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Care of the Patient with Anxiety

1 Contact Hour
Accredited for assistant level professions only
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This peer reviewed course is applicable for the following professions:
Certified Nursing Assistant (CNA), Home Health Aid (HHA), Licensed Nursing Assistant (LNA), Medical Assistant (MA), Medication Nursing Assistant
This course will be updated or discontinued on or before Sunday, February 22, 2026

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


Outcomes

The purpose of this course is to provide the Nursing Assist with the tools to recognize different types of anxiety as well as symptoms, provide methods for communicating with an anxiety patient and when and what should be report to the nurse. 

Objectives
  1. Define and distinguish between different types of anxiety.
  2. Describe symptoms of anxiety disorders
  3. Discuss effective methods of communication when working with an anxiety patient
  4. Recognize defense mechanisms used by patient's with anxiety
  5. Describe what symptoms are reported to the nurse
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Care of the Patient with Anxiety
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Author:    Kelley Madick (MSN/ED, PMHNP)

What is Anxiety?

Anxiety is a daily experience and normal. It can be described as a short-term, mild to moderate feeling that is a response to or a particular stressor. Anxiety also has physical expressions such as quick, heavy breathing, nausea, or shaking, to name a few.

Anxiety becomes abnormal or a diagnosis when the response is greater than the actual risk or situation justifies; the response continues at the time of the event; there is impaired function of all daily activities; and there may be physical effects (Hives, nausea, or diarrhea). It is important to note that often, anxiety leads to agitation.

Anxiety is the most common psychiatric disorder in the United States today. It affects more than 40 million Americans over 18 (Anxiety and Depression Society of America, 2015). There is a ratio of 2:1 higher in women than in men. Treatment of anxiety costs over $22 billion annually (Anxiety and Depression Society of America, 2015). Research indicates that there are several factors involved in anxiety, including genetics, environment, development, and psychological states.

Disorders of anxiety are particularly present in the older population. It is estimated that 4-10% of older adults suffer from anxiety (Calleo & Stanley, 2008). The diagnosis symptoms are often masked by physical complaints that tend to be focused on more. The most anxious patients are seen as homebound and nursing home patients. Approximately 40% of these patients suffer from anxiety symptoms due to disabilities or chronic diseases (Calleo & Stanley, 2008). Also, patients who have dementia are very likely to suffer from anxiety as well.

Mary is driving home from work when a van suddenly pulls out front of her. She pulls the car over and notices that she is shaking, she feels nauseous, and her head is spinning. She takes a few moments to gather herself and then drives home. She recalls the events to her husband with no physical effect. She is just glad she is home.

Janet is also driving home from work when a car pulls out in front of her. Janet slams on the brakes, stops the car in the middle of the road, and starts to cry hysterically. She feels nauseous, her head is spinning, and she is shaking uncontrollably. She cannot calm down. Another driver stops to help her and notices how visibly upset she is. They move the car off to the side of the road and call her husband to come and get her. Janet is still shaking, crying, and agitated hours later and even into the next day.

Mary suffers from anxiety, but it is short-lived. She can go on with her daily activities without repercussions or reliving the events. Janet, on the other hand, is not able to do so. Janet suffers from a diagnosis of anxiety.

Types of Anxiety

Several types of anxiety exist in the Diagnostic and Statistical Manual 5, which is used to diagnose mental health disorders.  This article will cover an overview of anxiety including generalized anxiety, phobias and panic attacks. 

Generalized Anxiety Disorder

Generalized anxiety disorder features unrealistic and exaggerated worry about everyday events (Halter, 2014).  For example, when grocery shopping or needing food, the person will worry excessively about how they will get food and what food they will get.  The worry consumes them and is uncontrollable. The thoughts interfere with their daily life.  This worry that they cannot control the situation leads to restlessness, feeling on edge, easily fatigued, difficulty concentrating, irritability, and even sleep disturbances (Sadock & Sadock, 2014).  This patient may appear fidgety, constantly asking questions about a common occurrence or restating how they will manage an activity.

