ENGLISH FOR NURSING

ANXIETY
CHAPTER I
INTRODUCTION
1. Background
Fear and stress reactions are essential for human survival. They enable
people to pursue important goals and to respond appropriately to danger. In a
healthy individual, the stress response (fight or flight) is provoked by a genuine
threat or challenge and is used as a spur for appropriate action.

An anxiety disorder, however, involves an excessive or inappropriate state

of arousal characterized by feelings of apprehension, uncertainty, or fear. The
word is derived from the Latin, angere, which means to choke or strangle. The
anxiety response is often not triggered by a real threat. Nevertheless it can still
paralyze the individual into inaction or withdrawal. An anxiety disorder persists,
while an appropriate response to a threat resolves, once the threat is removed.

Anxiety disorders are classified according to the severity and duration of

their symptoms and specific behavioral characteristics. Types of anxiety disorders
include : Generalized anxiety disorder (GAD), Panic disorder, Phobias,
Obsessive-compulsive disorder (OCD), Post-traumatic stress disorder (PTSD),
Separation anxiety disorder (which is almost always seen in children) .(reference :
www.healthcentral.com).
2 . Problem Formulation
a. What is the causes of Anxiety?
b. What is the symptoms and sign of Anxiety ?
c. What is treatment ?
3 . Aim

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 This study was conducted to find out what is anxiety, to know the
symptoms and to prevent the anxiety.
4. Usefulness
Preparation of this paper aims to provide useful information and increase
knowledge to the reader especially nursing students about anxiety.

CHAPTER II
LITERATURE REVIEW

Journal of Anxiety Disorders 23 (2009) 928934, Prevalence of anxiety

disorders among adults seeking speech therapy for stuttering.

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 CHAPTER III
DISCUSSION
A. Definition
Anxiety is an emotion characterized by feelings of tension, worried
thoughts and physical changes like increased blood pressure. People with anxiety
disorders usually have recurring intrusive thoughts or concerns. They may avoid
certain situations out of worry. They may also have physical symptoms such as
sweating, trembling, dizziness or a rapid heartbeat.
Anxiety can range from a feeling of unease at its mildest, to a panic attack
at the most severe end of the spectrum.

B. Statistic Of Anxiety
About 8.3% of general population have a diagnosable anxiety disorder. A
crosssectional study to obtain an information on anxiety disorder among women
15 to 55 years of age was conducted in West Jakarta from May through December
2001. This study included 700 respondents. Questionnaires of Hamilton anxiety
rating scale (HARS) were given to the respondents and the data collected were
analyzed. Results showed that the prevalence of anxiety disorder among women
15 to 55 years of age in Tanjung Duren district, West Jakarta was 8.71%. There
were significant associations between ageing education, working and marriage
status and anxiety disorder in women 15 - 55 years of age.

C. The Causes Of Anxiety

Anxiety disorders may be caused by environmental factors, medical

factors, genetics, substance abuse, or a combination of these. It is most commonly
triggered by the stress in our lives. Usually anxiety is a response to outside forces,

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but it is possible that we make ourselves anxious with "negative self-talk" - a habit
of always telling ourselves the worst will happen.

1. Environmental and external factors

Environmental factors that are known to cause several types of anxiety

include:

Trauma from events such as abuse, victimization, or the death of a loved

one
Stress in a personal relationship, marriage, friendship, and divorce

Stress at work

Stress from school

Stress about finances and money

Stress from a natural disaster

Lack of oxygen in high altitude areas

2. Medical factors

Anxiety is associated with medical factors such as anemia, asthma, infections,

and several heart conditions. Some medically-related causes of anxiety include:

Stress from a serious medical illness

Side effects of medication

Symptoms of a medical illness

Lack of oxygen from emphysema, or pulmonary embolism (a blood clot in

the lung)

3. Substance use and abuse

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 It is estimated that about half of patients who utilize mental health services for
anxiety disorders such as GAD, panic disorder, or social phobia are doing so
because of alcohol or benzodiazepine dependence. More generally, anxiety is also
know to result from:

Intoxication from an illicit drug, such as cocaine or amphetamines

Withdrawal from an illicit drug, such as heroin, or from prescription drugs
like Vicodin, benzodiazepines, or barbiturates

4. Genetics

It has been suggested by some researchers that a family history of anxiety

increases the likelihood that a person will develop it. That is, some people may
have a genetic predisposition that gives them a greater chance of suffering from
anxiety disorders.

