in life -Divert his mind. |
NURSING IMPLEMENTATION
| PLANNING | IMPLEMENTATION |
| 1. Therapeutic Need * Physiological changes can lead the patient to Shock. *The nurse must try to maintain the B.P. of the patient Restore warmth of the body, reduce dehydration by providing liquids | * Observe and record the vital signs of the patient *Record the blood pressure of the patient * Give chewing gum to improve salivation. * Administer anti- Anxiety drugs, if Prescribed * Observe for the side-effects of Drugs * Massage the Patient’s feet and hands to improve peripheral circulation. |
| 2. PHYSICAL NEEDS i. Improve sleep pattern * Due to increased activity and apprehension the patient does not sleep adequately. * Encourage the patient to sleep for a longer duration. | *Reassure the patient * Provide a comfortable environment * Allow relatives to stay. * Encourage the patient to sleep for 6 to 8 hours duration. * provide a hot glass of milk . * Encourage afternoon naps. |
| ii. Decreased activity and restlessness * Plan the activities in which the patient is discouraged to walk too much. The covert anxiety may lead to increased activities, help the patient to identify. | *Calm and serene attitude of the nurse *Detect covert anxiety ( Presence of a particular relative or situation or message. * Encourage the patient to verbalaize relationship between the visit of a relative and increased activity and restlessness. |
| iii. Improve appetite & weight * Due to anxiety the appetite is poor or the patient eats too fast without chewing. | * Observe the amount of intake of diet. * Encourage small and frequent meals * Explain the patient to chew and eat food * Provide food of his/her choice. * Record weight. |
| iv. Prevent from injury * The patient is very restless due to anxiety , paces up down , may cause injury to self and by neglect or by mistake injure other persons. | * Provide safe environment with less equipment’s. * Cut fruits and give him. * Ensure that the floor is not slippery. |
| 3. PSYCHOSOCIAL NEEDS i. Reduce anxiety *Plan care to decrease symptoms of anxiety. * Identify the source of anxiety like threat to self security or others, inability to gain respect. from others, actual or impending interference with basic needs like food, sleep. | *Adopt a reassuring and friendly attitude. *Encourage the patient to talk (mental catharsis). *Listen actively (by responding, nodding your head). *Remain with the patient (feels secure.) *Use ‘simple but firm sentences. |
| ii. Improve perception * Plan activities in which the patient s attention and concentration are improved. Misperception is due to high anxiety and decreased attention and concentration. | * Orient him to ward and staff * Encourage the patient to sit down and do some activity. * Give a painting and ask the patient to identify the figures and colores used. * Motivate the patient to complete the activity which he has started. * Talk to patient slowly with pause. |
| iii. Improve socialization * Due to anxiety the patient has a purposeless activity and speech which may irritate others and they may avoid him/her. | * Explain to family members that the phase of symptoms is temporary. * Encourage relatives to support his/her appropriate behavior. * Accept the patient with his symptoms. * Encourage the patient to participate in activities like day care, occupational therapy. |
| iv. Improve family support * Help the patient to identify who all can support him. * He needs to identify and develop the support system. | * Encourage the patient to talk about the support system in family. * Help him to identify and develop relationship. * Encourage family members to provide security ( social) to the patient. |
| 4. RECREATIONAL ACTIVITIES * The patient is too preoccupied with stress and anxiety. His min can be diverted by providing activities of choice | * Ask the patient about his hobies. * Encourage him/her to go to the day room. * Provide material if he likes to do painting , writing or drawing. |