Definition-of-Anxiety

Nursing Diagnosis for Anxiety-A Guide for Nursing Students

Introduction

Anxiety is a psychiatric disorder that can affect people of all ages, socioeconomic backgrounds, and cultures. It has been found to impact mental health in self-esteem, relationships with others, work performance, and academic success.

This blog post is designed to discuss the diagnosis for anxiety, including general statements about the diagnosis, its prevalence, and how nurses may manage it. As you read, keep in mind that our top nursing writers are ready to help in case you get stuck with your nursing assignment. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What Is Anxiety?

Anxiety is a feeling of worry, nervousness, or unease. People with anxiety are often afraid that something terrible will happen due to their thoughts and feelings. Anxiety can be both physical and psychological.

What Are the Causes of Anxiety?

1. Psychological causes

The individual’s experiences and life histories contribute to the development of anxiety. Anxiety may develop from a single traumatic experience or an ongoing series of traumas that have produced fear, helplessness, or loss. The individual is likely to feel anxious when faced with similar circumstances in the future. 

2. Genetical Causes

Some people who develop anxiety may have a family history of the condition. The risk is exceptionally high if a close relative, e.g., parent or sibling, has experienced anxiety in the past. This suggests that heredity and environmental factors play complex roles in its development.

3. Environmental Causes

Environmental stressors, particularly childhood abuse or neglect, can lead to anxiety later in life. Sometimes individuals develop anxiety because of aversive and traumatic events experienced during their childhood, and sometimes they inherit an “anxiety gene” from one or both parents.

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What Are the Levels of Anxiety?

Mild levels of Anxiety:

Mild anxiety can mean that you are nervous about meeting a friend for lunch or taking an exam. This type of anxiety is standard and feels vaguely unpleasant, but it is not overwhelming to the person experiencing it. You do not feel as though your life may be in danger, and you have some control over the feeling of being anxious.

Moderate Anxiety:

Moderate anxiety is characterized by a feeling of being worried, nervous, or uneasy for more than a little while. You feel as though you are “on edge” and have trouble concentrating on your daily activities because of it. For example, walking to your home from work may cause you to feel anxious even if nothing terrible is happening to you at that time.

Severe Anxiety:

Being unable to stop worrying, experiencing physical symptoms of anxiety, and having trouble performing your daily activities may indicate severe anxiety. You are overwhelmed by the feeling of anxiousness, and it interferes significantly with your life or ability to function on a day-to-day basis. Severe anxiety can be life-threatening or even fatal.

Panic Attacks:

Panic attacks are periods of intense fear or apprehension that strike suddenly and without warning. Panic attacks typically last several minutes, but the symptoms can be so severe that they have been known to last for an hour or longer. 

What Are the Signs and Symptoms of Anxiety?

The main symptoms of anxiety are:

1.  Fears and phobias

2.  Hyperventilation or rapid, shallow breathing for a prolonged period (rapid inhalation with quick exhalation) can lead to dizziness or lightheadedness. This occurs because carbon dioxide levels in the blood drop when you take in large amounts of air. These physical symptoms are often interpreted as panic attacks.

3.  Night sweats and hot flashes

4. Restlessness or being on edge due to stress and feelings of fear 

5.  Tension headaches, muscle aches and backaches, fatigue, and sleep disturbances

6.  Irritability, nervousness, and anxiety

7.  Difficulty concentrating, remembering details, or making decisions is often associated with stress and feeling overwhelmed during times of intense anxiety or fear. You may also feel as if you are worried all the time with no relief from your anxiety.

8.  Frustration that seems to have no purpose

9.  Panic attacks, which are sudden periods of intense fear or anxiety often accompanied by physical symptoms such as heart

What is the Diagnostic Process for Anxiety?

The Diagnosis of Anxiety can be broken into several phases:

Phase 1: Specific Diagnosis vs. Generalized Anxiety Disorder

Specific Diagnosis – a medical condition that is present, correctable, and known to be related to the patient’s symptoms.

Generalized Anxiety Disorder – this is diagnosed when:

a.   Anxiety persists for six months with three or more of the above symptoms occurring at least one day per week treatments for Anxiety-

Nursing diagnoses associated with anxiety would include Anxiety related to uncertainty about diagnosis and treatment of illness;    Disturbed personal identity related to psychological stress;    Ineffective coping, related to lack of knowledge regarding available support systems and resources.

Phase 2: Diagnosis of Anxiety Due to Underlying Medical Condition

The second phase is to identify any underlying medical conditions or comorbid psychiatric disorders and determine whether the symptomology due to anxiety meets diagnostic criteria for a medical illness. This is necessary because certain medical illnesses or psychiatric conditions may result in anxiety.

For example, thyroid dysfunction may cause restlessness, muscle fatigue, increased heart rate, and palpitations. Diabetes insipidus may cause excessive thirst; systemic lupus may cause various symptoms (including chest pain); heart disease may cause shortness of breath.

