NCP Nursing Diagnosis: Anxiety

Nursing Diagnosis: Anxiety
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Anxiety Control
* Coping

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Anxiety Reduction
* Presence
* Calming Technique
* Emotional Support

NANDA Definition: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat.

Anxiety is probably present at some level in every individual’s life, but the degree and the frequency with which it manifests differs broadly. Each individual’s response to anxiety is different. Some people are able to use the emotional edge that anxiety provokes to stimulate creativity or problem-solving abilities; others can become immobilized to a pathological degree. The feeling is generally categorized into four levels for treatment purposes: mild, moderate, severe, and panic. The nurse can encounter the anxious patient anywhere in the hospital or community. The presence of the nurse may lend support to the anxious patient and provide some strategies for traversing anxious moments or panic attacks.

* Defining Characteristics: Physiological:
o Increase in blood pressure, pulse, and respirations
o Dizziness, light-headedness
o Perspiration
o Frequent urination
o Flushing
o Dyspnea
o Palpitations
o Dry mouth
o Headaches
o Nausea and/or diarrhea
o Restlessness
o Pacing
o Pupil dilation
o Insomnia, nightmares
o Trembling
o Feelings of helplessness and discomfort
* Behavioral:
o Expressions of helplessness
o Feelings of inadequacy
o Crying
o Difficulty concentrating
o Rumination
o Inability to problem-solve
o Preoccupation

* Related Factors: Threat or perceived threat to physical and emotional integrity
* Changes in role function
* Intrusive diagnostic and surgical tests and procedures
* Changes in environment and routines
* Threat or perceived threat to self-concept
* Threat to (or change in) socioeconomic status
* Situational and maturational crises
* Interpersonal conflicts

* Expected Outcomes Patient is able to recognize signs of anxiety.
* Patient demonstrates positive coping mechanisms.
* Patient may describe a reduction in the level of anxiety experienced.

Ongoing Assessment

* Assess patient’s level of anxiety. Mild anxiety enhances the patient’s awareness and ability to identify and solve problems. Moderate anxiety limits awareness of environmental stimuli. Problem solving can occur but may be more difficult, and patient may need help. Severe anxiety decreases patient’s ability to integrate information and solve problems. With panic the patient is unable to follow directions. Hyperactivity, agitation, and immobilization may be observed.
* Determine how patient copes with anxiety. This can be done by interviewing the patient. This assessment helps determine the effectiveness of coping strategies currently used by patient.
* Suggest that the patient keep a log of episodes of anxiety. Instruct patient to describe what is experienced and the events leading up to and surrounding the event. Patient should note how the anxiety dissipates. Patient may use these notes to begin to identify trends that manifest anxiety. If the patient is comfortable with the idea, the log may be shared with the care provider who may be helpful in problem solving. Symptoms often provide the care provider with information regarding the degree of anxiety being experienced. Physiological symptoms and/or complaints intensify as the level of anxiety increases.

Therapeutic Interventions

* Acknowledge awareness of patient’s anxiety. Because a cause for anxiety cannot always be identified, the patient may feel as though the feelings being experienced are counterfeit. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings.
* Reassure patient that he or she is safe. Stay with patient if this appears necessary. The presence of a trusted person may be helpful during an anxiety attack.
* Maintain a calm manner while interacting with patient. The health care provider can transmit his or her own anxiety to the hypersensitive patient. The patient’s feeling of stability increases in a calm and nonthreatening atmosphere.
* Establish a working relationship with the patient through continuity of care. An ongoing relationship establishes a basis for comfort in communicating anxious feelings.
* Orient patient to the environment and new experiences or people as needed. Orientation and awareness of the surroundings promote comfort and may decrease anxiety.
* Use simple language and brief statements when instructing patient about self-care measures or about diagnostic and surgical procedures. When experiencing moderate to severe anxiety, patients may be unable to comprehend anything more than simple, clear, and brief instructions.
* Reduce sensory stimuli by maintaining a quiet environment; keep "threatening" equipment out of sight. Anxiety may escalate with excessive conversation, noise, and equipment around the patient. This may be evident in both hospital and home environments.
* Encourage patient to seek assistance from an understanding significant other or from the health care provider when anxious feelings become difficult. The presence of significant others reinforces feelings of security for the patient.
* Encourage patient to talk about anxious feelings and examine anxiety-provoking situations if able to identify them. Assist patient in assessing the situation realistically and recognizing factors leading to the anxious feelings. Avoid false reassurances.
* As patient’s anxiety subsides, encourage exploration of specific events preceding both the onset and reduction of the anxious feelings. Recognition and exploration of factors leading to or reducing anxious feelings are important steps in developing alternative responses. Patient may be unaware of the relationship between emotional concerns and anxiety.
* Assist the patient in developing anxiety-reducing skills (e.g., relaxation, deep breathing, positive visualization, and reassuring self-statements). Using anxiety-reduction strategies enhances patient’s sense of personal mastery and confidence.
* Assist patient in developing problem-solving abilities.
o Emphasize the logical strategies patient can use when experiencing anxious feelings.
Learning to identify a problem and evaluate alternatives to resolve it helps the patient to cope.
* Instruct the patient in the appropriate use of antianxiety medications.

Education/Continuity of Care

* Assist patient in recognizing symptoms of increasing anxiety; explore alternatives to use to prevent the anxiety from immobilizing her or him. The ability to recognize anxiety symptoms at lower-intensity levels enables the patient to intervene more quickly to manage his or her anxiety. Patient will be able to use problem-solving abilities more effectively when the level of anxiety is low.
* Remind patient that anxiety at a mild level can encourage growth and development and is important in mobilizing changes.
* Instruct patient in the proper use of medications and educate him or her to recognize adverse reactions. Medication may be used if patient’s anxiety continues to escalate and the anxiety becomes disabling.
* Refer the patient for psychiatric management of anxiety that becomes disabling for an extended period.