Panic Attack

This person experiences intense apprehension, fear, and even terror.  This is often associated with feelings of impending doom and intense physical discomfort.  Panic attacks have an unpredictable onset, and there are usually no stimuli (Sadock & Sadock, 2014).  The person cannot function during the panic attack and show signs of severe anxiety.  These symptoms may include chest pain, shortness of breath, rapid heart rate, numbness and tingling in hands, dizziness, and the person may state they are losing control or feeling like they will die (Halter, 2014; Sadock & Sadock, 2014).  Panic attacks can last for a few minutes or longer.  They can occur multiple times throughout the day.  Often, people will avoid places where panic attacks have occurred.

Phobias

A phobia is a persistent, irrational fear of a specific object, activity, or situation that causes the person to avoid that object, activity, or situation (Sadock & Sadock, 2014). Several types of phobias exist, including specific phobias, social phobias, and agoraphobia.

Specific phobias are seen as anxiety or fear provoked by a specific object or situation that is real or imagined (Sadock & Sadock, 2014). These phobias are very common and usually do not cause much difficulty as long as the person can avoid the spirit object or situation. The person recognizes that the fear is exaggerated or irrational; however, they avoid the object or situation anyway. An example may be a fear of spiders. The person may avoid corners or places where spiders might be.

Social phobias or social anxiety is seen as anxiety or fear provoked by exposure to a social or performance situation (Sadock & Sadock, 2014). An example may be public speaking or eating in a public place. People with social phobia tend to experience overwhelming anxiety when faced with a situation such as eating in public. The person may fear possible embarrassment or ridicule from others. They may feel that they are being laughed at, made fun of, or even losing control of their bowels. The person may become anxious hours or days before the event. The person will avoid the activity. A decrease in daily activities may be seen.

Agoraphobia is the fear of being alone in an open public place where escape may be difficult (Sadock & Sadock, 2014). This can include being alone outside or at home, traveling in a car or bus, and arriving in an elevator. Intense, excessive anxiety may be seen in this person. The person will avoid these places and activities that may restrict their daily activities.

Overall signs and symptoms of anxiety may include feeling like they have a lump in their throat, butterflies in the stomach, feeling like their heart is going to jump out of their chest, feeling like they're going to have a heart attack, rapid pulse, rapid breathing, increased blood pressure, rapid speech, voice changes, dry mouth, sweating, nausea, diarrhea, or short attention span, difficulty following directions, difficulty sleeping, or loss of appetite. These symptoms are vast. It is important to observe the patient and the environment to understand if anxiety in any form is occurring. Looking for triggers or behaviors is equally important.

Defense Mechanisms

Defense mechanisms are automatic, unconscious reactions that block unpleasant, threatening feelings (Whitbourne, 2011). Defense mechanisms are normal to protect people from anxiety, maintain self-image, and block feelings, conflicts, and memories. Using defense mechanisms can help people adjust to the environment or be adaptive (Whitbourne, 2011). However, these mechanisms become problematic or maladaptive when they keep people from facing reality. The individual using them does not always acknowledge defense mechanisms (Halter, 2014). Most people use several defense mechanisms, but not always at the same level or at the same time. In order to evaluate whether a defense mechanism is adaptive or maladaptive, it will be important to observe for frequency, intensity, and duration.

Some examples of defense mechanisms are as follows (Halter, 2014; Whitbourne, 2011):

Compensation is used to cover up shortcomings related to perceived deficiencies and protect the mind from recognizing them. For example, an adaptive use of compensation is a person becoming assertive and dressing themself even though they feel they make poor clothing choices. An example of a maladaptive use of compensation is when a person with low self-esteem throws objects to relieve the discomfort.

Denial-Refusal to accept facts or an uncomfortable event in order to make thoughts and feelings not exist. For example, an alcoholic will deny they have a problem with alcohol even though they have been arrested several times for driving drunk.

Displacement - the transference of one emotion toward a particular person, object, or situation onto something else. For example, a patient may be angry with the nurse when his spouse fails to visit.

Projection- Unpleasant or unacceptable characteristics of one’s own self are unconsciously given to another person, situation, or object. For example, a woman is really angry at herself for missing deadlines at work, comes home and yells at her husband.

