Nursing Diagnosis & Nursing Care plan for Anxiety

Nanda Nursing Diagnosis: Anxiety

Anxiety in classified in Nanda nursing diagnosis List 2014-2017 under Domain 9: Coping/stress tolerance, Class 2: Coping responses.

Definition of Anxiety Nursing Diagnosis:

Anxiety is a type of an actual nursing diagnosis that is described as feelings of discomfort and apprehensions in response to the disturbance of the usual concept or pattern situation or environment. In contrast with fear, which is related to a more obvious and more specific threat, anxiety is not associated with clear of identifiable source of threat.
Feelings of anxiety are inevitable in life, and it has been found to serve as drivers or motivators to many people in problem-solving, decision-making, and in facing several stress-producing events such as calamities and examinations. Anxiety helps prepare the person both psychologically and physiologically. It involves the person’s sympathetic system to increase focus and attention. Moreover, it creates excitation in the cardiovascular system, pupil dilatation and hyperglycemia that are useful in preparing the body for impending danger or threat.

The intensity of the symptoms of anxiety depends on the severity of the person’s perceived threat. There are instances wherein the coping mechanisms inherent or learned by the person cannot overcome the feelings, consequently develop maladaptive behaviors. The physiological manifestations of anxiety may also become pathologic.

There are two ways of classifying anxiety. It can be classified according to onset, namely, acute and chronic. Acute or state anxiety is an immediate response to sudden change or stressor such as interviews or death of a relative. Chronic or trait anxiety is a category in which feelings and apprehension persist for a long period of time. Its symptoms include insomnia, learning difficulties and troubled relationships.

Anxiety is also categorized as to the degree of its manifestations, namely, mild, moderate, severe and panic. Mild anxiety is somehow constructive because it increases person’s alertness and perception. This type of anxiety is an opportunity for insight and learning. It is also associated with habits such hair-twisting and nail-biting in reducing the tension.
Moderate anxiety is characterized by increased heart respiratory rates, mild tremors and high-pitched voice. Person with moderate anxiety may experience difficulty in learning because of lack of concentration and selective attention. While, the person with severe anxiety experiences headache, nausea and vomiting in addition to the symptoms of moderate anxiety. It also associated with self-absorption and increased irritability.
The highest level of anxiety is panic. Its clinical manifestations include palpitations, sweating, dyspnea, and choking. The individual is observed to have destructive behaviors, transient amnesia, and feelings of impending doom.

ANXIETY CAUSATIVE/RELATED FACTORS:

1. Physiologic

• Interference with basic needs
  • Food
  • Air
  • Shelter
  • Safety

2. Contextual

• Threat to biologic integrity
  • Dying
  • Assault
  • Invasive procedures
  • Specific Disease
• Loss of significant others
  • Death
  • Divorce
• Change in environment
  • Hospitalization
  • Moving/Immigration/Refuge
  • Natural disasters
  • Employment/Deployment/Retirement
• Change in socioeconomic status
  • Unemployment
  • Promotion /Displacement
• Threat to self-concept
  • Lack of recognition from others
  • Failure
  • Loss of valued possessions
  • Ethical dilemma
• Idealistic expectations and goals

3. Developmental

• Infant/Child
  • Separation
  • Unfamiliar environment
• Adolescent
  • Death of significant others
  • Threat to self-concept
    • Sexual development
    • Peer relationships changes
• Adult
  • Threat to self-concept
    • Pregnancy
    • Parenting
    • Career changes
    • Effects of aging
  • Previous pregnancy complications, miscarriage, or fetal death
  • Lack of knowledge of changes associated with pregnancy
  • Lack of knowledge about labor experience
• Older Adult
  • Threat to self-concept
    • Sensory/Motor losses
    • Financial concerns
    • Retirement

