Fear/Anxiety | Nursing Care Plan (NCP) for Upper GI Bleeding

Nursing diagnosis: Fear/Anxiety May be related to Change in health status, threat of death

Possibly evidenced by

Increased tension, restlessness, irritability, fearfulness

Trembling, tachycardia, diaphoresis

Lack of eye contact, focus on self

Verbalization of specific concern

Withdrawal, panic, or attack behavior

Desired Outcomes/Evaluation Criteria—Client Will

Anxiety Self-Control

Discuss fears and concerns recognizing healthy versus unhealthy fears.

Verbalize appropriate range of feelings.

Appear relaxed and report anxiety is reduced to a manageable level.

Demonstrate problem-solving and effective use of resources.

Nursing intervention with rationale:

1. Monitor physiological responses, such as tachypnea, palpitations, dizziness, headache, tingling sensations, and behavioral cues, such as restlessness, irritability, lack of eye contact, and combativeness or attack behavior.

Rationale: May be indicative of the degree of fear client is experiencing— client may feel out of control of the situation or reach a state of panic. However, symptoms may also be related to

physical condition or shock state.

2. Encourage verbalization of concerns. Assist client in expressing feelings by active listening.

Rationale: Establishes a therapeutic relationship. Assists client in dealing with feelings, and provides opportunity to clarify misconceptions.

3. Acknowledge that this is a fearful situation and that others have expressed similar fears.

Rationale: When client is expressing own fear, the validation that these feelings are normal can help client to feel less isolated.

4. Provide accurate, concrete information about what is being done, including sensations to expect and usual procedures undertaken.

Rationale: Involves client in plan of care and decreases unnecessary anxiety about unknowns.

5. Provide a calm, restful environment.

Rationale: Removing client from outside stressors promotes relaxation and may enhance coping skills.

6. Encourage significant other (SO) to stay with client, as able. Respond to call signal promptly. Use touch and eye contact, as appropriate.

Rationale: Helps reduce fear of going through a frightening experience alone.

7. Provide opportunity for SO to express feelings and concerns. Encourage SO to project positive, realistic attitude.

Rationale: Helps SO to deal with own anxiety and fears that can be transmitted to client. Promotes a supportive attitude that can facilitate recovery.

8. Demonstrate and encourage relaxation techniques such as visualization, deep-breathing exercises, and guided imagery.

Rationale: Learning ways to relax can be helpful in reducing fear and anxiety. Because client with GI bleeding may be a person who has difficulty relaxing, learning these skills can be important to recovery and prevention of recurrence.

9. Help client identify and initiate positive coping behaviors used successfully in the past.

Rationale: Successful behaviors can be fostered in dealing with current fear, enhancing client’s sense of self-control and providing reassurance.

10. Encourage and support client in evaluation of lifestyle.

Rationale: Changes may be necessary to avoid recurrence of ulcer condition.