5 Nursing Care Plan Anxiety

Anxiety disorders are abnormal states in which the most striking features are mental and physical symptoms of anxiety, occurring in the absence of organic brain disease or another psychiatric disorder. Here is a comprehensive Nursing Care Plan Anxiety.

Anxiety represents an emotional response to environmental stressors and is, therefore, part of the person’s stress response.

Each individual’s experience with 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. These pathological anxiety disorders include panic attacks, social phobias, specific phobias, obsessive-compulsive disorder, and post-traumatic stress disorder

Anxiety is generally categorized into four levels: mild, moderate, severe, and panic. Mild anxiety can enhance a person’s perception of the environment and readiness to respond. Moderate anxiety is associated with a narrowing of the person’s perception of the situation.


A person with moderate anxiety may be more creative and more effective in solving problems. Severe anxiety is associated with increased emotional and physical feelings of discomfort. Perceptions are further narrowed.

The person with severe anxiety disorders begins to manifest excessive autonomic nervous system signs of the fight-or-flight stress response. The person in a panic stage of anxiety has distorted perceptions of the situation. His or her thinking skills become limited and irrational.

The person may be unable to make decisions. In the severe and panic stages of anxiety, the nurse needs to intervene to promote patient safety. The nurse can encounter anxious patients anywhere in the hospital or community. The presence of the nurse may lend support to the anxious patient and provide strategies for effectively coping with anxious moments or panic attacks.

Table of Contents

Symptoms of anxiety disorders
Categories of anxiety disorders
Assessment
Nursing care plan Anxiety

  • Nursing Care Plan Anxiety Anxiety/Recurring panic attacks
  • Nursing Care Plan Anxiety Fear
  • Ineffective coping (Nursing Care Plan Anxiety )
  • Nursing Care Plan Anxiety Powerlessness
  • Nursing Care Plan Anxiety Social Isolation

Nursing Diagnosis
Goals
Short term goals
Long term goal

Symptoms of anxiety disorders

Psychological arousal
Fearful anticipation
Irritability
Sensitivity to noise
Restlessness
Poor concentration
Worrying thoughts
Autonomic arousal:

Gastrointestinal
Dry mouth
Difficulty in swallowing
Epigastric discomfort
Excessive wind
Frequent or loose motions
Respiratory
Constriction in the chest, Difficulty inhaling, Cardiovascular, Palpitations, Discomfort in the chest, Awareness of missed beats
Genitourinary

Frequent or urgent micturition, Failure of erection, Menstrual discomfort, Muscle tension, Tremor, Headache
Aching muscles, Hyperventilation, Dizziness, Tingling in the extremities, Feeling of breathlessness, Sleep disturbance, Insomnia
Night terror

Categories of anxiety disorders

There are eight major categories.
Generalized anxiety disorder: Characterized by excessive, uncontrollable worrying over a period of at least 6 months. Symptoms include motor tension (trembling; shakiness; muscle tension, aches, soreness; easy fatigue), autonomic
hyperactivity (shortness of breath, palpitations, sweating, dry mouth, dizziness, nausea, diarrhea, frequent urination), and
scanning behavior (feeling on edge, having an exaggerated startle response, difficulty concentrating, sleep disturbance,
irritability).
Panic disorder: Characterized by a specific period of intense fear or discomfort with at least four of the following symptoms: palpitations or pounding heart, sweating, trembling or shaking, sensations of smothering or difficulty breathing, feeling of choking, chest pain, nausea, feeling dizzy or faint, feeling of unreality or losing control, numbness, and chills or flushes.
Phobias: Characterized by a persistent and severe fear of a clearly identifiable object or situation despite awareness that
the fear is unreasonable. There are two types, specific and social. Specific phobias are subdivided into five types: animals,
natural environment (e.g., lightning), blood-injection-injury type, situational (e.g., flying), and other (situations that could
lead to choking or contracting an illness). Social phobiarelates to profound fear of social or performance situations in
which embarrassment could occur.
Agoraphobia is characterized by feelings of intense fear of being alone in open or public places where escape might be difficult. Individuals with agoraphobia become immobilized with anxiety and may find it impossible to leave their homes.
Acute stress disorder: Like posttraumatic stress disorder (PTSD), the problem begins with exposure to a traumatic
the event, with a response of intense fear, helplessness, or horror.
In addition, the person shows dissociative symptoms, that is, subjective sense of numbing, feeling “in a daze,” depersonalization, or amnesia, and clearly tries to avoid stimuli that arouse recollection of the trauma. But just like PTSD, the victim reexperiences the trauma and shows functional impairment in social, occupational, and problem-solving skills. The key difference is that this syndrome occurs within 4 wk of the traumatic event and only lasts 2 days to 4 wk.

