Anxiety Nursing Diagnosis and Nursing Care Plan

Anxiety Nursing Care Plans Diagnosis and Interventions

Anxiety NCLEX Review and Nursing Care Plans

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:

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.

Anxiety Nursing Diagnosis

Nursing Care Plan for Anxiety 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.

Nursing Interventions for AnxietyRationale
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 for Anxiety 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.

Nursing Interventions for AnxietyRationale
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.

Nursing Care Plan for Anxiety 3

Fear

Nursing Diagnosis: Fear related to stimulation to phobia and appearance of physiological symptoms indicative of panic behavior secondary to anxiety, as evidenced by acknowledgment and verbalization of fear, trembling muscles, and increased heart rate.

Desired Outcomes:

  • The patient will be able to speak with the nurse about a phobic object or situation.
  • By the end of treatment, the client will be able to function in the presence of the phobic object or circumstance without experiencing panic anxiety.
Nursing Interventions for AnxietyRationale
Assure the patient about safety and security.  The patient with panic anxiety may fear for his/her own life.
Examine the patient’s impression of a threat to physical integrity or threat to self-concept.To help with the desensitization process, it is important to understand the patient’s perception of the phobic object or situation.
Present and discuss with the patient the reality of the situation to identify what can be changed and what cannot.Before the work of reducing fear can begin, the patient must accept the reality of the situation.
Advice the patient to practice replacing the negative thoughts with the positive ones.    Thought and emotion are related, and transitioning to a more optimistic thought can help to reduce anxiety. This also provides the patient with a different perspective on the situation.
Include the patient in the decision-making process when it comes to planning for alternative coping mechanisms.Allowing and including the patient to make decisions give the patient a sense of control and boost self-esteem.
Encourage the patient to look into any underlying emotions that may be contributing to the irrational fears. Assist the patient in understanding how addressing these feelings, rather than repressing them, can lead to improved coping abilities.Patients may benefit from verbalizing their feelings in a nonthreatening environment to help them deal with unresolved problems.    
Explain to the patient the process of thinking about the feared object or situation before it actually happens and how it can help in overcoming the fear.Patients can deal with the physical indications of fear by anticipating a future phobic reaction.
Encourage the patient to share with others about the unusual fears and emotions, including the nurse therapist.  Patients are typically afraid to express their thoughts for fear of ridicule and may have been advised repeatedly to disregard their feelings. It becomes clear that the patient’s worries are manageable once the patient begins to acknowledge and discuss them.
Encourage the patient to slow down, wait, and not to hurry out of a scary situation. Encourage the patient to use other relaxation methods.        When the patient is exposed to the fear-producing stimuli, the patient fears disorganization and loss of body and mind control. This fear causes an escape response, and reality is never tested. If the patient waits out the initial bouts of fear and reduces them with relaxation techniques, the patient is ready to face the fear.
Explore the things that may lower the patient’s level of fear and keep it under control such as singing while dressing, repeating a mantra, positive self-talk while in a fearful situation.Gives the patient a sense of control over the fear and allows the patient to be distracted so that fear is not fully concentrated on and allowed.
Expose the patient to a predefined selection of anxiety-inducing stimuli that are ranked from least frightening to most frightening.        Fear is experienced in increasingly difficult but attainable steps, allowing the patient to understand that dangerous outcomes will not occur. Helps in the elimination of the conditioned avoidance response
Advise the patient that each anxiety-inducing stimuli such as standing in an elevator should be paired with the arousal of another effect of different nature such as relaxation, exercise, or biofeedback that is strong enough to suppress fear.As the anxiety becomes less uncomfortable, it helps the patient in achieving physical and mental relaxation.  
Assist the patient in learning how to apply these alternative techniques in a real-life anxiety-provoking situation. Provide opportunities for practice (e.g., role-playing) and dealing with phobic reactions in real-life circumstances.To gain control over fear, the patient needs to be confronted on a regular basis. Practice allows the body to develop accustomed to the sensation of relaxation, allowing the patient to cope with the fearful object or scenario.  
Encourage the patient to establish more challenging goals.Confidence and progress toward increased functioning and independence are developed.

Nursing Care Plan for Anxiety 4

Social Isolation

Nursing Diagnosis: Social Isolation related to maturational crisis, fear in panic level, difficulty in interacting with others in the past, and repressed fears secondary to anxiety, as evidenced by the inability to communicate, withdrawal from others, lack of eye contact, insecurity, verbalization of feelings of rejection and estrangement.

Desired Outcomes:

