Fear/Anxiety | Nursing Care Plan for Ventilatory Assistance

Nursing diagnosis: Fear/Anxiety related to situational crises; threat to self-concept; threat of death, dependency on mechanical support; change in health, socioeconomic status, or role functioning; interpersonal transmission or contagion

Possibly evidenced by

Increased muscle and facial tension

Insomnia and restlessness

Hypervigilance

Feelings of inadequacy

Fearfulness, uncertainty, apprehension

Focus on self and negative self-talk

Expressed concern regarding changes in life events

Desired Outcomes/Evaluation Criteria—Client Will

Fear Self-Control [or] Anxiety Self-Control

Verbalize or communicate awareness of feelings and healthy ways to deal with them.

Demonstrate problem-solving skills or behaviors to cope with current situation.

Report that anxiety or fear is reduced to manageable level.

Appear relaxed and sleeping or resting appropriately.

Nursing intervention with rationale:

1. Identify client’s perception of threat represented by situation. Determine current respiratory status and adequacy of ventilation.

Rationale: Defines scope of individual problem separate from physiological causes, and influences choice of interventions.

2. Observe and monitor physical responses, such as restlessness, changes in vital signs, and repetitive movements. Note congruency of verbal/nonverbal communication.

Rationale: Useful in evaluating extent or degree of concerns, especially when compared with “verbal” comments.

3. Encourage client and SO to acknowledge and express fears.

Rationale: Provides opportunity for dealing with concerns, clarifies reality of fears, and reduces anxiety to a more manageable level.

4. Acknowledge the anxiety and fear of the situation. Avoid meaningless reassurance that everything will be all right.

Rationale: Validates the reality of the situation without minimizing the emotional impact. Provides opportunity for client and SO to accept and begin to deal with what has happened, reducing anxiety.

5. Identify and review with client and SO the safety precautions being taken, such as backup power and oxygen supplies and emergency equipment at hand for suctioning. Discuss or review the meanings of alarm system.

Rationale: Provides reassurance to help allay unnecessary anxiety, reduce concerns of the unknown, and preplan for response in emergency situation.

6. Note reactions of SO. Provide opportunity for discussion of personal feelings, concerns, and future expectations.

Rationale: Family members have individual responses to what is happening, and their anxiety may be communicated to client, intensifying these emotions.

7. Identify previous coping strengths of client and SO and current areas of control and ability.

Rationale: Focuses attention on own capabilities, increasing sense of control.

8. Demonstrate and encourage use of relaxation techniques, such as focused breathing, guided imagery, and progressive relaxation. Provide music therapy and biofeedback as appropriate.

Rationale: Provides active management of situation to reduce feelings of helplessness.

9. Provide and encourage sedentary diversional activities within individual capabilities, such as handicrafts, writing, and television.

Rationale: Although handicapped by dependence on ventilator, activities that are normal or desired by the individual should be encouraged to enhance quality of life.

10. Refer to support individuals, groups, and therapy, as needed.

Rationale: May be necessary to provide additional assistance if client and SO are not managing anxiety or when client is “identified with the machine.”