There are eight major categories.
Generalized anxiety disorder: Characterized by excessive, uncontrollable worrying over a period of at least 6 months. Symptoms include motor tension (trembling; shakiness; muscle tension, aches, soreness; easy fatigue), autonomic
hyperactivity (shortness of breath, palpitations, sweating, dry mouth, dizziness, nausea, diarrhea, frequent urination), and
scanning behavior (feeling on edge, having an exaggerated startle response, difficulty concentrating, sleep disturbance,
irritability).
Panic disorder: Characterized by a specific period of intense fear or discomfort with at least four of the following symptoms: palpitations or pounding heart, sweating, trembling or shaking, sensations of smothering or difficulty breathing, feeling of choking, chest pain, nausea, feeling dizzy or faint, feeling of unreality or losing control, numbness, and chills or flushes.
Phobias: Characterized by a persistent and severe fear of a clearly identifiable object or situation despite awareness that
the fear is unreasonable. There are two types, specific and social. Specific phobias are subdivided into five types: animals,
natural environment (e.g., lightning), blood-injection-injury type, situational (e.g., flying), and other (situations that could
lead to choking or contracting an illness). Social phobiarelates to profound fear of social or performance situations in
which embarrassment could occur.
Agoraphobia is characterized by feelings of intense fear of being alone in open or public places where escape might be difficult. Individuals with agoraphobia become immobilized with anxiety and may find it impossible to leave their homes.
Acute stress disorder: Like posttraumatic stress disorder (PTSD), the problem begins with exposure to a traumatic
the event, with a response of intense fear, helplessness, or horror.
In addition, the person shows dissociative symptoms, that is, subjective sense of numbing, feeling “in a daze,” depersonalization, or amnesia, and clearly tries to avoid stimuli that arouse recollection of the trauma. But just like PTSD, the victim reexperiences the trauma and shows functional impairment in social, occupational, and problem-solving skills. The key difference is that this syndrome occurs within 4 wk of the traumatic event and only lasts 2 days to 4 wk.
Anxiety disorder caused by a general medical condition: May be characterized by severe anxiety, panic attacks, or
obsessions, or compulsions, but the cause is clearly related to a medical problem, excluding delirium. History, physical
examination, and laboratory findings support a specific diagnosis, for example, hypoglycemia, pheochromocytoma, or
thyroid disease.
Assessment
Physical indicators: Dry mouth, elevated vital signs, diarrhea, increased urination, nausea, diaphoresis, hyperventilation, fatigue, insomnia, sexual dysfunction, irritability, tenseness.
Emotional indicators: Fear, sense of impending doom, helplessness, insecurity, low self-confidence, anger, guilt.
Cognitive indicators: Mild anxiety produces increased awareness and problem-solving skills. Higher levels produce
narrowed perceptual fields; missed details; diminished problem-solving skills; and catastrophic, dichotomous thoughts resulting in deteriorated logical thinking.
Social indicators: Occupational, social, and familial role, e.g., marital and parental functioning may be adversely affected by anxiety and therefore should be assessed.
Spiritual indicators: Hopelessness/helplessness, the feeling of being cut off from God, and anger at God for allowing anxiety
maybe experienced.
Suicidality: Suicide assessment is critical with anxious patients, especially those with panic disorder.
Nursing care plan
Nursing Diagnosis
Anxiety/Recurring panic attacks
related to
lack of knowledge regarding cause and treatment
unconscious conflict about essential values and goal of life
situational and maturational crises
threat of death
unmet needs
being exposed to phobic stimulus
traumatic experiences
as evidenced by
increased respiration
increased pulse
increased or decreased blood pressure
Nausea
confusion
increased perspiration
faintness
trembling or shaking
Insomnia
going crazy
Goals
Short term goals
The client will verbalize ways to intervene in escalating anxiety within 1 week.
Long term goals
The client will be able to recognize symptoms of the onset of anxiety and intervene before reaching panic stage by time of discharge from treatment.
Intervention
Rationales
Maintain a calm, non-threatening manner while working with clients.
Anxiety is contagious and may be transferred from staff to client or vice versa. Client develops feeling of security in presence of calm staff person.
Reassure client of his or her safety and security. This can be conveyed by physical presence of nurse. Do not leave client alone at this time.
The client may fear for his or her life. The presence of a trusted individual provides the client with a feeling of security and assurance of personal safety.
Use simple words and brief messages, spoken calmly and clearly, to explain hospital experiences to clients.
In an intensely anxious situation, the client is unable to comprehend anything but the most elementary communication.
Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor).
A stimulating environment may increase the level of anxiety.
Administer tranquilizing medication, as ordered by the physician. Assess medication for effectiveness and for adverse side effects.
When the level of anxiety has been reduced, explore with the client possible reasons for the occurrence.
Recognition of precipitating factor(s) is the first step in teaching the client to interrupt the escalation of the anxiety.
Encourage the client to talk about traumatic experiences under nonthreatening conditions. Help the client work through feelings of guilt related to the traumatic event. Help the client
understand that this was an event to which most people would have responded in like manner. Support client during flashbacks of the experience.
Verbalization of feelings in a nonthreatening environment may help the client come to terms
with unresolved issues.
Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep breathing exercises, physical exercises, brisk walks, jogging,
meditation).