Dissociation- A separation of emotions and thoughts. Typically, this person will lose track of time and can lose their self-image. An example is an adult who was abused during childhood, disconnected from reality, and mentally goes to a different place when stressed.

There are several other defense mechanisms that people use to decrease their feelings of anxiety. Understanding how and why defense mechanisms are used will help the caregiver assist the patient in coping with anxiety.

What To Do For A Person With Anxiety

Helping a person who is upset, anxious, or agitated may include the following (Acello & Hegner, 2015):

  • Attempt to identify and eliminate the stressor.
  • Do not argue or confront the person.
  • Make sure the environment is safe for them.
  • Assign the patient a brief task or activity to distract them.
  • Watch for injuries.
  • Prevent the patient from becoming exhausted.
  • Get the nurse if panic or severe anxiety is present.

If the patient is becoming anxious, try to help them gain control by using distraction or giving them something else to do. Help them to identify coping strategies that they have used in the past to calm down (Halter, 2014). Use communication techniques such as asking open-ended questions, giving broad opening statements, and exploring and seeking clarification of the situation. It is important to remain calm and recognize that the person is in distress. The ability to listen is also important.

For severe or panic-level anxiety, the nurse should be involved as the patient may not know what is happening and may be unable to follow directions well (Acello & Hegner, 2015). However, the patient experiencing severe or panic level of anxiety is out of control, and they need to know they are safe. Use short, simple sentences and remain with the person when possible (Halter, 2014). It is also important to maintain their physical needs, such as fluid and rest, to prevent exhaustion when they are calm. The person may be moved to a quieter environment with minimal stimulation. The nurse may also give medications to help lessen the anxiety.

What to Watch For in The Anxious Patient

Certain behaviors need to be reported immediately to the nurse. Anytime the patient is in an unsafe environment or at risk for injury, it should be reported immediately.

If the patient is unable to focus on the environment, appears paralyzed with fear, is not able to communicate, begins to hallucinate or have delusions, or is blocking out the environment or events around them, the nurse should be notified immediately (Acello & Hegner, 2015; Halter, 2014). It is, however, important that someone stay with the patient or keep an eye on the patient until the nurse arrives.

Also, if the patient can describe a feeling of dread, confusion, a sense of impending doom, physical complaints, hyperventilation, rapid heartbeat, loud, rapid speech, or if they begin to threaten or make demands upon anyone, the nurse should also be notified (Sadock & Sadock, 2014; Halter, 2014). The patient may also be observed to be hyperactive or in flight mode, have dilated pupils, jumbled words, severe shakiness, sleeplessness, or agitation (American Psychiatric Association, 2013). Be sure to stay clear of the patient unless they appear to be at risk of falling or injuring themselves. Do not allow yourself to be in harm's way.

Watch for signs that the patient is becoming agitated. Express your willingness to help and listen to their feelings and concerns. Approach the patient calmly and non-threateningly; however, maintain your personal space. Your eyes should be on the same level as the patient to decrease intimidation. Always leave yourself an escape route if the patient becomes out of control. If the patient becomes verbally abusive, do not take the verbal abuse personally. Use open-ended statements and questions rather than challenging statements such as what's wrong with you? Avoid threatening, accusatory, or challenging statements. Instead, try to find out what is behind the aggressive behavior. Ask the patient if they want to go to a quieter place. Pay close attention to the environment. For example, is a lot of activity around the patient that might be agitating them and causing their anxiety? If the patient becomes agitated, which may be seen by an appropriate speech words or activity or even disorientation, the nurse should intervene (Halter, 2014).

One of the most important interventions for anxious patients is to remain calm (Acello & Hegner, 2015). If the patient can see how calm the caregiver is, they may become calmer. It is also important to stay with the patient and speak slowly and calmly, as this conveys calmness and promotes security.

If the patient is given medication for anxiety, be sure to watch for side effects. Side effects can include drowsiness, lack of energy, slow reflexes, slurred speech, confusion, disorientation, and depression (Halter, 2014). If any of these signs are noticed, report them to the nurse immediately.

What would you do?

