Ursula Brozek, RN, MSN
Deidra Gradishar, RNC, BS
NANDA: A vague, uneasy feeling, the source of which is often
nonspecific or unknown to the individual
Anxiety most often manifests as a vague, uneasy feeling of disquiet
or discomfort. Quite unpredictably, it can become pervasive and disabling to
the patient. The source or precipitating event (related factor) may be
identified or be nonspecific or unknown to the person experiencing the anxiety.
Anxiety is probably present at some level in every individual's life but the
degree and the frequency with which it manifests differs broadly. Each
individual's responses to anxiety is different. Some people are able to use the
emotional edge that anxiety provokes to stimulate creativity or problem-solving
abilities; others can become immobilized to a pathological degree. The feeling
is generally categorized into four levels: mild, moderate, severe, and panic.
The nurse can encounter the anxious patient anywhere--in the hospital or
community. The presence of the nurse may lend support to the anxious patient
and provide some strategies for traversing anxious moments or panic
- Threat or perceived threat to physical and emotional integrity
- Changes in role function
- Intrusive diagnostic and surgical tests and procedures
- Changes in environment and routines
- Threat or perceived threat to self-concept
- Threat to (or change in) socioeconomic status
- Situational and maturational crises
- Interpersonal conflicts
- Increase in blood pressure, pulse, and respirations
- Dizziness, light-headedness
- Frequent urination
- Dry mouth
- Nausea and/or diarrhea
- Pupil dilation
- Insomnia, nightmares
- Feelings of helplessness and discomfort
- Expressions of helplessness
- Feelings of inadequacy
- Difficulty concentrating
- Inability to problem-solve
- Patient is able to recognize signs of anxiety.
- Patient demonstrates positive coping mechanisms.
- Patient may describe a reduction in the level of anxiety
Ongoing Assessment Actions/Interventions/Rationale
- (i) independent
- (i) Assess patient's level of anxiety.
- Mild anxiety enhances the patient's awareness and ability to
identify and solve problems. Moderate anxiety limits awareness of environmental
stimuli. Problem solving can occur but may be more difficult, and patient may
need help. Severe anxiety decreases patient's ability to integrate information
and solve problems. Panic is severe anxiety. Patient is unable to follow
directions. Hyperactivity, agitation, and immobilization may be
- (i) Determine how patient copes with
- This can be done by interviewing the patient. This assessment
helps determine the effectiveness of coping strategies currently used by
- (i) Suggest that the patient log episodes of
anxiety. Instruct to describe what is experienced and the events leading up to
and surrounding the event. Patient should note how the anxiety dissipates.
- Patient may use these notes to begin to identify trends that
manifest. If the patient is comfortable with the idea, the log may be shared
with the care provider who may be helpful in problem solving. Symptoms often
provide the health-care provider with information regarding the degree of
anxiety being experienced. Physiological symptoms and/or complaints intensify
as the level of anxiety increases.
- (i) independent
- (i) Acknowledge awareness of patient's anxiety.
- Since a cause for anxiety cannot always be identified, the
patient may feel as though the feelings they are experiencing are counterfeit.
Acknowledgment of the patient's feelings validates the feelings and
communicates acceptance of those feelings.
- (i) Reassure patient that he or she is safe.
Stay with patient if this appears necessary.
- The presence of a trusted person may be helpful during an
- (i) Maintain a calm manner while interacting
- The health care provider can transmit his or her own anxiety
to the hypersensitive patient. The patient's feeling of stability increases in
a calm and nonthreatening atmosphere.
- (i) Establish a working relationship with
the patient through continuity of care.
- An ongoing relationship establishes a basis for comfort in
communicating anxious feelings.
- (i) Orient patient to the environment and
new experiences or people as needed.
- Orientation and awareness of the surroundings promotes
comfort and may decrease anxiety.
- (i) Use simple language and brief statements
when instructing patient about self-care measures, or diagnostic and surgical
- When experiencing moderate to severe anxiety, patients may be
unable to comprehend anything more than simple, clear, and brief
- (i) Reduce sensory stimuli by maintaining a
quiet environment; keep "threatening" equipment out of sight.
- Anxiety may escalate with excessive conversation, noise, and
equipment around the patient. This may be evident in both hospital and home
- (i) Encourage patient to seek assistance
from an understanding significant other or from the health care provider when
anxious feelings become difficult.
- The presence of significant others reinforces feelings of
security for the patient.
- (i) Encourage patient to talk about anxious
feelings and examine anxiety-provoking situations if able to identify them.
Assist patient in assessing the situation realistically and recognizing factors
leading to the anxious feelings. Avoid false reassurances.
- (i) As patient's anxiety subsides, encourage
to explore specific events preceding both the onset and reduction of the
- Recognition and exploration of factors leading to or reducing
anxious feelings are important steps in developing alternative responses.
Patient may be unaware of the relationship between emotional concerns and
- (i) Assist the patient in developing
anxiety-reducing skills (relaxation, deep breathing, positive visualization,
reassuring self-statements, and others).
- Using anxiety-reduction strategies enhances patient's sense
of personal mastery and confidence.
- (i) Assist patient in developing
problem-solving abilities. Emphasize the logical strategies patient can use
when experiencing anxious feelings.
- Learning to identify a problem and evaluate alternatives to
resolve it helps patient to cope.
- (c) Instruct the patient in the appropriate
use of anti-anxiety medications.
Education/Continuity of Care
- (i) independent
- (i) Assist patient in recognizing symptoms of
increasing anxiety; explore alternatives to use to prevent the anxiety from
immobilizing her or him.
- The ability to recognize anxiety symptoms at lower-intensity
levels enables the patient to intervene more quickly to manage his or her
anxiety. Patient will be able to use problem-solving abilities more effectively
when the level of anxiety is low.
- (i) Remind patient that anxiety at a mild
level can encourage growth and development and is important in mobilizing
- (i) Instruct patient in the proper use of
medications and educate him or her to recognize adverse reactions.
- Medication may be used if patient's anxiety continues to
escalate and the anxiety becomes disabling.
- (c) Refer the patient for psychiatric
management of anxiety that becomes disabling for an extended period.
Anxiety Reduction; Presence; Calming Technique; Emotional
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