7 Anxiety and Panic Disorders Nursing Care Plans for Anxiety
Stress is a vague sense of dread or anxiety (uneasiness); it is the activation of the adrenal nervous system in reaction to internal or external stimuli that can have behavioural, emotional, cognitive, and physical signs. In contrast, fear is your sense of apprehension over a specific threat or danger to the person.
Stress disorders include a set of conditions which share an integral quality of excessive anxiety with ensuing behavioural, psychological, cognitive, and bodily reactions. Individuals afflicted by anxiety disorders can demonstrate unusual behaviours like panic without motive, unwarranted fear of objects, or unexplainable or unwavering worry. They experience significant distress as time passes, and the disease significantly impairs their daily routines, social lives, and occupational functioning.
Anxiety disorders are diagnosed with stress no longer function as a sign of danger or motivation for desired change but becomes persistent and permeates major portions of the person’s life, leading to maladaptive behaviours and psychological disability.
Panic disorder is composed of distinct episodes of panic attacks typically of 15 to 30 minutes of rapid, extreme, escalating anxiety in which the individual experiences great emotional fear as well as bodily distress. It’s diagnosed when the person has recurrent, unexpected panic attacks followed by a minimum of one month of persistent concern or worry about potential attacks or their significance or significant behavioural change related to them.
Nursing Care Plan for anxiety
Nurses encounter anxious clients and families in many different situations. The nurse must first assess the individual’s anxiety level because this determines what interventions are likely to be effective. Treatment of anxiety disorders usually involves medication and treatment. A mixture of both generates better results than either one alone.
When working with an anxious individual, the nurse must be aware of her anxiety level. It is easy for a nurse to stay calm become readily anxious and be in control. That is essential if the nurse is going to work effectively with the customer.
The following are seven (7) medical care plans for patients with anxiety and anxiety disorders:
- 1. Stress
- 2. Fear
- 3. Ineffective Coping
- 4. Powerlessness
- 5. Social Isolation
- 6. Self-Care Deficit
- 7. Deficient Awareness
Anxiety: the Vague, uneasy feeling of distress or dread accompanied by an autonomic response.
May be Associated with
- · lack of knowledge regarding symptoms, a progression of illness, and treatment regimen.
- · perceived or actual threat to biologic integrity.
- The · unconscious battle about crucial values and goals of life.
- · Situational and maturational crises.
Maybe evidenced by
- · Reduced attention span
- · Restlessness
- · Poor impulse control
- · Hyperactivity, pacing
- · Feelings of distress, jealousy or helplessness
- · Delusions
- A · Disorganized thought process
- · Inability to discriminate harmful stimuli or situations
- · Be free of injury
- · Discuss feelings of fear, anxiety, and so forth
- · Respond to comfort techniques with a diminished anxiety level.
- · Reduce own stress level.
- · Be free of anxiety attacks.
Keep a calm, non-threatening way while working with the client.
Stress is contagious and may be moved from health care provider to customer or vice versa. Customer develops a feeling of security in the presence of calm staff individual.
Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions right, offering unconditional acceptance; being available and respecting the client’s usage of personal space.
Therapeutic skills are needed to be directed toward putting the customer at ease since the nurse who is a stranger can pose a danger to the highly anxious customer.
Remain with the client at all times when levels of anxiety are high (severe or panic); reassure a client of their safety and security.
The customer’s safety is the utmost priority. A highly anxious client shouldn’t be left alone as his fear will escalate.
Move the customer to a quiet area with minimal stimulation such as a small space or seclusion area (dim lighting, few people, etc.)
Anxious behaviour escalates by outside stimulation. A smaller or secluded area enhances a feeling of safety as compared to a huge area which can make the customer feel lost and panicked.
Maintain calmness on your approach to the customer.
The client will feel more calm and secure if you are calm and if the customer feels that you are in charge of the situation.
- Provide reassurance and comfort measures.
- Helps alleviate anxiety.
- Educate the patient and SO who anxiety disorders are treatable.
- Pharmacological treatment is an effective remedy for anxiety disorders; treatment regimen could include antidepressants and anxiolytics.
- Confirm the client’s defences initially.
The client uses defences in an attempt to Deal with an unconscious conflict, and giving up these defences prematurely may cause increased anxiety.
Maintain awareness of your feelings and Level of distress.
Stress is communicated interpersonally. Being with an anxious client can raise your anxiety level. Discussion of those feelings can supply a role model for your customer and show another way of dealing with them.
Stay with the patient during panic attacks. Use Short, simple directions.
