ANXIETY IS A VAGUE FEELING of dread or apprehension; it is a response

to external or internal stimuli that can have behavioral, emotional,

cognitive, and physical symptoms. Anxiety is distinguished from fear,
which is feeling afraid or threatened by a clearly identifiable external
stimulus that represents danger to the person.

Anxiety is unavoidable in life and can serve many positive functions such
as motivating the person to take action to solve a problem or to resolve
a crisis. It is considered normal when it is appropriate to the situation
and dissipates when the situation has been resolved.

disorders comprise a group of conditions that share a key feature of

excessive anxiety with ensuing behavioral, emotional, cognitive, and
physiologic responses. Clients suffering from anxiety disorders can
demonstrate unusual behaviors such as panic without reason,
unwarranted fear of objects or life conditions, or unexplainable or
overwhelming worry. They experience significant distress over time, and
the disorder significantly impairs their daily routines, social lives, and
occupational functioning.

This chapter discusses anxiety as an expected response to stress. It also

explores anxiety disorders, with particular emphasis on panic disorder.
Other disorders that include excessive anxiety are discussed in other
chapters: obsessive–compulsive disorder (OCD)1is in Chapter 15 and
posttraumatic stress disorder (PTSD) is in Chapter 13.

•Decreased attention span

•Restlessness, irritability

•Poor impulse control

•Feelings of discomfort, apprehension, or helplessness

•Hyperactivity, pacing

•Wringing hands
•Perceptual field deficits

•Decreased ability to communicate verbally2

Palpitations, pounding heart, or accelerated heart rate•

Sweating•

Trembling or shaking•

Sensations of shortness of breath or smothering•

Feelings of choking•

Chest pain or discomfort•

Nausea or abdominal distress•

Feeling dizzy, unsteady, light-headed, or faint2•

1) Nursing Diagnosis:

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by

an autonomic response (the source often nonspecific or unknown to the
individual); a feeling of apprehension caused by anticipation of danger. It
is an alerting signal that warns of impending danger and enables the
individual to take measures to deal with the threat related to Real or
perceived threat to self-concept evidenced by Increased respiration.

(1) N
Rem
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2
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2) Nursing Diagnosis:

FEAR: Response to perceived threat that is consciously recognized as a

danger3related to Phobic stimulus3evidenced by3Refuses to eat in
public.

(2) Nursing interventions Ration

1. Reassure client of his or her safety and At pa
security. 3 fear fo
2. Explore the client’s perception of threat It is
to physical integrity or threat to self- client
concept.3 object
with t

3) Nursing Diagnosis:

INEFFECTIVE COPING: Inability to form a valid appraisal of the stressors,

inadequate choices of practiced responses, and/or inability to use
available resources related to Fear of failure3evidenced by Ritualistic
behavior3
 (3) Nursing interventions
1. Assess client’s level of an
determine the types of sit
increase anxiety and result
behaviors.4
In the beginning of trea
plenty of time for rituals.
judgmental or verbalize disap
behavior.4

4) Nursing Diagnosis:

DISTURBED BODY IMAGE :Confusion in mental picture of one’s physical

self related to4Low self-esteem evidenced by4Preoccupation with real
or imagined change in bodily structure

or function.

(4) Nursing interventions Rationale

Preoccupation with real or imagined change Establish trusting relationshi
in bodily structure or function4 with client.
Identify misperceptions or distortions client Lack of attention may encourag
has regarding bodyimage. Correct elimination of undesirabl
inaccurate perceptions in a matter-of-fact, behaviors.4
nonthreatening manner. Withdraw
attention when preoccupation with
distorted image persists.4
5) Nursing Diagnosis:

INEFFECTIVE IMPULSE CONTROL: A pattern of performing rapid,

unplanned reactions to internal or external stimuli without regard for
the negative consequences of these reactions to the impulsive individual
or to others5related to5Stress vulnerability5evidenced by5Inability to
control impulse to pull out own hair5

Nursing interventions Rationale

Support client in his or her effort to stop hair Support from the nurse builds
pulling. Help client understand that it is possible trust
to discontinue the behavior.Client realizes that
the behavior ismaladaptive but feels helpless to
stop. 5
Ensure that a nonjudgmental attitude is An attitude of acceptance
conveyed, and criticism of the behavior is promotes feelings of dignity and
avoided. 5 self-worth.5