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Anxiety and Jeopardized Developmental Tasks Ms. Rica A. Santos.

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Presentation on theme: "Anxiety and Jeopardized Developmental Tasks Ms. Rica A. Santos."— Presentation transcript:

1 Anxiety and Jeopardized Developmental Tasks Ms. Rica A. Santos

2 Objectives Describe how the nurse as teacher uses knowledge of mental health concepts and dynamics to facilitate self-awareness to guide the client towards coping. Link the nursing diagnosis of anxiety to understanding dynamics of anxiety and client’s use of defense mechanisms.

3 Objectives Describe the communicator roles and nursing interventions of anxiety reduction and coping enhancement. Describe residual conflicts, anxiety, and behavioral manifestations of poorly resolved tasks requiring the nursing caregiver role to assist the client towards health.

4 Stress

5 State produced by the change in the environment that is perceived as challenging, threatening, or damaging to a person’s well- being. (Varcarolis)

6 Anxiety

7 Feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual cause is unknown or unrecognized.

8 Anxiety vs. Fear

9 Fear Reaction to a specific danger, whereas anxiety is a vague sense of dread relating to unspecified danger. The body reacts in similar ways Anxiety erodes the individual feelings of self- esteem and personal worth that contribute to a sense of being fully human

10 Anxiety 4 levels 3 categories

11 Categories of Anxiety Normal Acute anxiety/ State anxiety Chronic anxiety/ trait anxiety

12 Levels of Anxiety Mild anxiety Moderate anxiety –Selective inattention Severe anxiety –Sense of impending doom or dread Panic anxiety

13 Interventions for mild to moderate anxiety

14 Help the client identify anxiety. Anticipate anxiety-provoking situations. Use nonverbal language to demonstrate interest Encourage the client to talk about his or her feelings and concerns Avoid closing off avenues of communication that are important to the client. Focus on the client’s concerns. Ask questions to clarify what is being said.

15 Help the client identify thoughts or feelings before onset of anxiety. Encourage problem solving with the client. Assist in developing alternative solutions to a problem through role play or modeling behaviors. Explore behaviors that have worked to relieve anxiety in the past. Provide outlets for working off excess energy

16 Interventions for severe to panic anxiety

17 Maintain a calm manner. Always remain with the person. Minimize environmental stimuli Use clear and simple statements and repetition. Use a low-pitched voice, speak slowly Reinforce reality if distortions occur Listen for themes in communication

18 Attend to physical and safety needs when necessary Because safety is an overall goal, physical limits may need to be set. Provide opportunities for exercise. When a person is constantly moving or pacing, offer high-calorie fluids. Assess need for medication or seclusion after other interventions have been tried and not been successful.

19 Defenses against Anxiety

20 Altruism Six months after losing her husband in a car accident, Jeanette began to spend one day a week doing grief counseling with families who had lost a loved one. She found that she was effective in helping others in their grief, and she obtained a great deal of satisfaction and pleasure from helping others work through their pain.

21 Sublimation A man with a strong hostile feelings may choose to become a butcher, or he may be involved in rough contact sports. A person who is unable to experience sexual activity may channel this energy into something creative, such as painting or gardening.

22 Humor A man goes to an interview that means a great deal to him. He is being interviewed by top executives of the company. He has recently had foot surgery and, on entering the interview room, he stumbles and loses his balance. There is a stunned silence, and then the man states calmly, “ I was hoping I could pit my best foot forward.”

23 Suppression I can’t worry about paying my rent until after my exam tomorrow.

24 Repression The involuntary exclusion of a painful or conflicting thought, impulse, or memory from awareness.

25 Displacement Displacements are often quite satisfactory and workable mechanisms; if one cannot have steak, it is comforting to like hamburger equally well. As the March Hare observed, "I like what I have is the same as I have what I like."

26 Reaction Formation Going to the opposite extreme; overcompensation for unacceptable impulses

27 Somatization A highly competitive and aggressive person, whose life situation requires that such behavior be restricted, develops hypertension

28 Undoing When asked to recommend a friend for a job, a man makes derogatory comments which prevent the friend's getting the position; a few days later, the man drops in to see his friend and brings him a small gift.

29 Rationalization Offering a socially acceptable and apparently more or less logical explanation for an act or decision actually produced by unconscious impulses. The person rationalizing is not intentionally inventing a story to fool someone else, but instead is misleading self as well as the listener.