During a panic attack, the individual needs Reassurance that he isn’t dying and the symptoms will resolve peacefully. In anxiety, the client’s ability to manage abstractions or complexity is diminished.
Avoid asking or forcing the customer to make choices.
The Customer may not make sound and proper Decisions or might not able to make decisions at all.
Watch for increasing stress. Assume a calm Manner, decrease environmental stimulation, and supply temporary isolation as indicated.
Early detection and intervention facilitate Modifying customer’s behaviour by changing the environment and the client’s interaction with it, to lessen the spread of anxiety.
PRN medications may be suggested for high Levels of stress. Watch out for negative side effects.
Medicine may be necessary to reduce Anxiety to some level where the customer can feel secure.
Encourage the client’s participation in Relaxation exercises like deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth.
Relaxation exercises are powerful Nonchemical ways to reduce anxiety.
Teach symptoms and signs of escalating Stress, and approaches to interrupt its development (e.g., relaxation methods, deep- breathing exercises, physical exercises, lively walks, running, meditation).
So the customer can start using relaxation Techniques; gives the client confidence in having control over his anxiety.
Administer SSRIs as dictated.
Panic attacks are caused by neuropsychiatric Disease that responds to SSRI antidepressants.
Help the client see that moderate anxiety can be A positive catalyst for change and doesn’t need to be prevented.
The Customer may feel that anxiety is poor Rather than helpful.
- Cognitive-behavioural therapy (further Discussed here)
- Positive reframing
- Turning negative messages into positive ones.
It involves the therapist’s use of questions To more realistically appraise the circumstance. It’s also referred to as the”what if” technique because the worst case situation is faced by asking a”what if” question.
Helps the individual take more control over life situations. These techniques help the individual negotiate interpersonal situations and boost self-assurance.
When the degree of stress has been reduced, Explore the client the probable reasons for an occurrence.
One of the factors is that the First step in educating the client to disrupt escalation of anxiety.
Invite the client to Discuss traumatic Experience under non-threatening ailments. Help customer work through feelings of guilt related to the traumatic event. Assist client to understand that this was an event to which most individuals would have reacted in like fashion. Support client during flashbacks of the experience.
Verbalization of feelings in a non-threatening Environment might help the client come to terms with unresolved is
Fear: Response to perceived threat That’s purposely known as a danger.
May be Associated with
- · Phobic stimulation
- · Physiological symptoms, mental/cognitive behaviours indicative of panic
Maybe evidenced by
- · Acknowledge and discuss fears.
- · Demonstrate understanding through the use of effective coping behaviours and active participation in a treatment regimen.
- · Resume normal life activities.
- · Client will have the ability to discuss phobic object or situation with the nurse.
- · Client will be able to operate in the presence of phobic object or situation without experiencing anxiety stress by time of release from therapy.
- Reassure client of the security and safety.
- At panic level anxiety, the customer may fear for Own life.
- Explore customer’s perception of danger to Bodily integrity or threat to self-concept.
It’s important to understand the client’s Understanding of the phobic object or situation to help with the desensitization procedure.
Current and talk reality of the Circumstance With customer to recognize aspects that can be changed and those that can’t.
The client needs to take the reality of this Situation before the work of reducing the anxiety can advance.
Suggest that the client substitute positive Thoughts for unwanted ones.
Emotion connected to consideration, and changing to A more positive idea can reduce the degree of anxiety experienced. This also provides the customer with an alternative method of studying the issue.
Contain client in making decisions associated with Choice of alternative coping strategies.
Permitting the customer choices provides a step Of control and functions to raise feelings of self-worth.
Encourage client to research underlying Feelings which could be contributing to ridiculous fears. Help client to comprehend how confronting these feelings, rather than suppressing them, may lead to more adaptive coping skills.
Verbalization of feelings in a non-threatening Environment may help customer come to terms with unresolved issues.
Examine the process of considering the Feared object/situation until it happens.
The anticipation of a prospective phobic reaction Allows customer to take care of the physical manifestations of fear.
Invite the client to talk about the seemingly Unnatural fears and feelings with other people, especially the nurse therapist.
Clients are often reluctant to share their fear feelings of ridicule and might have been advised to dismiss feelings. Once the customer begins to admit and talk about these fears, it will become evident that the feelings are somewhat manageable.
Encourage to stop, wait, and not rush from a Feared situation as soon as experienced. Offer Support and use relaxation exercises.
Client fears disorganization and loss of Control of mind and body when exposed to the anxiety-producing stimulus. This fear leads to an avoidance reaction, and the truth is not tested. If a customer waits out the starts of anxiety and reduces it with comfort exercises, then she or he may be prepared to keep on confronting the fear.
