7 Anxiety and Panic Disorders Nursing Care Plans

ADVERTISEMENTS

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.

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.

ADVERTISEMENTS

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: 

  1. Anxiety
  2. Fear
  3. Ineffective Coping
  4. Powerlessness
  5. Social Isolation
  6. Self-Care Deficit
  7. Deficient Knowledge
ADVERTISEMENTS

Fear

Nursing Diagnosis

  • Fear

May be related to

ADVERTISEMENTS
  • Phobic stimulus
  • Physiological symptoms, mental/cognitive behaviors indicative of panic

Possibly evidenced by

  • Acknowledge and discuss fears.
  • Demonstrate understanding through use of effective coping behaviors and active participation in treatment regimen.
  • Resume normal life activities.

Desired Outcomes

  • Client will be able to discuss phobic object or situation with the nurse.
  • Client will be able to function in presence of phobic object or situation without experiencing panic anxiety by time of discharge from treatment.
Nursing InterventionsRationale
Reassure client of his safety and security.At panic level anxiety, client may fear for own life.
Explore client’s perception of threat to physical integrity or threat to self-concept.It is important to understand the client’s perception of the phobic object or situation in order to assist with the desensitization process.
Present and discuss reality of the situation with client in order to recognize aspects that can be changed and those that cannot.Client must accept the reality of the situation before the work of reducing the fear can progress.
Suggest that the client substitute positive thoughts for negative ones.Emotion connected to thought, and changing to a more positive thought can decrease the level of anxiety experienced. This also gives the client an alternative way of looking at the problem.
Include client in making decisions related to selection of alternative coping strategies.Allowing the client choices provides a measure of control and serves to increase feelings of self-worth.
Encourage client to explore underlying feelings that may be contributing to irrational fears. Help client to understand how facing these feelings, rather than suppressing them, can result in more adaptive coping abilities.Verbalization of feelings in a nonthreatening environment may help client come to terms with unresolved issues.
Discuss the process of thinking about the feared object/situation before it occurs.Anticipation of a future phobic reaction allows client to deal with the physical manifestations of fear.
Encourage client to share the seemingly unnatural fears and feelings with others, especially the nurse therapist.Clients are often reluctant to share feelings for fear of ridicule and may have repeatedly been told to ignore feelings. Once the client begins to acknowledge and talk about these fears, it becomes apparent that the feelings are manageable.
Encourage to stop, wait, and not rush out of feared situation as soon as experienced. Support use of relaxation exercises.Client fears disorganization and loss of control of body and mind when exposed to the fear producing stimulus.This fear leads to an avoidance response, and reality is never tested. If client waits out the beginnings of anxiety and decreases it with relaxation exercises, then she or he may be ready to continue confronting the fear.
Explore things that may lower fear level and keep it manageable (e.g. singing while dressing, repeating a mantra, practicing positive self-talk while in a fearful situation).Provides the client with a sense of control over the fear. Distracts the client so that fear is not totally focused on and allowed to escalate.
Use desensitization approach:
  • Systematic desensitization
Systematic desensitization (gradual systematic exposure of the client to the feared situation under controlled conditions) allows the client to begin to overcome the fear, become desensitized to the fear. Note: Implosion or flooding (continuous, rapid presentation of the phobic stimulus) may show quicker results than systematic desensitization, but relapse is more common, or client may become terrified and withdraw from therapy.
  • Expose client to a predetermined list of anxiety-provoking stimuli rated in hierarchy from the least frightening to the most frightening.
Experiencing fear in progressively more challenging but attainable steps allows client to realize that dangerous consequences will not occur. Helps extinguish conditioned avoidance response
  • Pair each anxiety-producing stimulus (e.g. standing in an elevator) with arousal of another affect of an opposite quality (e.g. relaxation, exercise,biofeedback) strong enough to suppress anxiety.
Helps client to achieve physical and mental relaxation as the anxiety becomes less uncomfortable.
  • Help client to learn how to use these techniques when confronting an actual anxiety-provoking situation. Provide for practice sessions (e.g.role-play), deal with phobic reactions in real- life situations.
Client needs continued confrontation to gain control over fear. Practice helps the body become accustomed to the feeling of relaxation, enabling the individual to handle feared object/situation.
Encourage client to set increasingly more difficult goals.Develops confidence and movement toward improved functioning and independence.
Administer antianxiety medications as indicated; watch out for any adverse side effects
Benzodiazepines:

 

  • Alprazolam (Xanax),
  • Clonazepam (Klonopin),
  • diazepam (Valium),
  • lorazepam (Ativan)
  • chlordiazepoxide (Librium),
  • oxazepam (Serax)
Biological factors may be involved in phobic/panic reactions, and these medications (particularly Xanax) produce a rapid calming effect and may help client change behavior by keeping anxiety low during learning and desensitization sessions. Addictive tendencies of CNS depressants need to be weighed against benefit from the medication.
ADVERTISEMENTS

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

ADVERTISEMENTS

See also

Other recommended site resources for this nursing care plan:

Other care plans for mental health and psychiatric nursing:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
  • 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.

  • >