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, according to the American Psychiatric Association, are the most common type of psychiatric disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. These disorders include the following:
- Separation anxiety disorders. An individual with separation anxiety disorder displays anxiety and fear atypical for his/her age and development level of separation from attachment figures. Although the symptoms develop in childhood, they can be expressed throughout adulthood as well (Chand & Marwaha, 2022).
- Selective mutism. This disorder is characterized by a consistent failure to speak in social situations where there is an expectation to speak even though the individual speaks in other circumstances, can speak, and comprehends spoken language (Chand & Marwaha, 2022).
- Specific phobia. Individuals with specific phobias are fearful or anxious about specific objects or situations which they avoid or endure with intense fear or anxiety. The fear, anxiety, and avoidance are almost always immediate and tend to be persistently out of proportion to the actual danger posed by the specific object or situation (Chand & Marwaha, 2022).
- Social anxiety disorder. This disorder is characterized by marked or intense fear or anxiety of social situations in which one could be the subject of scrutiny.
- Panic disorder. Individuals with this disorder experience recurrent, unexpected panic attacks and experience persistent concern and worry about having another panic attack. Panic attacks are abrupt surges of intense fear or extreme discomfort that reach a peak within minutes, accompanied by physical and cognitive symptoms (Chand & Marwaha, 2022).
- Agoraphobia. Individuals with this disorder are fearful and anxious in two or more of the following circumstances: using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, or being outside of the home alone (Chand & Marwaha, 2022).
- Generalized anxiety disorder. The key feature of this disorder is persistent and excessive worry about various domains, including work and school performance, that the individual finds hard to control (Chand & Marwaha, 2022).
- Substance/medication-induced anxiety disorder. This disorder involves anxiety symptoms due to substance intoxication or withdrawal or medical treatment.
- Anxiety disorder due to other medical conditions. Anxiety symptoms are the physiological consequence of another medical condition (Chand & Marwaha, 2022).
Anxiety disorders are diagnosed when anxiety no longer functions as a signal of danger or motivation for needed change but becomes chronic and permeates major portions of the person’s life, resulting in maladaptive behaviors and emotional disability.
Anxiety disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interacts with situations, stress, or trauma to produce clinically significant syndromes (Bhatt & Bienenfeld, 2019).
Anxiety disorders have high rates of comorbidity with major depression and alcohol and drug abuse. Severe anxiety disorders may be complicated by suicide, with or without secondary mood disorders. Anxiety disorders occur more frequently in females than in males with an approximate 2:1 ratio (Chand & Marwaha, 2022).
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 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 clients with anxiety and panic disorders:
- Ineffective Coping
- Social Isolation
- Self-Care Deficit
- Deficient Knowledge
Fear is an automatic neurophysiological state of alarm characterized by a fight or flight response to a cognitive appraisal of present or imminent danger (Chand & Marwaha, 2022). Clients with anxiety disorders experience fear as a nursing diagnosis related to phobic stimulus and physiological symptoms and mental behaviors because their bodies and minds react in a heightened state of arousal in response to perceived threats or triggers. This can lead to avoidance behaviors and physical symptoms such as sweating and trembling, which can further exacerbate their anxiety.
May be related to
- Phobic stimulus
- Physiological symptoms, and mental/cognitive behaviors indicative of panic
Possibly evidenced by
- Feelings of paranoia
- Apprehensions; agitation
- Excessive sweating, increased heart rate
- The client will be able to discuss phobic objects or situations with the nurse.
- The client will be able to function in presence of a phobic object or situation without experiencing panic anxiety by the time of discharge from treatment.
Nursing Assessment and Rationales
1. Determine the type of the client’s fear by thorough, rational questioning and active listening.
Active listening and thorough questioning promote trust and rapport between the client and the nurse. This, in turn, can encourage clients to be more open and honest about symptoms and feelings, which can lead to more effective treatment and improved outcomes. Anxiety is linked to fear and manifests as a future-oriented mood state that consists of a complex cognitive, affective, physiological, and behavioral response system associated with preparation for the anticipated events or circumstances perceived as threatening (Chand & Marwaha, 2022).
2. Explore the client’s perception of a threat to physical integrity or a threat to self-concept.
It is important to understand the client’s perception of the phobic object or situation to assist with the desensitization process. Triggers of panic can include injury, illness, interpersonal conflict or loss, use of cannabis, use of stimulants (caffeine, decongestants, cocaine), certain settings such as stores and public transportation, use of sertraline, and the SSRI discontinuation syndrome (Bhatt & Bienenfeld, 2019).
