Anxiety

Anxiety Nursing Diagnosis Interventions and Care Plans

Anxiety NCLEX Review Care Plans

Nursing Study Guide on Anxiety Disorders

Anxiety is defined as a feeling of worry, apprehension, and/or fear in response to a perceived harm or threat.

It is normal to feel anxious occasionally about a particular situation or life in general.

However, intense, persistent, constant, and/or excessive anxiety can lead to anxiety disorder.

A patient with anxiety disorder tends to have sudden outbursts of anxiety that can peak and turn into panic attacks.

They may feel overwhelmed, helpless, and hopeless about the situation at hand.

The symptoms may emerge from childhood or adolescence, but it can also start during adulthood.

Signs and Symptoms of Anxiety Disorders

  • Restlessness and nervousness
  • Feeling of impending doom or danger
  • Tachycardia
  • Tachypnea and hyperventilation
  • Chest pain
  • Sweating
  • Trembling
  • Weakness and fatigue
  • Cognitive problems, such as trouble thinking or concentrating
  • Sleeping problems
  • Gastrointestinal problems
  • Attempting to avoid anxiety triggers

Types of Anxiety Disorders

  1. Generalized anxiety disorder – intense and excessive anxiety over situations and activities of daily life
  2. Agoraphobia – fear of places and situations where the person feels helpless, worried, or trapped
  3. Panic disorder – reoccurring outbursts of intense anxiety, terror, or fear that peak within minutes after they begin
  4. Selective mutism – persistent inability to speak in particular places, situations, or with certain people; mostly affects children in their activities of daily living (ADLs)
  5. Separation anxiety disorder – usually stems from inability to separate from parents or guardians during childhood
  6. Social anxiety disorder – excessive a worry, fear, and anxiety over perceived negative views or judgment by other people; may involve feelings of avoidance, self-consciousness and embarrassment in social situations
  7. Substance-induced anxiety disorder – intense anxiety directly due to prescribed medications, illegal drug use, exposure in toxic substances, or drug withdrawal.

Causes and Risk Factors of Anxiety Disorders

Some people may develop anxiety disorder due to underlying health problems such as heart disease, diabetes, respiratory disorders, thyroid dysfunction, chronic pain, or cancer.

Others have traumatic life experiences that have triggered anxiety disorders. Some researchers believe that anxiety disorders can be inherited.

The risk factors that can predispose a person to anxiety disorder include:

  • Physical trauma or abuse
  • A traumatic life event such as death of a close relative or friend
  • Stress build up
  • Illness-induced stress
  • Depression or other mental health issues
  • Alcohol and/or drug use, or withdrawal from these

Complications of Anxiety Disorders

In left unmanaged, anxiety can result to the development of physical and mental health conditions, including:

  • Depression
  • Insomnia
  • Gastrointestinal disorders
  • Suicide
  • Social isolation
  • Poor social functioning

Diagnosis of Anxiety Disorders

  • Psychological exam – to discuss thoughts, emotions or feelings, life experiences, and behavior that can help in the diagnosis of anxiety or other mental health disorder; can be carried out by a psychiatrist or a psychologist
  • Use of DSM-5 – the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is widely used medical manual that contains criteria for diagnosing mental health disorders
  • History Taking –to check for physical symptoms of anxiety; to check for substance use or withdrawal
  • Electrocardiogram (ECG) – may be used if the patient has chest pain to rule out cardiac event

Treatment for Anxiety Disorders

  1. Psychotherapy. Also called psychological counselling or talk therapy, this treatment for anxiety disorders involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Psychotherapy is an effective and proven treatment for anxiety disorders. There are many forms of psychotherapy, but cognitive behavioral therapy (CBT) is found to be the most effective. CBT aims to help the patient develop specific skills to cope with anxiety symptoms and slowly go back to the activities that the patient has been avoiding. It involves exposing the patient slowly to the trigger/s of his/her anxiety.
  2. Medications. Anxiolytic medications and certain antidepressants are often prescribed for anxiety disorders. Sedatives such as benzodiazepines may be prescribed for short-term anxiety relief. A group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) is effectively used in conjunction with CBT.
  3. Lifestyle changes. Being physically active can reduce stress levels, improve mood, and help maintain a healthy body. Nicotine, caffeine, recreational drugs, and alcohol should be avoided as they can worsen anxiety symptoms. Getting enough sleep can help the person feel relaxed. Meditation, yoga, guided imagery, and deep breathing exercises can also relax the mind and reduce the symptoms. Keeping a journal can help the patient understand what triggers his/her anxiety and what increases his/her stress levels, as well as what makes him/her calm and relaxed.
  4. Anxiety support group. The patient can be referred to an anxiety support group where he/she can participate in discussed of relatable experiences as well as experience compassion from others.

