ANXIETY

(GANGGUAN KECEMASAN)
Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response
(the source often nonspecific or unknown to the individual); a feeling of apprehension caused by
anticipation of danger. It is an alerting signal that warns of impending danger and enables the
individual to take measures to deal with the threat.

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in
the United States age 18 and older, or 18% of the population, according to the National Institute
of Mental Health. In fact, anyone from all walks of life can suffer from anxiety disorders. It affects
the poor, the rich, the young, the old, the sick, the healthy, and more. 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 were 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, its 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:

o Economic status
o Environment
o Health status
o Interaction patterns
o Interpersonal relationships

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 o Role function or status
o 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

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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.
patient demonstrates ability to reassure self.
Patient maintains a desired level of role function and problem solving.
Patient monitors signs and intensity of anxiety.
Patient identifies strategies to reduce anxiety.
Patient identifies and verbalizes anxiety precipitants, conflicts, and threats.
Patient demonstrates return of basic problem-solving skills.
Patient demonstrates increased external focus.
Patient has vital signs that reflect baseline or decreased sympathetic stimulation.
Patient has posture, facial expressions, gestures, and activity levels that reflect
decreased distress.

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Nursing Assessment

Assessment is required in order to distinguish possible problems that may have lead to Anxiety as
well as name any episode that may happen during nursing care.

Assessment Rationales

Assess for the presence of culture- The context in which anxiety is experienced, its meaning,
bound anxiety states. and responses to it are culturally mediated.

The patient with mild anxiety will have minimal or no

physiological symptoms of anxiety. Vital signs will be
within normal ranges. The patient will appear calm but
may report feelings of nervousness such as butterflies in
the stomach. The patient with moderate anxiety may
appear energized, with more animated facial expressions
and tone of voice. Vital signs may be normal or slightly
elevated. The patient may report feeling tense.
With severe anxiety, the patient will have symptoms of
Assess the patients level of
increased autonomic nervous system activity, such as
anxiety. Hildegard E.
elevated vital signs, diaphoresis, urinary urgency and
Peplau described 4 levels of
frequency, dry mouth, and muscle tension. At this stage,
anxiety: mild, moderate, severe
the patient may experience palpitations and chest pain.
and panic.
The patient may be agitated and irritable and report
feeling overloaded or overwhelmed by new stimuli. 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 What the patient considers stressful may be based on
patients perspective of a stressful cultural perceptions.
situation.

Assess physical reactions to

Anxiety also plays a role in somatoform disorders, which
anxiety.
are characterized by physical symptoms such as pain,

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Validate observations by asking
patient, Are you feeling anxious
now?
Use the State-Trait Anxiety
Inventory to differentiate between
the patients anxiety level as a
temporary response state and a
long-standing personality trait.
Observe how the patient uses
coping techniques and defense
mechanisms to cope with anxiety.
Nursing Interventions
Nursing interventions for Anxiety can apply to any individual with anxiety, regardless of etiologic
and contributing factors.
Interventions
Recognize awareness of the patients
anxiety.
nausea, weakness, or dizziness that have no apparent
physical cause.
Anxiety is a highly individualized, normal physical and
psychological response to internal or external life events.
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 40 languages.
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.
Rationales
Since a cause of anxiety cannot always be identified,
the patient may feel as though the feelings being
experienced are counterfeit. Acknowledgment of
the patients feelings validates the feelings and
communicates acceptance of those feelings.
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Use presence, touch (with permission),
verbalization, and demeanor to remind
patients that they are not alone and to Being supportive and approachable promotes
encourage expression or clarification of communication.
needs, concerns, unknowns, and
questions.

Awareness of the environment promotes comfort

Familiarize patient with the environment and may decrease anxiety experienced by the
and new experiences or people as patient. Anxiety may intensify to a panic level if
needed. patient feels threatened and unable to control
environmental stimuli.

The nurse or health care provider can transmit his or

Interact with patient in a peaceful her own anxiety to the hypersensitive patient. The
manner. patients feeling of stability increases in a calm and
non-threatening environment.

Accept patients defenses; do not dare, If defenses are not threatened, the patient may feel
argue, or debate. secure and protected enough to look at behavior.

When experiencing moderate to severe anxiety,

Converse using a simple language and
patients may be unable to understand anything more
brief statements.
than simple, clear, and brief instruction.

Reinforce patients personal reaction to

or expression of pain, discomfort, or
Talking or otherwise expressing feelings sometimes
threats to well-being (e.g., talking,
reduces anxiety.
crying, walking, other physical or
nonverbal expressions).

