unwanted, intrusive, persistent ideas, thoughts, impulses or images that cause marked anxiety or distress. 

EXAMPLE: repeated thoughts about contamination, doubts, things in particular order, aggressive or horrific impulses, sexual imagery

Ineffective Coping r/t underdeveloped ego, punitive superego

Ineffective Role performance r/t the need to perform rituals evidenced by inability to fulfill usual patterns of responsibility

The Client:

1. Is able to refrain from ritualistic behavior in the fact of escalating anxiety

2. Is able to mantain anxiety at manageable level

Ineffective Coping 

TNI's

1. Identify triggers to ritualistic behaviors

2. meet client's dependency needs

3. initially allow time for rituals

4. provide structured schedule of activities

5. Gradually begin to limit amount of time for rituals

6. Give positive reinforcement for nonritualistic behavior

Ineffective Role Performance

(Compulsive disorder)

TNI's

1. Identify client's role with the family and how changed

2. Discuss client's perception of his/her role

3. Identify family conflicts

4. Roleplay potential changes

5.Encourage family participation

6. Give recognition for positive change and decreasing rituals

Ineffective Role Performance

(Compulsive disorder)

Outcomes

Client demonstrates ability to fulfill role-related responsibilities

Client demonstrates more adaptive strategies to deal with anxiety and decreased need for rituals that interfere with role responsibilities

Fear cued by an object or anticipation of situation that causes anxiety or panic attack

(subject can realizes fear is excessive or unreasonable)

Fear r/t causing embarrassment to self in front of others, being in place from which one unable to escape, avoidance of feared object

Social Isolatoin r/t fears of being in a place in which one unable to escape, evidence by staying home, refusal to leave room or house

Client will discuss the phobic object or situation with the PCP by...

By the time of discharge , the clien will be able to function in presence of phobic object or situation without panic anxiety

1. Reassure the client is safe

2. Encourage client ot verbalize about fears

3. Discuss reality of the situation

4. Help client select alternative coping strategies

5. Help client face underlying feelings that may be contributing

Stays alone

Refuses to leave room or home

1. Convey acceptance and unconditional positive regard

2. attend activities with client

3. be cautious with touch

4. administer tranquilizer

5. Discuss S&S of increasing anxiety and ways to intervene

6. Give recognition for voluntary interactions with others.

Client voluntarily attends activities alone

Client verbalizes S&S of excalating anxiety

Client demonstrates techniques to disrupt escalating anxiety

Client is aware of help within community

Repression

Displacement

palpitations

sweating

trembling/shaking

shortness of breath

feeling of choking

chest pain

nausea/abd distress

dizzy, unsteady, lightheaded

derealization

losing control

fear of dying

chills

Chronic, unrealistic, excessive anxiety and worry. 

Symptoms last 6 months or longer

causing significant distress or impairment in social, occupational or other important areas of functioning.

Lasting more days than not over 6 months 

TENDS TO BE CHRONIC

restlessness or feeling on edge

easily fatigued

difficulty concentrating (going blank)

Irritability

muscle tension

sleep disturbance (falling or staying asleep)

Somatization Disorder

Pain Disorder

Hypochondriasis

Conversion Disorder

Body Dysmorphic Disorder

Characterized by physical symptoms suggesting medical disease, but without organic pathology or dx.

psychological factors are the major cause

anxiety becomes overwhelming and personality becomes disorganized

defense mechanisms that govern consciousness, identity and memory break down

behavior has little to do with consious self

Loss of or change in body function resulting from a psychological conflict.

Phsyical condition can not be explained

lack of concern -uncaring affect of physical symptom

this can clue the PCP that problem is psychological

dissociative identity disorder

Formally mutliple personality disorder

It's characterized by the existence of two or more personalities in single individual

Characterized by a temporary change in the quality of self-awareness,

which often takes the form of feelings of unreality, changes in body image,

feelings of detachment from the environment,

observing oneself outside the body

1. states decreased anxiety-feels better, more comfortable

2. exhibits decreased anxiety: specify behaviors (Less fidgeting, less pacing, dec. wringing of hangs)

3. VS witnin certain parameters

4. States ways to cope with anxiety

5. Demostrates ways to cope with anxiety (relaxation techniques, discussing feelings, using medications)

Implementation of TNI's 

for ANXIETY

• Perform ongoing assessments of mental status and level of anxiety
• Minimize environmental stimuli
• reassure and support client
• assist with decision making/problem solving (discuss pros and cons of choices)
• Medicate as needed with sedatives or anti-anxiety, minor tranquilizers

• Structure and refocus obsessive thinking
• structure day to accommodate compulsive rituals
• avoid challenges and logic regarding strange rituals and obsessions
• Encourage discussion of feelings regarding client issues and coping skills instead of focus on physical symptoms/pain when physical exam is negative

Signs and symptoms of anxiety in self

Cause of anxiety, if relevant

Management of anxiety

     Connect S&S of anxiety with stress

     Avoid anxiety-producing situations, when possible

     Learn relaxation techniques

     Utilize behavior modification and cognitive-behavioral          approaches

     Use of medications (anxiolytics an some antidepress)

     Use available resources and support services: heal care provider, clinics, groups, websites