D. The symptoms and sign of Anxiety

1. Excessive worry
The hallmark of generalized anxiety disorder (GAD)the broadest type of
anxietyis worrying too much about everyday things, large and small. But what
constitutes "too much"? In the case of GAD, it means having persistent anxious
thoughts on most days of the week, for six months. Also, the anxiety must be so
bad that it interferes with daily life and is accompanied by noticeable symptoms,
such as fatigue". The distinction between an anxiety disorder and just having
normal anxiety is whether your emotions are causing a lot of suffering and
dysfunction," says Sally Winston, PsyD, co-director of the Anxiety and Stress
Disorder Institute of Maryland in Towson.

2. Sleep problems
Trouble falling asleep or staying asleep is associated with a wide range of
health conditions, both physical and psychological. And, of course, it's not
unusual to toss and turn with anticipation on the night before a big speech or job
interview. But if you chronically find yourself lying awake, worried or agitated

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about specific problems (like money), or nothing in particularit might be a sign
of an anxiety disorder. By some estimates, fully half of all people with GAD
experience sleep problems. Another tip-off that anxiety might be involved? You
wake up feeling wired, your mind is racing, and you're unable to calm yourself
down.

3. Irrational fears
Some anxiety isn't generalized at all; on the contrary, it's attached to a
specific situation or thinglike flying, animals, or crowds. If the fear becomes
overwhelming, disruptive, and way out of proportion to the actual risk involved,
it's a telltale sign of phobia, a type of anxiety disorder. Although phobias can be
crippling, they're not obvious at all times. In fact, they may not surface until you
confront a specific situation and discover you're incapable of overcoming your
fear. "A person who's afraid of snakes can go for years without having a problem,"
Winston says. "But then suddenly their kid wants to go camping, and they realize
they need treatment."

4. Muscle tension
Near-constant muscle tensionwhether it consists of clenching your jaw,
balling your fists, or flexing muscles throughout your bodyoften accompanies
anxiety disorders. This symptom can be so persistent and pervasive that people
who have lived with it for a long time may stop noticing it after a while. Regular
exercise can help keep muscle tension under control, but the tension may flare up
if an injury or other unforeseen event disrupts a person's workout habits, Winston
says. "Suddenly they're a wreck, because they can't handle their anxiety in that
way and now they're incredibly restless and irritable."

5. Chronic indigestion
Anxiety may start in the mind, but it often manifests itself in the body
through physical symptoms, like chronic digestive problems. Irritable bowel
syndrome (IBS), a condition characterized by stomachaches, cramping, bloating,
gas, constipation, and/or diarrhea, "is basically an anxiety in the digestive tract,"

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Winston says. IBS isn't always related to anxiety, but the two often occur together
and can make each other worse. The gut is very sensitive to psychological stress
and, vice versa, the physical and social discomfort of chronic digestive
problems can make a person feel more anxious.

6. Stage fright
Most people get at least a few butterflies before addressing a group of
people or otherwise being in the spotlight. But if the fear is so strong that no
amount of coaching or practice will alleviate it, or if you spend a lot of time
thinking and worrying about it, you may have a form of social anxiety disorder
(also known as social phobia). People with social anxiety tend to worry for days
or weeks leading up to a particular event or situation. And if they do manage to go
through with it, they tend to be deeply uncomfortable and may dwell on it for a
long time afterward, wondering how they were judged.

7. Self-consciousness
Social anxiety disorder doesn't always involve speaking to a crowd or
being the center of attention. In most cases, the anxiety is provoked by everyday
situations such as making one-on-one conversation at a party, or eating and
drinking in front of even a small number of people. In these situations, people
with social anxiety disorder tend to feel like all eyes are on them, and they often
experience blushing, trembling, nausea, profuse sweating, or difficulty talking.
These symptoms can be so disruptive that they make it hard to meet new people,
maintain relationships, and advance at work or in school.

8. Panic
Panic attacks can be terrifying: Picture a sudden, gripping feeling of fear
and helplessness that can last for several minutes, accompanied by scary physical
symptoms such as breathing problems, a pounding or racing heart, tingling or
numb hands, sweating, weakness or dizziness, chest pain, stomach pain, and
feeling hot or cold. Not everyone who has a panic attack has an anxiety disorder,

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but people who experience them repeatedly may be diagnosed with panic disorder.
People with panic disorder live in fear about when, where, and why their next
attack might happen, and they tend to avoid places where attacks have occurred in
the past.