Nursing Care Plans for Anxiety Disorders

Nursing Care Plan 1

Nursing Diagnosis: Anxiety related to situational crisis of new cancer diagnosis as evidenced by decreased attention span, restlessness, shortness of breath, disorganized thought process, crying, and verbalization of feeling hopeless

Desired Outcome: The patient will be able to reduce his/her own anxiety level.

InterventionRationale
Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.
Ensure to speak in a calm and non-threatening manner to the patient. Maintain eye contact when communicating with him/her. Provide a comfortable environment by providing sufficient lighting, good ventilation, and reduced noise levels. Respect the personal space of the client but sit not too far from him/her.A calm voice and a comfortable environment can help the patient feel secured and comfortable to speak about his/her worries and fears. The client may become more relaxed and open for discussion if he/she sees the nurse as calm and appears to be in control.
Do not leave the patient when the anxiety levels are high, especially during a panic attack. Re-assure that the healthcare team are here to help him/her.To ensure the patient’s safety against self-harm. Leaving the patient alone during heightened levels of anxiety is dangerous.  
Discuss with the patient and significant other/s the available treatments for anxiety.Anxiety disorders are treatable. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Psychotherapy is an effective and proven treatment for anxiety disorders. Medications such as anxiolytics and antidepressants can help the patient cope with anxiety.
Administer medications as prescribed. Educate the patient about each drug’s benefits, side effects, and proper administration details.Anxiolytics and certain antidepressants are often prescribed for anxiety disorders. Sedatives such as benzodiazepines may be prescribed for short-term anxiety relief.
Provide a supportive approach when the patient has panic attacks by giving simple and short directions.The patient has a limited attention span and is irritable or restless during a panic attack, thus simple and short directions are important in helping the patient cope with the situation.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.
Administer “as needed” or PRN medications during panic attacks.Panic attacks can be resolved by giving certain antidepressants such as selective serotonin reuptake inhibitors or SSRIs.

Nursing Care Plan 2

Nursing Diagnosis: Ineffective coping related to maturational crisis as evidenced by obsessive thoughts, ritualistic behavior, inability to meet basic needs and role expectations

Desired Outcome: The patient will demonstrate effective coping through the situational crisis.

InterventionRationale
Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.
In the beginning of treatment / therapy, allow the patient to continue ritualistic behavior without any judgment or verbalization of disapproval.The client may become more relaxed and open for discussion if he/she is allowed to precipitate the heightened anxiety by performing ritualistic behaviors.
Initially, support the patient by meeting dependency needs if deemed necessary.The patient can become more anxious if the avenues for dependency are suddenly and/or complete eliminated.
Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.  
Discuss with the patient and significant other/s the available treatments for anxiety.Anxiety disorders are treatable. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medications such as anxiolytics and antidepressants can help the patient cope with anxiety.  
Support the patient’s efforts to verbalize and explore the meaning behind each ritualistic behavior or obsessive thought.The patient should first recognize and accept the presence of obsessive thoughts and ritualistic behavior before change can happen.
Provide a supportive approach when gradually limiting the time given for ritualistic behavior.To encourage the patient to replace his/her ritualistic behaviors with adaptive behaviors.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.

Other possible nursing diagnoses:

  • Self-care Deficit
  • Powerlessness
  • Fear

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

Facebooktwitterredditpinterestmail

Check Also

Hemophilia

Hemophilia Nursing Diagnosis Interventions and Care Plans

Hemophilia NCLEX Review Care Plans Nursing Study Guide on Hemophilia Hemophilia is a rare blood …

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.