Which is the correct nursing intervention when assessing a client with anxiety?

All nurses will meet people who experience anxiety, and an awareness of the underlying causes, simple interventions and when to refer to specialist services can help patients to manage their symptoms. This article comes with a self-assessment enabling you to test your knowledge after reading…

Abstract
Of all psychiatric illnesses, anxiety disorders are the most prevalent and generalised anxiety disorder is the most common of all the anxiety disorders. Causes of anxiety can include stress and trauma, environmental factors and genetics. Symptoms of anxiety are both psychological and physical in their presentation, and can cause affected individuals and their families or carers significant distress. Treatment can include self-help, lifestyle adjustments, pharmacological therapy and psychological approaches. Nurses across all fields of practice work with patients who experience anxiety; an awareness of simple interventions and psychoeducation can help these patients.
Citation: Milne R, Munro M (2020) Symptoms and causes of anxiety, and its diagnosis and management. Nursing Times [online]; 116: 10, 18-22.
Authors: Rosa Milne is community mental health nurse, Royal Cornhill Hospital Aberdeen; Mary Munro is lecturer, mental health nursing, Robert Gordon University Aberdeen, and community mental health nurse (substance misuse), Royal Cornhill Hospital Aberdeen.

This article has been double-blind peer reviewed
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Oct.01.2020

Clinical Description

• Care of the hospitalized patient experiencing feelings of apprehension, uneasiness, uncertainty or dread about possible future events and the ability to deal with the events.

Key Information

• Anxiety is a subjective, individual experience ranging from vague discomfort to feelings of panic. It is a normal response to threatening situations.

• Anxiety can become excessive and difficult to control; negatively affecting day-to-day living, physical comfort and medical diagnosis symptoms.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:

• Anxiety Reduction or Resolution

B. Patient, family or significant other will teach back or demonstrate education topics and points:

• Education: Overview
• Education: Self Management
• Education: When to Seek Medical Attention

Correlate Health Status

• Correlate health status to:

  • history, comorbidity
  • age, developmental level
  • sex, gender identity
  • baseline assessment data
  • physiologic status
  • response to medication and interventions
  • psychosocial status, social determinants of health
  • barriers to accessing care and services
  • health literacy
  • cultural and spiritual preferences
  • safety risks
  • family interaction
  • plan for transition of care

Anxiety

Signs/Symptoms/Presentation

• acting out
• agitation
• anger
• apprehension
• crying
• distress
• fear
• helplessness
• hypervigilance
• increased dependence
• irritability
• joking
• nervousness
• panic
• regressive behavior
• restlessness
• sense of impending doom
• social withdrawal
• worry

Physical symptoms

• dry mouth
• muscle tension
• shortness of breath
• skin flushed
• skin rash
• sleep disturbance
• urinary frequency
• urinary urgency

Vital Signs

• heart rate increased

Problem Intervention

Promote Anxiety Reduction

• Maintain a calm and reassuring environment; minimize noise; provide familiar items; cluster care; offer choices.
• Encourage support system presence and participation.
• Support expression and identification of feelings and worries; compassionately acknowledge and validate concerns.
• Utilize existing coping strategies and assist in developing new strategies (e.g., music, deep breathing, relaxation techniques, massage, meditation or pet therapy).
• Identify thoughts and feelings that led to current anxiety onset to enhance understanding of triggers.
• Reframe anxiety-provoking situations; provide a new perspective; engage in problem-solving.
• Utilize anticipatory guidance to enhance sense of control.
• Consider referral for a comprehensive assessment if there are concerns about the number, severity and duration of symptoms; degree of distress; functional impairment or excessive substance use.

• Complementary Therapy
• Supportive Measures
• Family/Support System Care

Education

Overview

• risk factors

• signs/symptoms

Self Management

• coping strategies

• resources for support

When to Seek Medical Attention

• unresolved/worsening symptoms

General Education

• admission, transition of care

• orientation to care setting, routine

• advance care planning

• diagnostic tests/procedures

• diet modification

• opioid medication management

• oral health

• medication management

• pain assessment process

• safe medication disposal

• tobacco use, smoke exposure

• treatment plan

Safety Education

• call light use

• equipment/home supplies

• fall prevention

• harm prevention

• infection prevention

• MDRO (multidrug-resistant organism) care

• personal health information

• resources for support

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Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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