1. CONCEPT
OF
ANXIETY
Prepared by: Eric F. Pazziuagan, RN,
MAN

3. Anxiety
The initial responses to a psychic
threat (Peplau).
 Anxiety in response to stress is
inevitable in everyday life.
 The way in which individuals cope with
anxiety and stress is important in
understanding the quality with which
individuals are functioning in their
personal, social, and occupational
roles.


4. LEVELS OF ANXIETY

5. Mild: +1
 Psychomotor
symptoms:
◦ Preparation of body for
constructive action.
◦ Slight muscle tension.
◦ Slight fidgeting.
◦ Energetic.
◦ Good eye contact.

6. 
Emotional symptoms:
◦ Occasional slight irritability.
◦ Feeling challenged.
◦ Confident (Use of adaptive coping
mechanisms)

Cognitive symptoms:
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Alertness
Awareness of surroundings
Concentration
Accurate perceptions
Attentiveness
Logical reasoning and problem-solving
skills

7.  Interventions:
◦ Discuss source of anxiety (steps
of learning)
◦ Problem solve
◦ Accept anxiety as natural;
tolerate and benefit from it.

8. Moderate: +2

Psychomotor Symptom:
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Preparation of body for protective action.
Moderate muscle tension.
Increased BP, pulse, and respirations.
Startle reflex.
Slight perspiration.
Difficulty sitting still.
Repeated fidgeting.
Periodic slow pacing.
Increased rate of speech.
Sporadic eye contact.

9.  Emotional
symptoms:
◦ Feeling uncomfortable, on edge,
keyed up
◦ Motivated to decrease anxiety.
◦ Increased irritability.
◦ Decreased confidence (use of
palliative coping mechanisms).

10. 
Cognitive symptoms:
◦ Difficulty in concentrating
◦ Easily distracted, can focus with
assistance
◦ Circumstantiality
◦ Tangentiality
◦ Loose associations
◦ Narrowed perceptions
◦ Decreased attention span
◦ Misperception of stimuli
◦ Problem solving and reasoning skills with
effort, or assistance.

11.  Interventions:
◦ Decrease anxiety- ventilation, crying,
exercise, relaxation techniques.
◦ Refocus attention; relate feelings and
behaviors to anxiety; then use
problem-solving techniques; give oral
medication, if needed.

12. Severe: +3

Psychomotor signs:
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Preparation of body for fight or flight.
Extreme muscle tension.
Increased perspiration.
Continuous and rapid pacing.
Reflex responses.
Loud or rapid speech, or both.
Poor eye contact.
Somatic symptoms.
Sleep disturbance.

13.  Emotional
symptoms:
◦ Extreme discomfort.
◦ Feeling of dread.
◦ Hypersensitivity.
◦ Defensiveness with threats and
demand.
◦ Use of maladaptive coping
mechanisms.

14.  Cognitive
symptoms:
◦ Distorted perceptions.
◦ Difficulty focusing, even with
assistance.
◦ Flight of ideas.
◦ Ineffective reasoning and problemsolving skills
◦ Disorientation.
◦ Delusions and hallucinations, if
prolonged.
◦ Suicidal or homicidal ideations, if
prolonged.

15.  Interventions:
◦ Decrease anxiety, stimuli and
pressure.
◦ Use kind, firm, simple
directions.
◦ Use time out (seclusion)
◦ Give intramuscular
medications, if needed.

16. Panic: +4
 Psychomotor
symptoms:
◦ Actual flight, fight, or
immobilization.
◦ Suicide attempts or violence.
◦ Depletion of body resources.
◦ Eyes fixed.
◦ Hysterical or mute.
◦ Incoherent.

17.  Emotional
symptoms:
◦ Feeling overwhelmed and out
of control.
◦ Rage
◦ Desperation.
◦ Feeling totally drained (Use
of dysfunctional coping
mechanisms)

18.  Cognitive
symptoms:
◦ Disorganized perceptions
◦ Disorganized or irrational
reasoning and problem solving
◦ Neologisms.
◦ Clang associations.
◦ Word salad.
◦ Out of contact with reality.
◦ Personality disorganization.

19. Interventions:
◦Guide firmly, or
physically take control
◦Give intramuscular
injection
◦Order restraints, if
needed

20. COPING WITH
ANXIETY

21. Adaptive
Solves
the problem that
is causing the anxiety, so
the anxiety is decreased.
The patient is objective,
rational and productive.

22. Palliative
 Temporarily
decreases the
anxiety but does not solve
the problem, so the anxiety
eventually returns.
 Temporary relief allows the
patient to return to problem
solving.

23. Maladaptive
Unsuccessful
attempts to
decrease the anxiety
without attempting to
solve the problem.
The anxiety remains.

24. Dysfunctional
Is
not successful in
reducing anxiety or
solving the problem.
Even minimal functioning
becomes difficult, and
new problems begin to
develop.

26. Most common adaptive
techniques:
Problem-solving
 Assertiveness
 Positive self-talk and self-acceptance
 Stress and anger management
 Learning skills needed for
communication and relationships
 Conflict management
 Time management
 Community living skills


27. Assignment:
Give actual patient examples of the
following types of coping:
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2.
3.
4.
Adaptive
Palliative
Maladaptive
Dysfunctional
What are the palliative techniques that
can be used to decrease the effects of
anxiety?
What is crisis? How does it differ from
stress?
What are the strategies for crisis
intervention?