The nurse providing this assessment would need to consider the type and severity of anxiety being experienced and any physical signs present. Suppose that a registered nurse determines that the cause of stress or anxiety in a patient during the diagnostic process is a physical illness. In that case, it may be possible to initiate treatment before completing an assessment.

The nursing assessment for medical conditions and related psychiatric disorders should include a review of past medical history, current medication, prescription drugs, over-the-counter drugs, herbal remedies, alcohol, tobacco, and any illicit drugs.

It is also essential to consider family history of medical or psychiatric illness and history, including trauma and other life experiences contributing to anxiety symptoms.

Phase 3: Assessment for Medication Side Effects. 

The third phase in the assessment process is determining whether anxiety symptoms are due to drug interactions or side effects. Several medications may cause anxiety. It may include antihypertensives (e.g., methyldopa), sedatives, narcotics, antidepressants, and antipsychotics.

Actual Diagnosis for Anxiety

If an underlying medical condition exists, it may be helpful to screen the patient for the following conditions:

1. Elevated blood pressurethyroid disease, or diabetes – all of which may have anxiety symptoms. Testing such as the following may be indicated:  laboratory tests including a basic metabolic panel, thyroid function tests, and glucose levels

2. Pulmonary function tests – to rule out any breathing disorders such as asthma and emphysema that may be causing anxiety-like symptoms.

3. Cardiac evaluation, including an electrocardiogram (EKG), chest X-ray, stress test to assess heart or cardiac functioning

4. Thyroid A thyroid disorder may be the cause of anxiety. The nurse will need to do a thorough history and physical examination, including laboratory studies (thyroid function tests).

5. Urinalysis- for excessive sweating, which could be due to hyperthyroidism or diabetes insipidus.

6. Musculoskeletal evaluation – This is important because other musculoskeletal disorders such as arthritis and fibromyalgia may lead to anxiety symptoms.

7. Psychiatric evaluation – to rule out any underlying psychiatric illness, including depression, adjustment disorder with anxiety, post-traumatic stress syndrome, obsessive-compulsive disorder, and panic attacks that might also be causing the patient’s symptomology.

If an underlying medical condition does not exist, the nurse will need to determine whether the patient meets diagnostic criteria for a psychiatric illness such as hypochondriasis, somatization disorder, conversion disorder, major depressive disorder (MDD), or obsessive-compulsive personality.

Phase 4: Planning and Implementation of Nursing Interventions  

After completing nursing assessments, the next step is to develop an individualized plan of care with specific interventions to the patient’s needs.  The treatment will be based on assessment findings and nursing diagnoses.

If the anxiety is caused by a medical condition or illness (i.e., primary anxiety disorder), then these can present an abnormal physiologic state which The patient will need to be cared for in a setting with immediate access to medical services.

Consult with a physician for further assessment of any underlying medical condition that is suspected.

Risk Diagnosis for Anxiety

1. Risk for Self-Neglect – If the patient has trouble with activities of daily living, they may neglect themselves in some way. This is referred to as self-neglect and can lead to worsening medical conditions due to lack of health care.

2 . Imbalanced Nutrition: Imbalanced Nutrition: Less than body requirements: The patient may not be eating enough and is at risk of malnutrition.

3. Risk for Physical Injury: They will need to be monitored closely while performing tasks such as driving or cooking.  If they are experiencing a panic attack, this might cause them to have problems with concentration.

4. Risk for Contracting an Infection-The patient may be at risk for contracting an infection if they are not getting proper medical care or not maintaining good hygiene.

5. Ineffective Coping related to emotional distress (includes, but is not limited to: Disruption in role performance) related to the inability to manage and cope with the symptoms of the anxiety disorder, or Disruption of the family unit about patient’s behavior and concerns

6. Disturbed Body Image related to concern regarding appearance due to anxiety disorders or perception that they have body image flaws such as excessive weight/appearance, poor skin condition, negative hair growth, etc.)

7. Deficient Knowledge related to anxiety disorders (includes, but is not limited to:     Unfamiliarity with community resources)

8. Ineffective Relationship related to isolation as a result of patient’s anxiety behaviors and symptoms

9. Impaired Social Interaction/Roles (includes, but is not limited to: Altered role performance) related to the inability to manage and cope with the symptoms of the anxiety disorder, or disruption of the family unit about patient’s behavior and concerns

10. Disturbed Sleep Pattern due to anxiety disorders (includes, but is not limited to: Altered sleep pattern).

11. Impaired Social/Occupational Functioning (includes, but is not limited to: Role performance in family or work environment) related to the inability to manage and cope with the symptoms of the anxiety disorder, or disruption of the family unit on patient’s behavior and concerns

12. Repeated use of specific reassurance-seeking related to anxiety disorders, such as the following:

a. Asking others to reassure them about their health status or ability to function in their daily roles after a minor symptom occurs (i.e., asking ten times if they have left a burner on before heading to work), or

b.  Requesting repeated tests, x-rays, or other reassurances that they are not seriously ill (i.e., repeatedly asking for a urine test for sugar after only having one cup of coffee)

13. History of Medical Condition related to an anxiety disorder in which the patient was previously diagnosed and had a successful course of treatment. This includes but is not limited to panic disorder, obsessive-compulsive disorder, phobias, and post-traumatic stress disorder.

