My PhotoS

Nursing Process for client with Anxiety

Anxiety Responses and Anxiety Disorder

Anxiety is stress, taste is not safe and evoked care because felt by something happening that unpleasantly but its source a large part unknown and originates from within (DepKes RI,1990).

Anxiety can a concern sensory situation, uneasiness, contingent, or fear of fact or current source threat perception that unknown or recognised (Stuart and Sundeens, 1998).

Anxiety is a situation that marked by fear feel that espoused by somatik's sign that declare for hiperaktifitas's happening otonom's nervous system. Anxiety is phenomena that don't frequent one specific be found and oft constitutes a normal emotion (kusuma w, 1997).

Anxiety is respond to a threat that its unknown source, internal, vaguely or conflict (Kaplan, Sadock, 1997).

Anxiety theory

Anxiety constitutes a response to fraught situation pressure. Stress can be defined as a threat perception to an expectation that triggers alarm. Its result is working for behaviour (Rawlins, at al, 1993). Stress can get psychological form, social or physical. Severally cognitive give contribution to pretty much etiology factor in developmental anxiety.

That theory are as follows:

a. Psikodinamik's theory

Freud (1993) reveal that anxiety constitutes to usufruct from unrealised psikis conflict. Anxiety becomes sign to ego to take worry decrease action. While is mechanism self successful, menurun's anxiety and coming security again. But if conflicting continually continuous, therefore dread available on high-level. Defense mechanism self is experienced as simptom, as phobia, ritualistik's regression and behaviour. psikodinamik's concept terminologicals Freud this also enlightens that first evoked dread in life man while comes into the world and feel peckish that first time. That time in condition still frail, so can't yet give response to cold and hunger, therefore comes into the world first dread. Emerging next dread if available a wishes from Id to charge releases of egos, but doesn't get bless from super ego, therefore happens conflict in ego, among Id's wish that wants release and calling into question from super ego comes into the world dread secondly. That conflict is depressed deep subconscious, with constant potency not effected by time, often not realistik and is stuck it on. This pressure will emerge to surface via three scenes, which is: super's censor menurun's ego, Id's pressure increases and mark sense stress psikososial, therefore comes into the world next dreads (Prawirohusodo, 1988).

b. Behavioural theory

Theoritically behavioural, Indigenous anxiety a response to special stimulus (fact), longs time enough time, someone develops to respond condition for stimulus what do be of important. That anxiety constitute frustasy's result, so will trouble individual ability to reach to the effect which at wants.

c. Interpersonal's theory

Word that happening dread of anxiety reject among individual, so causes individual pertinenting to perceive worthless.

d. Cognitive family

Word that anxiety can happen and arises manifestly effect mark sense conflict in family.

e. Biological theory

Severally anxiety case (5,42%), constitute an attention to physiological process (Hall, 1980). This anxiety gets because of physical or abnormality disease, are not by conflicting emotional. This anxiety included secondary dread (Rockwell cit stuart & sundeens, 1998).

Predisposisi's factors

Anxiety is a prime factor in the development of the personality and formation of individual character traits. Because of its importance, various theories of the origin of anxiety have been developed.

Each change in life or life scene that can evoke stress situation called by stresor. Stress that experienced by someone can evoke anxiety, or anxiety constitutes manifestasi direct of life stress and so hand in glove bearing it by patterns life (Wibisono, 1990).

A variety factor predisposisi who can evoke anxiety (Roan, 1989) which is genetic factor, organic factor and psychology factor. On patient who will trip operation, predisposisi's factor anxiety that really influential is psychological factor, particularly uncertainty about procedure and operate for that will be tripped.

Symptom of Anxiety

Patient that experience anxiety usually have typical and subdivided phenomenas in a few phase, which is:

a. Phase 1

Situation is physical as it were on phase reacts warning, therefore body unlimbers to berkelahi (fight), or flight (run at full speed). On this phase body feels not delicate consequent of increasing secretion adrenalin hormone and nor is adrenalin.

Therefore, therefore phenomena marks sense anxiety can as perceive convulsively at muscle and exhaustion, particularly at chest muscles, jugular and back. In its preparation for fight, causing muscle wills be stiffer and accordingly will evoke ache and spasme at chest muscle, jugular and back. Stress of agonis's group and antagonist will evoke tremor and quiver that easily gets to be seen on fingers (Wilkie, 1985). On this phase anxiety constitutes step-up mechanism of nervous system that reminds we that system its function nerve begins mengolah's baffled ala aught information is right (Asdie, 1988).

b. Phase 2 (two)

Over and above clinical phenomena as on phase one, as perturbed as, muscle stress, sleeping trouble and belly complaint, patient also beginning can't control its emotion and no motifasi self (Wilkie, 1985).

c. Phase 3

Phase anxiety situation one and two that doesn't be settled whereas stresor just make a abode continued, patient will fall into phase anxiety three. In contrast to phenomena which appear on phase one and two one are easily at its bearing identification with stress, anxiety phenomena on phase three by and large as changed as deep behavioral and not usually in evidence bearing it with stress. On phase three it can appear phenomenas as: intoleransi by stimulates sensoris, tolerance ability loss to something earlier one have that it can tolerir, trouble reacts to something that glimpses most see as personality trouble (Asdie, 1988).

