Nursing diagnosis – anxiety

Anxiety
DEFINITION
Vague uneasy feeling of discomfort or dread accompanied by an
autonomic response (the source often non-specific or unknown to
the individual); a feeling of apprehension caused by anticipation of
danger. It is an alerting signal that warns of impeding danger and
enables the individual to take measures to deal with threat
DEFINING CHARACTERISTICS
• Behavioral: Diminished productivity, fidgeting, restlessness,
scanning and vigilance, poor eye contact, insomnia
• Affective: Apprehensive, distressed, fearful, jittery, uncertain, wary
• Physiological: Facial tension, hand tremors, increased perspiration,
quivering voice
• Sympathetic: Anorexia, cardiovascular excitation, diarrhea, facial
flushing, increased blood pressure and/or pulse, dilated pupils
• Parasympathetic: Abdominal pain, decreased blood pressure and/or
pulse, fatigue, nausea, urinary frequency, hesitancy, or urgency
• Cognitive: Blocking of thoughts, confusion, impaired attention,
forgetfulness, tendency to blame others
RELATED FACTORS
• ANXIETY
• Threat to self-concept
• Situational crises
• Maturational crises
• Stress
• Unmet needs
• Role change
• Familial association
• Substance abuse
• Unconscious conflict about
goals or values
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Communication
• Coping
EXPECTED OUTCOMES
The patient will
• Identify factors that elicit anxious behaviors.
• Participate in activities that decrease feelings of anxious behaviors.
• Practice relaxation techniques at specific intervals each day.
• Cope with current medical situation without demonstrating severe
signs of anxiety.
• Demonstrate observable signs of reduced anxiety.
• State that the level of anxiety has decreased.
SUGGESTED NOC OUTCOMES
Anxiety Level; Coping; Grief Resolution; Hyperactivity Level;
Impulse Self-Control; Psychosocial Adjustment: Life Change; Social
Interaction Skills; Stress Level; Symptom Control
INTERVENTIONS AND RATIONALES
Determine: Listen attentively to patient to determine exactly what he or
she is feeling. Listening on the part of the nurse helps the patient
• Emotional status
• Psychological status
identify anxious behaviors more easily and discover the source of
anxiety.
Assess types of activities that help reduce patient’s stress levels.
Monitor physiologic responses including respirations, heart rate
and rhythm, and blood pressure.
Perform: Reduce environmental stressors (including people), and
remain with patient during severe anxiety. Anxiety often results from
lack of trust in the environment and/or fear of being alone.
Offer relaxing types of music for quiet listening periods. Listening
to relaxing music may have a calming effect.
Promote proper body alignment to avoid contractures and maintain
optimal musculoskeletal balance and physiologic function.
Encourage active exercise to promote a sense of well-being.
Inform: Teach patient relaxation techniques (guided imagery, progressive
muscle relaxation, and meditation) to be performed at least
every 4 hr to restore psychological and physical equilibrium by
decreasing autonomic response to anxiety.
Attend: Provide emotional support and encouragement to improve
self-concept and encourage frequent use of relaxation techniques.
Allow extra visiting times with family if this seems to allay
patient’s anxiety about activities of daily living.
Involve patient in planning and decision making to encourage
interest and compliance. Encourage patient to talk about the kinds
of activities that promote feelings of comfort. Assist patient to create
a plan to try engaging in at least one of these activities each day.
This gives the patient a sense of control.
Make sure that patient has clear explanations for everything that
will happen to him or her. Ask for feedback to ensure that the
patient understands. Anxiety may impair patient’s cognitive abilities.
Manage: Refer to case manager/social worker or professional mental
health caretaker to provide mental health assistance. Encouraging
the use of community mental health resources reinforces the fact
that anxiety reduction is a long-term process.
SUGGESTED NIC INTERVENTIONS
Anger Control Assistance; Anticipatory Guidance; Anxiety
Reduction; Behavior Modification: Social Skills; Calming Technique;
Coping Enhancement; Simple Guided Imagery; Support Group
Reference
Buffin, M. D., et al. (2006, September). A music intervention to reduce anxiety
before vascular angiography procedures. Journal of Vascular Nursing,
24(3), 68–73.

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