Possibly evidenced by
Fearful attitude
Apprehension, increased tension, restlessness, facial tension
Uncertainty, feelings of inadequacy
Somatic complaints and sympathetic stimulation
Focus on self, expressions of concern about current and future events
Fight- (e.g., belligerent attitude) or-flight behavior
Desired Outcomes/Evaluation Criteria—Client Will
Anxiety Self-Control [or] Fear Self-Control
Recognize and verbalize feelings.
Identify causes and contributing factors.
Verbalize reduction of anxiety or fear.
Demonstrate positive problem-solving skills.
Identify and use resources appropriately.
Nursing care plan intervention with rationale:
1. Identify and acknowledge client’s perception of threat or situation. Encourage expressions of, and avoid denying feelings of anger grief, sadness, and fear.
Rationale: Coping with the pain and emotional trauma of an MI is difficult. Client may fear death or be anxious about immediate environment. Ongoing anxiety related to concerns about impact of heart attack on future lifestyle, matters left unattended or unresolved, and effects of illness on family may be present in varying degrees for some time and may be manifested by symptoms of depression.
2. Note presence of hostility, withdrawal, and denial—inappropriate affect or refusal to comply with medical regimen.
Rationale: Research into survival rates between type A and type B individuals and the impact of denial has been ambiguous; however, studies show some correlation between degree
and expression of anger or hostility and an increased risk for MI.
3. Maintain confident manner, without false reassurance.
Rationale: Client and SO may be affected by the anxiety or uneasiness displayed by health team members. Honest explanations can alleviate anxiety.
4. Observe for verbal and nonverbal signs of anxiety, and stay with client. Intervene if client displays destructive behavior.
Rationale: Client may not express concern directly, but words or actions may convey sense of agitation, aggression, and hostility. Intervention can help client regain control of own behavior.
5. Accept but do not reinforce use of denial. Avoid confrontations.
Rationale: Denial can be beneficial in decreasing anxiety but can postpone dealing with the reality of the current situation. Confrontation can promote anger and increase use of denial, reducing cooperation and possibly impeding recovery.
6. Orient client and SO to routine procedures and expected activities. Promote participation when possible.
Rationale: Predictability and information can decrease anxiety for client.
7. Answer all questions factually. Provide consistent information; repeat as indicated.
Rationale: Accurate information about the situation reduces fear, strengthens nurse-client relationship, and assists client and SO to deal realistically with situation. Attention span may be short, and repetition of information helps with retention.
8. Encourage client and SO to communicate with one another, sharing questions and concerns.
Rationale: Sharing information elicits support and comfort and can relieve tension of unexpressed worries.
9. Provide privacy for client and SO.
Rationale: Allows needed time for personal expression of feelings; may enhance mutual support and promote more adaptive behaviors.
10. Provide rest periods and uninterrupted sleep time and quiet surroundings, with client controlling type and amount of external stimuli.
Rationale: Conserves energy and enhances coping abilities.
11. Support normality of grieving process, including time necessary for resolution.
Rationale: Can provide reassurance that feelings are normal response to situation and perceived changes.
12. Encourage independence, self-care, and decision making within accepted treatment plan.
Rationale: Increased independence from staff promotes self-confidence and reduces feelings of abandonment that can accompany transfer from coronary unit and discharge from hospital.
13. Encourage discussion about postdischarge expectations.
Rationale: Helps client and SO identify realistic goals, thereby reducing risk of discouragement in face of the reality of limitations of condition and pace of recuperation.
Collaborative management:
1. Administer anti-anxiety or hypnotics, as indicated, such as alprazolam (Xanax) and lorazepam (Ativan).
Rationale: Promotes relaxation and rest and reduces feelings of anxiety.
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