ANXIETY Nursing Care Plan

Abby experienced trauma, both physical and emotional in her past life when she and her husband live together. She escapes and left her husband and went to other city 1300 miles away from their house to change her life for she thought the better. Unfortunately, she still gathers her fear from the past and it kept haunting her day and night. She has been always lack of sleep, she felt fear when someone touches her or even calls her. She screams most of the time, she preoccupied most of the time. She feels that someone is stalking her and wants to abduct her. It's been 6 months since she left but she still experiencing this anxiety which is considered severe and she also were experiencing panic state. Below is a sample of anxiety nursing care plan of Abby.

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 Celsius, 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 decrease 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 Abby, 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 Abby's behaviors to determine the level of patient's anxiety: mild, moderate, severe or panic.

- Encourage therapeutic relationship and be available to Abby for her listening and talking. Provide accurate information to the situation and do not give false reassurance, it helps the patient what is reality based. Provide her diversional activities such as watching TV or listening to her music, before and after the operation. Gradually increase the Abby's activities and her involvement with others as anxiety is decreased. Use cognitive therapy to focus on her correct faulty catastrophic interpretations of symptoms. 

- Assist Abby, the patient, to identify precipitating factors and new methods of coping with disability anxiety. Assist her 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 her medication regimen and possible interactions, especially with over-the-counter drug substitution and changes in dosage.

During Panic State:
- You may stay with Abby, maintaining her a calm, confident manner. Speak in brief statements using simple words. Provide her for non-threatening, consistent environment and atmosphere. You must also minimize her stimuli. Monitor visitors and interaction to lessen effect of transmission of feelings. Set limits on inappropriate behavior and help her 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).

For more samples of nursing care plan you are free to check it out in our NCP LIST page.