1. Define Anxiety:

Anxiety is a natural human response to stress or a perceived threat. It is characterized by feelings of worry, nervousness, or fear that can be mild or severe and can interfere with daily life.

2. Causes and Predisposing Factors of Anxiety:

• Genetic factors: Family history of anxiety disorders can increase the likelihood of developing anxiety.

• Environmental factors: Stressful life events such as trauma, abuse, or significant life changes can trigger anxiety.

• Brain chemistry: Imbalances in neurotransmitters, such as serotonin and dopamine, can contribute to anxiety disorders.

•  Personality factors: Certain personality traits, such as perfectionism or a tendency to overthink, may predispose individuals to anxiety.

•  Medical conditions: Chronic illnesses or conditions that affect hormone levels or the nervous system can increase the risk of anxiety.

3. Signs and Symptoms of Anxiety:

The signs and symptoms of anxiety can be caused by a combination of physiological, psychological, and environmental factors. Here's how each symptom may be triggered:

• Excessive worry or fear: Anxiety can cause the brain to perceive situations as more threatening than they actually are, leading to excessive worry or fear. This can also be influenced by past traumatic experiences or learned behaviors.

• Restlessness or irritability: Increased levels of stress hormones, such as cortisol, can lead to feelings of restlessness and irritability. The body's natural "fight or flight" response to stress can manifest as restlessness.

• Difficulty concentrating: Anxiety can make it challenging to focus on tasks because the mind is preoccupied with worries or fears. The constant stream of anxious thoughts can interrupt concentration and cognitive function.

• Muscle tension: Anxiety activates the body's stress response, causing muscles to tense up as a protective mechanism. This tension can be a physical manifestation of the psychological stress experienced during anxiety.

• Fatigue: Constant worrying and heightened arousal associated with anxiety can lead to fatigue. The body may become exhausted from the persistent state of heightened alertness and tension.

• Rapid heartbeat: Anxiety triggers the release of adrenaline and other stress hormones, which can increase heart rate as part of the body's "fight or flight" response. This heightened arousal prepares the body to respond quickly to perceived threats.

• Sweating: Increased sweating is a physiological response to anxiety caused by the activation of the sympathetic nervous system, which controls the body's stress response. Sweating is the body's way of regulating temperature during times of stress.

• Trembling or shaking: Anxiety-induced adrenaline release can cause trembling or shaking as the body prepares for action. This physical symptom is part of the body's response to perceived danger.

• Trouble sleeping: Anxiety can disrupt sleep patterns in several ways, including intrusive thoughts, physical discomfort from muscle tension, and heightened arousal preventing relaxation. Additionally, the fear of not being able to fall asleep can exacerbate insomnia.

• Gastrointestinal problems: Anxiety can affect the digestive system by altering gut motility and increasing sensitivity to gastrointestinal discomfort. Stress hormones released during anxiety can also directly affect the digestive tract, leading to symptoms such as stomachaches, nausea, or diarrhea.

4. Types of Anxiety (May also be known as Classes):

•   Generalized Anxiety Disorder (GAD)

•   Panic Disorder

•   Social Anxiety Disorder (Social Phobia)

•   Specific Phobias

•   Obsessive-Compulsive Disorder (OCD)

•   Post-Traumatic Stress Disorder (PTSD)

5. Levels of Anxiety:

• Mild Anxiety:

  • Mild anxiety is characterized by mild, manageable symptoms that do not significantly interfere with daily functioning.

  • Individuals experiencing mild anxiety may feel mildly nervous, worried, or uneasy, but they are still able to cope with their symptoms and carry out their usual activities.

  • Physiological symptoms such as slight muscle tension, mild restlessness, and occasional difficulty concentrating may be present.

  • Mild anxiety is often transient and may be a normal response to stressful situations or life events.

• Moderate Anxiety:

  • Moderate anxiety is characterized by more pronounced symptoms that interfere to a greater extent with daily functioning.

  • Individuals experiencing moderate anxiety may have difficulty concentrating, experience muscle tension, and feel restless or on edge.

  • They may exhibit avoidance behaviors or seek reassurance from others to manage their anxiety.

  • Moderate anxiety can impair performance at work, school, or in social situations, but individuals can still function with some difficulty.

• Severe Anxiety:

  • Severe anxiety is characterized by intense, overwhelming symptoms that significantly disrupt daily functioning and quality of life.

  • Individuals experiencing severe anxiety may feel extremely fearful, panicked, or overwhelmed by their symptoms.

  • Physiological symptoms such as rapid heartbeat, trembling, sweating, and difficulty breathing may be severe and debilitating.

  • Severe anxiety can lead to avoidance behaviors, social withdrawal, and impairment in multiple areas of life, including work, relationships, and self-care.

• Panic Anxiety (Panic Attacks):

  • Panic anxiety refers to sudden and intense episodes of extreme fear or discomfort, known as panic attacks.

  • Panic attacks typically occur unexpectedly and reach a peak within minutes, accompanied by intense physical symptoms such as chest pain, shortness of breath, dizziness, and feelings of impending doom.

