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.

Anxiety /Fear | Nursing Care Plan for Peritonitis

Nursing diagnosis: Anxiety/Fear related to Situational crisis, Threat of death, change in health status, Physiological factors, hypermetabolic state

Possibly evidenced by
Increased tension, helplessness
Apprehension, uncertainty, worry, sense of impending doom
Sympathetic stimulation; restlessness, focus on self

Desired Outcomes/Evaluation Criteria—Client Will
Anxiety Self-Control
Verbalize awareness of feelings and healthy ways to deal with them.
Report anxiety is reduced to a manageable level.
Appear relaxed.

Nursing intervention with rationale:
1. Evaluate anxiety level, noting client’s perception of situation and verbal and nonverbal responses. Encourage free expression of emotions.
Rationale: Apprehension may be escalated by severe pain, severity of illness, urgency of diagnostic procedures, and possibility of surgery.

2. Review physiological factors present, such as sepsis or toxins related to infection, medications, and metabolic imbalances
Rationale: These factors are present in seriously ill client and can cause or contribute to anxiety.

3. Provide ongoing information regarding disease process and anticipated treatment.
Rationale: Knowing what to expect can reduce anxiety for both client and significant other (SO). Also, ongoing review helps to identify those factors adding to anxiety that could be changed—client getting more uninterrupted sleep or adding or deleting medications.

4. Provide presence. Acknowledge anxiety and fear. Do not deny or reassure client that everything will be all right. Be accurate and factual in providing information. Correct misconceptions about disease process and possible treatments.
Rationale: Affirms client’s value as a human being in need of assistance in dealing with a serious health threat; helps client and SO identify and deal with reality.

5. Schedule adequate rest and uninterrupted periods for sleep.
Rationale: Limits fatigue, conserves energy, and can enhance coping ability.

6. Provide comfort measures: family presence, quiet environment, soft music, back rub, and Therapeutic Touch (TT).
Rationale: Promotes relaxation and enhances ability to deal with situation.

Anxiety | Nursing Care Plan for Herniated Nucleus Pulposus (HNP)

Nursing diagnosis: Anxiety related to situational crisis, threat to or change in health status, socioeconomic status, role functioning, recurrent disorder with continuing pain, inadequate relaxation, little or no exercise, inadequate coping methods

Possibly evidenced by
Apprehension, uncertainty, helplessness
Expressed concerns regarding changes in life events
Verbalization of inability to cope
Muscular tension, general irritability, restlessness; insomnia, fatigue
Inability to meet role expectations

Desired Outcomes/Evaluation Criteria—Client Will
Anxiety Self-Control
Appear relaxed and report anxiety is reduced to a manageable level.
Identify ineffective coping behaviors and consequences.
Assess the current situation accurately.
Demonstrate effective problem-solving skills.
Develop plan for necessary lifestyle changes.

Nursing intervention with rationale
1. Assess level of anxiety. Determine previous coping strategies. Help client identify strategies to address current perceived or actual problems.
Rationale: Aids in identifying strengths and skills that may help client deal with current situation and enable others to provide appropriate assistance.

2. Provide accurate information and honest answers.
Rationale: Honest answers and accurate information facilitate development of rapport. These enable the client to use own experiences and knowledge to make decisions.

3. Provide opportunity for expression of concerns, such as possible permanent nerve damage, paralysis, effect on sexual ability, changes in employment, finances, and altered role responsibilities.
Rationale: Open communication promotes client realization of short- and long-term implications of current condition and can promote coping with situation.

4. Assess presence of secondary gains that may impede recovery.
Rationale: Client may unconsciously experience positive reinforcement, such as attention, control of others, and relief from responsibilities. These need to be recognized and addressed positively to promote recovery.

5. Note behaviors of SO that promote “sick role” for client.
Rationale: By relieving the client from roles and responsibilities or not allowing the client to perform optimal level of function, the SO may unconsciously enable client to remain dependent.

6. Refer to appropriate support groups, social services, financial or vocational counseling, and marital therapy or psychotherapy, as appropriate.
Rationale: These services provide support for promoting coping and adaptation to life changes.

Anxiety | Nursing Care Plan for Glaucoma

Nursing diagnosis: anxiety physiological factors, change in health status, presence of pain, possibility or reality of loss of vision; unmet needs; negative self-talk

Possibly evidenced by

Apprehension, uncertainty

Expressed concern regarding changes in life events

Desired Outcomes/Evaluation Criteria—Client Will

Anxiety Self-Control

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

Demonstrate positive problem-solving skills.

Use resources effectively.

Nursing intervention with rationale:

1. Assess anxiety level, degree of pain experienced, suddenness of onset of symptoms, and current knowledge of condition.

Rationale: These factors affect client’s perception of threat to self, potentiate the cycle of anxiety, and may interfere with medical attempts to control IOP.