  • The patient will be able to willingly participate in therapy activities with the assistance of a trustworthy support person.
  • The patient will be able to freely spend time with other patients and staff members during group activities.
  • The patient will be able to willingly seek treatment for the underlying causes of social isolation.
  • The patient will be able to develop social skills.
  • The patient will appear more confident and report a sense of greater self-worth.
Nursing Interventions for AnxietyRationale
Assess the patient’s emotions and perspectives on the situation.     .  The patient’s perspective serves as a starting point for developing a treatment plan. It reveals if the patient believes that there is control over the situation and wants to be alone, or whether the issue is beyond the patient’s control.
Convey an accepting and happy attitude to the patient when making quick and frequent encounters.An Accepting attitude boosts self-esteem and makes it easier to trust others.  
Demonstrate unwavering positive regard to the patient at all times.To express your belief in the patient as a valuable person.
Assist the patient through group activities that may be frightening or challenging for the patient.The presence of a trusted individual gives the patient emotional stability.
Always keep all promises and be truthful with the patient.A trusting relationship is built on honesty and dependability.
Respect the patient at all times. When it comes to touching, be cautious. Allow sufficient room and an exit for the patient if he becomes too agitated.Touch might be perceived as a threatening gesture by someone suffering from panic anxiety
Ensure safe administration of the patient’s tranquilizing medications as directed, and keep an eye on any negative side effects.Most patients find that taking anti-anxiety drugs for a short period of time helps them feel less anxious.
Discuss with the patient the signs of increasing anxiety, as well as ways for interrupting the response, such as breathing exercises, thought stopping, relaxation, and meditation.During times of increased anxiety, maladaptive habits develop.  
Recognize and praise the patient for the willingness shown to interact with others.Positive reinforcement boosts self-esteem and encourages people to repeat good habits.
Allow the patient to be a part of the goal-setting and care-planning process.The more actively the patient participates in the development of the care plan, the more compliant the patient will be. This also allows for as much personalization as possible of the care plan.
Assess the patient’s cognitive and physical abilities to see whether it is   interfering with the patient’s ability to socialize.    Identifying the variables that cause patients to isolate is a good place to start. Some factors are beyond the patient’s control, such as age, disease, or other diseases. These medical issues must be addressed by nurses in the care plan and guarantee the finest possible care.
Assist the patient in selecting activities that need social interaction.The patient must be exposed to these types of scenarios in order to become more comfortable in social interactions.
Allow the patient to have a large number of visitors to foster social interaction if the patient permits.Discussing matters with others might be beneficial for the patient.
Encourage the patient to have social interactions with others who have the same interests.When there is a similar interest in the topic, it may be easier for the patient to initiate and maintain a conversation with other people.

Nursing Care Plan for Anxiety 5

Self-care Deficit

Nursing Diagnosis: Self-care Deficit related to excessive ritualistic behavior, lack of knowledge, withdrawal, and unmet dependency need secondary to anxiety, as evidenced by an unwillingness to perform self-hygiene, uncombed hair, untidy clothes, offensive body odor, unwillingness to select appropriate clothing to wear, and urinary incontinence.

Desired Outcomes:

  • The patient will be able to express the willingness to be in charge of self-care activities.
  • The patient will be able to perform activities of daily living on its own safely and recognize when assistance is needed.
  • The patient will be able to identify available resources to continue to improve building independence.
InterventionRationale
Observe the patient’s self-care activities.      This establishes a baseline for how reliant the patient is and how much assistance the patient requires. The nurse can then construct a personalized care plan for the patient that emphasizes maximum independence.
Assess the patient’s ability to perform ADLs efficiently and cautiously on a daily basis, using a proper evaluation tool, such as the Functional Independence Measures (FIM).The patient may simply require assistance with some self-care activities. FIM assesses 18 different aspects of self-care, including feeding, bathing, grooming, clothing, toileting, bladder and bowel management, transfer, ambulation, and stair climbing.
Include the patient in the creation of the treatment plan.  Involving the patient in the care plan gives the patient a sense of control. If the patient was involved in the development of the plan, the patient is more likely to follow it.
Encourage the patient to perform typical activities of daily living to the best of his ability.Self-esteem is boosted when independent actions are completed successfully.  
Boost the patient’s maximum independence by encouraging the patient to be independent and intervene only when the patient is unable to perform the task.The goal of the treatment plan is to achieve the highest level of independence and the patient’s safety and comfort are the highest nursing priorities.  
Recognize and praise the patient for the accomplishments done independently.  Positive reinforcement boosts the patient’s self-esteem and encourages desired behavior to be repeated.
Assist and supervise the patient during each activity, until the patient successfully demonstrates the competence and is placed in independent care; review on a regular basis to ensure that the patient maintains the skill level and is safe in the setting.The patient’s ability to conduct self-care measures may fluctuate over time and should be evaluated on a frequent basis.    
Keep a strict record and monitor the patient’s food and fluid intake.          This will help to maintain an accurate nutritional assessment for the patient.
Determine the patient’s food preferences and regularly offer nutritious snacks and fluids to the patient between meals.           Patients are far more likely to eat foods they enjoy. Nutrition is an important part of the healing process. It is important to think about the patient’s cultural views. Some religions forbid people from eating particular foods. If the healthcare team takes into account all of these aspects, the patient is more likely to eat and heal more rapidly and the patient may have a hard time tolerating large amounts of foods and mealtimes and may therefore need additional nourishment through snacks and fluids.
Determine the cause of the patient’s poor self-care.          The foundation of the care plan is the reason for the lack of self-care. Knowing why the patient is unable to perform self-care allows the nurse to concentrate on the source of the problem and work to improve it. Mental health issues such as dementia or schizophrenia, for example, can be medically treated, and thus the self-care process can be enhanced.
Arrange a routine with the patient and allow the patient to have an adequate time in completing the tasks.  Routines provide a sense of safety. Knowing the repeating individual steps of a specific process gives the patient a lot more confidence.
Encourage the patient to express feelings, fears, and frustrations.    The patient may be in a new situation or experiencing a worsening condition that requires change. Allowing the patient to vent negative emotions may provide relief and allow the healing process to begin.

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. (2022). 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.

Nursing Stat Facts
Nursing Stat Facts

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

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