5 nursing care plan anxiety 1

Nursing Care Plan Anxiety

Anxiety disorder caused by a general medical condition: May be characterized by severe anxiety, panic attacks, or obsessions, or compulsions, but the cause is clearly related to a medical problem, excluding delirium. History, physical examination, and laboratory findings support a specific diagnosis, for example, hypoglycemia, pheochromocytoma, or
thyroid disease.

Assessment

Physical indicators: Dry mouth, elevated vital signs, diarrhea, increased urination, nausea, diaphoresis, hyperventilation, fatigue, insomnia, sexual dysfunction, irritability, tenseness.
Emotional indicators: Fear, sense of impending doom, helplessness, insecurity, low self-confidence, anger, guilt.
Cognitive indicators: Mild anxiety produces increased awareness and problem-solving skills. Higher levels produce narrowed perceptual fields; missed details; diminished problem-solving skills; and catastrophic, dichotomous thoughts resulting in deteriorated logical thinking.
Social indicators: Occupational, social, and familial role, e.g., marital and parental functioning may be adversely affected by anxiety and therefore should be assessed.
Spiritual indicators: Hopelessness/helplessness, the feeling of being cut off from God, and anger at God for allowing anxiety
maybe experienced.
Suicidality: Suicide assessment is critical with anxious patients, especially those with panic disorder.

Nursing care plan Anxiety

Nursing Diagnosis

Anxiety/Recurring panic attacks ( Nursing Care Plan Anxiety )

related to

  • lack of knowledge regarding cause and treatment
  • unconscious conflict about essential values and goal of life
  • situational and maturational crises
  • threat of death
  • unmet needs
  • being exposed to phobic stimulus
  • traumatic experiences

as evidenced by

  • increased respiration
  • increased pulse
  • increased or decreased blood pressure
  • Nausea
  • confusion
  • increased perspiration
  • faintness
  • trembling or shaking
  • Insomnia
  • going crazy

Goals

Short term goals

The client will verbalize ways to intervene in escalating anxiety within 1 week.

Long term goals

The client will be able to recognize symptoms of the onset of anxiety and intervene before reaching panic stage by time of discharge from treatment. Nursing Care Plan Anxiety

InterventionRationales
Maintain a calm, non-threatening manner while working with clients.Anxiety is contagious and may be transferred from staff to client or vice versa. Client develops feeling of security in presence of calm staff person.
Reassure client of his or her safety and security. This can be conveyed by physical presence of nurse. Do not leave client alone at this time.The client may fear for his or her life. The presence of a trusted individual provides the client with a feeling of security and assurance of personal safety.
Use simple words and brief messages, spoken calmly and clearly, to explain hospital experiences to clients.In an intensely anxious situation, the client is unable to comprehend anything but the most elementary communication.
Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor).A stimulating environment may increase the level of anxiety.
Administer tranquilizing medication, as ordered by the physician. Assess medication for effectiveness and for adverse side effects.
When the level of anxiety has been reduced, explore with the client possible reasons for the occurrence.Recognition of precipitating factor(s) is the first step in teaching the client to interrupt the escalation of the anxiety.
Encourage the client to talk about traumatic experiences under nonthreatening conditions. Help the client work through feelings of guilt related to the traumatic event. Help the client
understand that this was an event to which most people would have responded in like manner. Support client during flashbacks of the experience.
Verbalization of feelings in a nonthreatening environment may help the client come to terms
with unresolved issues.
Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep breathing exercises, physical exercises, brisk walks, jogging,
meditation).
Nursing Care Plan Anxiety
Nursing care plan anxiety
Nursing Care Plan Anxiety

2. Nursing diagnosis ( Nursing Care Plan Anxiety )

Fear

related to

  • phobic stimulus
  • Being in a place or situation from which escape might be difficult
  • Causing embarrassment to self in front of others

evidenced by

  • Refuses to leave own home alone
  • Refuses to eat in public
  • Refuses to speak or perform in public
  • Refuses to expose self to (specify phobic object or situation
  • Identifies object of fear
  • Symptoms of apprehension or sympathetic stimulation in presence of phobic object or situation

Goals

Short term goal

The client will discuss a phobic object or situation with the nurse or therapist within 5 days.

