Stress and Anxiety Nursing Care Management

Stress and anxiety are universal feelings and are part of our daily lives. Of course, everyone feel stress and anxious from time to time. People are expected to feel some degree of worry, apprehension, and uncertainty. However, the person’s ability to perceive it accurately and be able to channel it appropriately dictates whether stress and anxiety will be beneficial or detrimental.

Description


People have various meanings for stress and anxiety. However, here is how the books define the two concepts:

  • Stress is the brain’s response to any demand. It is most often triggered by change (positive or negative, real or perceived).
  • Anxiety is anticipation of future threat.

Anxiety Levels and Effects


Anxiety is divided into different levels and each level has unique effects:

Mild

  • Characterized by an individual’s awareness that something is different and his attention is warranted by it.
  • There is increased in sensory stimulation which helps the individual focus his attention for learning.
  • Rarely threatens one’s coping ability; may motivate the individual to try new things and take risks.
  • Alert; more aware of environment and motivated to deal with existing problems in this state.
  • Behavioral and emotional responses: unable to sit still, fine tremors, a little impatient

Moderate

  • Person starts getting nervous or agitated. His perception is narrower and concentration is increased.
  • Feels fearful or uneasy but is still able to function. However, voice quivers and there may be changes in pitch.
  • Behavioral and emotional responses: uncomfortable, shaken, and sensitive

Severe

  • Believes that there is a threat.
  • Person feels very agitated, confused, and inadequate. Range of perception is reduced and anxiety interferes with effective functioning.
  • Person will feel threatened and either avoid the anxiety or become overwhelmed by it. Person is experiencing increased pulse/respirations with reports of dizziness, tingling sensations, and headache.

Panic

  • Ability to concentrate is disrupted; behavior is disintegrated.

Causes of Stress and Anxiety


Here are the causes of stress and anxiety:

  1. Psychobiological. These are the stressors that affect the integrity of the body (e.g. injuries).
  2. Psychological. Include various kinds of trauma.
  3. Psychosocial. Originates from interaction to people and manifested in different ways (e.g. sweating, high blood pressure, rapid heartbeat, etc.)

Anxiety-Related Disorders


When anxiety ceased to be beneficial, real illness sets in. In fact, anxiety disorders are the most common type of psychiatric disorders.

Overview

  • Anxiety disorders are group of conditions that share features of excessive fear (emotional response to real or perceived imminent threat) and anxiety and related behavioral disturbances.
  • Anxiety disorders appear comorbid but they differ in the types of objects or situations that induce fear and anxiety. These fear and anxiety are excessively and persistently beyond developmentally appropriate periods.

Generalized Anxiety Disorder (GAD)

  • Is characterized by anxiety that is persistent, overwhelming, uncontrollable, and out of proportion to stimulus.
  • Emerges slowly and tends to be chronic.
  • Usual onset is early 20s and affects 3% of the population.

Panic Disorder

  • Represents anxiety in its most severe form.
  • Characterized by recurrent, unexpected panic attacks that cause intense apprehension and feelings of impending doom. It may change patient’s behavior.

Obsessive-Compulsive Disorder (OCD)

  • Characterized by unwanted, recurrent, intrusive thoughts or images (obsession) that the person tries to alleviate through repetitive behaviors or mental acts (compulsions).
  • Obsession produces anxiety and compulsions are meant to reduce anxiety or prevent some dreaded event from happening. Compulsions typically are overt behaviors like hand washing, counting, and praying.

Phobic Disorder

  • Social phobia commonly involves anxieties about speaking or eating in public and using public restroom. It is associated with deep concern that others will see the patient’s anxiety symptoms (e.g. sweating, blushing) or will judge him as weak and stupid.
  • Specific phobias are divided into five subtypes: natural environment, animal, blood-injection-injury, situational, and others.

Post-traumatic Stress Disorder (PTSD)

  • Characterized by persistent, recurrent images and memories of a serious traumatic event that the person has either experienced or witnessed, impairing his ability to function. 

