In this post, we are discussed 6 nursing care plan about anxiety with 6 nursing diagnoses with nursing intervention
Definition and introduction of anxiety
Anxiety is a diffuse response to a vague threat, unlike fear, which is an acute response to a clear external threat.
Anxiety represents an emotional response to environmental stressors and is therefore part of a person’s stress response. Each individual’s experience with anxiety is different. Some people are able to use the emotional boundary provoked by anxiety to stimulate creativity or problem-solving ability; others may 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.
Stages of anxiety
Anxiety is usually classified into four levels:
- Mild anxiety
Mild anxiety can improve a person’s perception of the environment and readiness to respond.
2. Moderate anxiety
Moderate anxiety is associated with a narrowing of a person’s perception of the situation. A person with moderate anxiety may be more creative and more effective in problem-solving.
3. Severe anxiety
Severe anxiety is associated with increased emotional and physical sensations of discomfort. Perceptions are further reduced. The severely anxious person begins to manifest excessive autonomic nervous system signs of the fight or flight stress response.
4. Panic Anxiety
The person in the panic phase of anxiety has distorted perceptions of the situation. Their thinking abilities become limited and irrational. The person may be unable to make decisions. In the severe anxiety and panic phases, the nurse must intervene to promote patient safety.
Indicator or sign and symptoms of anxiety
Dry mouth, Elevated vitals,Diarrhea,Increased urination,Nausea, Diaphoresis,Hyperventilation,Fatigue,Insomnia,Sexual dysfunction,Irritability,Tension.
Fear, sense of impending doom, helplessness, insecurity, low self-confidence, anger, guilt.
Mild anxiety produces increased awareness and problem-solving ability. Higher levels produce a reduced perceptual field; loss of detail; decreased problem-solving ability; and catastrophic and dichotomous thoughts resulting in impaired logical thinking.
Work, social, and family roles, e.g., marital and parental functioning, may be adversely affected by anxiety and therefore should be assessed.
Hopelessness/helplessness, feelings of being cut off from God, and anger at God for allowing anxiety may be experienced.
Suicidality assessment is critical with anxious patients, especially those with panic disorder. For patients with a dual diagnosis of depression and substance abuse or other anxiety disorders, the risk of self-harm is even greater.
6 Nursing diagnosis for anxiety
- Deficient knowledge
- Recurring panic attacks related to anxiety
- Social isolation
- Ineffective coping
- Compromised family coping
Nursing care plan about anxiety with nursing diagnosis and intervention
Nursing diagnosis : Anxiety
It may be related to
- Economic status
- Health status
- Interaction patterns
- Interpersonal relationship
- Role function
- Maturational for situation crisis
- Substance abuse
- Unconscious conflict about essential Life goal or value
- Unmet needs
Characteristics or signs and symptoms of anxiety
- Diminished productivity
- Expressed concern about changes in life events
- Feeling of inadequacy
- Focus on self
- Difficulty concentration
- Diminished ability to learn or solve problems
2. Physiological or sympathetic
- Dry mouth
- Facial flushing
- Increased BP, pulse, respirations
3. Physiological parasympathetic
- Abdominal pain
- Urinary frequency, urgency.
Nursing intervention with rationale for anxiety
Assessment of patient’s anxiety level
Patients with mild anxiety have minimal or no physiological symptoms of anxiety. Vital signs are within normal limits. The patient appears calm but may complain of tension in the form of butterflies in the stomach.
Patients with moderate anxiety appear energetic, with a more animated facial expression and tone of voice. Vital signs may be normal or slightly elevated. The patient may report being nervous.
In severe anxiety, patients show symptoms of increased autonomic nervous system activity, including elevated vital signs, sweating, urinary urgency and frequency, thirst, and muscle tension. At this stage, patients may experience palpitations and chest pain. Patients may complain of feeling agitated, irritable, overworked, and overwhelmed by new stimuli.
In the panic phase of anxiety, the autonomic nervous system is hyperactive to the point of releasing sympathetic neurotransmitters. Patients may experience pallor, hypotension, and loss of muscle coordination. Patients feel completely out of control and may engage in extreme behaviors ranging from combative to withdrawn.
Maintain composure when interacting with the patient.