2. Provide accurate, honest information. Discuss probability that careful monitoring and treatment can prevent additional loss of vision.

Rationale: Reduces anxiety related to unknown or future expectations and provides factual basis for making informed choices about treatment.

3. Encourage client to acknowledge concerns and express feelings.

Rationale: Provides opportunity for client to deal with reality of situation, clarify misconceptions, and problem-solve concerns.

4. Identify helpful resources.

Rationale: Provides reassurance that client is not alone in dealing with problems.

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.”

Fear/Anxiety | Nursing Care Plan for Lung Cancer

Nursing diagnosis: anxiety related to situational crises; threat to or change in health status; perceived threat of death

Possibly evidenced by

Withdrawal

Apprehension

Anger

Increased pain, sympathetic stimulation

Expressions of denial, shock, guilt, insomnia

Desired Outcomes/Evaluation Criteria—Client Will

Fear Self-Control [or] Anxiety Self-Control

Acknowledge and discuss fears and concerns.

Demonstrate appropriate range of feelings and appear relaxed and resting appropriately.

Verbalize accurate knowledge of situation.

Report beginning use of individually appropriate coping strategies.

Nursing intervention with rationale:

1. Evaluate client and significant other (SO) level of understanding of diagnosis.

Rationale: Client and SO are hearing and assimilating new information that includes changes in self-image and lifestyle. Understanding perceptions of those involved sets the tone for individualizing care and provides information necessary for choosing appropriate interventions.

2. Acknowledge reality of client’s fears and concerns and encourage expression of feelings.

Rationale: Support may enable client to begin exploring and dealing with the reality of cancer and its treatment. Client may need time to identify feelings and even more time to begin to

express them.

3. Provide opportunity for questions and answer them honestly. Be sure that client and care providers have the same understanding of terms used.

Rationale: Establishes trust and reduces misperceptions or misinterpretation of information.

4. Accept, but do not reinforce, client’s denial of the situation.

Rationale: When extreme denial or anxiety is interfering with progress of recovery, the issues facing client need to be explained and resolutions explored.

5. Note comments and behaviors indicative of beginning acceptance or use of effective strategies to deal with situation.

Rationale: Fear and anxiety will diminish as client begins to accept and deal positively with reality. Indicator of client’s readiness to accept responsibility for participation in recovery and to

“resume life.”

6. Involve client and SO in care planning. Provide time to prepare for events and treatments.

Rationale: May help restore some feeling of control and independence to client who feels powerless in dealing with diagnosis and treatment.

7. Provide for client’s physical comfort.

Rationale: It is difficult to deal with emotional issues when experiencing extreme or persistent physical discomfort.

Nursing Diagnosis for Myocardial Infarction | Anxiety

Nursing diagnosis: anxiety related to threat to or change in health and socioeconomic status; threat of loss or death; unconscious conflict about essential values, beliefs, and goals of life; interpersonal transmission or contagion.

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.

Nursing Diagnosis for Angina Pectoris | Anxiety

Nursing diagnosis: anxiety related to situational crises; threat to self-concept, such as altered image or abilities; underlying pathophysiological response; threat to or change in health status, such as a disease course that can lead to further compromise, debility, and even death; negative self-talk.

Possibly evidenced by

Expressed concern regarding changes in life events

Increased tension and helplessness

Apprehension, uncertainty, restlessness

Association of diagnosis with loss of healthy body image, loss of place or influence

View of self as noncontributing member of family or society

Fear of death as an imminent reality

Desired Outcomes/Evaluation Criteria—Client Will

Anxiety Self-Control

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

Report that anxiety is reduced to a manageable level.

Express concerns about effect of disease on lifestyle and position within family and society.

Demonstrate effective coping strategies and problem-solving skills.

Nursing care plan intervention with rationale:

1. Explain purpose of tests and procedures.

Rationale: Reduces anxiety attributable to fear of unknown diagnosis and prognosis.

2. Promote expression of feelings and fears such as denial, depression, and anger. Let client or SO know these are normal reactions. Note statements of concern, such as, “heart attack is inevitable.”

Rationale: Unexpressed feelings may create internal turmoil and affect self-image. Verbalization of concerns reduces tension, verifies level of coping, and facilitates dealing with feelings. Presence of negative self-talk can increase level of anxiety and may contribute to exacerbation of anginal

attacks.

3. Encourage family and friends to treat client as before.

Rationale: Reassures client that role in the family and business has not been altered.

4. Tell client the medical regimen has been designed to reduce or limit future attacks and increase cardiac stability.

Rationale: Encourages client to test symptom control such as no angina with certain levels of activity, to increase confidence in medical program, and to integrate abilities into perceptions of self.

5. Administer sedatives and tranquilizers, as indicated.

Rationale: May be desired to help client relax until physically able to reestablish adequate coping strategies.