ANXIETY Nursing Care Plan

The anxiety or the fear of something unknown has 4 types namely: mild anxiety, moderate anxiety, severe anxiety, and panic state. A person experiencing mild anxiety is alert and more aware of the environment. His/her attention is focus on environment and immediate events. But they are restless, irritable, and sometimes reported insomniac. Moderate anxiety is a person that had a narrow perception in which he/she is able to ignore distractions in dealing with problems. In this state, concentration increased, pulse and respiration is also increased. The client is trembling and his/her voice quivers or changes pitch.

Severe anxiety is when a person is preoccupied with feelings of discomfort and sense of impending doom. Impending doom is an unaccountable fear or being terrified. His/her range of perception is reduced and anxiety interferes with effective functioning. The person is experiencing headache, tingling sensation, and increased pulse and respiration with reports of dizziness. In panic state, the ability to concentrate is disrupted and person's behavior is disintegrated. The person distorts situation and does not have realistic perceptions of what is happening. The person in panic state may be experiencing terror or confusion or unable to move or speak.

ASSESSMENT
Subjective:
"I'm afraid, I don't know what will happen after my operation," as verbalized by the patient.
 
Objectives:

The patient is pale in appearance and cold clammy skin. The patient is poor eye contact. Vital signs are taken and noted as follows: Body temperature is 36.5 degrees Celcius, blood pressure is 130/90 mmHg, respiratory rate is 18 cycles per minute, and pulse rate is 88 beats per minute. The patient's body temperature, pulse rate, and respiratory rate are all normal while his/her blood pressure is above normal and consider as hypertension.

DIAGNOSIS
Anxiety related to fear of unknown secondary to cold clammy skin and pale in appearance. (Cold clammy skin is due to cold sweat).

PLANNING
After 4 hours of nursing intervention, the patient's anxiety level will gradually decreased to manageable level. (Why not totally gone? Because only if the operation was finished, the patient's anxiety will be gone.)

INTERVENTION
You must monitor the patient's vital signs because increase anxiety may affect physiologic changes. Determine prescribed medications or OTC medications, some medications can heighten sense of anxiety such as steroids, weight-loss pills, and caffeine. Observe the client's behaviors to determine the level of patient's anxiety: mild, moderate, severe or panic.
 
Encourage therapeutic relationship and be available to client for listening and talking. Provide accurate information to the situation and do not give false reassurance, helps the client what is reality based. Provide diversional activities such as watching TV or listening to music, before and after the operation. Gradually increase the client's activities and involvement with others as anxiety is decreased. Use cognitive therapy to focus on correct faulty catastrophic interpretations of symptoms.

Assist the patient to identify precipitating factors and new methods of coping with disability anxiety. Assist also in developing skills like awareness of negative thoughts,saying stop and substituting a positive thought to eliminate negative self-talk. Mild phobias tend to respond well to behavioral therapy.

Review strategies such as role playing and use of visualizations to practice anticipated events, prayer, and medication. Also review medication regimen and possible interactions, especially with over-the-counter drug substitution and changes in dosage.

During Panic State:

You may stay with the client, maintaining a calm, confident manner. Speak in brief statements using simple words. Provide for non threatening, consistent environment and atmosphere. You must also minimize stimuli. Monitor visitors and interaction to lessen effect of transmission of feelings. Set limits on inappropriate behavior and help client to develop acceptable ways of dealing with anxiety. 

Review strategies, such as role playing, use of visualizations to practice anticipated events, prayer and medication. Also review medication regimen and possible interactions, especially with over-the-counter drug substitutions, changes in dosage, or time of side to minimize side effects.

EVALUATION

After 4 hours of nursing intervention, the patient's anxiety level was gradually decreased to manageable level. (If the nursing intervention did not work, try to reassess the patient and make another nursing care plan).

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