Question
How can I recognize anxiety in patients?
Answer
Sometimes it is very easy to recognize anxiety in our patients. However, anxiety symptoms are typically reported verbally. Medically complex patients, including patients on ventilators or those that are sedated, often are unable to do that. They are unable to voice their symptoms. The accuracy of interpreting observable clues is confounded by pain, delirium, medical status, and their inability to communicate. Some of my patients have said things like, I cannot think straight, I do not remember, my heart is racing, I am sweating, I cannot relax, I cannot sleep, or I am scared.
Physiological or Somatic Signs
The physiological or somatic signs are our vital signs. This includes tachycardia, hypertension, tachypnea, sweating, and abdominal stress. These can all be signs of anxiety in patients.
Behavioral Signs
Some behavioral signs of anxiety include large muscle group movement, such as when patients are kicking, attempting to stand or sit up, or striking out or thrashing. Other behavioral signs include small muscle group movements such as picking at the sheets or bandages and rhythmic head movements such as tossing their head back and forth. In addition, grimacing, trembling, crying, or increased complaints by the patient can be signs of anxiety.
Psychological Signs
Some of the psychological signs of anxiety include sadness, being withdrawn, or being angry. Patients can be hypervigilant, watching every move we make. They may distrust us and be very fearful. They also might have an unrealistic perception of their situation or express feelings of loss of control.
This Ask the Expert is an edited excerpt from the course, Caring for the High Anxiety Pulmonary Patient and Family, presented by Nancy Nathenson, BS, RRT.