Nursing Interventions and Rationales
1. Present and discuss the reality of the situation with the client to recognize aspects that can be changed and those that cannot.
The client must accept the reality of the situation before the work of reducing the fear can progress. Anxiety disorders often involve excessive and persistent worry about future events or past experiences, which can lead to a sense of disconnection from the present moment. Additionally, clients with anxiety disorder tend to ruminate, focusing on negative thoughts and worrying about things that may or may not happen in the future.
2. Reassure the client of his safety and security.
At panic-level anxiety, the client may fear for their own life. Reassure and calm the client. Untreated panic attacks can subside spontaneously within 20 to 30 minutes, especially with reassurance and a calming environment (Bhatt & Bienenfeld, 2019).
3. Suggest that the client substitute positive thoughts for negative ones.
Emotion is 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. By accepting these emotions, the client can learn to regulate their emotional responses and develop more effective coping strategies.
4. Include the client in making decisions related to the selection of alternative coping strategies.
Allowing the client choices provides a measure of control and serves to increase feelings of self-worth. This sense of control can reduce anxiety symptoms, as clients feel more empowered and better able to manage their anxiety. Additionally, when the client is involved in decision-making, healthcare providers can personalize treatment plans to meet the client’s unique needs, resulting in effective treatment.
5. Encourage the client to explore underlying feelings that may be contributing to irrational fears. Helping the client to understand how facing these feelings, rather than suppressing them, can result in more adaptive coping abilities.
Verbalization of feelings in a non-threatening environment may help the client come to terms with unresolved issues. The nurse may give the client a broad opening during conversations. Therapeutic communication is often most effective when clients direct the flow of the conversation and decide what to talk about. To that end, giving the client a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” can be a good way to allow the client an opportunity to discuss their feelings (Rivier University, 2023).
6. Discuss the process of thinking about the feared object/situation before it occurs.
Anticipation of a future phobic reaction allows the client to deal with the physical manifestations of fear. Exposure can take several forms including imaginal, in vivo, and interoceptive. In vivo exposure involves a gradual approach to places, objects, people, or situations that were previously avoided although they are safe. Interoceptive exposure involves deliberately inducing physical sensations the client fears are indicative of a panic attack (Kaczkurkin & Foa, 2022).
7. Encourage the client to share 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. The client may be more likely to open up about their fears if they feel comfortable and safe with their nurse therapist. It is essential to establish a trusting relationship by being empathetic, non-judgmental, and validating their experiences.
8. Encourage to stop, wait, and not rush out of feared situations as soon as experienced. Support the use of relaxation exercises.
The 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 the 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.
9. 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).
This provides the client with a sense of control over the fear. It also distracts the client so that fear is not focused on and is allowed to escalate. Distraction techniques are often used along with other coping mechanisms. The client may try to control their breathing, use entertainment such as reading or watching TV, engage in a relaxation technique, or participate in a creative pursuit (Star, 2020).
10. Use a desensitization approach:
- 10.1. 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 and 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 the client may become terrified and withdraw from therapy.
- 10.2. Expose the client to a predetermined list of anxiety-provoking stimuli rated in a hierarchy from the least frightening to the most frightening.
Experiencing fear in progressively more challenging but attainable steps allows the client to realize that dangerous consequences will not occur. This helps extinguish conditioned avoidance responses. Systematic desensitization begins with imaginary exposure to feared situations. The client uses their anxiety hierarchy to break down the feared situation into manageable components (Ankrom, 2020).
- 10.3. Pair each anxiety-producing stimulus (e.g. standing in an elevator) with the arousal of another effect of an opposite quality (e.g. relaxation, exercise, biofeedback) strong enough to suppress anxiety.
This helps the client to achieve physical and mental relaxation as the anxiety becomes less uncomfortable. For example, the client may stand in the checkout line, which could be their highest fear response. Then the client starts to focus on the action that causes the least amount of distress and then works their way up (Ankrom, 2020).
- 10.4. Help the client to learn how to use these techniques when confronting an actual and anxiety-provoking situation. Provide practice sessions (e.g.role-play) to deal with the phobic reactions in real-life situations.
