Anxiety

Overview

 Nonspecific feeling of uneasiness or dread

 Mild anxiety: can cause slight physical or psychological discomfort

 Severe anxiety: can be incapacitating or even life-threatening

History

 Determine the patient's chief complaint.

 Ask about the onset and duration of the anxiety and the frequency
of anxiety attacks.

 Determine precipitating or exacerbating factors.

 Obtain a medical history, including drug use (prescribed, over-the-counter, and illicit
drugs).

 If the patient has a history of anxiety, ask him which measures he's used to relieve
it.

Physical Assessment

 Perform a physical examination, noting evidence of anxiety, such as tachycardia,

tachypnea, pallor, sweating, tremors, or an inability to sit still.

 Focus on complaints that trigger or are aggravated by anxiety.

 Assess level of consciousness (LOC) and observe behavior.

Causes

Medical

Acute Respiratory Distress Syndrome (ARDS)

 Acute anxiety occurs along with tachycardia, mental sluggishness and, in severe
cases, hypotension.
  Respiratory symptoms include dyspnea, tachypnea, intercostal and suprasternal
retractions, crackles, and rhonchi.

Anaphylactic Shock

 Acute anxiety signals the onset of anaphylactic shock.

 Anxiety is accompanied by urticaria, angioedema, pruritus, and shortness of breath.

 Others signs and symptoms include light-headedness, hypotension, tachycardia,

nasal congestion, sneezing, wheezing, dyspnea, barking cough, abdominal cramps,
vomiting, diarrhea, and urinary urgency and incontinence.

Angina Pectoris

 Acute anxiety may precede or follow an attack.

 Sharp, crushing substernal or anterior chest pain may radiate to the back, neck,
arms, or jaw during an attack.

Asthma

 Acute anxiety occurs with dyspnea, wheezing, productive cough, accessory muscle
use, hyperresonant lung fields, diminished breath sounds, coarse crackles, cyanosis,
tachycardia, and diaphoresis.

Autonomic Hyperreflexia

 Anxiety, severe headache, and dramatic hypertension may be early signs.

 Pallor and motor and sensory deficits occur below the level of the lesion.

 Flushing occurs above the level of the lesion.

Cardiogenic Shock

 Acute anxiety is accompanied by cool, pale, clammy skin; tachycardia; weak, thready
pulse; tachypnea; ventricular gallop; crackles; jugular vein distention; decreased urine
output; hypotension; narrowing pulse pressure; and peripheral edema.

Chronic Obstructive Pulmonary Disease (COPD)

  Acute anxiety occurs with exertional dyspnea, cough, wheezing, crackles,
hyperresonant lung fields, tachypnea, and accessory muscle use.

 Other signs include “barrel” chest, pursed-lip breathing, and finger clubbing (late in
the disease).

Heart Failure

 Acute anxiety is a symptom of inadequate oxygenation.

 Other signs and symptoms include restlessness, shortness of breath, tachypnea,

decreased LOC, edema, crackles, ventricular gallop, hypotension, diaphoresis, and
cyanosis.

Hyperthyroidism

 Acute anxiety may be an early sign.

 Classic signs and symptoms include heat intolerance, weight loss despite increased
appetite, nervousness, tremor, palpitations, sweating, an enlarged thyroid gland,
exophthalmos, and diarrhea.

Hyperventilation Syndrome

 Anxiety, pallor, and circumoral and peripheral paresthesia occur.

 Other signs and symptoms include carpopedal spasms, chest pain, tachycardia,
belching, flatus, and dizziness.

Hypochondriasis

 Mild to moderate chronic anxiety occurs.

 Patient is focused more on the belief that he has a specific serious disease than on
the actual symptoms.

 Difficulty swallowing, back pain, light-headedness, and upset stomach are common
complaints.

Hypoglycemia

 Mild to moderate anxiety occurs.

  Other signs and symptoms include dizziness, hunger, mild headache, palpitations,
blurred vision, weakness, and diaphoresis.

