Anxiety | Nursing Care Plan for Renal Dialysis

Nursing diagnosis: Anxiety related to situational crisis, threat to self-concept, change in health status, role functioning, socioeconomic status, threat of death, unknown consequences or outcome

Possibly evidenced by
Increased tension, apprehension, uncertainty, fear
Expressed concerns
Sympathetic stimulation, focus on self

Desired Outcomes/Evaluation Criteria—Client Will
Anxiety [or] Fear Self-Control
Verbalize awareness of feelings and reduction of anxiety or fear to a manageable level.
Demonstrate problem-solving skills and effective use of resources.
Appear relaxed and able to rest and sleep appropriately.

Nursing intervention with rationale:
1. Assess level of fear of both client and SO. Note signs of denial, depression, or narrowed focus of attention.
Rationale: Helps determine the kind of interventions required.

2. Explain procedures and care as delivered. Repeat explanations frequently, as needed. Provide information in multiple formats, including pamphlets and films.
Rationale: Fear of unknown is lessened by information and knowledge and may enhance acceptance of permanence of ESRD and necessity for dialysis. Alteration in thought processes and high levels of anxiety or fear may reduce comprehension, requiring repetition of important information. Note: Uremia can impair short-term memory, requiring repetition or reinforcement of information provided.

3. Acknowledge normalcy of feelings in this situation.
Rationale: Knowing feelings are normal can allay fear that client is losing control.

4. Provide opportunities for client and SO to ask questions and verbalize concerns.
Rationale: Creates feeling of openness and cooperation and provides information that will assist in problem identification and solving.

5. Encourage SO to participate in care, as able and desired.
Rationale: Involvement promotes sense of sharing, strengthens feelings of usefulness, provides opportunity to acknowledge individual capabilities, and may lessen fear of the unknown.

6. Acknowledge concerns of client and SO.
Rationale: Prognosis and possibility of need for long-term dialysis and resultant lifestyle changes are major concerns for this client and those who may be involved in future care.

7. Point out positive indicators of treatment—improvement in laboratory values, stable BP, and lessened fatigue.
Rationale: Promotes sense of progress in an otherwise chronic process that seems endless while client still is experiencing physical deterioration and depression.

8. Arrange for visit to dialysis center and meeting with another dialysis client, as appropriate.
Rationale: Interaction with others who have encountered similar problems may assist client and SO to work toward acceptance of chronic condition and focus on problem-solving activities.

9. Address financial considerations. Refer to appropriate resources.
Rationale: Treatment for kidney failure is expensive, although Medicare and other health insurance programs pay much of the cost.