Long term Goals

The client will be able to function in presence of a phobic object or situation without experiencing panic anxiety by the time of discharge from treatment.

InterventionsRationales
Reassure the client of his or her safety and security.At a panic level of anxiety, the client may fear for their own life.
Explore client’s perception of threat to physical integrity or threat to self-concept.It is important to understand the client’s perception of the phobic object or situation in order to assist with the desensitization process.
Discuss reality of the situation with client in order to recognize aspects that can be changed and those that cannot.The client must accept the reality of the situation (aspects that cannot change) before the work of reducing the fear can progress.
Include the client in making decisions related to the selection of alternative coping strategies. (Example: Client may choose
either to avoid the phobic stimulus or attempt to eliminate
the fear associated with it.)
Allowing the client choices provides a measure of control and serves to increase feelings of self-worth.
If the client elects to work on the elimination of the fear, techniques of desensitization may be employed.
This is a systematic plan of behavior modification, designed to expose the individual gradually to the situation or object (either in reality or through fantasizing) until the fear is no longer experienced.
This is also sometimes accomplished through implosion therapy, in which the individual is “flooded” with stimuli related to the phobic situation or object (rather than in gradual steps) until anxiety is no longer experienced in
relation to the object or situation.
Fear is decreased as the
physical and psychological sensations diminish in response to repeated exposure to the phobic stimulus under nonthreatening conditions.
Encourage the client to explore underlying feelings that may be contributing to irrational fears. Help client to understand how facing these feelings, rather than suppressing them,
can result in more adaptive coping abilities.
Verbalization of
feelings in a nonthreatening environment may help the client come to terms with unresolved issues.
Nursing Care Plan Anxiety

3. Nursing Diagnosis ( Nursing Care Plan Anxiety )

Ineffective coping ( Nursing Care Plan Anxiety )

related to

  • Underdeveloped ego; punitive superego
  • Fear of failure
  • Situational crises
  • Maturational crises
  • Personal vulnerability
  • Inadequate support systems
  • Unmet dependency needs

evidenced by

  • Ritualistic behavior
  • Obsessive thoughts
  • Inability to meet basic needs
  • Inability to meet role expectations
  • Inadequate problem solving
  • Alteration in societal participation
Goals
Short term Goal

Within 1 week, the client will decrease participation in ritualistic behavior by half

Long term Goal

By the time of discharge from treatment, the client will demonstrate an ability to cope effectively without resorting to obsessive-compulsive behaviors or increased dependency.

InterventionsRationales
Assess client’s level of anxiety. Try to determine the types of situations that increase anxiety and result in ritualistic behaviors.Recognition of precipitating factors is the first step in teaching the client to interrupt the escalating anxiety.
Initially meet client’s dependency needs as required. Encourage independence and give positive reinforcement for independent behaviors.Sudden and complete elimination of all avenues for dependency would create intense anxiety on the
part of the client. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors.
At the beginning of treatment allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior.To deny the client this activity may precipitate a panic level of anxiety.
Support client’s efforts to explore the meaning and purpose of the behaviorThe client may be unaware of the relationship between emotional problems and compulsive behaviors.
Recognition is important before change can occur.
Provide a structured schedule of activities for the client, including adequate time for completion of rituals.The structure provides a feeling of security for the anxious client.
Gradually begin to limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities.Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones.
Give positive reinforcement for nonritualistic behaviors.Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors
Encourage recognition of situations that provoke obsessive thoughts or ritualistic behaviors. Explain ways of interrupting these thoughts and patterns of behavior (e.g., thought-stopping techniques, relaxation techniques, physical exercise, or other constructive activity with which the client feels comfortable).
Nursing Care Plan Anxiety

