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.
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.
May be related to
- 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.
- 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.
|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 (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.|
||Experiencing fear in progressively more challenging but attainable steps allows client to realize that dangerous consequences will not occur. Helps extinguish conditioned avoidance response|
||Helps client to achieve physical and mental relaxation as the anxiety becomes less uncomfortable.|
||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|
|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.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
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