9. Flashbacks
Reliving a disturbing or traumatic eventa violent encounter, the sudden
death of a loved oneis a hallmark of post-traumatic stress disorder (PTSD),
which shares some features with anxiety disorders. (Until very recently, in fact,
PTSD was seen as a type of anxiety disorder rather than a stand-alone condition.)
But flashbacks may occur with other types of anxiety as well. Some research,
including a 2006 study in the Journal of Anxiety Disorders, suggests that some
people with social anxiety have PTSD-like flashbacks of experiences that might
not seem obviously traumatic, such as being publicly ridiculed. These people may
even avoid reminders of the experienceanother symptom reminiscent of PTSD.

10. Perfectionism
The finicky and obsessive mind-set known as perfectionism "goes hand in
hand with anxiety disorders," Winston says. "If you are constantly judging
yourself or you have a lot of anticipatory anxiety about making mistakes or falling
short of your standards, then you probably have an anxiety disorder."
Perfectionism is especially common in obsessive-compulsive disorder (OCD),
which, like PTSD, has long been viewed as an anxiety disorder. "OCD can happen
subtly, like in the case of somebody who can't get out of the house for three hours
because their makeup has to be absolutely just right and they have to keep starting
over," Winston says.

11. Compulsive behaviours

In order to be diagnosed with obsessive-compulsive disorder, a person's
obsessiveness and intrusive thoughts must be accompanied by compulsive
behavior, whether it's mental (telling yourself It'll be all right over and over again)

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or physical (hand-washing, straightening items). Obsessive thinking and
compulsive behavior become a full-blown disorder when the need to complete the
behaviorsalso known as "rituals"begins to drive your life, Winston says. "If
you like your radio at volume level 3, for example, and it breaks and gets stuck on
4, would you be in a total panic until you could get it fixed?"

12. Self-doubt
Persistent self-doubt and second-guessing is a common feature of anxiety
disorders, including generalized anxiety disorder and OCD. In some cases, the
doubt may revolve around a question that's central to a person's identity, like
"What if I'm gay?" or "Do I love my husband as much as he loves me?" In OCD,
Winston says, these "doubt attacks" are especially common when a question is
unanswerable. People with OCD "think, 'If only I would know 100% for sure
whether I was gay or straight, either one would be fine,' but they have this
intolerance for uncertainty that turns the question into an obsession," she says.

E. Treatment
In some cases, anxiety may be treated at home, without a doctor's supervision.
However, this may be limited to situations in which the duration of the anxiety is
short and the cause is identified and can be eliminated or avoided. There are
several exercises and actions that are recommended to cope with this type of
anxiety: Learn to manage stress in your life. Keep an eye on pressures and
deadlines, and commit to taking time away from study or work. Learn a variety of
relaxation techniques. Information about physical relaxation methods and
meditation techniques can be found in book stores and health food shops.
Practice deep abdominal breathing. This consists of breathing in deeply and
slowly through your nose, taking the air right down to your abdomen, and then
breathing out slowly and gently through your mouth. Breathing deeply for too
long may lead to dizziness from the extra oxygen. Learn to replace "negative self
talk" with "coping self talk." Make a list of the negative thoughts you have, and
write a list of positive, believable thoughts to replace them. Replace negative
thoughts with positive ones. Picture yourself successfully facing and conquering

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a specific fear. Talk with a person who is supportive. Meditate. Exercise. Take a
long, warm bath. Rest in a dark room.

CHAPTER IV
CLOSING
Conclusion
Anxiety is fear feeling about what might happen. The factor caused
anxiety are environmental, medical, substance and abuse and genetic factor. Sign
and symptoms of anxiety are chronic indigestion, Muscle tension, Phobia, Sleep
problems, Excessive worry, Flashback, Panic, Perfectionism. Treatment, Manage
the stress.

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 REFERENCE

BCs Mental Health Journal by Nan Dickie, Dr. Rajpal Singh, Dr.
Raymond Lam, Victoria Schuckel
Journal of Anxiety Disorders, by Lisa Iveracha, Sue OBrian , Mark
Jones , Susan Block , Michelle Lincoln , Elisabeth Harrison ,Sally Hewat ,
Ross G. Menzies , Ann Packman, Mark Onslow

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