The client needs a continued confrontation to gain control over fear. Practice helps the body become accustomed to the feeling of relaxation, enabling the individual to handle feared objects/situations. This technique is based on the principles of classical conditioning and the premise that what has been learned can be unlearned (Ankrom, 2020).
11. Encourage the client to set increasingly more difficult goals.
This develops confidence and movement toward improved functioning and independence. Systematic desensitization usually starts with the client imagining themselves in a progression of fearful situations and using relaxation strategies that compete with anxiety. Once successfully managed, the client may use the technique in real-life situations (Ankrom, 2020).
12. Administer benzodiazepines 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 the client change behavior by keeping anxiety low during learning and desensitization sessions. The risk of addiction to benzodiazepines should be carefully considered before use in anxiety disorders. Benzodiazepines should not be used in clients with a prior history of alcohol or other drug abuse (Bhatt & Bienenfeld, 2019).
13. Administer anti-anxiety agents as prescribed.
Buspirone is a nonsedating antipsychotic drug unrelated to benzodiazepines, barbiturates, and other sedative-hypnotics. This is a novel antianxiety agent that is comparable with benzodiazepines in reducing symptoms of anxiety. Buspirone also has fewer cognitive and psychomotor adverse effects, which makes it preferable in older adults. Major limitations include a lack of anti-panic activity and reduced anxiolytic effects in clients recently withdrawn from benzodiazepines (Bhatt & Bienenfeld, 2019).
14. Administer beta-blockers as indicated.
Beta-blockers control the physical symptoms of anxiety such as rapid heart rate, a trembling voice, sweating, dizziness, and shaky hands. They are most helpful for phobias, particularly social phobias (Chand & Marwaha, 2022).
15. Provide information about cranial electrotherapy stimulators (CES).
In 2019, the FDA approved CES for the treatment of anxiety, depression, and insomnia. The prescription device delivers micro pulses of electrical current across the brain, which in clinical trials led to a reduction in anxiety levels, insomnia, and depressed mood. It is the first CES integrated into noise-canceling, Bluetooth-enabled headphones, and the first CES managed through an app (Bhatt & Bienenfeld, 2019).
Recommended books and resources for your NCLEX success:
Saunders Comprehensive Review for the NCLEX-RN
Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.
Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items
Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.
Saunders Q & A Review for the NCLEX-RN® Examination
This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.
NCLEX-RN Prep Plus by Kaplan
The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.
Illustrated Study Guide for the NCLEX-RN® Exam
The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.
NCLEX RN Examination Prep Flashcards (2023 Edition)
NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.
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 UPDATED!
- Personality Disorders | 4 Care Plans
- Schizophrenia | 6 Care Plans UPDATED!
- Sexual Assault | 1 Care Plan
- Substance Dependence and Abuse | 8 Care Plans UPDATED!
- Suicide Behaviors | 3 Care Plans
References and Sources
- Ankrom, S. (2020, December 27). Systematic Desensitization for Panic Disorders. Verywell Mind. Retrieved April 4, 2023.
- Aucoin, M., LaChance, L., Naidoo, U., Remy, D., Shekdar, T., Sayar, N., Cardozo, V., Rawana, T., Chan, I., & Cooley, K. (2021, December 10). Diet and Anxiety: A Scoping Review – PMC. NCBI. Retrieved April 6, 2023.
- Ayuso-Murillo, D., Colomer-Sanchez, A., Santiago-Magdalena, C. R., Lendinez-Mesa, A., De Gracia, E. B., Lopez-Pelaez, A., & Herrera-Peco, I. (2020, May 21). Effect of Anxiety on Empathy: An Observational Study Among Nurses. NCBI. Retrieved April 6, 2023.
- Batsikoura, M., Zyga, S., Tzavella, F., Sachias, A., & Gil, A. P. R. (2021, October 15). Anxiety Status and Coping Strategies in Association with Sociodemographic Factors, Dietary and Lifestyle Habits in Greece. NCBI. Retrieved April 5, 2023.
- Bhatt, N. V., & Bienenfeld, D. (2019, March 27). Anxiety Disorders: Background, Anatomy, Pathophysiology. Medscape Reference. Retrieved April 4, 2023.
- Brock, H., & Hany, M. (2022). Obsessive-Compulsive Disorder – StatPearls. NCBI. Retrieved April 5, 2023.
- Chand, S. P., & Marwaha, R. (2022, May). Anxiety – StatPearls. NCBI. Retrieved April 4, 2023.
