An anxiety disorder is considered a chronic condition in which the individual has an excessive and persistent sense of apprehension. It can often result in repeated episodes of sudden intense feelings of fear, terror, or being anxious. These episodes are then commonly referred to as panic attacks. The anxiety that causes these can become quite debilitating and interfere with an individual’s normal daily activities as they can be difficult to control and may last for long periods of time. There are many types of anxiety disorders, some of which are listed below.
In this article:
- Types of Anxiety Disorders
- Prevention
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Types of Anxiety Disorders
- Anxiety disorder related to a specific medical diagnosis
- Generalized anxiety
- Panic disorders
- Separation anxiety disorder
- Social anxiety disorder
- Various phobias
Prevention
Unfortunately, it is not possible to predict exactly who will develop anxiety and everyone that experiences anxiety may display and handle it differently. Prevention is key though. Individuals experiencing anxiety are more likely to become depressed, misuse substances, have difficulty sleeping, socially isolate themselves, have a poorer quality of life, and are at an increased risk of suicide. It is important to be aware of these possible risks and complications to ensure anxiety is dealt with early and the patient is educated on ways for preventing and/or coping with it in the future.
Causes (Related to)
The causes of anxiety can be extensive and sometimes the exact cause is not able to be clearly identified. Below is a general list of some potential causes however this list is not all inclusive.
- Other medical conditions (i.e. heart disease, diabetes, chronic pain)
- Side effects to medications
- Family history of anxiety disorders
- Stress
- Other mental health disorders
- Drug or alcohol use
- Trauma – having experienced a traumatic event either as a child or as an adult
Signs and Symptoms (As evidenced by)
Individuals suffering from anxiety may display a wide range of symptoms. This means the individual may be able to verbalize what she or he is feeling or there may be physical signs and symptoms a nurse should be aware of and note if present. Some of these signs and symptoms include:
Subjective (Patient reports)
- Feeling nervous
- Verbalizing a sense of impending danger
- Difficulty controlling one’s worrying
Objective (Nurse assesses)
- Restlessness and tense appearance
- Tachycardia
- Tachypnea
- Hyperventilation
- Diaphoresis
- Trembling/tremors
- Weakness or tiredness
- Difficulty concentrating
- Difficulty sleeping
- GI distress
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for anxiety:
- Patient will be able to acknowledge and discuss fears and concerns.
- Patient will be able to verbalize feelings of anxiety and present ideas of how to handle those feelings.
- Patient will be able to develop and demonstrate problem-solving techniques.
- Patient will be able to identify appropriate resources.
- Patient’s vital signs will remain or return to stable baseline state.
- Patient will be able to maintain regular sleep routine.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to anxiety.
1. Assess and acknowledge presence of anxiety.
It is important to be aware of patient’s feeling of anxiety and let the patient know these feelings are real and matter.
2. Conduct head-to-assessment.
This will allow the nurse to note any physical signs or symptoms of anxiety that the patient may not be able to verbalize. The nurse may also be able to uncover root causes of the anxiety if precipitated by other diseases or symptoms.
3. Assess vital signs.
Patients’ vital signs may be abnormal if feeling anxious (i.e. tachycardia or tachypnea may be present).
4. Assess the degree of anxiety the patient is experiencing (mild, moderate, severe) and the reality of this degree and anxiety threat.
Every individual may perceive a situation differently and an individual’s response to anxiety will vary from person to person. It is important the nurse knows how the anxiety relates to each individual person in order to better tailor care to that patient.
5. Assess the patient’s ability to focus/concentrate.
Individuals suffering from anxiety may struggle to focus on more than one thing at a time. Difficulty concentrating can further assist the nurse in assessing the severity of the anxiety.
6. Observe and assess the patient’s speech.
Patient’s ability to speak may give the nurse another indicator into the level of anxiety one is experiencing. Anxiety may cause the individual to change his or her speech in terms of the rate of speech, words used, repetition, use of humor or laughter, or use of profane language.
7. Assess the patient’s perception of the situation.
An individual’s perception affects how the individual will handle the situation.
8. Assess current coping mechanisms.
This can help to guide the nurse’s education later in the treatment plan if they have already identified areas of strength and/or areas of improvement for the patient in handling these difficult situations.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with anxiety.
1. Acknowledge the feelings the patient is experiencing.
Acknowledging the patient’s feelings will help the patient feel she or he is being heard and can assist the patient in becoming more trusting and comfortable with the nurse.
2. Administer medication as appropriate and as ordered.
Individuals with a history of anxiety may have PRN anxiety medications to assist with breakthrough anxiety/panic attacks.
3. Provide active-listening to the patient.
Sometimes patients need to discuss what exactly they are feeling and what is causing them to feel this way. Providing active-listening will allow for a trusting therapeutic relationship between nurse and patient to be developed.
4. Instruct the patient through guided imagery or other relaxation techniques/methods.
This will promote relaxation for the patient and the release of endorphins that will further reduce anxiety.
5. Educate patient on new coping mechanisms or previously used ones that were effective for the patient.
This will allow the patient to build confidence in oneself in being able to handle these difficult situations and will gain the individual independence once discharged home.
6. Identify resources the patient can use at home, in the future, along with a plan to follow for breakthrough episodes of anxiety.
This will allow the patient more independence at home and comfort in having already developed a plan to follow if another episode of anxiety occurs.
