MODULE D2

Care of Adult with Maladaptive Patterns of Behavior

ANXIETY
Anxiety
- feelings of uncertainty, uneasiness, apprehension or tension that a
person experiences in response to an unknown object or situation.
- a fight-or-flight decision is made by the person in an attempt to
overcome conflict, stress, trauma or frustration.
Signal anxiety
Anxiety trait
Anxiety trait
Free floating anxiety

LEVELS OF ANXIETY
LEVEL
Mild

Psychological Responses

Physiological
Responses

Wide perceptual field

Restlessness

Sharpened senses (sees,

hears and grasps more
information)

Figdeting

Increased motivation
Effective problem solving
Increased learning ability
Irritability

GI butterflies
Difficulty sleeping
Hypersensitivity to noise
Nail biting
Foot/finger tapping

LEVELS OF ANXIETY
LEVEL
Moderate

Psychological
Responses
Perceptual field narrowed to
immediate task
Selective inattention (things are
only heard when brought to
persons attention)
Cannot connect thoughts or
events independently

Physiological Responses
Muscle tension
Diaphoresis
Pounding pulse / heart
Headache
Dry mouth

Increased use of automatisms

High voice pitch

Problem solving ability is greatly

enhanced by the supportive
presence of another

Faster rate of speech

GI upset
Frequent urination

NOTE:

MILD and MODERATE Anxiety can be

CONSTRUCTIVE because anxiety can
be viewed as a signal that something
in the persons life needs attention

NURSING INTERVENTIONS:
For MILD to MODERATE level of anxiety
1. Help patient focus and solve problems with the use of specific
communication technique (open ended question, giving broad openings,
exploring, seeking clarification)
2. Observe calm presence.
3. Recognize distress.
4. Show willingness to listen.

LEVELS OF ANXIETY
Psychological
Responses

LEVEL
High

Perceptual field reduced to one

detail or scattered details
Cannot complete task
Cannot solve problems or learn
effectively
Behavior geared toward anxiety
relief and usually ineffective
Doesnt respond to redirection
Feels awe, dread or horror

Physiological Responses
Severe headache
Nausea, vomiting, diarrhea
Trembling
Rigid stance
Vertigo
Pale
Tachycardia

Crying

Chest pain

Ritualistic behavior

Hyperventilation

LEVELS OF ANXIETY
LEVEL
Panic

Psychological Responses
Perceptual field reduced to focus on self
Cannot process any environmental
stimuli
Distorted perceptions
Loss of rational thought
Doesnt recognize potential danger

Physiological Responses
May bolt and run or totally
immobile and mute
Dilated pupils
Increased BP and PR
fight or flight or freeze

Cannot communicate verbally

Confusion

Possible delusions and hallucinations

Shouting

May be suicidal

Screaming

May lose touch with reality

Withdrawal

SEVERE TO PANIC LEVEL OF ANXIETY

Nursing interventions:
1.

Provide SAFETY

2.

Physical needs

3.

Minimize stimulation

4.

Provide a quiet environment

5.

Provide gross motor activities

6.

Medications nay be considered

7.

Use firm, short and simple statements

Rationale:

To prevent exhaustion (high-caloric fluids)

Because patients ability to deal with
excessive stimuli is impaired.
To drain off some of the tension
To decrease the level of anxiety
Ability to deal with abstractions and complexity is impaired.

Primary gain individuals desire to relieve anxiety in order to feel better

and secure
- is the relief of anxiety driven behavior
- e.g. staying in the house to avoid anxiety of leaving a safer place
Secondary gain attention/support one derives from others because of
illness
- Is the attention received from others as a result of these behaviors
- e.g. a person with agoraphobia may receive attention and caring concern
from family members, who also assume all the responsibilities of family
life outside the home *

1. BIOLOGICAL THEORIES:
1.1 Genetic theories:
- numerous studies substantiate that anxiety disorders tend to cluster in
families
- nearly have all clients with panic disorder have a relative with the
disorder
- National Institute of Mental determined that the gene 5 HTTP
influences how the brain makes use of serotonin

1.2 Neurochemical theories:

- Gamma aminobutyric Acid (GABA) amino acid neurotransmitter
believed to be dysfunctional in anxiety disorder
- GABA inhibitory neurotransmitter functions as bodys natural antianxiety agent by reducing cell excitability, thus reducing neuronal firing.
- Norepinephrine - increases anxiety
- Serotonin (5-HT) indolamine neurotransmitter usually implicated in
psychosis and mood disorders

2. PSYCHODYNAMIC THEORIES:
2.1 Intrapsychic / Psychoanalytic theories
Freud described defense mechanisms as humans attempt to control
awareness of and reduce anxiety. These are unconsciously used to
maintain a sense of being in control of a situation, to lessen discomfort and
to deal with stress.

