Nursing diagnosis: Anxiety
Definition of anxiety
- Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an altering signal that warns of impending danger and enables the individual to take measures to deal with threat.
Related Factors
- Unconscious conflict about essential [beliefs]/goals/values of life
- Situational/maturational crises
- Stress
- Familial association; heredity
- Interpersonal transmission/contagion
- Threat to self-concept [perceived or actual]; [unconscious conflict]
- Threat of death [perceived or actual]
- Threat to/change in: health status [progressive/debilitating disease, terminal illness]; interaction patterns; role function/status; environment [safety]; economic status
- Unmet needs
- Exposure to toxins; substance abuse
- [Positive or negative self-talk]
- [Physiological factors, such as hyperthyroidism, pulmonary embolism, dysrhythmias, pheochromocytoma, drug therapy, including steroids]
Defining Characteristics | Nursing care plan for anxiety
SUBJECTIVE
Behaviorala
- Expressed concerns due to change in life events; insomnia
Affective
- Regretful; scared; rattled; distressed; apprehensive; fearful; feel-ings of inadequacy; uncertainty; jittery; worried; painful/persistent increased helplessness; [sense of impendingdoom]; [hopelessness]
Cognitive
- Fear of unspecified consequences; awareness of physiological symptoms
Physiological
- Shakiness
- Sympathetic
- Dry mouth; heart pounding; weakness; respiratory difficulties;
- anorexia; diarrhea
Parasympathetic
- Tingling in extremities; nausea; abdominal pain; diarrhea; uri-nary frequency/hesitancy; faintness; fatigue; sleep distur-bance; [chest, back, neck pain]
OBJECTIVE
Behavioral
- Poor eye contact; glancing about; scanning; vigilance; extraneous movement [e.g., foot shuffling, hand/arm movements, rocking motion]; fidgeting; restlessness; diminished productivity; [cry-ing/tearfulness]; [pacing/purposeless activity]; [immobility]
Affective
- Increased wariness; focus on self; irritability; overexcited; anguish
Cognitive
- Preoccupation; impaired attention; difficulty concentrating; forgetfulness; diminished ability to problem solve; diminished ability to learn; rumination; tendency to blame others; blocking of thought; confusion; decreased perceptual field
Physiological
- Voice quivering; trembling/hand tremors; increased tension; facial tension; increased perspiration
Sympathetic
- Cardiovascular excitation; facial flushing; superficial vasocon-striction; increased pulse/respiration; increased blood pres-sure; pupil dilation; twitching; increased reflexes
Parasympathetic
- Urinary urgency; decreased blood pressure/pulse
Desired Outcomes/Evaluation Criteria—Client Will:
- Appear relaxed and report anxiety is reduced to a manageable level.
- Verbalize awareness of feelings of anxiety.
- Identify healthy ways to deal with and express anxiety.
- Demonstrate problem-solving skills.
- Use resources/support systems effectively.
Nursing interventions for anxiety| Nursing care plan for anxiety
NURSING PRIORITY NO.1.To assess level of anxiety:
- Review familial/physiological factors, such as genetic depres-sive factors; psychiatric illness; active medical conditions (e.g., thyroid problems, metabolic imbalances, cardiopulmonary disease, anemia, or dysrhythmias); recent/ongoing stressors (e.g., family member illness/death, spousal conflict/abuse, or loss of job). These factors can cause/exacerbate anxiety/anxiety disorders.
- Determine current prescribed medications and recent drug history of prescribed or OTC medications (e.g., steroids, thyroid preparations, weight loss pills, or caffeine). Thesemedications can heighten feelings/sense of anxiety.
- Identify client’s perception of the threat represented by the situation.
- Monitor vital signs (e.g., rapid or irregular pulse, rapid breathing/hyperventilation, changes in blood pressure, diaphorsesis, tremors, or restlessness) to identify physical responses associated with both medical and emotional conditions.
- Observe behaviors,which can point to the client’s level of anxiety:
1. Mild
- Alert; more aware of environment; attention focused on envi-ronment and immediate events
- Restless; irritable; wakeful; reports of insomnia
- Motivated to deal with existing problems in this state
2. Moderate
- Perception narrower; concentration increased; able to ignoredistractions in dealing with problem(s)
- Voice quivers or changes pitch
- Trembling; increased pulse/respirations
3. Severe
- Range of perception is reduced; anxiety interferes with effective functioning
- Preoccupied with feelings of discomfort/sense of impending doom
- Increased pulse/respirations with reports of dizziness, tingling sensations, headache, and so forth
4. Panic
- Ability to concentrate is disrupted; behavior is disintegrated; client distorts the situation and does not have realistic perceptions of what is happening. Client may be experiencing terror or confusion or be unable to speak or move (paralyzed with fear)
- Note reports of insomnia or excessive sleeping, limited/avoid-ance of interactions with others, use of alcohol or other drugs of abuse,which may be behavioral indicators of use of with-drawal to deal with problems.
- Review results of diagnostic tests (e.g., drug screens, cardiac testing, complete blood count, and chemistry panel), which may point to physiological sources of anxiety.
- Be aware of defense mechanisms being used (e.g., denial or regression) that interfere with ability to deal with problem.
- Identify coping skills the individual is currently using, such as anger, daydreaming, forgetfulness, overeating, smoking, or lack of problem solving.
- Review coping skills used in past to determine those that might be helpful in current circumstances.
NURSING PRIORITY NO.2.To assist client to identify feelings and begin to deal with problems:
- Establish a therapeutic relationship, conveying empathy and unconditional positive regard.Note: Nurse needs to be aware of own feelings of anxiety or uneasiness, exercising careto avoid the contagious effect/transmission of anxiety.
- Be available to client for listening and talking.
- Encourage client to acknowledge and to express feelings; for example, crying (sadness), laughing (fear, denial), or swearing (fear, anger).
- Assist client to develop self-awareness of verbal and nonverbal behaviors.
- Clarify meaning of feelings/actions by providing feedback and checking meaning with the client.
- Acknowledge anxiety/fear. Do not deny or reassure client that everything will be all right.
- Provide accurate information about the situation.Helps client to identify what is reality based.
- With a child, be truthful, avoid bribing, and provide physical contact (e.g., hugging or rocking) to soothe fears and provide assurance.
- Provide comfort measures (e.g., calm/quiet environment, soft music, warm bath, or back rub).
- Modify procedures as much as possible (e.g., substitute oral for intramuscular medications or combine blood draws/use fingerstick method) to limit degree of stress and avoid over-whelming child or anxious adult.
- Manage environmental factors, such as harsh lighting and high traffic flow, which may be confusing/stressful to older individuals.
- Accept client as is. (The client may need to be where he or she is at this point in time, such as in denial after receiving the diagnosis of a terminal illness.)
- Allow the behavior to belong to the client; do not respond per-sonally. (The nurse may respond inappropriately, escalating the situation to a nontherapeutic interaction.)
- Assist client to use anxiety for coping with the situation, if helpful.(Moderate anxiety heightens awareness and permits the client to focus on dealing with problems.)
This is a sample of nursing care plan for anxiety