Explore things that may lower fear level and Keep it manageable (e.g. singing while grooming, repeating a mantra, practising optimistic self-talk while in a fearful scenario ).
Provides the client with a Feeling of control Over the fear. Distracts the customer so that fear isn’t totally focused on and allowed to escalate.
Use desensitization approach:
· Systematic desensitization
Systematic Desensitization (slow, systematic exposure of the client to the feared scenario under controlled conditions) enables the consumer to begin to overcome the panic, become desensitized to the fear. Notice: Implosion or flooding (continuous, rapid presentation of the phobic stimulus) may reveal quicker results than systematic desensitization, but relapse is more prevalent, or customer can become terrified and withdraw from therapy.
· Expose customer to a predetermined list of anxiety-provoking stimulation rated in the hierarchy from the least frightening to this most frightful.
Experiencing fear in Progressively harder but attainable steps allows the client to realize dangerous consequences will not happen. Helps extinguish conditioned avoidance response
· Pair each anxiety-producing stimulus (e.g. standing in an elevator) with the arousal of another effect of the opposite quality (e.g. relaxation, exercise, biofeedback) strong enough to suppress anxiety.
Invite the client to Achieve physical and mental relaxation as the stress becomes less uncomfortable.
· Help client to understand how to use those methods when facing an actual anxiety-provoking circumstance. Provide for training sessions (e.g.role-play), deal with phobic reactions in real- life situations.
A client needs continued Confrontation to acquire control over fear. Exercise helps the body become accustomed to the feeling of relaxation, enabling the individual to handle feared object/situation.
Invite Client to set increasingly more difficult goals.
Develops Confidence and movement toward improved freedom and functioning.
Administer antianxiety drugs as Suggested; watch out for any adverse side effects
- · Alprazolam (Xanax),
- · Clonazepam (Klonopin),
- · diazepam (Valium),
- · lorazepam (Ativan)
- · chlordiazepoxide (Librium),
- · oxazepam (Serax)
Biological Elements Might be included in phobic/panic reactions, and such medications (especially Xanax) produce a quick calming effect and might help client change behaviour by maintaining anxiety low during learning and desensitization sessions. Addictive tendencies of CNS depressants need to be weighed against benefit from this medication.
Ineffective Coping: Inability to make a valid Evaluation of these stressors, insufficient choices of practised answers, and inability to use available resources.
May be Associated with
- · Situational crises
- · Maturational emergencies
- · Fear of failure
Possibly evidenced by
- · Ritualistic behaviour or obsessive ideas
- · Inability to Satisfy basic needs
- · Inability to Satisfy role expectations
- · Lack problem solving
- · Client will reduce involvement in ritualistic behaviour.
- · Client will demonstrate the ability to deal effectively.
- · Client will verbalize symptoms and signs of increasing anxiety and intervene to maintain stress at a manageable amount.
- · Client will demonstrate the ability to interrupt obsessive ideas and refrain from ritualistic behaviours.
Evaluate client’s degree of anxiety. Investigate The types of situations that increase anxiety and lead to ritualistic Behaviours.
behaviours the client recognize the Precipitating factors is the first step in teaching the customer to disrupt the escalating anxiety.
- Initially meet the Customer’s dependency Requirements As vital.
- Sudden and complete elimination of paths For dependency would cause anxiety and will load the customer more.
- Encourage independence and give positive Reinforcement for independent behaviours.
- Positive reinforcement enhances self-esteem And promotes repeat of desirable behaviours.
- Throughout the Start of treatment, let Plenty of time for rituals. Do not be judgmental or verbalize disapproval of this behaviour.
- To deny customer, this action can precipitate Panic level of stress.
- Support and encourage client’s attempts to Explore the meaning and aim of this behaviour.
A client may be oblivious to the connection Between emotional problems and compulsive behaviours. Recognition and acceptance of issues are important before change can happen.
Gradually limit the amount of time allocated For ritualistic behaviour as the client becomes involved in unit activities.
Anxiety is minimized when a customer can Replace ritualistic behaviours with more adaptive ones. Encourage the recognition of situations that Provoke obsessive thoughts or ritualistic behaviours. One of the factors is the First step in teaching client to interrupt escalation of anxiety.
Give positive reinforcement for Nonritualistic behaviours.
Positive reinforcement enhances self-esteem And encourages repetition of desirable behaviors.
Powerlessness: The understanding that one’s personal Action won’t significantly impact an outcome; a perceived lack of control on a present situation or instantaneous happening.
