AnxietyAnxietyAll rights reserved Austin Community CollegeAll rights reserved Austin Community College

Normal Response to StressNormal Response to Stress

Situational anxietySituational anxiety– A testA test– A masteryA mastery– A job interviewA job interview

AnxietyAnxiety– MOTIVATESMOTIVATES– Helps to focusHelps to focus– Helps thinking and Helps thinking and

retention of retention of informationinformation

Physiologic Response to AnxietyPhysiologic Response to Anxiety

The individual protects The individual protects themselvesthemselves

Human response to Human response to anxiety was anxiety was developed a long time developed a long time ago when they could ago when they could have been eaten have been eaten

FIGHT and FLIGHT FIGHT and FLIGHT (Sympathetic Nervous (Sympathetic Nervous System)System)

When Anxiety is NOT HelpfulWhen Anxiety is NOT Helpful

Humans are no Humans are no longer at risk for longer at risk for being eatenbeing eaten

But sometimes the But sometimes the Fight Flight Fight Flight response still response still occursoccurs

When the person When the person cannot run or fight cannot run or fight the anxiety the anxiety worsensworsens

Anxiety and the Anxiety and the Sympathetic Nervous System Sympathetic Nervous System

Arousal and the Arousal and the Autonomic Nervous SystemAutonomic Nervous System

Motor tension; shaky, muscle tension, Motor tension; shaky, muscle tension, fatigues easilyfatigues easily

Tachycardia, pupils dilate, decrease Tachycardia, pupils dilate, decrease secretion in GI tract, Sphincters contract, secretion in GI tract, Sphincters contract, Convert glycogen to glucose in liverConvert glycogen to glucose in liver

Blood vessels dilate (peripheral)Blood vessels dilate (peripheral) Adrenaline; dry mouth, dizziness, nausea, Adrenaline; dry mouth, dizziness, nausea,

diarrhea diarrhea InsomniaInsomnia

Levels of AnxietyLevels of Anxiety

MildMild

ModerateModerate

SevereSevere

PanicPanic

Mild AnxietyMild Anxiety

Great level for maximum work Great level for maximum work efficiencyefficiency

Perceptual field very broad; alertPerceptual field very broad; alert High level problem solving can occurHigh level problem solving can occur Excellent level for: Excellent level for:

– learning conceptslearning concepts– writing a paperwriting a paper– teaching patientteaching patient

Great level for sportsGreat level for sports

Moderate AnxietyModerate Anxiety Perceptual field is narrowed Perceptual field is narrowed

– may be very focused or easily distractedmay be very focused or easily distracted Increased BP, P, R. Increased BP, P, R. Moderate Muscle tensionModerate Muscle tension Tune out stimuli Tune out stimuli

– Very focused on task at hand Very focused on task at hand – May miss other observationsMay miss other observations

Can learn list of facts or do step by step Can learn list of facts or do step by step taskstasks

Problem solving and reasoning with Problem solving and reasoning with assistance assistance

Severe Anxiety Severe Anxiety

Perception is reduced or distortedPerception is reduced or distorted Difficulty focusing even with Difficulty focusing even with

assistanceassistance Flight of ideasFlight of ideas Learning cannot take place; Learning cannot take place;

ineffective reasoningineffective reasoning Physical symptoms problematicPhysical symptoms problematic Behavior is directed toward reliefBehavior is directed toward relief

Panic LevelPanic Level

Feelings of terrorFeelings of terror Actual flight , fight Actual flight , fight

– or immobilizationor immobilization May be violentMay be violent Out of contact with reality Out of contact with reality Eyes fixedEyes fixed Hysterical Hysterical IncoherentIncoherent

Nursing Interventions: Mild AnxietyNursing Interventions: Mild Anxiety

Physiologic: Physiologic: – Warm bathWarm bath– Deep breathing Deep breathing – back rubback rub– Relaxation Relaxation

Cognitive Cognitive – Alert and Motivated to learnAlert and Motivated to learn– Teach client concepts about illness, prognosisTeach client concepts about illness, prognosis

EmotionalEmotional– Assess using therapeutic communication. Assess using therapeutic communication.

Identify feelings, guilt, anger sadness Identify feelings, guilt, anger sadness

Moderate Anxiety: InterventionsModerate Anxiety: Interventions Physiological Physiological

– Deep breathing Deep breathing – Relaxation techniquesRelaxation techniques

CognitiveCognitive– Decreased attention to Decreased attention to

detaildetail– Teach factual informationTeach factual information

task orientedtask oriented– learning to give learning to give

insulininsulin– Client can still Client can still

problem solve wellproblem solve well

Emotional/Behavioral Emotional/Behavioral – Therapeutic Therapeutic

communication communication – Assist to identify feelings Assist to identify feelings – Limit choices Limit choices

– Physical activityPhysical activity

Severe/Panic Level: InterventionsSevere/Panic Level: Interventions Role ChangesRole Changes

– Become more nurturing Become more nurturing and directiveand directive

– May not be able to give May not be able to give choiceschoices

PhysiologicPhysiologic– antianxiety medication antianxiety medication – Provide for safetyProvide for safety

CognitiveCognitive– Orient the client Orient the client – Give directionGive direction– Do not expect the client to Do not expect the client to

solve problemssolve problems– Use simple statementsUse simple statements– Give reassurance.Give reassurance.

Emotional/BehavioralEmotional/Behavioral– Be sensitive for patients Be sensitive for patients

need for spaceneed for space– Decrease StimuliDecrease Stimuli– Careful with touch/ non-Careful with touch/ non-

verbal communication.verbal communication.– Calm, firm, Quiet voiceCalm, firm, Quiet voice– May walk with the clientMay walk with the client– May restrain if May restrain if

necessarynecessary