related to:
  1. exacerbation of symptoms and need for hospitalization;
  2. lack of understanding of diagnostic tests, the diagnosis, and treatments;
  3. cost of hospitalization and lifelong treatment;
  4. possibility of early disability and death.
Desired Outcome
The client will experience a reduction in fear and anxiety as evidenced by:
  1. verbalization of feeling less anxious
  2. usual sleep pattern
  3. relaxed facial expression and body movements
  4. stable vital signs
  5. usual perceptual ability and interactions with others.
Nursing Actions and Selected Purposes/Rationales
  1. Assess client for signs and symptoms of fear and anxiety (e.g. verbalization of feeling anxious, insomnia, tenseness, shakiness, restlessness, increased dyspnea, diaphoresis, tachycardia, elevated blood pressure, self-focused behaviors). Validate perceptions carefully, remembering that some behavior may result from tissue hypoxia or fluid imbalance.
  2. Implement measures to reduce fear and anxiety:
    1. maintain a calm, supportive, confident manner when interacting with client
    2. if client is in acute respiratory distress:
      1. do not leave him/her alone during this period
      2. perform actions to improve respiratory status (see Diagnosis 2, action b)
      3. perform actions to reduce feeling of suffocation:
        1. open curtains and doors
        2. limit the number of visitors in room at any one time
        3. remove unnecessary equipment from room
        4. administer oxygen via nasal cannula rather than mask if possible
    3. encourage significant others to project a caring, concerned attitude without obvious anxiousness
    4. once the period of acute respiratory distress has subsided:
      1. orient client to environment, equipment, and routines
      2. introduce client to staff who will be participating in care; if possible, maintain consistency in staff assigned to his/her care
      3. assure client that staff members are nearby; respond to call signal as soon as possible
      4. provide a calm, restful environment
      5. keep cardiac monitor out of client's view and the sound turned as low as possible
      6. encourage verbalization of fear and anxiety; provide feedback
      7. explain all diagnostic tests
      8. reinforce physician's explanations and clarify misconceptions the client has about heart failure, the treatment plan, and prognosis
      9. instruct client in relaxation techniques and encourage participation in diversional activities
      10. initiate a social service referral and/or assist client to identify and contact appropriate community resources if indicated
      11. provide information based on current needs of client at a level he/she can understand; encourage questions and clarification of information provided
      12. include significant others in orientation and teaching sessions and encourage their continued support of the client
      13. administer prescribed antianxiety agents if indicated.
  3. Consult appropriate health care provider (e.g. psychiatric nurse clinician, physician) if above actions fail to control fear and anxiety.