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The Anxious Patient
When receiving a call for anxiety, it is useful to distinguish between fear, anxiety, and panic. These are all states characterized by a feeling of apprehension and are often accompanied by physiologic signs of autonomic arousal. Fear is a normal response to a realistic and a clearly identified source of danger. It is adaptive in that it activates the body’s autonomic system in preparation for a “flight-or-fight” response in case of dangerous or life-threatening situations. Anxiety refers to a more sustained, generalized apprehension without any identifiable stimulus. Anxiety is pathologic in nature when characterized by uncertainty and excessive worries with many physical symptoms of arousal. When anxiety is intense and rapid in onset, it can take the form of a panic attack, which is experienced as a state of sudden terror and feelings of imminent death or losing control, along with a number of physical symptoms.
In the evaluation of the anxious patient, one should attempt to understand the patient’s anxiety symptoms and search for any potential source of the anxiety. Rule out any underlying medical or drug-related etiology before attributing anxiety to a known psychiatric disorder. Anxiety of sufficient intensity that necessitates an emergency room visit or a call from staff nurses requires careful assessment and treatment.
Phone call
Questions
- 1.
What are the patient’s presenting symptoms and the duration of anxiety?
- 2.
What is the patient’s age and reason for hospitalization?
- 3.
What are the vital signs?
- 4.
What medications is the patient taking?
- 5.
Is the patient taking any alternative medicine therapies or nutritional supplements?
- 6.
Does the patient have a history of a psychiatric disorder?
- 7.
Does the patient have a history of drug or alcohol abuse?
Orders
- 1.
The most important aspect of assessment over the telephone is to determine if the patient is in a life-threatening situation. Order the vital signs if they were not already taken.
- 2.
Order other tests based on the patient’s additional symptoms. For example, if the patient also complains of shortness of breath, order a pulse oximeter, or, if the patient has accompanying chest pain, order an electrocardiogram (ECG).
- 3.
Although it is not usual practice to order medications over the telephone, this may be indicated in certain situations. For example, a wheezing patient with a known history of asthma may benefit from as-needed (PRN) medications for asthma before the arrival of the psychiatrist.
- 4.
Place the patient in a safe and quiet environment, and make sure the patient is being closely monitored.
Inform RN
“Will arrive in…minutes.”
After the telephone call, prioritize the timing of arrival depending on the severity of the patient’s symptoms. If the cardiovascular or respiratory system is the suspected etiology, see the patient immediately. If the patient’s vital signs are stable, there are no acutely concerning physical symptoms, and the situation is not life threatening, arrival is less urgent.
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