Nursing diagnosis – death anxiety

Death Anxiety
DEFINITION
Vague uneasy feeling of discomfort or dread generated by
perceptions of a real or imagined threat to one’s existence
DEFINING CHARACTERISTICS
• Worry about the impact of one’s death on significant others
• Powerlessness over issues related to dying
• Fear of loss of physical and mental abilities when dying
• Total loss of control over aspects of one’s own death
• Worry about being the cause of others’ suffering or grief
• Fear of leaving family alone after death
• Fear of developing a terminal illness
RELATED FACTORS
• DEATH ANXIETY
• Anticipating the impact of
death on others
• Anticipating suffering
• Experiencing the dying process
• Uncertainty about life after
death
• Uncertainty about the
existence of a higher power
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Behavior
• Communication
• Emotional status
EXPECTED OUTCOMES
The patient will
• Identify time alone and time needed with others.
• Communicate important thoughts and feelings to family members.
• Obtain the level of spiritual support desired.
• Use available support systems.
• Perform self-care activities to tolerance level.
• Express feelings of comfort and peacefulness.
SUGGESTED NOC OUTCOMES
Acceptance: Health Status; Anxiety Level; Depression Level; Dignified
Life Closure; Fear Self-Control; Hope
INTERVENTIONS AND RATIONALES
Determine: Assess how much support the patient desires. Patients
may want a higher degree of independence in dealing with death
than the caregiver wants to allow.
Assess patient’s spiritual needs. Often as death approaches, individuals
begin thinking more about the needs of the spirit.
Determine which comfort measures the family believes will enhance
feelings of well-being. Dying patients have the right to decide how
much physical, emotional, and spiritual care they wish to have.
Perform: Administer medication to relieve pain and provide comfort
as required. Medicating at an appropriate level does much to relieve
pain and often helps the dying person maintain greater feeling of
self-control.
Turn and reposition patient at least every 2 hr. Turning and repositioning
prevent skin breakdown, improve lung expansion, and prevent
atelectasis. Establish a turning schedule for the dependent
patient. Post schedule at bedside and monitor frequency.
Provide simple physical gestures of support such as holding hands with
the patient and encouraging family members to do the same. Patient
may want to experience less touching when he or she begins to let go.
Provide comfort measures including bath, massage, regulation of
environmental temperature, and mouth care according to patient’s
preferences. These measures promote relaxation and feelings of well
being.
Inform: Teach family members ways of discerning unobtrusively what
the patient’s desires for comfort and peace are at this time because some
patients prefer not to be bothered unless they specifically request comfort
measures. Being sensitive to patient needs promotes individualized care.
Teach caregivers to assist patient with self-care activities in a way
that maximizes patient’s rights to choose. This enables caregivers to
participate in patient’s care while supporting patient’s independence.
Attend: Help family identify, discuss, and resolve issues related to
patient’s dying. Provide emotional support and encouragement to
help. Clear communication promotes family integrity.
Demonstrate to patient willingness to discuss the spiritual aspects
of death and dying to foster an open discussion. Keep conversation
focused on patient’s spiritual values and the role they play coping
with dying. Meeting the patient’s spiritual needs conveys respect for
the importance of all aspects of care.
If patient is confused, provide reassurance by telling him or her
who is in the room. This information may help to reduce anxiety.
Manage: Refer to hospice for end-of-life care if this has not already
been done. Communicate to the hospice nurse where the patient is
at present in coping with the terminal illness. Continuity of care is
crucial during times of stress.
Refer to a member of the clergy or a spiritual counselor, according
to the patient’s preference, to show respect for the patient’s
beliefs and provide spiritual care.
SUGGESTED NIC INTERVENTIONS
Active Listening; Anticipatory Guidance; Family Involvement Promotion;
Pain Management; Spiritual Support; Touch
Reference
Duggleby, W., & Berry, P. (2005, August). Transitions and shifting goals of
care for palliative patients and their families. Clinical Journal of Oncology
Nursing, 9(4), 425–448.

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.