Anxiety may intensify to a panic state with

Lessen sensory stimuli by keeping a
excessive conversation, noise, and equipment
quiet and peaceful environment; keep
around the patient. increasing anxiety may become
threatening equipment out of sight.
frightening to the patient and others.

Help patient determine precipitants of Obtaining insight allows the patient to reevaluate
anxiety that may indicate interventions. the threat or identify new ways to deal with it.

Allow patient to talk about anxious

feelings and examine anxiety-provoking Talking about anxiety-producing situations and
situations if they are identifiable. anxious feeling can help the patient perceive the

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If the situational response is rational, use
empathy to encourage patient to interpret
the anxiety symptoms as normal.
Recommend patient to keep a log of
episodes of anxiety. 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.
Encourage the patient to consider
positive self-talk like Anxiety wont kill
me, I can do this one step at a time,
Right now I need to breathe and
stretch, I dont have to be perfect.
Consider the patients use of coping
strategies that the patient has found
effective in the past.
Avoid unnecessary reassurance; this may Reassurance is not helpful for the anxious
increase undue worry. individual.
Assist the patient in developing new
anxiety-reducing skills (e.g., relaxation,
deep breathing, positive visualization,
and reassuring self-statements).
Intervene when possible to eliminate
sources of anxiety.
situation realistically and recognize factors leading
to the anxious feelings.
Anxiety is a normal response to actual or perceived
danger.
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.
Cognitive therapies focus on changing behaviors
and feelings by changing thoughts. Replacing
negative self-statements with positive self-
statements aids to reduce anxiety.
This enhances the patients sense of personal
mastery and confidence.
Discovering new coping methods provides the
patient with a variety of ways to manage anxiety.
Anxiety is a normal response to actual or perceived
danger; if the threat is eliminated, the response will
stop.
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Assist the patient in strengthening
problem-solving abilities. Highlight the
logical strategies that the patient can use
when experiencing anxious feelings.
Explain all activities, procedures, and
issues that involve the patient; use
nonmedical terms and calm, slow
speech. Do this in advance of procedures
when possible, and validate patients
understanding.
Instruct the patient in the appropriate use
of antianxiety medications.
Benzodiazepines
Buspirone HCl (BuSpar)
Selective serotonin reuptake
inhibitors (SSRIs)
Nonselective beta-
blockers and alpha-2-receptor
agonists
Tell the patient to limit use of
central nervous system stimulants.
Provide massage and backrubs for
patient to reduce anxiety.
Learning to identify a problem and to evaluate the
alternatives to resolve that problem helps the patient
cope.
With preadmission patient education, patients
experience less anxiety and emotional distress and
have increased coping skills because they know
what to expect. Uncertainty and lack of
predictability contribute to anxiety.
Short-term use of antianxiety medications can
enhance patient coping and reduce physiological
manifestations of anxiety.
Drugs in this group work through enhancing the
action of the inhibitory neurotransmitter gamma-
aminobutyric acid (GABA). These drugs are
recommended for short-term use, not to exceed 3 to
4 months. Physical dependence and tolerance are
problems associated with prolonged use of these
drugs.
This drug has fewer side effects and less risk for
dependence than the benzodiazepines. The drug has
a slower onset of action and may take 1 to 2 weeks
to produce a noticeable therapeutic effect.
Several drugs in this group have been approved by
the Food and Drug Administration (FDA) for use in
the management of panic disorder. Their use in
treatment of other types of anxiety is being
investigated.
Beta-blockers are effective in managing the
physical symptoms of anxiety that occur with the
social phobias (e.g., stage fright). The alpha-2
agonists are used to manage anxiety associated with
withdrawal from nicotine and opioids.
Stimulants (e.g., caffeine, nicotine,
theophylline, terbutaline sulfate, amphetamines,
and cocaine) can increase physical symptoms of
anxiety.
This aids in reduction in anxiety.
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Provide patients with a means to listen to Music is a simple, inexpensive, esthetically pleasing
music of their choice. means of alleviating anxiety.
Rule out withdrawal from alcohol,
Withdrawal from these substances is characterized
sedatives, or smoking as the cause of
by anxiety.
anxiety.
Educate patient and family about the If patient and family can identify anxious responses,
symptoms of anxiety. they can intervene earlier than otherwise.
Teach patient to visualize or fantasize
about the absence of anxiety or pain,
Use of guided imagery has been useful for reducing
successful experience of the situation,
anxiety.
resolution of conflict, or outcome of
procedure.
Teach use of appropriate community
resources in emergency situations (e.g., The method of suicide prevention found to be most
suicidal thoughts), such as hotlines, effective is a systematic, direct-screening procedure
emergency rooms, law enforcement, and that has a high potential for institutionalization.
judicial systems.