Anxiety is a vague feeling of dread or apprehension (uneasiness); it is the activation of the autonomic nervous system in response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms. In contrast, fear is the feeling of apprehension over a specific threat or danger to a person.
Anxiety disorders comprise a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiologic responses. People suffering from anxiety disorders can demonstrate unusual behaviors such as panic without reason, unwarranted fear of objects, or unexplainable or unwavering worry. They experience significant distress over time, and the disorder significantly impairs their daily routines, social lives, and occupational functioning.
Anxiety disorders are diagnosed when anxiety no longer function as a signal of danger or a motivation for needed change but becomes chronic and permeates major portions of the person’s life, resulting in maladaptive behaviors and emotional disability.
Panic disorder is composed of discrete episodes of panic attacks usually of 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiologic discomfort. It is diagnosed when the person has recurrent, unexpected panic attacks followed by at least one month of persistent concern or worry about future attacks or their meaning or significant behavioral change related to them.
Nursing Care Plans
Nurses encounter anxious clients and families in a variety of situations. The nurse must first assess the person’s anxiety level because this determines what interventions are likely to be effective. Treatment of anxiety disorders usually involves medication and therapy. A combination of both produces better results than either one alone. When working with an anxious person, the nurse must be aware of her own anxiety level. It is easy for the nurse to become easily anxious – remaining calm and in control is essential if the nurse is going to work effectively with the client.
Nursing care planning goals for clients with anxiety disorders typically include reducing anxiety levels, promoting self-care, improving coping skills, enhancing social support, and encouraging treatment compliance.
The following are seven (7) nursing care plans (NCP) and nursing diagnoses (NDx) for patients with anxiety and panic disorders:
- Anxiety
- Fear
- Ineffective Coping
- Powerlessness
- Social Isolation
- Self-Care Deficit
- Deficient Knowledge
Anxiety
Anxiety nursing diagnosis is appropriate for patients with anxiety disorders due to various factors, including lack of knowledge about their condition, actual threats to their physical health, unconscious conflicts related to their values and goals, and situational crises that trigger their anxiety symptoms. Clients with anxiety may experience physiological symptoms such as increased heart rate and blood pressure, which can lead to further anxiety and distress. By addressing these underlying factors, nurses can provide targeted interventions and education that help patients manage their anxiety and improve their overall quality of life.
Nursing Diagnosis
- Anxiety
May be related to
- Lack of knowledge regarding symptoms, progression of the condition, and treatment regimen.
- An actual or perceived threat to biological integrity.
- Unconscious conflict about essential values and goals of life.
- Situational and maturational crises.
Possibly evidenced by
- Decreased attention span
- Restlessness
- Poor impulse control
- Hyperactivity, pacing
- Feelings of discomfort, apprehension, or helplessness
- Delusions
- Disorganized thought process
- Inability to discriminate harmful stimuli or situations
Desired Outcomes
- The client will be free from injury
- The client will discuss feelings of dread, anxiety, and so forth
- The client will respond to relaxation techniques with a decreased anxiety level.
- The client will reduce own anxiety level.
- The patient will be free from anxiety attacks.
Nursing Assessment and Rationales
1. Assess physical and behavioral symptoms of anxiety, such as increased heart rate, sweating, and restlessness.
Anxiety also plays a role in somatoform disorders, which are characterized by physical symptoms such as pain, nausea, weakness, or dizziness that have no apparent physical cause.
2. Assess the patient’s anxiety triggers, including situational factors and personal history.
To identify the specific causes or situations that are contributing to the patient’s anxiety.
Nursing Interventions and Rationales
1. Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions directly, offering unconditional acceptance; being available, and respecting the client’s use of personal space.
Therapeutic skills need to be directed toward putting the client at ease, because the nurse who is a stranger may pose a threat to the highly anxious client.
2. Maintain a calm, non-threatening manner while working with the client.
Anxiety is contagious and may be transferred from the healthcare provider to the client or vice versa. The client develops a feeling of security in presence of a calm staff person.
3. Remain with the client at all times when levels of anxiety are high (severe or panic); reassure the client of his or her safety and security.
The client’s safety is an utmost priority. A highly anxious client should not be left alone as his anxiety will escalate.
4. Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.)
Anxious behavior escalates by external stimuli. A smaller or secluded area enhances a sense of security as compared to a large area which can make the client feel lost and panicked.
5. Provide reassurance and comfort measures.
Helps relieve anxiety.
6. Educate the patient and/or SO that anxiety disorders are treatable.
Pharmacological therapy is an effective treatment for anxiety disorders, these may include antidepressants and anxiolytics.
7. Support the client’s defenses initially.
The client uses defenses in an attempt to deal with an unconscious conflict, and giving up these defenses prematurely may cause increased anxiety.
8. Maintain awareness of your own feelings and level of discomfort.
Anxiety is communicated interpersonally. Being with an anxious client can raise your own anxiety level. Discussion of these feelings can provide a role model for the client and show a different way of dealing with them.
9. Stay with the client during panic attacks. Use short, simple directions.
During a panic attack, the patient needs reassurance that he is not dying and the symptoms will resolve spontaneously. In anxiety, the client’s ability to deal with abstractions or complexity is impaired.
10. Avoid asking or forcing the client to make choices.
The client may not make sound and appropriate decisions or may be unable to make decisions at all.
11. Instruct the client that PRN medications may be indicated for high levels of anxiety. Watch out for adverse side effects.
Medication may be necessary to decrease anxiety to a level at which the client can feel safe.
12. Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation, and so forth.
Relaxation exercises are effective nonchemical ways to reduce anxiety.
13. Teach signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep-breathing exercises, physical exercises, brisk walks, jogging, meditation).
By recognizing the early signs of escalating anxiety, patients can learn how to manage the symptoms and prevent them from becoming more severe, which gives the patients confidence in having control over his/her anxiety.
14. Administer SSRIs as ordered.
Panic attacks are caused by a neuropsychiatric disorder that responds to SSRI antidepressants.
15. Help the client see that mild anxiety can be a positive catalyst for change and does not need to be avoided.
The client may feel that all anxiety is bad and not useful.
16. Cognitive-behavioral therapy (further discussed here)
- 16.1. Positive reframing
Turning negative messages into positive ones. - 16.2. Decatastrophizing
It involves the therapist’s use of questions to appraise the situation. It is also called the “what if” technique because the worst-case scenario is confronted by asking a “what if” question. - 16.3. Assertiveness training
Helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance.
17. When the level of anxiety has been reduced, explore with the client the possible reasons for the occurrence.
Recognition of precipitating factors is the first step in teaching the client to interrupt the escalation of anxiety.
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans for mental health and psychiatric nursing:
- Alcohol Withdrawal | 5 Care Plans
- Anxiety and Panic Disorders | 7 Care Plans
- Bipolar Disorders | 6 Care Plans
- Major Depression | 9 Care Plans
- Personality Disorders | 4 Care Plans
- Schizophrenia | 6 Care Plans
- Sexual Assault | 1 Care Plan
- Substance Dependence and Abuse | 8 Care Plans
- Suicide Behaviors | 3 Care Plans
Are nurses eligible to give mandala coloring activities to inpatients and college students for anxiety and stress
I just came over this, though this has been asked 3 years ago yet. Yes, I would say it can help them. I had my students do their own mandala and they commented that doing it has helped them with their stress and anxieties especially during this lockdown and pandemic.
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