Anxiety Nursing Diagnosis Care Plan

Last updated on June 23rd, 2023 at 09:07 am

An anxiety disorder is a mental health condition characterized by excessive and persistent feelings of fear, worry, and apprehension.

It is more than just feeling anxious or stressed in certain situations. Anxiety disorders interfere with a person’s daily life and can significantly impact their ability to function normally.

There are several types of anxiety disorders, including:

1. Generalized Anxiety Disorder (GAD): People with GAD experience excessive and uncontrollable worry about various aspects of life, such as work, relationships, health, and everyday situations. This worry is often disproportionate to the actual threat.
2. Panic Disorder: This disorder involves recurrent and unexpected panic attacks, which are intense periods of overwhelming fear and physical discomfort. Panic attacks can be accompanied by symptoms such as a racing heart, shortness of breath, trembling, sweating, and a sense of impending doom.
3. Social Anxiety Disorder (Social Phobia): Individuals with social anxiety disorder have an intense fear of social situations and being scrutinized or judged by others. They may feel excessively self-conscious and avoid social interactions as a result.
4. Specific Phobias: These are intense and irrational fears of specific objects, situations, or activities, such as heights, spiders, flying, or public speaking. When confronted with their phobia, individuals may experience extreme anxiety or panic attacks.
5. Obsessive-Compulsive Disorder (OCD): OCD involves intrusive thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions). People with OCD may feel driven to perform these rituals to alleviate anxiety or prevent a feared outcome.
6. Post-Traumatic Stress Disorder (PTSD): PTSD can develop after experiencing or witnessing a traumatic event. Symptoms include flashbacks, nightmares, severe anxiety, and avoidance of reminders associated with the trauma.

Anxiety disorders can be caused by a combination of genetic, environmental, and neurological factors.

They are treatable conditions, and various treatment options are available, including therapy (such as cognitive-behavioral therapy) and medications (such as selective serotonin reuptake inhibitors).

Signs and Symptoms of Anxiety

Excessive Worry: Feeling a constant sense of worry or dread that is difficult to control, often about multiple aspects of life, such as work, health, relationships, or everyday situations.

Restlessness: Feeling restless or on edge, being unable to relax, and having a constant feeling of tension or unease.

Fatigue: Feeling tired, lacking energy, and experiencing a general sense of exhaustion, even without engaging in physically or mentally strenuous activities.

Difficulty Concentrating: Finding it challenging to focus or concentrate on tasks due to racing thoughts or preoccupation with worries.

Irritability: Feeling easily irritated, agitated, or on edge, and having a decreased tolerance for things that wouldn’t typically bother you.

Muscle Tension: Physical symptoms such as muscle tension, aches, or soreness. It may manifest as tension headaches, jaw clenching, or aches in the neck, back, or shoulders.

Sleep Problems: Having trouble falling asleep, staying asleep, or experiencing restless and unsatisfying sleep. Anxiety can lead to racing thoughts or nightmares that disrupt sleep patterns.

Changes in Appetite: Experiencing changes in appetite, such as loss of appetite or overeating, due to the impact of anxiety on the digestive system.

Excessive Sweating: Experiencing increased perspiration, even in non-strenuous situations or at moderate temperatures.

Racing Heart: Feeling a rapid or pounding heartbeat, heart palpitations, or experiencing chest discomfort or tightness.

Shortness of Breath: Having difficulty catching your breath or feeling like you cannot take a deep breath. This can contribute to a feeling of suffocation or a sense of impending doom.

Gastrointestinal Issues: Anxiety can manifest in the form of gastrointestinal problems such as stomachaches, nausea, diarrhea, or irritable bowel syndrome (IBS).

Causes of Anxiety

Genetics: There is evidence to suggest that certain genetic factors can increase the risk of developing anxiety disorders. People with a family history of anxiety or other mental health conditions may be more predisposed to experiencing anxiety themselves.

Brain Chemistry: Neurotransmitters, which are chemical messengers in the brain, play a role in regulating mood and anxiety. Imbalances or abnormalities in neurotransmitters like serotonin, dopamine, and gamma-aminobutyric acid (GABA) may contribute to the development of anxiety disorders.

Environmental Factors: Traumatic events, such as physical or emotional abuse, the loss of a loved one, or witnessing a traumatic incident, can trigger anxiety disorders. Chronic stress from ongoing life challenges, such as work pressure, relationship difficulties, or financial problems, can also contribute to the development of anxiety.

Personality Traits: Certain personality traits may increase the vulnerability to anxiety disorders. Individuals who are naturally more cautious, perfectionistic, or prone to negative thinking patterns may be at a higher risk.

Medical Conditions: Some medical conditions, such as thyroid disorders, heart disease, respiratory conditions, and chronic pain, have been associated with an increased risk of anxiety disorders. Additionally, the use of certain medications or substances, including caffeine, nicotine, and illicit drugs, can also contribute to anxiety symptoms.

