chapter 9

Question 1

Mild: +1

Answer 1

Discuss source of anxiety (steps of learning)

Problem solve

Accept anxiety as natural; tolerate and benefit from it

Preparation of body for constructive action

Slight muscle tension

Slight fidgeting

Energetic

Good eye contact

Occasional slight irritability

Feeling challenged

Confident (Use of adaptive coping mechanisms)

Alertness

Awareness of surroundings

Concentration

Accurate perceptions

Attentiveness

Logical reasoning and problem-solving skills

Question 2

Moderate: +2

Answer 2

Decrease anxiety—ventilation, crying, exercise, relaxation techniques
Refocus attention; relate feelings and behaviors to anxiety; then use problem-solving techniques; give oral medication, if needed

Preparation of body for protective action

Moderate muscle tension

Increased blood pressure, pulse, and respirations

Startle reflex

Slight perspiration

Difficulty sitting still

Repeated fidgeting

Periodic slow pacing

Increased rate of speech

Sporadic eye contact

Feeling uncomfortable, on edge, keyed up

Motivated to decrease anxiety

Increased irritability

Decreased confidence (Use of palliative coping mechanisms)

Difficulty in concentrating

Easily distracted, can focus with assistance

Circumstantiality

Tangentiality

Loose associations

Narrowed perceptions

Decreased attention span

Misperception of stimuli

Problem solving and reasoning skills with effort or assistance

Question 3

Severe: +3

Answer 3

Decrease anxiety, stimuli, and pressure

Use kind, firm, simple directions

Use time out (seclusion)

Give intramuscular medications, if needed

Preparation of body for flight or fight

Extreme muscle tension

Increased perspiration

Continuous and rapid pacing

Reflex responses

Loud or rapid speech, or both

Poor eye contact

Somatic symptoms

Sleep disturbance

Extreme discomfort

Feeling of dread

Hypersensitivity

Defensiveness with threats and demand (Use of maladaptive coping mechanisms)

Distorted perceptions

Difficulty focusing, even with assistance

Flight of ideas

Ineffective reasoning and problem-solving skills

Disorientation

Delusions and hallucinations, if prolonged

Suicidal or homicidal ideations, if prolonged

Question 4

Panic: +4

Answer 4

Guide firmly, or physically take control
Give intramuscular medication
Order restraints, if needed

Actual flight, fight, or immobilization

Suicide attempts or violence

Depletion of body resources

Eyes fixed

Hysterical or mute

Incoherent

Feeling overwhelmed and out of control

Rage

Desperation

Feeling totally drained (Use of dysfunctional coping mechanisms)

Disorganized perceptions

Disorganized or irrational reasoning and problem solving

Neologisms

Clang associations

Word salad

Out of contact with reality

Personality disorganization

Question 5

Adaptive

Answer 5

Solves the problem that is causing the anxiety, so the anxiety is decreased. The patient is objective, rational, and productive.

Question 6

Palliative

Answer 6

Temporarily decreases the anxiety but does not solve the problem, so the anxiety eventually returns. Temporary relief allows the patient to return to problem solving.

Question 7

Maladaptive

Answer 7

Unsuccessful attempts to decrease the anxiety without attempting to solve the problem. The anxiety remains.

Question 8

Dysfunctional

Answer 8

Is not successful in reducing anxiety or solving the problem. Even minimal functioning becomes difficult, and new problems begin to develop.