Levels Of Anxiety

Peplau identified four levels of anxiety and described their effects on the individual:

1. Mild Anxiety.

Is associated with tension of day to day living. During the stage the person is alert and the perceptual field is increased. The person sees, hears, and grasps more than previously. This kind of anxiety can motivate learning and can produce growth and creativity.

2. Moderate Anxiety

In which the person focuses only on immediate concerns, involves the narrowing of the perceptual field as the person sees hears, and grasps less. The person blocks out selected areas but can attend to more if directed to do so.

3. Severe Anxiety

Is marked by a significant reduction in the perceptual field. The person tends to focus on a specific detail and not think about anything else. All behavior is aimed at relieving anxiety and much direction is needednto focus on another area.

4. Panic

Is associated with awe, dread, and terror. At this stage details are blown out of proportion. Because of complete loss of control, the person is unable to do things even with direction. Panic involves the disorganization of the personality. A person can no longer function as an organized human being. There is increased motor activity, decreased ability to relate to others, distorted perceptions, and loss of rational though. Panic a frightening and paralyzing experience. The person in panic is unable to communicate or function effectively. This level of anxiety cannot persist indefinitely because it is incompatible with life prolonged period of panic wold result in exhaustion and death.

The Nursing Process

Assesment

Obsessive Compulsive Disorder

Behaviour Assessment	Affective Assessment	Cognitive Assessment	Social Assessment
What kinds of objects or situation do you feel a need to check or recheck frequently? How much time during a day do you spend on checking activities? Desribe any movements you are forced to repeat. What kinds of things do you count, silently or our loud?	Describe how you experience the feeling of anxiety. What happens to you when you feel out of control in situation? Describe your relationships with significant others. How do these others relate to you? What are your greatest fears in life?	Describe the qualities you like about your self. Describe the qualities you do not like about your self. What are you thoughts about you compulsive bahaviour? Would you like to decrease the need for your compulsive behavior? How much time a day do you spend doubting what you have done? What are the fears you worry about every day?	In what way do habits or thoughts get in the way of work? Social life? Personal life? Describe situations in which you feel close to and warm with your family members. In what ways do you feel dependent on your family?

Phobic Disorders

Behaviour Assessment	Affective Assessment	Cognitive Assessment	Social Assessment
What situation or objects do you try to avoid in life? Describe wthat you do to avoid these situations or objects. Are you social or work activities limited to a prescribed geographic area? How often and in what circumstance are you able to leave home?	What are you greatest fears in life? Do you fear others laughing are you? Being humiliated? Being abandoned by others? Being alone in an unfamiliar situation? What feeling do you experience when you are confronted with the situation or object that you fear? What else happens to you at this time? To what degree do you fear having future panic attacks?	Do you dislike being controlled by your fears? What does the future look like for you? Describe the qualities you like about your self. How much support do you need from others to cope with life? How hepless and dependent on others do you feel?	Who is able to support you in avoiding your feared situations or objects? Describe how family living patterns have changed around you fears. Under what circumstances are you able to socialize wih friends?

Nursing Diagnosis

Anxiety, mild, related to threat to self concept due to far of being out of control.

Outcome Identification

Goals such as “decrease anxiety” and “minimize anxiety” lack specific behaviors and evaluation criteria. These goals therefore are not particularly useful in guiding nursing care and evaluating its effectiveness. The expected outcome for patients with maladaptive anxiety responses is :

The patient will demonstrate adaptive ways of coping with sress. Short term goals can then break this down into readily attainable steps. This allows the patient and nurse to see progress even if the ultimate goal still appears distant.

When the nursing diagnosis describes the patient’s anxiety at the server or panic levels, the highest- priority short-term goals should address lowering the anxiety level. Only after this has been achieved can additional progress be made. The reduced level of anxiety should be evident in a reduction of behaviours associated with the severe or panic levels. Following are examples of short-term goals for a particular patient.

When these goals are met, the nurse can assume and validate that the patient’s level of anxiety has been reduced. The nurse may then develop new short- term goals directed toward insight or relaxation therapy.

Planning

The main goal of the nurse working with anxious patients is not to free them totally from anxiety. Patients need to develop the capacity to tolerate mild anxiety and to use it consciously and constructively. In this way the self will become stronger and more integrated. As they learn from these experiences, they will move on in teheir development. Patients must also be convinced that the values to be gained in moving ahead are greater than those to be gained by escape. Anxiety can be considered a war between the therat and the values individuals identify with their existences. Maladaptive behavior means that the strunggle is won by the threat. The constructive approach to anxiety means that the strunggle is won by the person’s values. Thus a general nursing goal is to help patients develop sound values. This does not mean that patients assume the nurse’s values. Rather, the nurse work with patients to sort out their own values.

Anxiety can also be an important factor in the patient’s decision to seek treatment. Since anxiety is undesirable, the individual will seek ways to reduce it. If the patient’s coping mechanism or symptom does not minimize anxiety, the motivation for treatment will be increased. Conversely, anxiety about the therapeutic process can delay or prevent the individual from seeking treatment.

The patient should actively participate in planning treatment strategies. If the patient is actively involved in identifying relevant stressors and planning possible solutions, the success of the implementation phase will be maximized. Patients in extreme anxiety initially will not be able to participate in the problem solving process. However, as soon as their anxiety is reduced, the nurse should encourage their involvement. This will also reinforce that they are responsible for their own growth and personal development.

Implementation

Severe and Panic Levels of Anxiety

1. Estabilishing a Trusting Relationship.

Patient may be hospitalized, to reduce this patient’s level of anxiety, most nursing action are supportive and protective. Nurses need to establish an open, trusting relationship. Nurse should actively listen to patients and encourage them to discuss their feelings of anxiety, hostility, guilt and frustration.

2. Self Awarness.

Nurse should strive to accept their patients anxiety without reciprocal anxiety by continually clarifying their own feelings and role

3. Protecting the Patient.

Nurse allowing the patient to determine the amount of stress that can be handled at the time. Nurse should also not attack their coping mechanism or try to strip them of these. Nurse should not attempt to argue with patients about it or reason them out of it.

4. Modifying the Environtment.

If the patient is hospitalized, the nurse can consult with other members of the health team to identify anxiety producing situations for the patient and attempt to reduce them. Nurse can set limits by assuming a quiet, calm manner and decreasing environmental stimulation.

5. Encouraging Activity.

Nurse should encourage the patient’s interest in activities. This limits the time available for destructive coping mechanisms and increase participation in and enjoyment of other aspects of life. Similar interventions can be implemented with the severely anxious patient who is not hospitalized. The nurse and patient can plan a daily schedule of activities that can be carried out in the community.

6. Medication.

Moderate Level of Anxiety

The specific nursing interventions for a moderate level of anxiety were originally describe by Peplau and Burd and reflect the problem solving process.

1. Recognition of Anxiety

After analyzing the patient’s behavior and determining the level of anxiety, the nurse helps the patient to recognize anxiety by helping the patient explore underlying feelings with such questions as “Are you feeling anxious now?” or “Are you uncomfortable?” it is also helpful for the nurse to identify the patient’s behavior and link it to the feeling of anxiety. Nurse should use open questions that move from nonthreatening topics to central issues of conflict.

2. Insight into the Anxiety.

The nurse then helps the patient see which values are being threatened by linking the threat with underlying causes, analyzing how the conflict developed and relating the patient’s present experiences to past ones. It is also important to explore how the patients reduced anxiety in the past and what kinds of actions produced relief.

3. Coping with the threat.

The nurse can help the patient in problem solving efforts in various cognitive and behavioral ways.

4. Promote the Relaxation Response.

Give relaxation in small groups, or even in larger group setting.

Evaluation

Evaluation is an ongoing process engaged in by the nurse ang patient that is part of each phase of the nursing process. Even before beginning to formulate the nursing diagnosis, the nurse should ask: “Did I critically observe my patient’s physiological and psychomotor behaviors? Did I listen to my patient’s subjective description of experience? Did I fail to see the relationships between my patient’s expressed hostility or guilt and underlying anxity? Did I assess intellectual and social functioning?” After collecting the data, the nurse should analyze it. Was I able to identify the precipitating stressor for the patient? What was the patient’s perception of the threat? How was this influenced by physical health, past experiences, and present feelings and needs? Did I correctly identify the patient’s level of anxiety and validate it?

When using the criteria of adequacy, effectiveness appropriateness, efficiency, and flexibility in evaluating the nursing goals and actions, the following question can be raised.

· Were the planning, implementation, and evaluation mutual?

· Were goals and actions adequate in number and sufficiently specific to minimize the patient’s level of anxiety?

· Were maladaptive responses reduced?

· Were new adaptive coping responses learned?

· Was the care plan reasonable in terms of time, energy, and expense?

· Was the nurse accepting of the patient and able to monitor personal anxiety throughout the relation ship?

Answering these questions enables the nurse to review the total care provided. The nurse will also identify personal strengths and limitations in working with the anxious patient. Plans may then be made for over coming the areas of limitation and further improving nursing care.

Daftar Pustaka

• D. Barry Patricia,1997. Mental health & Mental Illness, Philadelphia Newyork : Lippincott
• Fontainate, Karen Lee.1999. Mental Health Nursing. 4 thred. Menlo Park, California : Addison Wesley
• Frinch Noreen Cavan & Lowrence E Frisch. 2006. Psychiatric Mental Health Nursing. Third edition, Colorado Springs, Colorado : Thomson Delmar Learning
• Wiscorz Stuart & Shandra J Sundeen. 1995, Principles and practice of Psychiatric nursing. Fifth edition. United states of america. Mosby. Year book. Inc
• http://andaners.wordpress.com/2009/04/21/konsep-cemas-stress-dan-adaptasi/
• http://perawatpskiatri.blogspot.com/2009/03/teori-kecemasan.html