02.01 Anxiety

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Anxiety Assessment (Picmonic)

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Okay guys, let’s chat about anxiety. First, understand I’m not talking about Generalized Anxiety Disorder, specifically - just about the symptom, the feeling of anxiety, which anyone and everyone could experience. I’m sure you’ve experienced this as a student or in your personal life. So what might it look like and how do we care for a client who is experiencing anxiety.

By definition, anxiety is a sense of worry or nervousness, typically about an upcoming event that may or may not have an uncertain outcome. This is a normal part of life, right? Things come up or life happens and we have a sense of worry. So there is the normal type of anxiety. It’s healthy, actually. It can be motivating, it can help you grow. And that’s okay. Acute anxiety is sudden and related to some sort of event or threat. Maybe a near-miss car accident or you found out a loved one is in the hospital. Something specific happened and you suddenly become anxious. That is also normal! BUT - the problem comes when anxiety starts to overtake your life, keep you from functioning, or becomes persistent and chronic. Chronic anxiety can mean you’re anxious about normal, everyday activities like driving or going to the grocery store...that’s when we start to be really concerned.

In addition to the types of anxiety - normal, acute, and chronic - there are also levels. So, at the very bottom is someone who is anxiety-free. They’re doing fine, nothing is worrying them. Then you have this mild level of anxiety - that’s like the normal, motivating, growth-producing anxiety. Again, this can be normal. But - we don’t want anyone to stay there. Think about how you feel right before a test that you studied really hard for - just a little bit of anxiety and nervousness - it actually keeps you focused and makes you do better. Now, imagine having that same level of anxiety ALL THE TIME. How awful would that be? So while this level is okay and can be healthy, we still want people to come back down to this anxiety-free level as often as possible. Then, there’s moderate anxiety - you can still function and problem-solve, but it’s a seriously palpable nervousness and it may begin to affect you physically or affect your ability to focus. We may start to see some tachycardia and tachypnea in this level. The next level is severe - at this point, you really can’t get yourself out of the worry and overwhelming anxiety. It requires someone else to intervene to help them off that level, possibly even medication. They’re so focused on whatever it is that got them there that they can’t get out on their own. Then there’s the panic level. This is the ultimate level and it comes with a sense of dread and impending doom, and usually physical symptoms as well, and you begin to lose rational thought. No matter what someone says or how much you try to reason with yourself, you absolutely cannot calm down. This usually requires significant intervention and/or medication. For those of you who’ve never experienced a panic attack, I am SO glad for you - please be empathetic and understand that it is absolutely terrifying. I’ve had two panic attacks in my life - and it is so scary and so hard to come down from.

Now, one thing I want you to realize is that the frequency with which someone experiences panic level anxiety is going to be entirely dependent on what level they exist on. If someone chills out between anxiety-free and mild anxiety, the leap up to panic is bigger and usually doesn’t happen as often. I’ll tell you, I live around this mild level most of the time. Anxiety-free is a luxury for me. But, imagine someone who lives in the moderate or even severe range ALL. THE. TIME - can you see how their little leap up to Panic is easier or shorter? People who struggle with higher levels of anxiety more often are more prone to panic attacks because their threshold is much higher. So make sure you recognize someone’s baseline level so you can recognize significant changes and intervene before they get up here to the more severe levels.

Really quickly, let’s just review presentation and management of an acute anxiety attack, or a panic attack. So, like I mentioned you’ll possibly see physical symptoms like tachypnea, tachycardia, diaphoresis. Patients will report anxiety and a sense of impending doom. Just make sure when you’re doing your assessment that you’re assessing for a risk of self-harm. This may look like helplessness or hopelessness, but you can also just ask them directly if they are thinking of hurting themselves. As far as management, I cannot stress enough that safety is your #1 priority. If you’re considering what your first intervention should be for a patient experiencing an anxiety attack, the very first question you should ask yourself is “is the scene safe?” If not, your first action is to ensure safety. A good example is if a client is in the day room with 20 other people when they begin having a panic attack - the first action should be to remove them from that environment to make sure everyone stays safe. We want to decrease stimuli and provide a calm environment because too much stimuli can make things worse. Focus on helping the patient to identify the cause and make connections between their behaviors and the things they’re feeling - that can help them in the future. And then, of course, medications are available in the form of anxiolytics like benzodiazepines.

So, the priority nursing concepts for a patient with anxiety are #1 safety, always. We also address coping by looking for the root cause, and we monitor mood/affect for any signs of a risk of self-harm.

So, let’s recap quickly. A small amount of anxiety can be healthy and motivating, even in response to a stressor - we just don’t want anyone to stay there. Make sure you understand the difference between acute - which is sudden and in response to a threat or event - and chronic which is persistent, all the time, and even in response to normal activities. And make sure you know what level of anxiety the client is experiencing and what their baseline is - they may have a higher threshold for panic-level anxiety. And, of course, safety first - always.

That’s it for anxiety, make sure you check out the patient story and other resources attached to this lesson, and check out the rest of the lessons to learn more about different mental health disorders. Now, go out and be your best self today. And, as always, happy nursing!
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