Case One:

Sally is a patient of yours today. The report you receive from the nurse says she is a little upset today. Her family visited her last night, and now she cannot stop talking about when she eats. As you enter the room, you notice that she is looking around the room, wringing her hands; she is mumbling to herself and appears upset. You enter her room smiling and asking how you can help her today. “You seem upset,” you state. Sally continues to wring her hands and looks even more upset.

“I have to leave. I have to get dinner ready. They will be here soon.” Sally tells you. Her face appears stressed, and she begins to get up to pace.

“Ok, Sally, let’s go into the other room and talk…”

Before you can finish, Sally picks up a hairbrush and throws it at you. She starts yelling that she has to leave now and you can’t keep her prisoner here anymore.

What do you do?

First, make sure you are near the door with an anxious or already agitated patient. Remember that anxiety can lead to agitation quickly, such as with Sally. Talk slowly and calmly. Although it may be difficult to stay calm in such a situation, Sally must see you calm and collected. Remaining quiet and not making sudden moves will help Sally calm down, too. Never argue or tell her she is wrong. If you can reach for the call light, do so and get someone in the room with you. If you must leave the room to get help, make sure Sally is safe. Notify the nurse how you found Sally and what happened. If this is happening in Sally’s home, get another family member to stand close by to help calm Sally or use distraction until you can get a hold of the nurse. Also, remember that she had visitors last night. Perhaps that is a trigger. Consider the following:

  • What is the current level of anxiety? Did it change as you talked to Sally? If so, can you tell me why?
  • Make sure Sally is not hurting herself and that her environment is free from objects she can hurt herself or others.
  • What does the environment look like?
  • What does Sally look like? Does it look like she has not slept? Is she eating?
  • What is she doing physically?
  • What is she saying? Is she talking to you, herself, or someone else?
  • Did something happen previously to trigger this episode?

You should ask these questions as you are in the room with Sally. The answers will give the nurse and you ideas on how to help Sally calm down.

Once Sally is calm, suggest a distraction such as folding clothes or walking the halls. You may suggest she wash up or get dressed or even get something to eat. Sally may prefer to stay in a quiet location rather than with others. Be sure to check on her frequently to make sure she does not begin to get anxious again. Develop a strategy with the nurse to anticipate Sally’s anxiety and calm her before it gets out of hand.

Self-Assessment

Working with a patient who suffers from anxiety can be difficult. You may experience feelings of anger or frustration. Understanding or using empathy is important, as well as having patience. If you feel yourself getting frustrated or angry, remember not to transfer those feelings to the patient (Halter, 2014). Instead, find another healthcare professional to talk to and try to come up with alternative ways of working with the patient. One way is to keep things simple. Small, reachable goals will help you and the patient feel less overwhelmed. 

Conclusion

Remember that everyone gets anxious at one time or another. It is when the anxiety does not allow the person to continue with their normal daily activities that it becomes a chronic problem. It is important to remembering to stay calm and have a plan to get help when needed. Try to recall the events that take place during the anxious episode as well as what might have occurred before. There might be triggers to report to the nurse and adjustments that can be made in the patient environment. In the case of a panic attack, which usually does not have a trigger, it is important to stay with the patient until they calm down. Talk slowly and calmly. Try to get the patient to focus on you or their own breathing until the nurse arrives or you get further instructions. Following these simple steps will help the patient overcome the anxious moment.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

References

Acello, B., & Hegner, B. (2015).Nursing assistant: A nursing process approach. Cengage Learning.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Association.

Anxiety and Depression Society of America. (2015). Facts & statistics | anxiety and depression association of America, ADAA. Retrieved January 25, 2016, (Visit Source).

Calleo, J., & Stanley, M. A. (2008, July 1). Anxiety disorders in later life. Retrieved January 25, 2016, (Visit Source)

Halter, Margaret J. Varcarolis' (2014). Foundations of psychiatric mental health nursing: A clinical approach. 7th ed. St. Louis, Mo.: Elsevier.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry. United States: Lippincott Williams and Wilkins.

Whitbourne, S. K. (2011, October 22). The essential guide to defense mechanisms. Retrieved January 25, 2016 (Visit Source).