14. Inadequate Knowledge related to Anxiety Disorders (includes, but is not limited to unfamiliarity with community resources)

15. Ineffective Coping related to the ineffectiveness in managing and coping with the symptoms of the anxiety disorder or the inability to manage and cope with the anxiety disorder symptoms due to denial or avoidance behaviors (includes, but is not limited to:  disruption in role performance).

16. Acute Stressor(s) related to primary diagnosis (stressors may include loss of employment, marital problems, financial difficulties, and work or school-related stressors)

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Treatment and Interventions for Anxiety

Interventions (based on your knowledge and assessment findings) 

1.) Encourage the patient to rest when feeling tired and suggest taking a nap during times of increased anxiety symptoms. Encourage and facilitate the patient with getting out of the house for exercise or socialization.

2.) Set up a routine with activities involving physical activity, such as walking, gardening, or running errands. 

3.) Help the patient learn relaxation techniques such as deep breathing exercises and progressive muscle relaxation (PMR) to help reduce anxiety. Promote a healthy diet, including eating three balanced meals per day and drinking at least eight glasses of water daily.  Encourage the patient to eat small frequent meals every 2-3 hours to avoid hypoglycemic symptoms that might trigger anxiety.

4.) The nurse can suggest that the patient monitor their need for caffeine in coffee, tea.)  Encourage the patient to rest when feeling tired and suggest taking a nap during increased anxiety symptoms.

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Care Plans for Anxiety

Anxiety treatments focus on changing thinking patterns and behavior to alleviate symptoms. 

1) Refer the patient to local support groups or community resources.

2) Administer the initial dose of medication. Provide information regarding side effects and potential drug interactions. Advise patient that medication does not “cure,” but instead manages symptoms while promoting treatment through therapy or self-care activities to help decrease anxiety.

3) Conduct psychosocial assessment for problem-solving, coping mechanisms, support systems, and stressors.

4) Discuss management of anxiety.

5) Identify triggers or precipitants for anxiety episodes. Engage patients in problem-solving and identify strategies to avoid these situations in the future.

6. Initiate a written contract with the patient to record when they felt anxious, what was experienced, and what coping methods were used to reduce anxiety.

7) Follow-up in 3 months with the patient using “Patient Health Questionnaire–9 (PHQ-9)” and Medical Outcomes Study 12 – Item Short-Form Health Survey (SF-12).” Scoring should be done on a scale of 0 to 27; higher scores indicate greater severity.

8) Provide reassurance and follow-up in 1 month.

9) Refer the client to individual, family, couples, or group therapy to improve coping mechanisms. Include the patient in this decision-making process.

10. Counseling interventions for patients and their families, including strategies, e.g., relaxation, self-hypnosis, biofeedback, are used in addition to or before medication is started.

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Post Care Considerations for Stress

1) The health care provider will monitor the patient’s progress.

2) Educate the client about anxiety, its symptoms, and discuss changes in treatment. 

3) Discuss safety, the need to avoid alcohol, caffeine, or sleep-depriving substances.

4) Instruct the patient in relaxation techniques such as deep breathing exercises.

5) Refer to appropriate local support groups or community resources for additional help with anxiety management.

6) Help the patient develop a follow-up plan. 

What Are the Common Medicines for the Anxiety?

Medicines commonly used for anxiety include:

Benzodiazepines –Examples include Ativan, Xanax and Valium. 

SSRIs — commonly used antidepressants, such as Paxil (paroxetine) may be prescribed.

Buspirone — This medicine can help with social anxiety disorder. It is usually used at low doses to treat generalized anxiety disorder in the United States, but it may be prescribed in higher doses for panic disorders. 

Beta-Blockers – These medicines work well for social phobia and specific phobias, offering relief from physical symptoms such as shaking, sweating, and racing heart.

Conclusion

Anxiety is a psychiatric disorder that can impact mental health in self-esteem, relationships with others, work performance, and academic success. Several events may cause it, and symptoms of anxiety are commonly experienced both emotionally and physically. These include feelings of unease, angry outbursts, difficulty concentrating, and even nausea.

Anxiety should always be managed with the patient’s needs in mind. Nursing interventions must consider each person individually based on their age, health history, and coping strategies.

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