Anxiety Nursing Diagnosis & Care Plans

Anxiety is a NANDA-I nursing diagnosis in its own right: a vague, uneasy feeling of dread in response to a threat the client often cannot name, with a body stress response to match. Use Anxiety when the worry itself is the problem. Common companion diagnoses are Ineffective Breathing Pattern when anxiety drives fast breathing, Ineffective Coping when the client’s usual ways of handling stress stop working, and Insomnia when worry keeps the client awake. Nursing care starts by ruling out physical causes of the symptoms, then matching interventions to the level of anxiety, staying with the client in severe anxiety or panic, teaching coping skills once the client can take them in, and screening for safety.

Pathophysiology

When the brain senses a threat, the amygdala signals the hypothalamus. This sets off the sympathetic nervous system (the fight-or-flight response) and the hypothalamic-pituitary-adrenal axis, which releases cortisol. Epinephrine and norepinephrine raise heart rate, blood pressure, breathing rate, muscle tension, and blood glucose and sharpen alertness. In short bursts this response is protective. When it fires too often, too strongly, or with no real danger, it becomes the problem.

• Brain chemistry — anxiety disorders are linked to changes in serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) signaling. This is why SSRIs, SNRIs, and other medicines that act on these systems can help.
• Hyperventilation — fast, deep breathing blows off carbon dioxide and causes respiratory alkalosis. This produces lightheadedness, tingling around the mouth and in the fingers, and sometimes muscle cramps, which feel frightening and feed the panic.
• Learned and thinking patterns — the client may misread normal body sensations as danger, avoid feared situations, and so never learn they are safe. Avoidance keeps anxiety going.
• Risk factors — family history, stressful or traumatic life events, chronic illness, chronic pain, substance use, and some personality traits.

Levels of anxiety

Matching care to the level of anxiety is a core nursing skill and a common exam topic. The higher the level, the narrower the client’s attention and the simpler your communication must be.

Nursing assessment

Subjective data

• What the client is worried about, in their own words, and how long the worry has been present
• Physical symptoms: palpitations, chest tightness, shortness of breath, tingling, dizziness, stomach upset, headache, muscle tension
• Triggers, and what the client avoids because of anxiety (driving, crowds, work, leaving home)
• Sleep: trouble falling or staying asleep, waking early, feeling unrested
• Usual coping methods and whether they still work; support people
• Caffeine, energy drinks, nicotine, alcohol, cannabis, and other substance use, including recent stopping
• All medicines, including recent changes, missed doses, over-the-counter products, and supplements
• History of anxiety disorders, depression, trauma, thyroid disease, heart or lung disease
• Thoughts of death, suicide, or harming others, asked directly

Objective data

• Heart rate, blood pressure, respiratory rate and depth, temperature, and oxygen saturation
• Point-of-care glucose when the client is shaky, sweaty, or confused
• Restlessness, pacing, trembling, sweating, wringing hands, rapid speech, poor eye contact
• Narrowed attention, trouble following directions, and the level of anxiety (mild to panic)
• Signs of withdrawal, such as tremor, sweating, agitation, or fast heart rate after recent alcohol or sedative use
• Results the provider orders, such as an ECG, troponin, thyroid tests, or a drug screen
• A standardized screening score when your setting uses one, such as the GAD-7

Screening tools

The GAD-7 is a short, 7-question self-report screen. Scores of about 5, 10, and 15 are commonly used as cutoffs for mild, moderate, and severe anxiety symptoms, and a score of 10 or more usually prompts further evaluation. A screen does not diagnose a disorder. Use the tools and cutoffs your facility uses, and screen for suicide risk with your facility’s approved tool, because anxiety disorders, especially with depression or substance use, raise that risk.

Nursing diagnoses used with anxiety

• Anxiety — the main diagnosis when apprehension and the stress response are the problem
• Ineffective Breathing Pattern — fast, deep breathing during a panic attack
• Ineffective Coping — the client’s usual ways of handling stress no longer work, or unhealthy ones take over
• Insomnia — worry keeps the client from falling or staying asleep
• Fear — when the threat is specific and known, such as a planned surgery
• Death Anxiety — worry focused on dying, common with serious illness
• Powerlessness — the client feels they have no control over the situation
• Risk for Suicidal Behavior — when screening finds risk factors such as hopelessness, depression, or substance use
• Inadequate Health Knowledge — gaps in knowing about the condition, medicines, and coping strategies

Worked care plans

Four plans in the same ADPIE shape. The scenario is a 29-year-old woman kept overnight for observation after an emergency visit for chest tightness and a racing heart. Her ECG showed sinus tachycardia, and the provider has ruled out a cardiac cause and a pulmonary embolism. She says she has had five similar “attacks” in the past two months, has stopped driving because she is afraid one will happen on the freeway, and sleeps about 4 hours a night. She drinks several energy drinks a day to get through long workdays at a new job. At 0200 she presses the call light, sitting upright and gripping the bed rail: “I can’t breathe. My hands are tingling. I think I’m dying.” Her respiratory rate is 30 and deep, heart rate 118, blood pressure 142/88, oxygen saturation 99% on room air, and glucose 96 mg/dL. She denies chest pain beyond the tightness she had on admission, which the provider has already evaluated. She denies thoughts of suicide. The provider orders a one-time anxiolytic as needed, a mental health consult, and outpatient follow-up for a possible panic disorder.

Interventions and rationales

Client and family teaching

• Anxiety and panic attacks are real and treatable. A panic attack feels dangerous but usually peaks within minutes and passes
• Learn your early warning signs and start slow breathing as soon as you notice them: in through the nose, a long, slow breath out
• Practice relaxation or grounding every day, not only during an attack, so it works when you need it
• Cut back on caffeine and energy drinks, and avoid using alcohol or cannabis to calm down; both can make anxiety worse over time
• Aim for regular sleep and physical activity; most adults need 7 or more hours of sleep a night
• Take medicines exactly as prescribed. Long-term medicines take weeks to help, and some need to be tapered by your provider rather than stopped suddenly
• If you were prescribed a sedating medicine, do not drive or drink alcohol until you know how it affects you, and keep it locked away from others
• Keep therapy appointments; facing feared situations step by step with a therapist helps more than avoiding them
• Get emergency care for chest pain, trouble breathing, or fainting, because these need to be checked every time. If you have thoughts of suicide, call or text 988 in the US or call 911

Frequently asked questions

References

• Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). NANDA International Nursing Diagnoses: Definitions and Classification, 2024–2026. Thieme.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing, 2022.
• Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 2006;166(10):1092–1097.
• National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113). NICE, 2011, updated 2020.
• U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Drug Safety Communication, 2020.
• American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 2023;71(7):2052–2081.
• Halter, M. J. Varcarolis’ Foundations of Psychiatric-Mental Health Nursing: A Clinical Approach. Elsevier.
• Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (13th ed.). Elsevier, 2023.
• Silvestri, L. A. Saunders Comprehensive Review for the NCLEX-RN Examination. Elsevier, 2023.

Screening tools and cutoffs, suicide risk protocols, as-needed medicine orders, sedation monitoring, and referral pathways vary by client, by provider, and by facility. Follow the provider’s orders and your own institution’s policies and protocols. This page supports study and does not replace course instruction or clinical judgment. If you or someone you know is in crisis in the US, call or text 988.

Related care plans