Mitral Valve Prolapse

 Panic may occur.

 A hallmark sign of mitral valve prolapse is a midsystolic click, followed by an apical

murmur.

 Paroxysmal palpitations with sharp, stabbing, or aching precordial pain may also
occur.

Mood Disorder

 Anxiety may be the chief complaint in the depressive or manic form.

 In the depressive form, the patient may exhibit dysphoria; anger; insomnia or
hypersomnia; decreased libido, energy, and concentration; appetite disturbance;
multiple somatic complaints; and suicidal thoughts.

 In the manic form, the patient may exhibit a reduced need for sleep, hyperactivity,
increased energy, rapid or pressured speech and, in severe cases, paranoid ideas and
other psychotic symptoms.

Myocardial Infarction

 A life-threatening disorder, acute anxiety occurs with persistent, crushing substernal

pain that may radiate.

 Accompanying signs and symptoms include shortness of breath, nausea, vomiting,

diaphoresis, and cool, pale skin.

Obsessive-Compulsive Disorder

 Chronic anxiety occurs along with thoughts or impulses to perform ritualistic acts.

 Anxiety builds if the patient can't perform rituals and diminishes if he can.

 The patient recognizes the acts as irrational, but he can't control them.

Pheochromocytoma
  Acute, severe anxiety accompanies the main sign of persistent or
paroxysmal hypertension due to this adrenal tumor.

 Common signs and symptoms include tachycardia, diaphoresis, orthostatic

hypotension, tachypnea, flushing, severe headache,palpitations, nausea, vomiting,
epigastric pain, and paresthesia.

Phobias

 Chronic anxiety occurs with persistent fear of an object, activity, or situation that
results in a strong desire to avoid it.

 The patient recognizes the fear as irrational, but he can't suppress it.

Postconcussion Syndrome

 Chronic anxiety or periodic attacks of acute anxiety may occur, especially in

situations demanding attention, judgment, or comprehension.

 Other symptoms include irritability, insomnia, dizziness, and mild headache.

Posttraumatic Stress Disorder

 Chronic anxiety occurs with intrusive, vivid thoughts and memories of the traumatic
event.

 The event is relived in dreams and nightmares.

 Related symptoms include insomnia, depression, and feelings of numbness and

detachment.

Pulmonary Edema

 Acute anxiety occurs along with dyspnea, orthopnea, cough with frothy sputum,
tachycardia, tachypnea, crackles, ventricular gallop, hypotension, thready pulse, and
cool, clammy skin.

Pulmonary Embolism

 Hypoxia may result in acute anxiety and restlessness.

 Other signs and symptoms include dyspnea, tachypnea, chest pain, tachycardia,
blood-tinged sputum, and low-grade fever.
Somatoform Disorder

 Anxiety and multiple somatic complaints (that can't be explained) are severe enough
to impair functioning.

Other

Drugs

 Many drugs cause anxiety, especially sympathomimetics and central nervous system
stimulants.

 Antidepressants may cause paradoxical anxiety.

Nursing Considerations

 Provide a calm, quiet atmosphere.

 Stay with the patient during an acute attack.

 Encourage the patient to express his feelings and concerns freely.

 Encourage anxiety-reducing measures, such as slow, controlled deep breathing;

distraction; relaxation techniques; or biofeedback.

 Administer anti-anxiety agents if ordered.

Pediatric Pointers

 Anxiety usually results from painful physical illness or inadequate oxygenation.

 The autonomic signs of anxiety tend to be more common and dramatic in children
than in adults.

Geriatric Pointers

 Distractions from ritualistic activity may provoke anxiety or agitation.

 Life changes commonly cause anxiety.

Patient Teaching

 Teach the patient about relaxation techniques and avoiding stressful situations.
 Encourage the patient's verbalization of anxiety.

 Help the patient to identify stressors.

 Help the patient better understand different coping mechanisms.

 Help the patient identify support systems, such as family and friends.