Anxiety is a vague feeling of dread or apprehension (uneasiness); it is the activation of the autonomic nervous system in response to an 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 the 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.
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.
The following are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for patients with anxiety and panic disorders:
Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
May be related to
- lack of knowledge regarding symptoms, progression of condition, and treatment regimen.
- actual or perceived threat to biologic integrity.
- unconscious conflict about essential values and goals of life.
- Situational and maturational crises.
Possibly evidenced by
- Decreased attention span
- Poor impulse control
- Hyperactivity, pacing
- Feelings of discomfort, apprehension or helplessness
- Disorganized thought process
- Inability to discriminate harmful stimuli or situations
- Be free from injury
- Discuss feelings of dread, anxiety, and so forth
- Respond to relaxation techniques with a decreased anxiety level.
- Reduce own anxiety level.
- Be free from anxiety attacks.
|Maintain a calm, non threatening manner while working with the client.||Anxiety is contagious and may be transferred from health care provider to client or vice versa. Client develops feeling of security in presence of calm staff person.|
|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.|
|Remain with the client at all times when levels of anxiety are high (severe or panic); reassure client of his or her safety and security.||The client’s safety is utmost priority. A highly anxious client should not be left alone as his anxiety will escalate.|
|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.|
|Maintain calmness in your approach to the client.||The client will feel more secure if you are calm and inf the client feels you are in control of the situation.|
|Provide reassurance and comfort measures.||Helps relieve anxiety.|
|Educate the patient and/or SO that anxiety disorders are treatable.||Pharmacological therapy is an effective treatment for anxiety disorders; treatment regimen may include antidepressants and anxiolytics.|
|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.|
|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.|
|Stay with the patient 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.|
|Avoid asking or forcing the client to make choices.||The client may not make sound and appropriate decisions or may unable to make decisions at all.|
|Observe for increasing anxiety. Assume a calm manner, decrease environmental stimulation, and provide temporary isolation as indicated.||Early detection and intervention facilitate modifying client’s behavior by changing the environment and the client’s interaction with it, to minimize the spread of anxiety.|
|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.|
|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.|
|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).||So the client can start using relaxation techniques; gives the client confidence in having control over his anxiety.|
|Administer SSRIs as ordered.||Panic attacks are caused by neuropsychiatric disorder that responds to SSRI antidepressants.|
|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.|
|Cognitive-behavioral therapy (further discussed here)|
|Positive reframing||Turning negative messages into positive ones.|
|Decatastrophizing||It involves the therapist’s use of questions to more realistically appraise the situation. It is also called the “what if” technique because the worst case scenario is confronted by asking a “what if” question.|
|Assertiveness training||Helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance.|
|When level of anxiety has been reduced, explore with the client the possible reasons for occurrence.||Recognition of precipitating factors is the first step in teaching client to interrupt escalation of anxiety.|
|Encourage client to talk about traumatic experience under nonthreatening conditions. Help client work through feelings of guilt related to the traumatic event. Help client understand that this was an event to which most people would have responded in like manner. Support client during flashbacks of the experience.||Verbalization of feelings in a nonthreatening environment may help client come to terms with unresolved issues.|
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Mental Health and Psychiatric Care Plans
Care plans about mental health and psychiatric nursing: