This article discusses Anxiety symptoms, risk factors, types, diagnosis and 4 Nursing Care Plans For Anxiety.
Introduction
Anxiety is a feeling of fear, dread, and uneasiness. This is a necessary emotional response for survival, a normal response to a threatening situation. It may result in sweating, feeling restlessness, and tensing.
Stress is the pressure that is brought to bear on the individual. It can result in anxiety. Mainly is brought about by emotional complications, relationship problems, deadlines, and physical ailments.
Fear is an innate intellectual response to dangerous or life-threatening situations.
Anxiety and panic can disrupt daily tasks, be challenging to regulate, be out of proportion to the actual risk, and last long. To avoid unpleasant feelings, you may avoid certain places or circumstances. Symptoms may appear in childhood or adolescence and persist throughout maturity.
Generalized anxiety disorder, social anxiety disorder (social phobia), particular phobias, and separation anxiety disorder are examples of anxiety disorders. There is a possibility that a person will have more than one anxiety disorder. Anxiety might be caused by a medical issue that requires treatment.
This blog post discusses what anxiety is, its symptoms nursing care plans and interventions with some examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Signs and Symptoms of Anxiety
The following are some of the most common anxiety indications and symptoms:
- Feeling jittery, agitated, or tense
- Feelings of impending danger, terror, or impending disaster
- An elevated heart rate is a condition in which your heart beats faster than usual.
- Rapid breathing (hyperventilation)
- Sweating
- Trembling
- Feeling tired or weak
- Having difficulty concentrating or thinking about anything other than your current concern
- Having difficulty sleeping
- Having troubles with your gastrointestinal tract (GI tract)
- Having trouble managing your anxiety
- Having a strong desire to avoid situations that cause uneasiness.
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Types of Anxiety Disorders
Agoraphobia is an anxiety disorder in which you fear and frequently avoid locations or situations that may make you feel imprisoned, helpless, or embarrassed.
Anxiety disorder caused by a medical disease comprises severe anxiety or panic symptoms triggered directly by a physical health problem.
Generalized anxiety disorder is characterized by persistent and excessive anxiety and stress about everyday activities and occurrences. Worry is out of proportion to the situation, is impossible to control, and impacts your physical well-being. It frequently happens in the presence of other anxiety disorders or depression.
Panic disorder is characterized by recurring bouts of severe anxiety, fear, or terror that peak within minutes (panic attacks). Feelings of impending doom, shortness of breath, chest pain, or a racing, fluttering, or pounding heart are all possible symptoms (heart palpitations). These panic episodes may cause you to worry about them happening again or avoid settings where they have already happened.
Selective mutism is a condition in which children refuse to talk in specific environments, such as school, yet can communicate in other settings, such as at home with close family members. This can cause problems at school, work, and social situations.
Separation anxiety disorder is a childhood disorder characterized by excessive anxiety for the child’s developmental level and related to separation from parents or others who have parental roles.
Social anxiety disorder (social phobia) involves high levels of anxiety, fear, and avoidance of social situations due to feelings of embarrassment, self-consciousness, and concern about being judged or viewed negatively by others.
Specific phobias are characterized by significant anxiety when you’re exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.
Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that directly result from misusing drugs, taking medications, being exposed to a toxic substance, or withdrawing from drugs.
You can also check out Assessing And Treating Patients With Anxiety Disorders
Psychoanalytic theory of phobias
- Conscious phobic objects represent unconscious childhood fears
- This is a defense mechanism called displacement: shifting of thoughts/emotions from one target to another, often a related target (phobic object), because first is unavailable to the conscious mind (too painful)
- Phobic object – has symbolic value, as it may represent an underlying fear
Behavioral theory of phobias
A person learns phobias through object associations with a painful or frightening stimulus.
Classical conditioning – e.g., Little Albert [J. B. Watson]
- Induced fear of the rat
- Unconditioned stimulus: a stimulus – loud noise – that elicits a fear response
- Conditioned stimulus: a stimulus- white rat – that does not elicit US response
- Associative learning: pairing CS with the US leads to a conditioned response to CS in the absence of US
Operant conditioning – fear of flying
- The setting the behavior occurs in – e.g., flying.
- The reinforced response – e.g., avoidance of flying
- The reinforcer – e.g., traveling by car
Risk factors for Anxiety
These factors may increase your risk of developing an anxiety disorder:
Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.
Stress due to an illness. Having a health condition or serious illness can cause significant worry about your treatment and future.
Stress buildup. A significant event or a buildup of more minor stressful life situations may trigger excessive anxiety, such as a family death, work stress, or ongoing worry about finances.
Personality. People with certain personality types are more prone to anxiety disorders than others are.
Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.
Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.
Drugs or alcohol. Drug or alcohol use or misuse, or withdrawal can cause or worsen anxiety.
Other specified anxiety disorders and unspecified anxiety disorders are terms for anxiety or phobias that don’t meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.
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Diagnosis of Anxiety Disorders
Psychological exam – to discuss thoughts, emotions or feelings, life experiences, and behavior that can help diagnose anxiety or other mental health disorder; can be carried out by a psychiatrist or a psychologist.
Use of DSM-5 – the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a widely used medical manual containing criteria for diagnosing mental health disorders.
History Taking -to check for physical symptoms of anxiety; to check for substance use or withdrawal.
Electrocardiogram (ECG) – may be used if the patient has chest pain to rule out a cardiac event.
Treatment for Anxiety Disorders
1. Psychotherapy. Also called psychological counseling or talk therapy, this treatment for anxiety disorders involves speaking with a licensed therapist and gradually coping with the symptoms. Psychotherapy is an effective and proven treatment for anxiety disorders.
There are many forms of psychotherapy, but cognitive behavioral therapy (CBT) is found to be the most effective. CBT aims to help the patient develop specific skills to cope with anxiety symptoms and slowly go back to the activities that the patient has been avoiding. It involves exposing the patient gradually to the trigger/s of their anxiety.
2. Medications. Anxiolytic medications and certain antidepressants are often prescribed for anxiety disorders. Sedatives such as benzodiazepines may be prescribed for short-term anxiety relief. A group of antidepressants called selective serotonin reuptake inhibitors (SSRIs) is effectively used with CBT.
3. Lifestyle changes. Being physically active can reduce stress levels, improve mood, and help maintain a healthy body. Nicotine, caffeine, recreational drugs, and alcohol should be avoided as they can worsen anxiety symptoms. Getting enough sleep can help the person feel relaxed.
Meditation, yoga, guided imagery, and deep breathing exercises can also relax the mind and reduce the symptoms. Keeping a journal can help the patient understand what triggers their anxiety and what increases their stress levels and what makes them calm and relaxed.
4. Anxiety support group. The patient can be referred to an anxiety support group where they can participate in the discussion of relatable experiences and experience compassion from others.
Nursing Diagnosis for Patients with Anxiety
- Anxiety
- Fear
- Ineffective Coping
- Powerlessness
Nursing Care Plans for Anxiety Based on Diagnosis
Nursing Care Plan 1: Anxiety
Nursing diagnosis of anxiety may be related to:
- Lack of knowledge regarding symptoms, progression of the condition, and treatment regimen.
- The actual or perceived threat to biological integrity.
- Unconscious conflict about essential values and goals of life.
- Situational and maturational crises.
Possibly evidenced by:
- Decreased attention span
- Restlessness
- Poor impulse control
- Hyperactivity, pacing
- Feelings of discomfort, apprehension, or helplessness
- Delusions
- Disorganized thought process
- Inability to discriminate harmful stimuli or situations
Desired Outcomes
- 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.
| Nursing Interventions | Rationale |
| 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. The client develops a feeling of security in the presence of a 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 stranger’s nurse 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 the client of their safety and security. | The client’s safety is the 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 compared to a large area, making 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 SO that anxiety disorders are treatable. | Pharmacological therapy is an effective treatment for anxiety disorders; treatment regimens 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 be 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 the client’s behavior by changing the environment and 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 a 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. |
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You can also check out Generalized Anxiety Disorder of a Middle-Aged White Male with Anxiety
Nursing Care Plan 2: Fear
Nursing diagnosis of fear may be related to:
- Phobic stimulus
- Physiological symptoms, mental/cognitive behaviors indicative of panic
Possibly evidenced by:
- Acknowledge and discuss fears.
- Demonstrate understanding by using effective coping behaviors and active participation in the treatment regimen.
- Resume normal life activities.
Desired Outcomes
- The client will be able to discuss phobic objects or situations with the nurse.
- The client will be able to function in the presence of a phobic object or situation without experiencing panic anxiety by the time of discharge from treatment.
| Nursing Interventions | Rationale |
| Reassure the client of his safety and security. | At panic level anxiety, the client may fear for their own life. |
| Explore client’s perception of threat to physical integrity or threat to self-concept. | Understanding the client’s perception of the phobic object or situation is important to assist with the desensitization process. |
| 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. |
| 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. |
| Include 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. |
| Encourage the client to explore underlying feelings that may be contributing to irrational fears. Help 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. |
| 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. |
| Encourage the 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 the feared situation as soon as experienced. Support 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 they 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 the client may become terrified and withdraw from therapy. |
| Expose the client to a predetermined list of anxiety-provoking stimuli rated in the 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. Helps extinguish conditioned avoidance response |
| 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. | It helps the 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. | 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. |
Nursing Care Plan 3: Ineffective Coping
Nursing diagnosis of ineffective coping may be related to:
- Situational crises
- Maturational crises
- Fear of failure
Possibly evidenced by:
- Ritualistic behavior or obsessive thoughts
- Inability to meet basic needs
- Inability to meet role expectations
- Inadequate problem solving
Desired Outcomes
- The client will decrease participation in ritualistic behavior.
- The client will demonstrate the ability to cope effectively.
- The client will verbalize signs and symptoms of increased anxiety and intervene to maintain anxiety at a manageable level.
- The client will demonstrate the ability to interrupt obsessive thoughts and refrain from ritualistic behaviors.
| Nursing Interventions | Rationale |
| Assess the client’s level of anxiety. Investigate the types of situations that increase anxiety and result in ritualistic behaviors. | Helping the client recognize the precipitating factors is the first step in teaching the client to interrupt the escalating anxiety. |
| Initially meet the client’s dependency needs as necessary. | Sudden and complete elimination of avenues for dependency would create anxiety and will burden the client more. |
| Encourage independence and give positive reinforcement for independent behaviors. | Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors. |
| During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. | To deny the client, this activity can precipitate a panic level of anxiety. |
| Support and encourage the client’s efforts to explore the meaning and purpose of the behavior. | The client may be unaware of the relationship between emotional problems and compulsive behaviors. Recognition and acceptance of problems are important before change can occur. |
| Gradually limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities. | Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones. |
| Encourage the recognition of situations that provoke obsessive thoughts or ritualistic behaviors. | Recognition of precipitating factors is the first step in teaching the client to interrupt escalation of anxiety. |
| Provide positive reinforcement for nonritualistic behaviors. | Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors. |
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Nursing Care Plan 4: Powerlessness
Nursing diagnosis of powerlessness may be related to:
- Lifestyle of helplessness
- Fear of disapproval from others
- Consistent negative feedback
Possibly evidenced by:
- Apathy
- Dependence on others may result in irritability, resentment, anger, and guilt.
- Verbal expressions of having no control
- Nonparticipation in care or decision-making when opportunities are provided.
- Reluctance to express true feelings.
Desired Outcomes
- The client will participate in decision-making regarding their own care.
- The client will be able to problem-solve ways to take control of their life situation effectively.
| Nursing Interventions | Rationale |
| Have clients take as much responsibility for their own self-care practices. | Providing clients with choices and responsibilities will increase their feelings of control. |
| Help client set realistic goals. | Unrealistic goals set the client up for failure and reinforce feelings of powerlessness. |
| Help identify areas of life situations that the client can control. | The client’s emotional condition prevents his ability to solve problems. Support is required to perceive the benefits and consequences of available alternatives. |
| Help the client identify areas of life situation that are not with his ability to control; encourage verbalization of these feelings. | To deal with unresolved issues and accept what cannot be changed. |
| Identify ways and instances in which the client can achieve and encourage participation in these activities; provide positive reinforcement for participation. | Positive reinforcement enhances self-esteem and encourages repetition of positive behaviors. |
References
ncbi.gov
scholar.google.com
Related FAQs
1. Why is a proper care plan for anxiety and depression important?
That is why a proper care plan for anxiety and depression is important. A nursing care plan for depression includes the assessment of the damage done by analyzing the behavioral patterns and coping abilities of the patient. Now let’s talk about the nursing plan for anxiety related to surgery.
2. What is the nursing plan for anxiety related to surgery?
Now let’s talk about the nursing plan for anxiety related to surgery. During surgery, the patient should be taken care of carefully, calmly, and with a full understanding of his/her suffering. If a person is constantly shaking and shivering his/her hands then it’s sure that he or she is suffering from anxiety.
3. How to diagnose and treat anxiety in nurses?
Here are the common nursing interventions for the Anxiety nursing diagnosis: Recognize awareness of the patient’s anxiety. Since a cause of anxiety cannot always be identified, the patient may feel as though the feelings being experienced are counterfeit.