Anxiety is a subjective warning of danger in which the specific nature of the danger is usually not known. It occurs when a person faces a new, unknown, or untried situation. Anxiety is also felt when a person perceives threat in terms of past experiences. It is a general concept underlying most disease states. In its milder form, anxiety can contribute to learning and is necessary for problem-solving. In its severe form, anxiety can impede a client's treatment and recovery. The general feelings elicited on all levels of anxiety are nervousness, tension, and apprehension.

It is essential that nurses recognize their own sources of anxiety and behavior in response to anxiety, as well as help clients recognize the manifestations of anxiety in themselves.

1. ASSESSMENT:
1. Physiological manifestations:
1. Increased heart rate and palpitations.
2. Increased rate and depth of respiration.
3. Increased urinary frequency and diarrhea.
4. Dry mouth.
5. Decreased appetite.
6. Cold sweat and pale appearance.
7. Increased menstrual flow.
8. Increased or decreased body temperature.
9. Increased or decreased blood pressure.
10. Dilated pupils.
2. Behavioral manifestations—stages of anxiety (Figure 10.6. Adaptation Responses to Anxiety on a Continuum):
1. Mild anxiety:
1. Increased perception (visual and auditory).
2. Increased awareness of meanings and relationships.
3. Increased alertness (notice more).
4. Ability to use problem-solving process.
2. Moderate anxiety:
1. Selective inattention (e.g., may not hear someone talking).
2. Decreased perceptual field.
3. Concentration on relevant data; "tunnel vision."
4. Muscular tension, perspiration, GI discomfort.
3. Severe anxiety:
1. Focus on many fragmented details.
2. Physical and emotional discomfort (headache, nausea, dizziness, dread, horror, trembling).
3. Not aware of total environment.
4. Automatic behavior aimed at getting immediate relief instead of problem-solving.
5. Poor recall.
6. Inability to see connections between details.
7. Drastically reduced awareness.
4. Panic state of anxiety:
1. Increased speed of scatter; does not notice what goes on.
2. Increased distortion and exaggeration of details.
3. Feeling of terror.
4. Dissociation (hallucinations, loss of reality, and little memory).
5. Inability to cope with any problems; no self-control.
3. Reactions in response to anxiety:
1. Fight:
1. Aggression.
2. Hostility, derogation, belittling.
3. Anger.
2. Flight:
1. Withdrawal.
2. Depression.
3. Somatization (psychosomatic disorder).
4. Impaired cognition: blocking, forgetfulness, poor concentration, errors in judgment.
5. Learning about or searching for causes of anxiety, and identifying behavior.
2. ANALYSIS/NURSING DIAGNOSIS: Anxiety related to:
1. Physical causes: threats to biological well-being (e.g., sleep disturbances, interference with sexual functioning, food, drink, pain, fever).
2. Psychological causes: disturbance in self-esteem related to:
1. Unmet wishes or expectations.
2. Unmet needs for prestige and status.
3. Impaired adjustment: inability to cope with environment.
4. Altered role performance: not using own full potential.
5. Altered meaningfulness: alienation.
6. Conflict with social order: value conflicts.
7. Anticipated disapproval from a significant other.
8. Altered feeling states: guilt.
3. NURSING CARE PLAN/IMPLEMENTATION:
1. Moderate to severe anxiety:
1. Provide motor outlet for tension energy, such as working at a simple, concrete task, walking, crying, or talking.
2. Help clients recognize their anxieties by talking about how they are behaving and by exploring their underlying feelings.
3. Help clients gain insight into their anxieties by helping them to understand how their behavior has been an expression of anxiety and to recognize the threat that lies behind this anxiety.
4. Help clients cope with the threat behind their anxieties by reevaluating the threats and learning new ways to deal with them.
5. Health teaching:
1. Explain and offer hope that emotional pain will decrease with time.
2. Explain that some tension is normal.
3. Explain how to channel emotional energy into activity.
4. Explain need to recognize highly stressful situations and to recognize tension within oneself.
2. Panic state:
1. Give simple, clear, concise directions.
2. Avoid decision making by client. Do not try to reason with client, because he or she is irrational and cannot cooperate.
3. Stay with client.
1. Do not isolate.
2. Avoid touching.
4. Allow client to seek motor outlets (walking, pacing).
5. Health teaching: advise activity that requires no thought.
4. EVALUATION/OUTCOME CRITERIA:
1. Uses more positive thinking and problem-solving activities and is less preoccupied with worrying.
2. Uses values clarification to resolve conflicts and establish realistic goals.
3. Demonstrates regained perspective, self-esteem, and morale; expresses feeling more in control, more hopeful.
4. Fewer or absent physical symptoms of anxiety.