30 Passive Aggression The individual deals with emotional conflict or internal or external stressors by indirectly and unassertively expressing aggression toward others. There is a facade of overt compliance masking covert resistance, resentment, or hostility. Passive aggression often occurs in response to demands for independent action or performance or the lack of gratification of dependent wishes but may be adaptive for individuals in subordinate positions who have no other way to express assertiveness more avertly.

31 Acting-out Behaviors A person may lash out in anger verbally or physically to distract the self from threatening thoughts or feelings.

32 Dissociation A politician works vigorously for integrity in government, but at the same time engages in a business venture involving a conflict of interest without being consciously hypocritical and seeing no connection between the two activities.

33 Devaluation The individual deals with emotional conflict or internal or external stressors by attributing exaggerated negative qualities to self or others

34 Idealization A lover speaks in glowing terms of the beauty and intelligence of an average- looking woman who is not very bright. A purchaser, having finally decided between two items, expounds upon the advantages of the one chosen.

35 Splitting This term is widely used today to explain the coexistence within the ego of contradictory states, representative of self and others, as well as attitudes to self and others; other individuals or the self is perceived as "All good or all bad.

36 Projection A man, unable to accept that he has competitive or hostile feelings about an acquaintance, says, “He doesn’t like me.” A woman, denying to herself that she has sexual feelings about a co-worker, accuses him, without basis, of flirt and described him as a “wolf.”

37 Denial A person having an extramarital affair gives no thought to the possibility of pregnancy. Persons living near a volcano disregard the dangers involved. A disabled person plans to return to former activities without planning a realistic program of rehabilitation.

38 Case Tom La Rue is a senior at college and is taking his final examinations for an engineering course. He is caught looking on and copying from the examination of his willing partner, June. Tom’s paper is taken away, and he is asked to see the professor after the examinations are all in. His heart starts to pound, his pulse and respiration rate increases, and he has to wipe perspiration from his hand and face several times.

39 He feels as is he has to vomit and has a throbbing in his head. When speaking to the professor after the examination, he initially has difficulty focusing, end when he starts to speak his voice trembles. Tom says that June convinced him that cheating was done all the time and, in fact, it was her idea. Tom goes on to say that this “silly little exam” doesn’t mean anything anyway, that he already passed the important courses.

40 He tells the professor I thought you were the greatest, and now I see that you are a fool.” the professor remains clam and explains that, regardless of Tom’s thoughts on this matter, Tom was caught cheating, he will have to take responsibility for his actions, and the choice to cheat was his. The professor will have Tom go before the disciplinary board, which is the well- known procedure when one is caught cheating.

41 When Tom realizes that this incident could affect his graduating on time, he begins to yell at the professor and call him unflattering names. Another professor who has come in to take the examination papers to the grading machine witnesses this encounter.

42 Identify the level of anxiety Tom was experiencing once he was caught cheating and describe all the signs and symptoms that helped you determine the correct level.

43 Identify and define five defense mechanisms that Tom used to lessen his anxiety.

44 Given the circumstances, once Tom was caught, how could he have reacted in a manner that would have reflected more self- responsibility using healthier coping defenses?

45 If at a later date Tom were to use defense mechanism of altruism, in light of this situation, what are some ways he could do this?

46 Quiz

47 1. Shortly after being told that he has 90% blockage of three major coronary arteries and needs a bypass surgery, Paul is noted by the nurse to appear dazed. His thoughts are scattered, as evidenced by the fact that his conversation jumps from topic to topic. He frequently states, “I’m overwhelmed. I don’t know what to do.” He is unable to give direction to his wife when she asks him whom he wants her to notify. His pulse rises 15 points.

48 The nurse can assess the type of anxiety Paul is experiencing as: A. normal anxiety B. sublimated anxiety C. acute anxiety D. chronic anxiety

49 2. In the scenario described in the first question, the nurse can assess Paul’s level of anxiety as: A. Mild B. Moderate C. Severe D. Panic

50 3. Nursing interventions that are helpful in lowering a client’s level of anxiety from severe to moderate include: A. speaking rapidly in a high-pitched voice B. permitting the existence of reality distortions C. listening for themes the client expresses D. providing solitude for client

51 4. Defense mechanisms are: A. a means of managing conflict B. predominantly conscious C. entirely pathological D. irreversible

52 5. What characteristic is true of mature ego defenses that is not true of ego defenses at other levels? A. mature defenses arise from experiencing panic level anxiety. B. Mature defenses do not distort reality to a significant degree. C. Mature defenses disguise reality to make it less threatening. D. Mature defenses are exclusively maladaptive.


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