All people experience some degree of anxiety (a tense emotional state) as they face new, challenging, or threatening life situations. In clinical settings, fear of the unknown, unexpected news about one’s health, and any impairment of bodily functions engenders anxiety. Although a mild level of anxiety can mobilize people to take a position, act on the task that needs to be done, or learn to alter lifestyle habits, a more severe level can be almost paralyzing. Anxiety that escalates to a near panic state can be incapacitating. When patients receive unwelcome news about results of diagnostic studies, they are sure to experience anxiety. Different patients man-ifest the physiologic, emotional, and behavioral signs and symptoms of anxiety in various ways (Nursing Research Profile 7-1).
Early clinical observations of guilt or anxiety are an essential component of nursing care (Chart 7-7). A high level of anxiety in a patient will probably exacerbate physiologic distress. For exam-ple, a postoperative patient who is in pain may discover that anx-iety intensifies the sensation of pain. A patient newly diagnosed with type 1 diabetes mellitus may be worried and fearful and therefore unable to focus on or complete essential self-care activ-ities. The possibility of developing somatic symptoms is high in any patient who is experiencing moderate to severe anxiety.
The DSM-IV TR (2000) lists general medical conditions that cause anxiety. They include endocrine diseases, such as hypo-thyroidism, hyperthyroidism, hypoglycemia, and hyperadrenocor ticism; cardiovascular conditions, such as cardiac dysrhythmia, con-gestive heart failure, and pulmonary emboli; respiratory problems, such as pneumonia and chronic obstructive pulmonary disease; and neurologic conditions, such as encephalitis and neoplasms.
Every nurse must be vigilant about the patient who worries ex-cessively and demonstrates deterioration in emotional, social, or occupational functioning. If participation in the therapeutic reg-imen (eg, administration of insulin) becomes a problem because of extreme anxiety, nursing interventions must be immediately initiated. Caring strategies emphasize ways for the patient to ver-balize feelings and fears and to identify sources of anxiety. The need to teach and promote effective coping abilities and the use of relaxation techniques are the priorities of care. In some cases, antianxiety medication may be prescribed. Chart 7-8 provides a list of basic nursing principles that are useful for assisting patients to manage severe anxiety.