  • Individuals experiencing panic attacks may fear that they are having a heart attack or losing control, which can further exacerbate their symptoms.

  • Panic attacks can occur in response to specific triggers or may occur unexpectedly (panic disorder). They can be debilitating and may lead to avoidance behaviors and significant impairment in daily functioning.

6. Management of Anxiety:

   A) Pharmacological:

• Antidepressants (SSRIs, SNRIs, TCAs)

• Benzodiazepines (short-term relief, due to risk of dependence)

• Buspirone (anxiolytic)

• Beta-blockers (for physical symptoms of anxiety)

• Antidepressants:

• Selective Serotonin Reuptake Inhibitors (SSRIs):

  • Example drugs:

  • Fluoxetine (Prozac): Starting dose typically 20 mg/day, may be increased to 40-60 mg/day.

  • Sertraline (Zoloft): Starting dose typically 50 mg/day, may be increased to 100-200 mg/day.

  • Escitalopram (Lexapro): Starting dose typically 10 mg/day, may be increased to 10-20 mg/day.

• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

  • Example drugs:

    • Venlafaxine (Effexor): Starting dose typically 37.5-75 mg/day, may be increased to 75-225 mg/day.

    • Duloxetine (Cymbalta): Starting dose typically 30 mg/day, may be increased to 60-120 mg/day.

• Tricyclic Antidepressants (TCAs):

  • Example drugs:

    • Amitriptyline: Starting dose typically 25-50 mg/day, may be increased to 75-150 mg/day.

    • Imipramine: Starting dose typically 25-50 mg/day, may be increased to 100-200 mg/day.

• Benzodiazepines:

• Example drugs:

  • Alprazolam (Xanax): Typical starting dose for anxiety is 0.25-0.5 mg three times daily. Maximum dose is 4 mg/day.

  • Lorazepam (Ativan): Typical starting dose for anxiety is 0.5-1 mg two to three times daily. Maximum dose is 10 mg/day.

  • Diazepam (Valium): Typical starting dose for anxiety is 2-10 mg two to four times daily. Maximum dose is 30 mg/day.

• Buspirone:

• Example drug:

  • Buspirone (Buspar): Starting dose typically 5 mg three times daily, may be increased to 20-30 mg/day in divided doses.

• Beta-blockers:

• Example drugs:

  • Propranolol: Typical dose for performance anxiety is 10-80 mg one hour before the event. For chronic anxiety, doses may range from 20-320 mg/day.

  • Atenolol: Typical dose for performance anxiety is 25-100 mg one hour before the event. For chronic anxiety, doses may range from 25-100 mg/day.

NURSING CARE

1. Create a Calm and Safe Environment

• I will reduce environmental stimuli by dimming the lights, closing curtains, and minimizing noise. To reduce overstimulation, which can help ease anxiety symptoms.

• I will ensure patient safety by removing any potentially harmful objects from the environment because creating a secure space minimizes the risk of harm and provides a sense of safety for the patient.

• I will encourage the patient to find a comfortable position in a chair or bed, offering blankets if needed. because Physical comfort can help alleviate physical tension associated with severe anxiety.

• I will limit external distractions by minimizing interactions with other staff and visitors, allowing only essential personnel. because Reducing interruptions and stimuli provides a more stable, controlled environment, helping to prevent sensory overload.

• I will set clear boundaries by explaining routines and what to expect during care. to give the patient a sense of control over their environment.

2. Establish Trust and Therapeutic Communication

• I will use open-ended questions to encourage the patient to express their feelings. To promote sharing, helping the patient feel understood and validated.

• I will acknowledge the patient’s feelings by validating their emotions (e.g., “It’s okay to feel overwhelmed”). To build trust and reduce feelings of isolation, which can help alleviate anxiety.

• I will maintain a non-judgmental attitude and actively listen without interrupting. To foster trust and encourage open communication.

• I will avoid overloading the patient with information, offering only one instruction at a time. To avoid worsening anxiety symptoms.

• I will use gentle eye contact when culturally appropriate to demonstrate active listening and empathy. To reassure the patient, making them feel acknowledged and understood.

3. Encourage Relaxation Techniques and Breathing Exercises

• I will guide the patient through deep breathing exercises, encouraging them to inhale, hold, and exhale slowly. To activate the parasympathetic nervous system, which can reduce physical symptoms of anxiety.

• I will demonstrate progressive muscle relaxation by leading the patient through tensing and relaxing various muscle groups. To help release physical tension, reducing overall anxiety.

• I will introduce visualization techniques and encourage the patient to imagine a peaceful scene. To divert focus from anxious thoughts to calming imagery, promoting mental relaxation.

• I will teach box breathing, guiding them to inhale for 4 seconds, hold for 4, exhale for 4, and pause for 4. To help regulate the body's response to stress by slowing the heart rate and calming the mind.

