Ovid: Rapid Assessment, A Flowchart Guide to Evaluating Signs & Symptoms

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Title: Rapid Assessment, A Flowchart Guide to Evaluating Signs & Symptoms, 1st Edition
Copyright

2004 Lippincott Williams & Wilkins

> Table of Contents > Signs and symptoms > A > Anxiety

Anxiety
A subjective reaction to a real or imagined threat, anxiety is a nonspecific feeling of uneasiness or dread. It may be mild,
moderate, or severe. Mild anxiety may cause slight physical or psychological discomfort. Severe anxiety may be incapacitating or
even life-threatening.
Everyone experiences anxiety from time to time it's a normal response to actual danger, prompting the body (through stimulation
of the sympathetic and parasympathetic nervous systems) to purposeful action. It's also a normal response to physical and
emotional stress, which can be produced by virtually any illness. Anxiety can also be precipitated or exacerbated by many
nonpathologic factors, including lack of sleep, poor diet, and excessive intake of caffeine or other stimulants. However, excessive,
unwarranted anxiety may indicate an underlying psychological problem.

Alert
If the patient displays acute, severe anxiety:

quickly take his vital signs, and determine his reason for seeking care (this will serve as a guide for how
to proceed)
try to keep him as calm as possible; suggest relaxation techniques and talk in a reassuring, soothing
voice.

If the patient displays mild or moderate anxiety, perform a focused assessment.

History

Ask the patient about the duration of his anxiety. Is the anxiety constant or sporadic? Did he notice any precipitating factors?

Ask the patient if the anxiety is exacerbated by stress, lack of sleep, or excessive caffeine intake. Does rest, exercise, or a
tranquilizer alleviate it?

Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the
patient about alcohol intake.

Physical assessment

Focus on complaints that may trigger or be aggravated by anxiety.

If significant physical signs don't accompany the patient's anxiety, suspect a psychological basis.

Determine the patient's level of consciousness, and observe his behavior.

Special considerations
Many drugs cause anxiety, especially sympathomimetics and central nervous system stimulants, and many antidepressants cause
paradoxical anxiety.

Pediatric pointers
Anxiety in children usually results from painful physical illness or inadequate oxygenation. Its autonomic
signs tend to be more common and dramatic than in adults.

Aging issues
In elderly patients, distractions from the patient's ritual activity may provoke anxiety or agitation.

Patient counseling

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Ovid: Rapid Assessment, A Flowchart Guide to Evaluating Signs & Symptoms

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Supportive care can help relieve anxiety. Provide a calm, quiet atmosphere, and make the patient comfortable. Encourage him to
express his feelings and concerns freely.
P.29

Additional differential diagnoses: alcohol withdrawal

autonomic hyperreflexia COPD depression

mitral valve prolapse obsessive-compulsive disorder pheochromocytoma phobias

disorder pulmonary embolism rabies somatoform disorder
Other causes: antidepressants CNS stimulants

hyperthyroidism hyperventilation syndrome hypoglycemia

pneumonia pneumothorax postconcussion syndrome posttraumatic stress

sympathomimetics

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