Causes of Anxiety-Related Disorders


Anxiety-related disorders are linked to a variety of factors:

  1. Genetic Factors. Some anxiety disorders (e.g. panic disorder, OCD, GAD) are inherited. A possibility of defective genes that regulate the neurotransmitters serotonin and dopamine is being researched.
  2. Biochemical Factors. Scientists believe in biological vulnerability to stress.
  3. Neuroanatomic Factors. MRI and other neuroimaging techniques reveal brain atrophy, underdeveloped frontal and temporal lobes, amygdala abnormalities (region for fear, memory, and emotion regulation), and hippocampus (region for emotion and memory storage).
  4. Other factors include traumatic events, medical conditions, and gender’s role in disorder development (women are at higher risk than men). Additional risk factors include marital separation or divorce, history of childhood physical or sexual abuse, and low socioeconomic status.

Medical Management


Individuals who are stressed and anxious can benefit from these therapies:

  • Social supports, psychotherapy, cognitive or behavioral therapy
  • Pharmacotherapy
  • Supportive counselling

Nursing Management


Here are the nursing responsibilities for taking care of patients who are stressed and anxious:

Nursing Assessment

  • Assess level of anxiety. Review familial and physiological factors (e.g. genetic depressive factors); psychiatric illness; active medical conditions (e.g. thyroid problems, metabolic imbalances). Monitor vital signs.
  • Description of feelings (expressed and displayed). Conduct interview and observe behaviors.
  • Awareness and ability to recognize and express feelings.
  • Related substance use, if present.

Nursing Diagnosis

  • Anxiety related to unconscious conflict about essential goals and values of life, threat to self-concept, positive or negative self-talk, or physiological factors (e.g. hyperthyroidism, pulmonary embolism, dysrhythmias).

Planning and Goals

Main Article: 7 Anxiety and Panic Disorders Nursing Care Plans

  • Treatment plan and individual responsibility for activities.
  • Teaching plan.

Nursing Interventions

  • Assist clients to identify feelings and begin to deal with problems. Establish a therapeutic relationship. Be available to client for listening and talking. Assist client to develop self-awareness of verbal and nonverbal behaviors. Clarify meaning of feelings and actions by providing feedback and checking meaning with client. Most of all, acknowledge anxiety and fear. When dealing with children, be truthful and avoid bribing.
  • Promote wellness. Assist client with identifying new methods of coping with disabling anxiety. Review happenings, thoughts, and feelings preceding the anxiety attack. List helpful resources and people. Assist in developing skills (e.g. awareness of negative thoughts, saying “Stop”, and substituting a positive thought).

Evaluation

  • Client involvement
  • Client response to interventions, teaching, and actions performed.

Discharge and Home Care Guidelines

Instruct patient and family to adhere to these reminders:

  • Relaxation techniques (e.g. deep breathing, imagery, music therapy)
  • Maintaining learned positive coping strategies
  • Avoidance of triggers
  • Stress management techniques
  • Strict adherence to medication (if doctor prescribed) and therapy schedule

Practice Quiz: Stress and Anxiety


Here a five item quiz about stress and anxiety.

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In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.

Practice Quiz: Stress and Anxiety

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Practice Quiz: Stress and Anxiety

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Questions

1. Level of anxiety in which the person believes there is a threat.

A. Mild
B. Moderate
C. Severe
D. Panic

2. Which is true about anxiety-related disorders?

A. Person knows the cause of anxiety attacks.
B. It can be inherited.
C. Amygdala is not affected when scanned using neuroimaging studies.
D. Both B and C.

3. Referred to as repetitive behaviors of mental acts

A. Obsession
B. Compulsions
C. Paranoia
D. Mannerisms

4. Structure in the brain which is responsible for memory and emotion storage.

A. Frontal lobe
B. Brainstem
C. Hippocampus
D. Cerebellum

5. The two neurotransmitters possibly involved in pathologic stress and anxiety.

A. Catecholamines
B. Dopamine and glutamate
C. Dopamine and serotonin
D. Serotonin and acetylcholine

Answers and Rationale

1. Answer: C. Severe.

At mild-moderate anxiety level, person senses there is something wrong but is still not convinced that there is a threat. At panic level, thought is disorganized and behavior is already disintegrated.

2. Answer: B. It can be inherited.

GAD and panic disorders among others can be inherited.

3. Answer: B. Compulsions.

On the other hand, obsessions are unwanted, recurrent, intrusive thoughts or images.

4. Answer: C. Hippocampus.

5. Answer: C. Dopamine and serotonin.

Dopamine and serotonin’s genes that might be faulty are studied by scientists as one of the factors contributing to anxiety-related disorders.

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