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Definition
A feeling of uneasiness that activates the autonomic nervous system in response to a vague, nonspecific threat
Differs from fear because fear is a response to a known threat.
4 Degrees of Anxiety
MILD Perceptual field widens slightly.
Increased ability to see relationships among data.
Person is alert, more perceptive, able to recognize the anxiety.
MODERATE Perceptual field narrows slightly. Can
change attention if directed.
Person is able to sustain attention on a focal point. May talk faster, V/S begin to increase, able to recognize and express anxiety.
SEVERE Perceptual field is greatly reduced.
Does not notice external events. Unable to redirect attention even with direction.
Attention is focused on a small part of a specific area. May be unaware of anxiety, V/S increasing, coping relief measures are used.
PANIC Perception is distorted, may jump
from one detail to another (flight of ideas) Person feels dread or terror.
Feeling of unreality, confusion, terror, self-absorption. Mat be expressed with violence toward self or others. Loss of control. Can result in exhaustion if prolonged.
Signs & Symptoms
Increased heart rate
Increased blood pressure
Dilated pupils
Cool skin
Piloerection (hair “standing on end”)
Decreased GI motility
Coping with anxiety
Coping behaviors are:
ADAPTIVE ~ A student receives a bad grade on an
exam. The student goes to the instructor to see what her faults are (problem solving).
MALADAPTIVE~ A student receives a bad grade on an exam.
The student does not seek advice or help, keeps studying the way he always does, hoping it will pay off (avoidance)
Task Oriented Reactions
Reactions to anxiety that are conscious ways to cope with problems or to meet needs.
Attack Behavior~ actively removing obstacles through problem solving while considering the rights of others
Withdrawal Behavior~ removing self either physically or emotionally from a stressful situation
Compromise~ changing the usual ways of behaving, substituting goals, or giving up aspects of person needs.
Attack Behavior
Adaptive attack behavior: Example~ A nurse asking another nurse to
help figure out why a client’s condition is changing
Maladaptive attack behavior: Example~ A nurse shouting at a nursing
assistant that made a mistake.
Withdrawal Behavior
Adaptive Withdrawal behavior: Example~ Person with asthma leaves a
smoke-filled room
Maladaptive Withdrawal behavior: Example~ Avoiding visiting family or
friends to avoid arguments
Compromise
Compromise is usually adaptive
Example~ Nursing student wanted to go on vacation to Disney World a week during school but would be penalized for it. She compromised by still going to Disney World, but on break from school.
Types of Anxiety Disorders
Generalized Anxiety Disorder
Panic Disorder (with or without Agoraphobia)
Agoraphobia (with out Panic Disorder)
Obsessive-Compulsive Disorder (OCD)
Acute Stress Disorder
Posttraumatic Stress Disorder (PTSD)
Generalized Anxiety Disorder
Characterized by excessive anxiety and worry occurring on most days for at least 6 months. Anxiety can be for a number of different events or activities, and the individual finds it difficult to control.
Must have at least 3 of the following: Restlessness Fatigue Difficulty Concentrating Irritability Muscle Tension Disturbed Sleep
Generalized Anxiety Disorder
Persons with GAD report they feel:
Significant stress
Difficulty controlling the worry
Impairment in social occupational functioning
Physical Symptoms of GAD
Fatigue
Headaches
Muscle tension
Muscle pain
Irritability
Sweating
Nausea/Vomiting
Difficulty breathing/swallowing
Trembling
Hot flashes
Panic Disorder
Panic Attack: Characterized by an episode of intense fear or
discomfort
People with Panic Disorder have recurrent, unexpected panic attacks followed by at least one month of persistent concern about having another one.
May occur without warning, or are associated with stressor(s)
Can occur at anytime (even sleep)
Peaks in severity within 10 minutes
Can severely limit an individual’s ability to function
Panic Disorder
During a panic attack, four or more of the following are present: Palpitations, pounding heart, or increased heart rate Sweating Trembling/shaking Sensations of shortness of breath or smothering Feeling of choking Chest pain or discomfort Nausea of abdominal distress Feeling dizzy, unsteady, lightheaded or faint Derealization (feeling of unreality) o depersonalization
(feeling detached from oneself) Fear of losing control or going crazy Fear of dying Paresthesias (numbness or tingling) Chills or hot flashes
Agoraphobia
Agoraphobia: Characterized by anxiety about being in places or
situations where escape may be difficult (or embarrassing) or when help might not be available in the case of a panic attack
Commonly associated with Panic Disorder More likely to occur in females than in
males Often include situation that involve being
alone away from home in a crowd or standing in line; on a bridge; or traveling in a plane, train, bus, or automobile.
Post-traumatic Stress Disorder (PTSD)
PTSD: Debilitating condition that follows an extreme
traumatic stressor
Stressor may be and even that threatens the individual’s life, serious injury, or personal integrity.
Characteristics of PTSD
Persistent re-experiencing the traumatic event
Increased arousal (difficulty sleeping, nightmares, exaggerated startle response, and hypervigilance or alertness for danger)
Numbing of general responsiveness (“psychic numbing” or “emotional anesthesia”)
Avoidance of stimuli associated with the trauma