related to:
  1. exacerbation of symptoms (e.g. increased dyspnea, feeling of suffocation), need for hospitalization, and concern about prognosis;
  2. lack of understanding of the diagnosis, diagnostic tests, treatments, and prognosis;
  3. financial concerns about hospitalization and lifelong treatment;
  4. feeling of lack of control over the progression of COPD and its effects on lifestyle and roles.
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, diaphoresis, elevated blood pressure, tachycardia, self-focused behaviors). Validate perceptions carefully, remembering that some behavior may result from hypoxia and/or hypercapnia.
  2. Implement measures to reduce fear and anxiety:
    1. maintain a calm, supportive, confident manner when interacting with client
    2. do not leave client alone during period of acute respiratory distress
    3. perform actions to improve respiratory status (see Diagnosis 1, action b) in order to reduce dyspnea
    4. perform actions to decrease client's feeling of suffocation:
      1. open curtains and doors
      2. approach client from the side rather than face-on (close face-on contact may make client feel closed in)
      3. limit number of visitors in room at any one time
      4. remove unnecessary equipment from room
      5. administer oxygen via nasal cannula rather than mask if possible
    5. encourage significant others to project a caring, concerned attitude without obvious anxiousness
    6. 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. encourage verbalization of fear and anxiety; provide feedback
      6. reinforce physician's explanations and clarify misconceptions the client has about COPD, the treatment plan, and prognosis
      7. explain all diagnostic tests
      8. instruct client in relaxation techniques and encourage participation in diversional activities
      9. provide information based on current needs of client at a level he/she can understand; encourage questions and clarification of information provided
      10. perform actions to promote effective management of therapeutic regimen (see Diagnosis 7, action b) in order to increase client's feeling of control over his/her life
      11. initiate a social service referral and/or assist client to identify and contact appropriate community resources if indicated
      12. 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.