May be Associated with
- · Lifestyle of helplessness
- · Fear of disapproval from others
- · Consistent negative comments
Possibly evidenced by
- · Apathy
- · Dependence on other people that might result in irritability, bitterness, anger, or guilt.
- · Verbal expressions of having no control
- · Nonparticipation in care or decision making when opportunities can be found.
- · Reluctance to express true feelings.
- · Client will take part in decision making regarding particular care.
- · Client will have the ability to effectively problem-solve approaches to take control of his or her life situation.
Have customer take as much responsibility For own self-care practices.
- Providing client with choices and Responsibility will boost his or her feelings of control.
- Assist customer set realistic objectives.
- Unrealistic goals put the client up for Failure and reinforce feelings of powerlessness.
- Help identify areas of lifestyle situation that Customer can control.
Customer’s psychological illness prevents his Ability to address problems. Support is required to perceive the advantages and consequences of accessible alternatives.
Help the client identify areas of life Situation which are not with his ability to control; promote verbalization of these feelings.
To Take Care of unresolved problems and accept What cannot be changed.
Identify ways and instances in which the Customer can achieve and encourage involvement in these activities; provide positive reinforcement for participation.
Positive reinforcement enhances self-esteem And encourages repeat of positive behaviours.
Social Isolation: Aloneness experienced by the patient and Perceived as enforced by others and as a negative or threatening state.
May be Associated with
- · Maturational crisis.
- · Panic level of stress.
- · Past experiences of difficulty in conversation with other individuals.
- · Repressed fears.
Maybe evidenced by
- · Uncommunicative
- · Withdrawn
- · No more eye touch
- · Insecurity in people
- · Expression of feelings of rejection
- · Preoccupation with own thoughts; repetitive, meaningless actions
- · Client will willingly attend treatment activities accompanied by a reputable support person.
- · Client will voluntarily spend time with different customers and team members in group activities.
- Convey an accepting and positive mindset by Making short, frequent contacts.
- An accepting attitude increases a sense of Self-worth and eases trust.
- Show unconditional positive regard.
- To communicate your belief from the client as a Rewarding individual.
- Be with the customer to provide support during Group activities which may be frightening or difficult for her or him.
- The presence of a trusted individual provides Emotional security for your customer.
- Be honest and keep all of the promises.
- Honesty and dependability market a trusting relationship.
- Be careful with signature. Allow client extra space and Avenue for departure if he becomes overly stressed.
A person in fear level anxiety may perceive touch as a threatening gesture.
- Administer tranquillizing drugs as Ordered; track adverse side effects.
- Short-term use of antianxiety drugs helps to Decrease the level of Anxiety in most individuals.
- Talk with the client the Symptoms of Increasing anxiety and methods for interrupting the reaction such as breathing exercises, thought stopping, meditation, relaxation.
- Maladaptive behaviours are manifested during Times of increased stress.
- Give recognition and positive reinforcement For client’s voluntary interaction with other individuals.
- Positive reinforcement enhances self-esteem And encourages repetition of acceptable behaviours.
Self-Care Deficit: Impaired ability to execute or complete activities of daily living (ADL) independently.
Maybe related to
- · Excessive curricular behaviour
- · Disabling anxiety
- · Withdrawal
- · Unmet dependency needs
Maybe evidenced by
- · Unwillingness to do self-hygiene.
- · Uncombed hair, dirty clothes, offensive body odour
- · Deficiency of interest in selecting appropriate clothes to wear
- · Incontinence
- · Client will verbalize want to take control of self-care activities.
- · Client will be able to look after personal ADLs and demonstrate a willingness to do so.
- Urge customer to perform normal ADLs to His level of skill.
- Successful performance of independent Actions enhances self-esteem.
- Encourage independence. Intervene when customer Is not able to execute.
- Safety and comfort of the client are nursing priorities.
- Offer recognition and positive reinforcement For independent accomplishments.
- Positive reinforcement will enhance self-esteem And promotes repeat of desired behaviours.
Show the client how they need to perform activities with which he or she is having trouble with.
During high levels of anxiety, a client may Require simple, concrete demonstrations of activities that would be done without difficulty under ordinary conditions.
- Keep strict records of food and fluid intake.
- For an accurate nutritional assessment.
- Offer nutritious snacks and fluids involving meals.
The client may be Not Able to tolerate large Amounts of meals and mealtimes and may, therefore, need additional nourishment.
Deficient Knowledge: The condition in which an Individual or team experiences a lack of cognitive understanding or psychomotor skills regarding the condition or treatment plan.
Maybe related to
· Unfamiliarity with medications used and possible adverse effects.
Maybe evidenced by
- · Verbalizes a lack of knowledge or skill or requests information.