2.2 Interpersonal theory

H. Peplau humans existed in interpersonal and physiologic realms; thus the nurse
help the client to achieve health by attending to both areas.

HS Sullivan viewed anxiety as being generated from problems in IPR.

communicate anxiety to infants or children through:

can better

Caregivers can

1. inadequate nurturing
2. agitation when holding or handling the child
3. distorted messages
Such communicated anxiety may result in dysfunction such as failure to
appropriate developmental tasks. *

achieve age

Increased level of anxiety

Decreased ability to communicate and solve problems

Increased chance for anxiety disorder

2.3 Behavioral theory

Behavioral theorists view anxiety as being learned through experiences.
People can change or unlearn behaviors through new experiences.
People can modify maladaptive behaviors without gaining insight into
the causes for them.
They can contend that behaviors that are disturbing that develop and
interfere with a persons life can be extinguished or unlearned by
repeated experiences guided by a trained therapist.

ANXIETY DISORDERS

GENERALIZED ANXIETY DISORDER

(GAD)
- characterized by UNREALISTIC or EXCESSIVE anxiety and worry
more days than not in a 6 month period
- at least 3 of the following symptoms are manifested:
1. restlessness
2. fatigue
3. impaired concentration/difficulty thinking
4. irritability
5. muscle tension
6. sleep disturbance
7. uneasiness

occurring

Nursing management:
1. Promote trust
2. Provide a calm and quiet environment

To minimize
stimulation

3. Ask patient to identify what and how they feel

4. Encourage to express feelings
5. Help identify possible causes of feelings

6. Ask if patient feels suicidal or has a plan to hurt himself

7. Involve in activities such as walking

To provide outlet

8. Assist in problem solving

9. Promote the use of hobbies and recreational activities

Pharmacologic management:
1. Benzodiazepines
Ex.
Lorazepam (Ativan)
Alprazolam (Xanax)

Do not use with alcohol

because it has potential
for ABUSE

2. Non Benzodiazepine anxiolytics

Ex.Buspirone (BuSpar)
3. Selective Serotonin Reuptake Inhibitor antidepressants (SSRI)
Ex.Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

PANIC DISORDER
With or without AGORAPHOBIA
- the person has recurrent, unexpected panic attacks followed by at
least 1 month of persistent concern and worry about future attacks or
their meaning or a significant behavioral change related to them.
- without precipitating factor
- 50% with this disorder have accompanying agoraphobia *
- peaks in late adolescence and the mid 30s
- SAFETY should be observed primarily

During panic attacks, patient has overwhelmingly intense anxiety and

displays at least 4 of the following symptoms:
1. Palpitations

6. Nausea

2. Sweating

7. Abdominal distress

3. Tremors

8. Dizziness

4. Shortness of breath

9. Paresthesia

5. Sense of suffocation

10. Chills

6. Chest pain

11. Hot flashes

Nursing management:
1. SAFETY should be prioritized
2. Ensure clients privacy
3. Provide a calm, quiet or less stimulating place
4. Use soothing and calm voice
5. Give simple and brief directions

Anxious cant focus

6. Let the client know that the nurse will be in control until the client regains self
control when client feels out of control and tell them nothings going to happen
to them.
7. May pace to release energy

May be interpreted as a
8. Dont touch threat
To decrease tension and
9. Provide gross motor activity anxiety

10.Encourage relaxation techniques

10.1 Deep breathing exercise
10.2 Guided imagery imagining a safe and enjoyable place to relax
10.3 Progressive relaxation person progressively tightens, holds then
relaxes
muscle groups while letting tension flow from the body
through
rhythmic breathing
11. Combined psychotherapy and medication
Note: The nurse should help the client to understand that these therapies
do not CURE the disorder but are methods to control and manage it.

12. Offer brown paper bag to clients hyperventilating.

Pharmacologic management: