Apa sh blog, katanya blog itu diibaratkan sebagai diary virtual yang bisa dibaca oleh semua orang yang sedang berselancar di dunia maya. Pembuatan blog ini, terispirasi oleh keinginan orang untuk bercerita ato curhat a.k.a curco hati tentang apa yang terjadi dan terpikirkan olehnya. konon dengan menulis pengalaman, unek - unek yang terjadi dan terfikirkan, bisa membuat beban pikiran seseorang berkurang.
Jadi yang pengen curhatanya ato tulisanya bisa dilihat orang (narsisya keliatanya hehe) bikin bloggg sana.....
Anxiety
Definition
NANDA Definition: Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response, with the source often nonspecific or unknown to the individual; a feeling of apprehension caused by anticipation of danger. It is an altering signal that warns of impending danger and enables the individual to take measures to deal with threat.
Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components.[1] These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry.
Anxiety is a generalized mood condition that occurs without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an observed threat. Additionally, fear is related to the specific behaviors of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable.[2]
Another view is that anxiety is "a future-oriented mood state in which one is ready or prepared to attempt to cope with upcoming negative events"[3] suggesting that it is a distinction between future vs. present dangers that divides anxiety and fear.
Anxiety is considered to be a normal reaction to stress. It may help a person to deal with a difficult situation, for example at work or at school, by prompting one to cope with it. When anxiety becomes excessive, it may fall under the classification of an anxiety disorder.
ANXIETY CHARACTERISTICS
· l PHYSIOLOGICAL
· l EMOTIONAL
· l COGNITIVE
RELATED FACTORS
· 
l PATHOPHYSIOLOGICAL
· l SITUATIONAL
· l MATURATIONAL
LEVELS OF ANXIETY
· Mild anxiety (1+)
· Moderate anxiety (2+)
· Severe anxiety (3+)
· Panic (4+)
ASSESSMENT
· Behaviors
Anxiety can be expressed directly through physiological an behavioral changes or indrecty through the formation of symptoms or coping mechanisms developed as a defense agains anxiety. The nature of the behaviors displayed by the patient depends on the behaviors displayed by the patient depends on the level of anxiety, the intensity of the behaviors will incres with in creasing anxiety.
In describing anxiety effect on physiological respons, mild and moderate anxiety heighten the person capacities. Conversely, severe and panic levels paralyze or overwork capacities structures. The physiological respons associated with anxiety are primarily mediated through the autonomic nervous system.This involves the internal adjustment of the body without a conscions effort. Two types of autonomic responses exit :
1. The sympathenic, which activated body processes
2. The parasympathetic. Which conserve body respons
· Predisposing Factors
Anxiety is a prime factor in the development of the personality ans formation of individual character traints. Because of its importance. Various theories of the origin of anxiety have been developed.
Ø Psychoanalytic View
Ø Interpersonal View
Ø Behavioral View
· Precipitating Stressors
Givens these numerous theories abaut the origin of anxiety, what kinds of evens might precipitate feeling of anxiety?Precipitating stressors can be gruped into two categories : threats to physical integrity and threats to self-system.
Ø Threats to Physical Integrity
Ø Threats to Self – system
Ø Integrative model
· Coping Resources
The individual can hope with stress and anxiety by mobilizing coping resources in the environment. These may include a variety of intrapersonal, interpersonal and social factor.
· Coping Mechanisms
As the level of anxiety incres to the severe and panic levels. The behavious displayed become more intense amd injurious to the individual. People seek to avoid anxiety and the circumstansces that produce it.
NURSING DIAGNOSIS
- Anxiety
- Ineffective coping
- Fear
- Risk for injury
- Self care deficits
PLANNING
Anxiety disorder are encountered in numerus settings. Nurses care for people with concurrent anxiety disorder in medical surgical units and in outpatientsettings, such as homes, day programs and clinic. Usually client with anxiety disorder do not require admission to inpatient psychiatric units. Therefore, planning for care unsually involves selecting intervention that can be implemented in a community setting.
Whenever possible, the client should be encouraged to participate actively in planning. By sharing decision making with the client, the nurse increses the likelihood that positive outcome will be attained. Shared planning is especially apporopeiate for a client with mild or moderate anxiety, when the client is experience severe level of anxiety, the client may be unable to participate in planning , wich requires the nurse to take a more directive role.
Earlier in this chapter you were given examples of care plan for client with panic disorder and GAD also refer to case study and nursing care plan involving a client with PTSD
OUTCOME INDENTIFICATION
NOC Outcomes (Nursing Outcomes Classification)
| Suggested NOC Labels | Client Outcomes |
| · Anxiety Control · Aggression Control · Coping · Impulse Control | · Identifies and verbalizes symptoms of anxiety · Identifies, verbalizes, and demonstrates techniques to control anxiety · Verbalizes absence of or decrease in subjective distress · Has vital signs that reflect baseline or decreased sympathetic stimulation · Has posture, facial expressions, gestures, and activity levels that reflect decreased distress · Demonstrates improved concentration and accuracy of thoughts · Identifies and verbalizes anxiety precipitants, conflicts, and threats · Demonstrates return of basic problem-solving skills · Demonstrates increased external focus · Demonstrates some ability to reassure self |
IMPLEMENTATION
Nursing diagnosis : Anxiety disorder ( All Types )
ASSESMENT DATA
Related Factore ( etiologi) :
- Biologic/psychosocial
- Sosial intgrity (illess, injury or perceived loss)
- Ineffevtive use of coping mecanism
- Depletion of coping strtegies
- Level of stress that exceeds coping abilities
- Hopelessnes
- Powerlessness
- pain
| NO | INTERVENTIONS | RATIONAL |
| 1 | Acknowledge awareness of patient’s anxiety. | Because a cause for anxiety cannot always be identified, the patient may feel as though the feelings being experienced are counterfeit. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings. |
| 2 | Reassure patient that he or she is safe. Stay with patient if this appears necessary | The presence of a trusted person may be helpful during an anxiety attack |
| 3 | Maintain a calm manner while interacting with patient. | The health care provider can transmit his or her own anxiety to the hypersensitive patient. The patient’s feeling of stability increases in a calm and nonthreatening atmosphere. |
| 4 | Establish a working relationship with the patient through continuity of care | An ongoing relationship establishes a basis for comfort in communicating anxious feelings. |
| 5 | Orient patient to the environment and new experiences or people as needed | Orientation and awareness of the surroundings promote comfort and may decrease anxiety. |
| 6 | Use simple language and brief statements when instructing patient about self-care measures or about diagnostic and surgical procedures | When experiencing moderate to severe anxiety, patients may be unable to comprehend anything more than simple, clear, and brief instructions |
| 7 | Reduce sensory stimuli by maintaining a quiet environment; keep "threatening" equipment out of sight. | Anxiety may escalate with excessive conversation, noise, and equipment around the patient. This may be evident in both hospital and home environments. |
| 8 | Encourage patient to seek assistance from an understanding significant other or from the health care provider when anxious feelings become difficult. | The presence of significant others reinforces feelings of security for the patient |
| 9 | Encourage patient to talk about anxious feelings and examine anxiety-provoking situations if able to identify them. Assist patient in assessing the situation realistically and recognizing factors leading to the anxious feelings | Avoid false reassurances. |
| 10 | As patient’s anxiety subsides, encourage exploration of specific events preceding both the onset and reduction of the anxious feelings. | Recognition and exploration of factors leading to or reducing anxious feelings are important steps in developing alternative responses. Patient may be unaware of the relationship between emotional concerns and anxiety. |
| 11 | Assist the patient in developing anxiety-reducing skills (e.g., relaxation, deep breathing, positive visualization, and reassuring self-statements). | Using anxiety-reduction strategies enhances patient’s sense of personal mastery and confidence. |
| 12 | Emphasize the logical strategies patient can use when experiencing anxious feelings. | Learning to identify a problem and evaluate alternatives to resolve it helps the patient to cope. |
| 13 | Assist patient in developing problem-solving abilities. | |
| 14 | Instruct the patient in the appropriate use of antianxiety medications. | |
EVALUATION
- Evaluation of autcome criteria is a critical method that determines :
- Client (individual, family, community) progress and respones to treatment
- Effective use of the nursing process
- Accountability for the nurse standards of care
- Evalution is dynamic and may be used at any stage of the nursing process
Nursing diagnosis : ineffective coping related to persisten anxiety, fatigue, diffculty concentrating
Outcome criteria : client will maintain role performance
Nursing care plan
| NO | Short – term Goal | Intervention | Rationale |
| 1 | Client will state that immediate distress is relived by end of session | a. Stay with client b. Speak slowly and calm c. Use short, simple sentences d. Assure client that you are in control andd can assist him or her e. Give brief direction f. Decrease excesssive stimuli , provide quiet environment g. Monitor and control own feeling |
|
| 2 | Client will be able to indentify source of anxiety by date |
|
|
| 3 | Client will indentify strengths and coping skill by date |
|
|
Nursing diagnosis : Self care deficits
Expected Outcomes
- Patient safely performs (to maximum ability) self-care activities.