Health care providers may communicate their own anxiety to hypertensive patients. In a calm, non-threatening atmosphere, patients will feel more stable.
If necessary, adapt the patient to the environment and to new experiences and people.
Adaptation and awareness of the environment may promote a sense of well-being and reduce the patient’s anxiety. Anxiety may develop into panic if the patient feels threatened and is unable to control environmental stimuli.
Encourage the patient to talk about feelings of anxiety and to explore situations that cause anxiety, if they can be identified.
Talking about anxiety-provoking situations and feelings of anxiety helps the patient to perceive the situation realistically and to identify factors that lead to feelings of anxiety.
Help the patient to develop new skills to reduce anxiety.
Learning new coping skills can give patients different ways to deal with anxiety.
Teach the patient to limit the use of central nervous system stimulants.
Stimulants can increase the physical symptoms of anxiety.
Nursing diagnosis : Deficient knowledge
This may be related to
- Ignorance of prescribed medications, their purpose, and potential side effects.
The patient verbalizes accurate information about the prescribed medication and its side effects.
Nursing intervention with rationale for deficient knowledge
Assess patient’s knowledge of prescribed medications and understanding of the importance of taking medications as prescribed.
This assessment helps the nurse reinforce information about medications as needed and correct misunderstandings.
Teach the physiologic effects of anxiolytics and/or antidepressants and how they relieve the patient’s anxiety disorder symptoms.
Anxiety disorders are neurobiological phenomena that respond to both anxiolytics and antidepressants. Many people who suffer from anxiety are afraid to take medications because they fear drug dependence and view taking them as a sign of weakness.
Explain the importance of taking antidepressant medication as prescribed.
These medications require specific blood levels to be therapeutically effective; therefore, patients must take them daily at the prescribed dose and intervals.
Educate the patient on the side effect profile and how to manage the prescribed medications that are subsequently taken:
Both anxiolytics and each class of antidepressants have a specific side effect profile. Knowing what side effects to expect, how to manage those side effects, and the duration of those side effects is important to ensure treatment adherence.
Educate the patient and caregiver about the holistic nature of anxiety, which produces physical, emotional, cognitive, social, and spiritual symptoms.
Many people believe that anxiety is synonymous with nervousness, overlooking the many other signs and symptoms that make this a holistic disorder.
Nursing diagnosis : Recurrent panic attacks
Associated with lack of knowledge about cause and treatment.
The patient verbalizes methods for managing panic attacks and understanding that panic attacks are not life-threatening and are temporary and demonstrates this knowledge appropriately.
Nursing intervention with rationale for recurrent panic attacks
Assess the patient’s current understanding of the nature, cause, and treatment of panic disorder and the patient’s current coping strategies.
Most patients who suffer from panic attacks have experienced multiple attacks before receiving an accurate diagnosis. Patients sometimes use unhealthy coping strategies, such as restricting their movement (e.g., avoiding bridges if they have experienced a panic attack on a bridge, or avoiding shopping in stores if they have experienced a panic attack there). It is important to provide information that the patient can understand and use to make appropriate lifestyle changes.
Teach the patient to reduce or avoid substances in the diet that can trigger anxiety and panic, such as caffeine, food dyes, and monosodium glutamate.
Caffeine increases feelings of anxiety. However, caffeine withdrawal symptoms can also trigger panic. Therefore, the plan should focus on reducing caffeine consumption first and then eliminating it from the diet. Some people are sensitive to food dyes and MSG. This sensitivity is perceived as increased anxiety.
Teaching relaxation techniques; assisting with imagery practice, deep breathing, progressive relaxation, and the use of relaxation tapes.
Relaxation is an effective means of reducing anxiety. The patient’s ability to master relaxation techniques provides a sense of control and improves self-care skills.
Teach the patient to self-administer an anxiolytic at the first signs and symptoms of a panic attack and to develop coping strategies to ward off the most severe symptoms.
This information provides the patient with a strategy for coping with panic attacks. When patients become aware of the early signs of impending panic, taking the prescribed anxiolytics and initiating relaxation and cognitive strategies to reduce the severity of the event can increase their sense of mastery over their panic anxiety.
