At first, the body's response to anxiety is known as the "fight or flight" response. The hypothalamic-pituitary-adrenal (HPA) system is activated. These glands release cortisol and catecholamines ("adrenaline") to heighten the body's senses.
As anxiety continues to escalate, the body starts becoming overwhelmed by the HPA system, and patients display a heightened perception of their environment. Some patients will exhibit the “flight” response and become restless. This restlessness can manifest as constantly moving around in bed, trying to climb out of bed, and pacing.
The ability of these patients to problem-solve diminishes. Patients will need assistance with completing tasks and staying focused.
The attention span also diminishes. Patients are easily distracted but start focusing on specific details.
Restlessness advances into shaking and muscular tension. The body is unable to relax, and the patient may start becoming disoriented.
The ability to problem solve comes to a halt, and the patient can have problems completing even the simplest tasks. The inability to problem solve leads the patient to either focus repeatedly on one detail or multiple details.
Automatic behavior and thoughts are aimed at reducing or relieving anxiety. Irrational and unrealistic thoughts "flash" in the anxious person's mind, such as, "I can't cope with this," or "I'm not going make it."
In response to the overproduction of catecholamines, breathing becomes more rapid, and CO2 will be blown off. This response leads to a hyperventilation state with symptoms of numbness and tingling in the extremities, lightheadedness, and dizziness (early signs of respiratory alkalosis).
Patients can experience hallucinations or delusions. These patients need to be approached with caution, as their reaction to an intervention is unknown. Nursing care should be supportive and protective.
In the highest state of anxiety, patients become withdrawn, and the patient behavior can be “wild.” Patients have a feeling of terror and may think they are “going crazy.”
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