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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Anxiety
Ursula Brozek, RN, MSN
Meg Gulanick, RN, PhD
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 attacks.

Related Factors

Defining Characteristics

Physiological Behavioral

Expected Outcomes

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(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 observed.
(i) Determine how patient copes with anxiety.
This can be done by interviewing the patient. This assessment helps determine the effectiveness of coping strategies currently used by patient.
(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.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(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 anxiety attack.
(i) Maintain a calm manner while interacting with patient.
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 procedures.
When experiencing moderate to severe anxiety, patients may be unable to comprehend anything more than simple, clear, and brief instructions.
(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 environment.
(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 anxious feelings.
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 anxiety.
(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

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(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 changes.
(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.

NIC

Anxiety Reduction; Presence; Calming Technique; Emotional Support

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