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However, everyone experiences anxiety differently. It can be a result of fear, uncertainty, circular and racing thoughts, and the avoidance of certain behaviors. It can affect our ability to function normally, and even convince us that we’re losing our minds. And worst, it can even lead to related psychological conditions, like substance abuse and personality difficulties. The reality is that many people struggle with anxiety. Thus, it’s important for health care providers and the patient to understand what anxiety he or she is suffering from and how it affects him or her. Patients can and do overcome anxiety if they stick with the cognitive strategies and practically apply them to their lives. Related Factors. Here are some factors that may be related to Anxiety: Changes in or threats to. Economic status. Environment. Health status. Interaction patterns. Interpersonal relationships. Role function or status. Self- concept. Maturational or situational status. Stress. Substance abuse. Unconscious conflict about essential life goals or values. Unmet needs. Defining Characteristics. Anxiety is characterized by the following signs and symptoms: Affective. Apprehensive. Feelings of inadequacy. Focus on self. Irritability. Painful or persistent increased helplessness. Behavioral. Diminished productivity. Expressed concerns about changes in life events. Insomnia. Restlessness. Cognitive. Confusion. Difficulty concentrating. Diminished ability to learn or solve problems. Fear of unspecified consequences. Physiological, sympathetic: Anorexia. Diarrhea. Dry mouth. Facial flushing. Increased BP, pulse, respirations. Twitching, increased reflexes. Physiological, parasympathetic. Abdominal pain. Faintness. Fatigue. Nausea. Urinary frequency, urgency. Goals and Outcomes. The following are the common goals and expected outcomes for Anxiety: Patient describes own anxiety and coping patterns. Patient demonstrates improved concentration and accuracy of thoughts. 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In the panic level of anxiety, the autonomic nervous system increases to the level of sympathetic neurotransmitter release. The patient becomes pale and hypotensive and experiences poor muscle coordination. The patient reports feeling completely out of control and may display extremes of behavior from combativeness to withdrawal. Assess for the influence of cultural beliefs, norms, and values on the patient’s perspective of a stressful situation. What the patient considers stressful may be based on cultural perceptions. Assess physical reactions to anxiety. Anxiety also plays a role in somatoform disorders, which are characterized by physical symptoms such as pain, nausea, weakness, or dizziness that have no apparent physical cause. Validate observations by asking patient, “Are you feeling anxious now?”Anxiety is a highly individualized, normal physical and psychological response to internal or external life events. Use the State- Trait Anxiety Inventory to differentiate between the patient’s anxiety level as a temporary response state and a long- standing personality trait. The State- Trait Anxiety Inventory, developed by Spielberger, is considered a definitive tool for measuring anxiety in adults. The tool is written at the sixth- grade reading level and is available in more than 4. Observe how the patient uses coping techniques and defense mechanisms to cope with anxiety. Asking questions requiring informative answers helps identify the effectiveness of coping strategies currently used by the patient. This approach may help the patient feel like he or she is contributing to patient care. Coping strategies may include reading, journaling, or physical activity such as taking a walk. Defense mechanisms are used by people to preserve the ego and manage anxiety. Some defense mechanisms are highly adaptive in managing anxiety, such as humor, sublimation, or suppression. Other defense mechanisms may lead to less adaptive behavior, especially with long- term use. These defense mechanisms include displacement, repression, denial, projection, and self- image splitting. Nursing Interventions. Nursing interventions for Anxiety can apply to any individual with anxiety, regardless of etiologic and contributing factors. Interventions. Rationales. Recognize awareness of the patient’s anxiety. Since a cause of anxiety cannot always be identified, the patient may feel as though the feelings being experienced are counterfeit. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings. Use presence, touch (with permission), verbalization, and demeanor to remind patients that they are not alone and to encourage expression or clarification of needs, concerns, unknowns, and questions. Being supportive and approachable promotes communication. Familiarize patient with the environment and new experiences or people as needed. Awareness of the environment promotes comfort and may decrease anxiety experienced by the patient. Anxiety may intensify to a panic level if patient feels threatened and unable to control environmental stimuli. Interact with patient in a peaceful manner. The nurse or health care provider can transmit his or her own anxiety to the hypersensitive patient. The patient’s feeling of stability increases in a calm and non- threatening environment. Accept patient’s defenses; do not dare, argue, or debate. If defenses are not threatened, the patient may feel secure and protected enough to look at behavior. Converse using a simple language and brief statements. When experiencing moderate to severe anxiety, patients may be unable to understand anything more than simple, clear, and brief instruction. Reinforce patient’s personal reaction to or expression of pain, discomfort, or threats to well- being (e. Talking or otherwise expressing feelings sometimes reduces anxiety. Lessen sensory stimuli by keeping a quiet and peaceful environment; keep “threatening” equipment out of sight. Anxiety may intensify to a panic state with excessive conversation, noise, and equipment around the patient. Instruct the patient to describe what is experienced and the events leading up to and surrounding the event. The patient should note how the anxiety dissipates. Recognition and exploration of factors leading to or reducing anxious feelings are important steps in developing alternative responses. The patient may be unaware of the relationship between emotional concerns and anxiety. If the patient is comfortable with the idea, the log may be shared with the health care provider, who may help the patient develop more effective coping strategies. Symptoms often provide the health care provider with information regarding the degree of anxiety being experienced. 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