Nursing diagnosis: Social isolation associated with agoraphobia
The patient exhibits behavior consistent with increased social interaction.
Nursing intervetion with rationale for Social isolation associated with agoraphobia
Assess the degree of social isolation experienced by the patient in response to their agoraphobia.
It is critical to know how isolated the patient has become as a result of his agoraphobia. If the patient no longer leaves his home and has no contact with anyone except those who either live in the home or come to visit, the social phobia is very severe and requires more intensive interventions to overcome it, including home visits.
Assist the patient with a graduated exposure plan to gradually increase independent functioning and interactions with others.
Gradual exposure is effective in treating agoraphobia.
Assist the patient in practicing relaxation techniques.
Relaxation helps mitigate impending panic attacks.
Discuss alternatives for social interaction.
Patients may need assistance in developing activity plans. Appropriate alternatives for social interaction may include volunteering in small groups and accompanying a friend to a social event to increase well-being.
Nursing diagnosis: Ineffective coping
Related to a perceived inadequate level of control or support/resources in coping with situational crises
The patient begins to recognize ineffective coping behaviors and their consequences, express feelings appropriately, identify options, use resources effectively, and use effective problem-solving techniques.
Nursing intervntion with rationale for ineffective coping
Assessment of the patient’s previous methods of coping with life problems.
The way people have handled problems in the past is a reliable indicator of how they will handle current problems.
Determine substance use (alcohol, other drugs, smoking, behavior).
The patient may have used substances as coping mechanisms to control anxiety. This pattern of behavior may interfere with the ability to cope with the current situation.
Educate the patient about different ways to cope with situations that trigger anxiety, such as recognizing and appropriately expressing feelings and problem-solving skills.
This information provides patients with the opportunity to learn new Coping strategies to learn.
Roleplay and practice of new skills.
Role-playing encourages skill acquisition in a non-threatening environment.
Encourage and assist patients in assessing their lifestyle and identifying family, work, and community activities and pressures.
These interventions allow patients to examine areas of their lives that may contribute to anxiety and make decisions about how to make changes gradually without creating unnecessary anxiety.
Helping patients set short- and long-term goals aimed at making life changes and reducing anxiety.
Goals help initiate the necessary changes.
Teaching the importance of balance in life.
An unbalanced life is a huge contributor to stress and anxiety. Changes such as adequate sleep, nutrition, exercise, time for rest, time for work, time for family, and time for spirituality improve quality of life, decrease
quality of life, reduce anxiety and increase feelings of power and control.
Refer to outside resources, including support groups, psychotherapy, religious resources, and community recreation services.
Many people benefit from the support of others and resources to keep life in balance and control stress levels.
Nursing diagnosis: Impaired family coping
Related to family disorganization and role changes.
Family members begin to recognize their own resources to cope; interact appropriately with the patient and offer support and assistance as needed; recognize their own need for support; seek help and use their resources effectively
Nursing intervention with rationale for impaired family coping
Assess how much information is available to and understood by the family.
Lack of understanding of the patient’s anxiety disorder can lead to unhealthy patterns of interaction and contribute to family members’ anxiety.
Identify the patient’s role and current roles in the family, and discuss how the illness has changed family organization.
The patient’s disabilities (e.g., resulting in inability to go to work or manage the household) interfere with their usual role in the family structure and may contribute significantly to stress and disorganization in the family.
Help the family identify other factors besides the patient’s illness that affect their ability to support each other.
This takes the focus off the patient as “the problem” and allows family members to examine their respective responsibilities and behaviors.
Discuss the psychoneurological basis of anxiety in order to avoid stigmatizing the Stigmatize the patient with an anxiety disorder.
This helps the family understand and accept behaviors that can be very difficult and prevents the patient from being labeled as weak, which can add to the stigma of the anxiety disorder.
Help the family support the patient but identify who owns the disorder and who is responsible for resolving it.
This recognition promotes self-responsibility. The individual can seek support and ask for help, but it is not the family’s responsibility to seek treatment.
The family should be taught constructive problem-solving strategies.
These skills help the family learn new ways of dealing with conflict and reduce anxiety-provoking situations.
Refer the family to appropriate resources in the community.
The family may need additional support to resolve their issues and remain intact.