Childhood Experiences: Adverse experiences during childhood, such as neglect, abuse, or significant life changes, can have a lasting impact on mental health. Childhood trauma is often linked to the development of anxiety disorders later in life.

Personality Disorders: Certain personality disorders, such as obsessive-compulsive personality disorder or avoidant personality disorder, have strong associations with anxiety disorders.

Expected Outcomes for Anxiety

Reduction of Anxiety Levels: The primary goal is to help the individual reduce their anxiety levels to a manageable or normal range. This may involve implementing relaxation techniques, providing emotional support, and teaching coping mechanisms.

Increased Coping Skills: The individual should develop or enhance their coping skills to manage anxiety effectively. This includes teaching relaxation exercises, deep breathing techniques, mindfulness, and stress management strategies.

Improved Emotional Well-being: The aim is for the person to experience improved emotional well-being and a sense of calm. This may involve exploring and addressing underlying emotional issues and promoting self-care practices.

Enhanced Problem-Solving Abilities: Helping the individual develop problem-solving skills can improve their ability to confront and overcome anxiety-provoking situations. This may involve teaching effective problem-solving techniques and encouraging the person to identify and challenge irrational thoughts or beliefs.

Increased Knowledge and Understanding: Educating the individual about anxiety and its management can empower them to take an active role in their own care. Providing information about the nature of anxiety, its triggers, and available treatment options can help them make informed decisions and actively participate in their recovery.

Reduction of Physical Symptoms: Anxiety often manifests with physical symptoms, such as muscle tension, headaches, and gastrointestinal distress. The expected outcome is a reduction in these physical symptoms through relaxation techniques, stress reduction, and medication management, if necessary.

Improved Social Functioning: Anxiety can impact a person’s ability to engage in social activities and maintain relationships. The expected outcome is an improvement in social functioning, such as increased participation in social interactions, reduced avoidance of social situations, and enhanced communication skills.

Prevention of Anxiety Exacerbation: Teaching the individual how to recognize early signs of escalating anxiety and providing them with tools to prevent further exacerbation of anxiety is an important expected outcome. This may involve developing personalized strategies and an action plan to address anxiety triggers and implement appropriate interventions.

Nursing Assessment and Rationales for Anxiety

Nursing assessment for anxiety involves gathering comprehensive information about the individual’s physical, emotional, and psychological well-being.

The assessment helps identify the underlying causes and manifestations of anxiety. Here are some key areas to assess and the rationales behind them:

1. Subjective Assessment:
   • Gather a detailed history of the individual’s anxiety symptoms, including the duration, intensity, and frequency of anxiety episodes.
   • Assess the individual’s perception of anxiety triggers and any specific situations or activities that exacerbate their anxiety. Rationale: Understanding the individual’s subjective experience of anxiety helps tailor interventions and identify specific triggers for anxiety episodes.
2. Objective Assessment:
   • Observe the individual’s physical appearance and behavior for signs of anxiety, such as restlessness, fidgeting, increased heart rate, sweating, or hyperventilation.
   • Assess the individual’s vital signs, including blood pressure, heart rate, and respiratory rate. Rationale: Objective assessment helps confirm the presence of anxiety symptoms and provides baseline data for evaluating the effectiveness of interventions.
3. Mental Health Assessment:
   • Assess the individual’s overall mental health status, including their mood, affect, and level of distress.
   • Evaluate the individual’s cognitive function and thought patterns, including any intrusive or irrational thoughts associated with anxiety. Rationale: A comprehensive mental health assessment helps determine the severity of anxiety, identify co-existing mental health conditions, and guide appropriate treatment interventions.
4. Assessment of Coping Mechanisms:
   • Explore the individual’s current coping strategies for managing anxiety, such as relaxation techniques, social support, or engaging in activities that provide a sense of calm.
   • Assess the effectiveness of their coping mechanisms and identify any maladaptive coping patterns, such as substance abuse or avoidance behaviors. Rationale: Understanding the individual’s coping mechanisms helps guide nursing interventions and identify areas where additional support or education may be needed.
5. Social Assessment:
   • Assess the individual’s social support system, including family, friends, and significant others.
   • Identify any significant life stressors, recent changes, or relationship issues that may contribute to or worsen anxiety. Rationale: Social assessment provides insights into the individual’s support network, potential sources of stress, and opportunities for involving family or loved ones in the care and support process.
6. Physical Assessment:
   • Perform a thorough physical examination to rule out any physical health conditions that may contribute to or mimic anxiety symptoms.
   • Pay particular attention to signs of co-existing medical conditions, such as cardiovascular or respiratory problems, that can exacerbate anxiety. Rationale: Identifying and addressing any physical health concerns is essential for comprehensive care and determining appropriate interventions for managing anxiety.