- Cherry, K. (2023, March 2). Positive Reinforcement and Operant Conditioning: Examples. Verywell Mind. Retrieved April 5, 2023.
- Christensen, T. (2021, January 22). Anxiety is linked with smoking – but how is still hazy. American Heart Association.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis Company.
- Donovan, N. J., & Blazer, D. (2020, December). Social Isolation and Loneliness in Older Adults: Review and Commentary of a National Academies Report. American Journal of Geriatric Psychiatry, 28(12).
- Elsevier. (2021). COMMUNICATION WITH ANXIOUS PATIENTS (HOME HEALTH CARE). Elsevier – Clinical Skills Communication: Anxious Patients (Home Health Care). Retrieved April 4, 2023.
- Farber, B. A., Suzuki, J. Y., & Lynch, D. A. (2018). Positive regard and psychotherapy outcome: A meta-analytic review. Psychotherapy, 55(4).
- Huang, Q., & Zhang, K. (2021, November 15). Self-Management in Anxiety and Depression: A Psychometric Evaluation of a Questionnaire. Frontiers. Retrieved April 6, 2023.
- Kaczkurkin, A. N., & Foa, E. B. (2022, April). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3).
- Lang, M., Kratky, J., & Xygalatas, D. (2020, June). The role of ritual behaviour in anxiety reduction: an investigation of Marathi religious practices in Mauritius. Philosophical Transactions of the Royal Society B, 375(1805).
- Lenze, E. J., & Wetherell, J. L. (2022). A lifespan view of anxiety disorders. Dialogues in Clinical Neuroscience, 13(4).
- Meek, W. (2021, January 5). Coping With Generalized Anxiety Disorder: Tips for Living Well. Verywell Mind. Retrieved April 5, 2023.
- Meunier, S., Roberge, C., Coulombe, S., & Houle, J. (2019, July). Feeling better at work! Mental health self-management strategies for workers with depressive and anxiety symptoms. Journal of Affective Disorders, 254.
- Montero-Marin, J., Garcia-Campayo, J., Lopez-Montoyo, A., Zabaleta-del-Olmo, E., & Cujipers, P. (2017, October). Is cognitive–behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis. Psychological Medicine, 48(9).
- National Institutes of Health. (2016). Understanding Anxiety Disorders. NIH News in Health.
- Pelletier, L., Shamila, S., & Scott, P. (2017). Self-management of mood and/or anxiety disorders through physical activity/exercise. NCBI. Retrieved April 6, 2023.
- Psychology Today. (2022, December 28). Interpersonal Psychotherapy. Psychology Today. Retrieved April 4, 2023.
- Rivier University. (2023). 17 Therapeutic Communication Techniques – Rivier Academics. Rivier University. Retrieved April 4, 2023.
- Saris, I. M. J., Aghajani, M., van der Werff, S. J. A., van der Wee, N. J. A., & Penninx, B. W. J. H. (2017). Social functioning in patients with depressive and anxiety disorders. Acta Psychiatrica Scandinavica, 136(4).
- Shepardson, R. L., Tapio, J., & Funderburk, J. S. (2017). Self-Management Strategies for Stress and Anxiety Used by Nontreatment Seeking Veteran Primary Care Patients. Military Medicine, 182(7).
- Star, K. (2020). Distraction Techniques for Panic Disorder. Verywell Mind. Retrieved April 4, 2023, from https://www.verywellmind.com/distraction-techniques-for-panic-disorder-2584138
- Star, K. (2020, September 17). The Benefits of Anxiety and Nervousness. Verywell Mind. Retrieved April 4, 2023.
- Tobias, M. R., & Ito, T. A. (2021, April). Anxiety Increases Sensitivity to Errors and Negative Feedback Over Time. Biological Psychology, 162.
- Wen Li, W., & Miller, D. J. (2020, November). The impact of coping and resilience on anxiety among older Australians. Australian Journal of Psychology, 69(4).
- Yu, W., Singh, S., Calhoun, S., Zhang, H., Zhao, X., & Yang, F. (2018, July). Generalized Anxiety Disorder in Urban China: Prevalence, Awareness, and Disease Burden. Journal of Affective Disorders, 234.
5 thoughts on “7 Anxiety and Panic Disorders Nursing 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.
You people are doing wonderful work l personal l appreciate .
Such a nice notes
This helped a lot.