- Resources are identified which are useful in optimizing the autonomy and independence of the patient.
Related Factors:
- Neuromuscular impairment, secondary to cerebrovascular accident (CVA)
- Musculoskeletal disorder such as rheumatoid arthritis
- Cognitive impairment
- Energy deficit
- Pain
- Severe anxiety
- Decreased motivation
- Environmental barriers
- Impaired mobility or transfer ability
NURSING CARE PLAN
| NO | Intervention | Rationale |
| 1 | Maintain privacy during bathing as appropriate | The need for privacy is fundamental for most patients |
| 2 | Ensure that needed utensils are close by | This conserves energy and optimizes safety |
| 3 | Instruct patient to select bath time when he or she is rested and unhurried | Hurrying may result in accidents and the energy required for these activities may be substantial. |
| 4 | Provide patient with appropriate assistive devices (e.g., long-handled bath sponge; shower chair; safety mats for floor; grab bars for bath or shower) | These aid in bed bathing |
| 5 | Encourage patient to comb own hair (a one-handed task). Suggest hairstyles that are low-maintenance | This enables the patient to maintain autonomy for as long as possible |
| 6 | Assist patient with care of fingernails and toenails as required. | Patients may require podiatric care to prevent injury to feet during nail trimming or because special implements are required to cut nails. |
| 7 | Offer frequent encouragement | Patients often have difficulty seeing progress |
Commonly Used Medications For Anxiety (Anxiolytics)
l Varcarolis table 14-14
l Benzodiazepines – Xanax, Valium, Ativan
– Used in GAD & panic disorder. Short-term
– S/E – sedation, dizziness, ¯ cognitive function
l Tricyclic antidepressants – Elavil, Pamelor
– Used in panic attacks, phobias, & PTSD
– S/E – anticholinergic
– Onset of drug effect 2-4 weeks
l Beta-blockers – Inderal - used for social phobas/test anxiety – single dose
l Selective serotonin reuptake inhibitors – SSRI’s
– Prozac, Paxil, Zoloft, Luvox, Celexa
– Useful with mixed anxiety & depression
– Also OCD, panic, agoraphobia, & GAD
– S/E – agitation, HA, GI upset, & sexual dysfunction
EVALUATION
indentified outcome serve as the basis for evaluation. Each NOC outcome has a built – in rating scale that helps the nurse to measure improvement. In general, evaluation of outcome for client with anxiety disorder deals with question such as the following :
1. Is the experiencing a reduces level anxiety?
2. Dose the client recognize symptoms as anxiety related?
3. Dose the client continue to display obsession, compulsions, phobias, worrying or other symptoms of anxiety?if still present, are they more or less frequent?more or less intense?
4. Is the client able to use newly learned behaviours to manage anxiety?
5. Can the client adequately perform self care activities?
6. Can the client maintain statisfying interpersonal relation?
7. Can the client assume unsual roles?
REFERENCES
· Videbeck, Sheila L. Psychiatric Mental Health Nursing. Lipincolt Williams and wilkins.2004
· Yosep,i. Keperawatan jiwa.2007.refika aditama.bandung
· en.wikipedia.org/wiki/Anxiety
· http://nursing-concept.blogspot.com/2009/02/nursing-care-plans-for-anxiety.html
(01).jpg)