Nursing Interventions and Rationales for Anxiety

1. Therapeutic Communication:
   • Establish a trusting and non-judgmental relationship with the individual.
   • Use active listening techniques and provide empathy and validation. Rationale: Therapeutic communication creates a safe and supportive environment, allowing the individual to express their concerns and emotions, which can help reduce anxiety and promote a sense of understanding and validation.
2. Education on Anxiety Management:
   • Provide information about anxiety, its causes, and common symptoms.
   • Teach relaxation techniques, deep breathing exercises, and mindfulness practices. Rationale: Educating individuals about anxiety helps increase their understanding of the condition, empowering them to actively participate in their own care. Teaching relaxation techniques provides practical tools for managing anxiety symptoms.
3. Cognitive-Behavioral Techniques:
   • Assist the individual in identifying and challenging irrational thoughts and beliefs associated with anxiety.
   • Teach problem-solving skills and positive self-talk. Rationale: Cognitive-behavioral techniques help individuals reframe negative thinking patterns and develop more adaptive thoughts and behaviors, reducing anxiety and improving coping skills.
4. Encouraging Physical Activity:
   • Promote regular physical exercise and engage in activities that promote relaxation, such as yoga or walking.
   • Encourage participation in recreational activities and hobbies. Rationale: Physical activity and engaging in enjoyable activities help release endorphins, improve mood, reduce stress, and provide a distraction from anxiety symptoms.
5. Relaxation Techniques:
   • Teach progressive muscle relaxation, guided imagery, or other relaxation techniques.
   • Encourage the use of calming sensory stimuli, such as soft music, aromatherapy, or soothing visuals. Rationale: Relaxation techniques activate the body’s relaxation response, reducing physiological arousal and promoting a sense of calmness and well-being.
6. Medication Management:
   • Collaborate with the healthcare team to administer prescribed medications for anxiety, such as anxiolytics or antidepressants.
   • Monitor and assess the individual’s response to medication and any side effects. Rationale: Medications may be prescribed to manage severe or chronic anxiety symptoms. Nursing interventions include proper administration, monitoring for therapeutic effects, and identifying and managing potential side effects.
7. Encouraging Social Support:
   • Facilitate the involvement of family and friends in the individual’s support network.
   • Encourage participation in support groups or counseling services. Rationale: Social support can provide emotional validation, practical assistance, and a sense of belonging, reducing feelings of isolation and enhancing the individual’s coping abilities.
8. Creating a Calming Environment:
   • Ensure a quiet, comfortable, and well-lit environment.
   • Reduce environmental stimuli that may contribute to anxiety, such as noise or excessive activity. Rationale: Creating a calm and soothing environment helps reduce external triggers and promotes relaxation and a sense of security.

More Nursing Diagnoses that can be used for Anxiety

In addition to the nursing diagnosis of Anxiety, there are several other nursing diagnoses that can be relevant for individuals experiencing anxiety. Here are some examples:

Ineffective Coping: This diagnosis is appropriate when the individual demonstrates difficulty in managing stress and anxiety. It may manifest as maladaptive coping strategies, a lack of effective problem-solving skills, or an inability to utilize available resources to alleviate anxiety.

Disturbed Sleep Pattern: Anxiety can disrupt normal sleep patterns, leading to difficulties falling asleep, staying asleep, or experiencing restful sleep. This diagnosis is used when there is evidence of sleep disturbances related to anxiety.

Impaired Social Interaction: Anxiety can interfere with an individual’s ability to engage in social interactions, leading to isolation, avoidance, or difficulty forming and maintaining relationships. This diagnosis is appropriate when anxiety significantly impacts the individual’s social functioning.

Risk for Injury: Anxiety can contribute to impaired concentration, restlessness, or hypervigilance, increasing the risk of accidents or self-harm. This diagnosis is used when there is a potential risk of harm to the individual due to anxiety-related behaviors.

Ineffective Coping: Family/Caregiver: This diagnosis focuses on the impact of an individual’s anxiety on their family or caregivers. It considers the emotional and practical challenges faced by family members or caregivers in supporting the individual with anxiety.

Self-Care Deficit: Anxiety can hinder an individual’s ability to perform self-care activities, such as grooming, hygiene, or maintaining a balanced diet. This diagnosis is used when there is evidence of compromised self-care due to anxiety symptoms.

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. 

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. 

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

Best Nursing Books and Resources

These are the nursing books and resources that we recommend.

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The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care

This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.

This handbook has been updated with NANDA-I approved Nursing Diagnoses that incorporates NOC and NIC taxonomies and evidenced based nursing interventions and much more.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023

All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.

Nursing Care Plans: Nursing Diagnosis and Intervention

It contains more than 200 care plans that adhere to the newest evidence-based recommendations.

Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.