NURSING ASSESSMENT ACTIVITIES FOR ANXIETY

ASSESSMENT	EXPLANATION/RATIONALE
Assess vital signs, pupil dilatation, bowel movements and orientation to time, place and persons.	The nurse must first attend the physical signs and symptoms of anxiety. These can also serve as baseline data, and indicators for the levels or degree of anxiety
Determine categories of the anxiety as to onset and level including the precipitating factors	The medical management and nursing care are based on the classification of the anxiety.
Check for feelings of worthlessness, helplessness, guilt, inability to cope, falling apart, and suicidal thoughts	It helps alert the medical team to institute necessary suicide precautions.
Identify typical coping behaviors that are relevant to the present situation or conflict	Patient’s previous coping strategies might be useful in dealing with the present situation.
Assess extent of social support system	The extent of social support system is significant in patient’s condition, recovery and wellness.
Consider the general appearance such as facial expressions, conduct and manner of dressing	It helps in assessing patient’s over-all well-being.
Observe behaviors during interview including communication pattern and trail of thoughts	Noting patient’s responses and trail of thought during interaction such as incomprehensible mumblings, hallucinations and delusions are vital for the diagnosis.
Note physical ability and interaction with the healthcare personnel, families and friends	It helps determine the patient’s level of independence to perform activities of daily living and healthcare procedures. The manner of interaction is also important in order to establish safety of significant others and health care personnel.
Note for signs somatization disorder	Somatization disorder or somatoform disorder is a form of illness that is characterized by physical symptom such as pain or gastrointestinal disturbances without pathologic causes, and believed to be brought about by anxieties and stress.

 

DESIRED GOALS AND OUTCOMES

Long-term Goals

• Recognize sources of stress and personal coping mechanisms
• Name at least three strategies in dealing with stressors and reducing anxiety

Short-term Goals

• Express feelings and emotions
• Establish normal breathing patterns, heart rate and bowel activities
• Demonstrate high level of consciousness and alertness

NURSING INTERVENTIONS FOR ANXIETY

INTERVENTIONS	RATIONALE
Independent
Understand own personal issues and concerns through regular reflection and self-awareness activities.	This can help reduce the incidence of counter-transference and avoid reciprocal anxiety.
Determine and respect personal space.	It will help build nurse-patient rapport and trust.
Avoid arguing or devaluing patient’s rationalizations with actions and behaviors	Supporting behaviors such as crying and catharsis reinforces patient’s coping mechanisms. Sometimes, denial is an effective coping strategy.
Provide a quiet, non-stimulating environment by managing nursing procedures and care, use of soft lights, and limiting visits of families who are also anxious	It will diminish feelings of anxiety and agitation. It will also help promote rest and sleep.
Allow patient to verbalize concerns and feelings.	Verbalization provides opportunity for the patient to reflect, and the nurse to make clarifications on misconceptions.
Demonstrate use of thought-stoppers or anxiety-interrupters such breathing control, self-directions, imagery and voice alterations that might be helpful for the patient when dealing with stressful events.	These techniques are found to be essential in managing the fight-or-flight response of the autonomic nervous system.
Explain the benefits of mild-moderate exercises and routine.	Exercise and physical activities increased release of serotonin and endorphins, which are considered as the ‘happy hormones”.
Collaborative
Encourage use of relaxation techniques such as music therapy and massage.	Complementary therapies are significant in reducing tensions and stress by providing patient calming and soothing experiences.
Give contact numbers for relevant hotlines, psychiatric emergency room, and consultation lines.	Giving patient access to the sources of support diminish feelings of helplessness. It is also an important suicide precaution.
Administer medications as prescribed by the attending physician.	The major classes of medications usually prescribed to manage anxiety are Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Benzodiazepines, and Tricyclic Antidepressants (TCA).
If applicable and available, refer the patient to a personnel who conducts “Assertiveness Therapy Training”.	Assertiveness Therapy Training facilitates development of positive-thinking, realistic goal-setting and learning limitations.
If the patient is diagnosed with chronic anxiety, refer him for a regular mental health counseling and treatment.	Chronic anxiety and maladaptive coping behaviors need on-going medical monitoring and treatment.