4. Nursing Diagnosis

Powerlessness

related to

  • Lifestyle of helplessness
  • Fear of disapproval from others
  • Unmet dependency needs
  • Lack of positive feedback
  • Consistent negative feedback

Evidenced by

  • Verbal expressions of having no control (e.g., over self-care, situation, outcome)
  • Nonparticipation in care or decision-making
  • Expression of doubt regarding role performance when opportunities are provided.
  • Reluctance to express true feelings
  • Apathy
  • Dependence on others may result in irritability, resentment, anger, and guilt
  • Passivity
Goal
Short term Goal

The client will participate in decision-making regarding his own care within 5 days.

Long term goal

The client will be able to effectively problem-solve ways to take control of his or her life situation by discharge, thereby decreasing feelings of powerlessness.

InterventionsRationales
Allow client to take as much responsibility as possible for own self-care practices.
For e.g.
a. Include the client in setting the goals of care he or she wishes to achieve.
b. Allow the client to establish his own schedule for self-care activities.
c. Provide the client with privacy as need is determined.
d. Provide positive feedback for decisions made. Respect the client’s right to make those decisions independently, and refrain from attempting to influence him or her toward those that may seem more logical.
Providing client with choices will increase his or her feelings of control.
Help client set realistic goals.Unrealistic goals set the client up for failure and reinforce feelings of powerlessness.
Help identify areas of life situation that client can control.Client’s emotional condition interferes with his or her ability to solve problems. Assistance is required to perceive the benefits and consequences of available alternatives accurately.
Help client identify areas of life situation that are not within his or her ability to control. Encourage verbalization of feelings related to this inability.In an effort to deal with
unresolved issues and accept what cannot be changed.
Identify ways in which the client can achieve. Encourage participation in these activities, and provide positive reinforcement for participation, as well as for achievement.Positive reinforcement enhances self-esteem and encourages the repetition of desirable behaviors.
Nursing Care Plan Anxiety

5. Nursing Diagnosis ( Nursing Care Plan Anxiety )

Social isolation

related to

  • Panic level of anxiety
  • Past experiences of difficulty in interactions with others
  • Need to engage in ritualistic behavior in order to keep anxiety under control
  • Repressed fears

evidenced by

  • Stays alone in a room
  • Uncommunicative
  • Withdrawn
  • No eye contact
  • Developmentally [or culturally] inappropriate behaviors
  • Preoccupation with own thoughts; repetitive, meaningless action
  • Expression of feelings of rejection or of aloneness imposed by others
  • Experiences feelings of differences from others
  • Insecurity in public
Goals
Short tem goal

The client will willingly attend therapy activities accompanied by a trusted support person within 1 week.

Long term goal

The client will voluntarily spend time with other clients and staff members in group activities by the time of discharge from treatment.

InterventionsRationales
Convey an accepting attitude by making brief, frequent contacts.An accepting attitude increases feelings of self-worth and facilitates trust.
Show unconditional positive regard.This conveys your belief in the client as a worthwhile human being
Be with the client to offer support during group activities that may be frightening or difficult for him or her.The presence of a trusted individual provides emotional security for the client.
Be honest and keep all promises.Honesty and dependability promote a trusting relationship.
Be cautious with touch. Allow client extra space and an avenue for exit if he or she becomes too anxious.A person in panic anxiety may perceive touch as a threatening gesture.
Administer tranquilizing medications as ordered by the physician. Monitor for effectiveness and for adverse side effects.Short-term use of antianxiety medications, such as diazepam, chlordiazepoxide, or alprazolam, helps to reduce the level of
anxiety in most individuals, thereby facilitating interactions with others.
Discuss with the client the signs of increasing anxiety and techniques for interrupting the response (e.g., relaxation exercises, thought
stopping).
Maladaptive behaviors, such as withdrawal and suspiciousness, are manifested during times of increased anxiety.
Give recognition and positive reinforcement for the client’s voluntary interactions with others.Positive reinforcement enhances self-esteem and encourages repetition of acceptable behaviors.

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