• I will use guided imagery to lead the patient through imagining a peaceful environment, focusing on sensory details. To shift focus from anxiety to positive, calming stimuli, which can reduce stress. 

4. Encourage and Educate on Healthy Coping Mechanisms

• I will encourage the patient to journal their thoughts and write down their emotions. To help the patient process their thoughts, identify patterns, and gain insight into their anxiety.

• I will introduce mindfulness exercises, such as focusing on physical sensations or breathing. To bring attention to the present moment, reducing anxious thoughts about the past or future.

• I will encourage light physical activity such as a brief walk or stretching if the patient is willing. To release endorphins and can alleviate symptoms of anxiety by promoting relaxation.

• I will support the patient in engaging in hobbies or relaxing activities, like drawing or listening to music. To provide a positive distraction from anxiety and improve mood.

• I will teach positive self-talk to help the patient recognize and counter negative thoughts with supportive or rational responses. To help reframe anxious thoughts, improving self-efficacy and resilience.

5. Administer and Monitor Medications as Prescribed

• I will administer anxiolytic medications as ordered by the healthcare provider, following correct dosage and timing. To help manage acute anxiety symptoms, providing short-term relief for the patient.

• I will monitor the patient for any adverse reactions to medications, documenting and reporting side effects as needed. To ensure patient safety and help adjust treatment as needed.

• I will educate the patient on the purpose and proper use of medications for anxiety. To increase compliance and reassure the patient about the effects of medication.

• I will assess the patient’s anxiety levels after medication administration to evaluate the treatment’s effectiveness. To allow for timely adjustments to enhance symptom relief.

• I will collaborate with the prescribing physician regarding patient progress and medication effects. To ensure that treatment remains effective and aligned with the patient’s needs.

6. Identify and Address Anxiety Triggers

• I will encourage the patient to identify personal triggers and explore how they respond to them. To help the patient understand what intensifies their anxiety, leading to better management strategies.

• I will assist the patient in developing a plan to address and manage triggers effectively. To help the patient feel more in control.

• I will educate the patient on healthy avoidance versus counterproductive avoidance of anxiety-provoking situations. To help reduce avoidance behaviors and build resilience.

• I will promote problem-solving skills by breaking down stressful situations into manageable steps. To empower the patient to handle stressful situations effectively.

• I will encourage journaling of triggers and responses to help the patient identify patterns and improve self-awareness. To promote insight into triggers and can improve the patient’s sense of control over anxiety.

7. Promote Autonomy and Sense of Control

• I will offer choices whenever possible in the patient’s care, such as preferred activities or routines. To foster a sense of autonomy, which can reduce anxiety by giving the patient control over their environment.

• I will encourage the patient to perform self-care tasks they feel capable of completing independently. To build self-confidence and a sense of self-efficacy.

• I will involve the patient in planning their care by discussing treatment options and preferences. To promotes patient engagement and helps the patient feel empowered.

• I will respect the patient’s personal boundaries by not forcing them into situations that heighten anxiety. To show empathy, helping the patient feel safe and in control.

• I will work with the patient to set realistic goals for coping with anxiety, based on their capabilities. To builds confidence and reinforces effective coping strategies.

8. Ensure Regular Follow-Up and Referral if Needed

• I will schedule routine anxiety assessments to monitor the patient’s progress and effectiveness of interventions. To allow timely adjustments to the care plan, ensuring it meets the patient’s evolving needs.

• I will coordinate care with mental health professionals to support a comprehensive treatment approach. To enhance the quality and continuity of care.

• I will educate the patient and family on signs of relapse to promote early intervention if symptoms worsen. To prevent escalation by enabling prompt support and treatment.

• I will arrange for follow-up appointments to monitor progress, reinforce coping skills, and provide ongoing support. To help maintain therapeutic support and continuity of care.

• I will encourage participation in group therapy or counselling as additional resources for coping with severe anxiety. To provide social and therapeutic resources that help reduce isolation and anxiety.

9. Support Groups or Therapy:

• Discuss the benefits of support groups or group therapy for individuals with anxiety disorders.

• Provide information about available support groups or therapy options in the community.

• Offer emotional support and reassurance to the patient as they participate in group therapy or support group meetings.

10. Lifestyle Changes (Healthy Diet, Adequate Sleep, Avoiding Caffeine and Alcohol):

• Educate the patient about the impact of diet, sleep, caffeine, and alcohol on anxiety symptoms.

• Encourage the adoption of a balanced and nutritious diet rich in fruits, vegetables, whole grains, and lean proteins.

• Provide guidance on establishing healthy sleep habits and improving sleep hygiene.

• Assist the patient in developing strategies to reduce or eliminate caffeine and alcohol intake, as these substances can exacerbate anxiety symptoms.

7. Possible Complications of Anxiety:

• Depression

• Substance abuse

• Suicidal thoughts or behaviors

• Impaired social and occupational functioning

• Increased risk of chronic health conditions (e.g., cardiovascular disease)

• Decreased quality of life

• Relationship problems

• Insomnia or other sleep disorders