7. Encourage the patient to engage in regular daily exercise and activity programs.
Research has shown that regular exercise and activity raises endorphin levels resulting in an increase in one’s sense of well-being and reduction of anxiety levels.
8. Instruct/educate the patient on how to use positive self-talk.
Oftentimes an individual’s internal dialogue may be negative; by guiding a patient through verbalizing these internal thoughts the nurse can assist the patient with developing ways to speak more positively about oneself which can further decrease anxiety levels.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section you will find nursing care plan examples for anxiety.
Care Plan #1
Diagnostic statement:
Anxiety related to chest pain secondary to heart failure, as evidenced by diaphoresis and crying.
Expected outcomes:
- Patient will report the absence or decrease in chest pain.
- Patient will have stable vital signs.
- Patient will display a relaxed appearance without respiratory distress.
Assessment:
1. Assess the feelings of the patient towards chest pain.
Irrational thoughts, fears, and strong negative feelings towards the pain may worsen anxiety leading to panic.
2. Monitor vital signs.
Aside from chest pain, elevated BP and PR are elevated due to sympathetic stimulation during pain. Once therapy is initiated, an abrupt decrease in BP may be observed.
Interventions:
1. Administer medications as indicated.
If the patient is currently experiencing chest pain, treat with medications as indicated. Chest pain is a sign of myocardial ischemia. Nitroglycerin, taken sublingually, is a vasodilator that provides relief from an anginal attack. The onset of action takes only minutes. Thus, nurses should continuously monitor the patient’s blood pressure, heart rate, and oxygen saturation.
2. Maintain a calm presence.
Nurses can transmit their anxiety to the hypersensitive patient and affect the patient’s emotions. The patient’s feeling of stability increases in a calm and nonthreatening environment.
3. Administer supplemental oxygen as ordered.
This helps deliver more oxygen to the heart relieving the myocardial oxygen supply and demand imbalance.
4. Provide comfort measures (i.e., massage, guided imagery, aromatherapy, etc.)
The reduction in myocardial oxygen supply triggers chest pain. Providing comfort measures decreases myocardial oxygen demand making oxygen more available to the heart.
5. Teach the patient about anxiety-reducing techniques during stressful situations.
- Look up—lower shoulders.
- Do controlled deep breaths.
- Give self-directions (out loud, if possible).
- Exercise.
- Imagine a nice scene.
Relaxation techniques switch the autonomous system from the fight-or-flight to rest response.
6. Educate the patient about the precipitating factors of chest pain.
Noncompliance with medications, emotional stress, and excessive exercise are some of the possible factors that may cause angina. Educating patients on identifying these triggers helps in preventing anginal attacks, thus reducing anxiety related to chest pain.
Care Plan #2
Diagnostics statement:
Anxiety related to impending surgery, as evidenced by restlessness and angry outbursts.
Expected outcomes:
- Patient will demonstrate techniques to control anxiety.
- Patient will demonstrate decreased distress, as evidenced by calm facial expressions, gestures, and activity.
Assessments:
1. Assess the level of anxiety.
Physiologic signs and behaviors vary with the level of anxiety. In mild anxiety, patients exhibit normal vital signs, and the patient may still appear calm but may report feelings of nervousness. In moderate anxiety, a change of facial expression and tone of voice with feelings of tension may be observed. In severe anxiety, increased autonomic system activity occurs, manifesting as tachycardia, hypertension, diaphoresis, dry mouth, and muscle tension. The patient may also appear agitated and irritable.
2. Assess the patient’s understanding of the impending surgery.
Knowing what the patient understands and does not understand about surgery will help the nurse plan a more accurate health education plan that targets the knowledge needs of the patient.
Interventions:
1. Use simple language and brief statements when explaining the procedure.
Since the patient is experiencing moderate to severe anxiety, they may not be able to comprehend anything more than simple, clear, and brief instructions. Make sure to discuss the procedure in an educational level and language that the patient can understand. Pediatric patients may require pictures or videos to understand processes.
2. Encourage the patient to express anxious feelings.
Talking about anxious feelings can help the patient perceive the situation realistically and recognize the factors leading to it.
3. Provide a non-threatening and calm environment.
Anxiety may escalate to a panic state with excessive noise around the patient. Panic may be harmful to the patient and to others.
4. Administer medications as indicated.
Anxiolytics treat various mental health conditions, including panic disorders and generalized anxiety. In cases of severe anxiety, when initial comfort measures do not work, and when patients may already exhibit threatening behavior towards themselves or others, pharmacologic therapy may be necessary.
5. Teach the patient about the signs of anxiety and how to prevent them.
Identifying the signs helps the patients to be more aware of their feelings and actions. They will be more able to control these feelings and behaviors through relaxation techniques.
6. Implement nonpharmacologic measures.
Massage, therapeutic touch, and music can reduce physiological stress before surgery.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Kim, K.H., Kerndt, C.C., Adnan, G., et al. (2022). Nitroglycerin. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482382/
- Marks, J. (2021). Medical definition of anxiety disorder. https://www.medicinenet.com/anxiety_disorder/definition.htm
- Mayo Clinic. (2018). Anxiety disorders. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
- Simone, C.G.& Bobrin, B.D. (2023). Anxiolytics and sedative-hypnotics toxicity. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK562309/