- · Expresses an inaccurate perception of health status.
- · Doesn’t correctly perform prescribed or desired health behaviour.
· Client states correct details regarding drugs and negative side effects.
- Explain the physiological activity of SSRI in Relieving anxiety.
- Anxiety disorders are often caused by a neuropsychiatric disorder that responds to medication.
- Check for nausea, headache, nervousness, Insomnia, agitation, erectile dysfunction.
- These are the typical adverse effects of SSRIs. Treatment ought to be started in low doses and increased slowly as the patient tolerates.
- Check for fatigue, drowsiness, and cognitive impairments.
- Common side effects of benzodiazepines.
- Gradual tapering is necessary when a Benzodiazepine is discontinued.
- Abrupt discontinuation can Lead to recurrence of anxiety.
What Are Anxiety Disorders?
Everyone feels nervous now and then. It’s a normal emotion. By way of instance, you might feel nervous when confronted with a problem at work, before taking an examination, or before making an important choice.
Stress disorders are different, though. They’re a group of mental disorders, and The distress they cause can keep you from carrying on with your life generally.
For People that have one, fear and anxiety are constant and overwhelming and may be disabling. But with treatment, many people can handle those feelings and return to a fulfilling lifestyle.
Types of Disorders
Stress Disorder is an umbrella term that includes different conditions:
Panic disorder. You are feeling the terror that strikes randomly. During a panic attack, you could also sweat, have chest pain, also feel palpitations(remarkably strong or irregular heartbeats). At times you may feel like you’re choking or using a heart attack.
Social anxiety disorder. Also referred to as social phobia, this is when you truly feel overpowering worry and self-consciousness about everyday social conditions. You fixate about others judging you or on being humiliated or ridiculed.
You cn feel intense fear of a particular situation or object, such as flying or heights. The fear goes past what is appropriate and may cause you to avoid ordinary scenarios.
Generalized anxiety disorder. You feel excessive, unrealistic worry and anxiety with little or no reason.
All Anxiety disorders share some typical symptoms:
- Anxiety, anxiety, and uneasiness
- Sleeping problems
- Not having the ability to remain calm and still
- Cold, sweaty, tingling or tingling hands or foot
- Shortness of breath
- Heart palpitations
- Dry mouth
- Tense muscles
Researchers do sometimes not know what brings on anxiety disorders. Like other forms of mental illness, they can originate from a mixture of things, including changes in your brain and environmental stress, and even your genes. The ailments can run in families and could be linked to faulty circuits in the brain that controls fear and other emotions.
If you Have symptoms, your physician will examine you and ask for your medical history. Then they will run tests to rule out medical conditions which may be causing your symptoms. No lab tests can diagnose stress disorders.
If your Physician can’t find any medical reason for how you are feeling, she could send one to a psychologist, psychologist, or another mental health professional. Those doctors will ask you questions and use tools and testing to discover if you might have an anxiety disorder.
Your Doctor will consider how long and how extreme the symptoms are when diagnosing you. She will also check to find out whether the symptoms prevent you from carrying out your normal activities.
Most Individuals with the illness try at least one of these therapies:
Medicine: a lot of antidepressants can work for stress disorders. They comprise escitalopram (Lexapro) and fluoxetine (Prozac). Certain anticonvulsant medications (normally taken for epilepsy) and low-dose antipsychotic medication can be added to help make other therapies work better. Anxiolytics are also drugs which help reduce stress. Cases are alprazolam (Xanax) and clonazepam (Klonopin). They’re prescribed for social or generalized anxiety disorder in Addition to for panic attacks.
Psychotherapy: This is a kind of counselling that addresses the emotional response to psychological illness. A mental health professional helps you by speaking about how to comprehend and handle your anxiety disorder.
Cognitive-behavioral treatment: This is a particular type of psychotherapy that teaches you how you can recognize and change thought patterns and behaviours that trigger profound anxiety or panic.
All these Tips might help you control or reduce your symptoms:
- Cut down on meals and drinks that have caffeine, including coffee, tea, cola, energy drinks, and chocolate. Caffeine is a mood-altering drug, and it may make symptoms of anxiety disorders worse.
- Eat right, exercise, and receive better sleep. Brisk aerobic exercises such as running and biking assist discharge mind compounds that reduce stress and improve your mood.
- Sleeping problems and anxiety disorder often go together. Make getting great rest a priority. Follow a relaxing bedtime routine. Speak to your healthcare provider if you still have trouble sleeping.
Ask your doctor or pharmacist before taking any over-the-counter meds or herbal remedies. Many contain chemicals that may make anxiety symptoms worse.