The nurse is caring for a client with anxiety disorder. identify three expected findings

An anxiety disorder is considered a chronic condition in which the individual has an excessive and persistent sense of apprehension. It can often result in repeated episodes of sudden intense feelings of fear, terror, or being anxious. These episodes are then commonly referred to as panic attacks. The anxiety that causes these can become quite debilitating and interfere with an individual’s normal daily activities as they can be difficult to control and may last for long periods of time. There are many types of anxiety disorders, some of which are listed below.

Types of Anxiety Disorders

• Anxiety disorder related to a specific medical diagnosis
• Generalized anxiety
• Panic disorders
• Separation anxiety disorder
• Social anxiety disorder
• Various phobias

Symptoms of Anxiety

Individuals suffering from anxiety may display a wide range of symptoms. This means the individual may be able to verbalize what she or he is feeling or there may be physical signs and symptoms a nurse should be aware of and note if present. Some of these signs and symptoms include: 

• Feeling nervous
• Restlessness and tense appearance
• Verbalizing a sense of impending danger
• Tachycardia
• Tachypnea
• Hyperventilation
• Diaphoresis
• Trembling/tremors
• Weakness or tiredness
• Difficulty concentrating
• Difficulty sleeping
• GI distress
• Difficulty controlling one’s worrying

Causes

The causes of anxiety can be extensive and sometimes the exact cause is not able to be clearly identified. Below is a general list of some potential causes however this list is not all inclusive.  

• Other medical conditions (i.e. heart disease, diabetes, chronic pain)
• Side effects to medications
• Family history of anxiety disorders
• Stress
• Other mental health disorders
• Drug or alcohol use
• Trauma – having experienced a traumatic event either as a child or as an adult

Expected outcomes

• Patient will be able to acknowledge and discuss fears and concerns
• Patient will be able to verbalize feelings of anxiety and present ideas of how to handle those feelings
• Patient will be able to develop and demonstrate problem-solving techniques
• Patient will be able to identify appropriate resources
• Patient’s vital signs will remain or return to stable baseline state
• Patient will be able to maintain regular sleep routine

Nursing Assessment for Anxiety

1. Assess and acknowledge presence of anxiety.
It is important to be aware of patient’s feeling of anxiety and let the patient know these feelings are real and matter.

2. Conduct head-to-assessment.
This will allow the nurse to note any physical signs or symptoms of anxiety that the patient may not be able to verbalize.

3. Assess vital signs.
Patients’ vital signs may be abnormal if feeling anxious (i.e. tachycardia or tachypnea may be present).

4. Assess the degree of anxiety the patient is experiencing (mild, moderate, severe) and the reality of this degree and anxiety threat.
Every individual may perceive a situation differently and an individual’s response to anxiety will vary from person to person. It is important the nurse knows how the anxiety relates to each individual person in order to better tailor care to that patient.

5. Assess patient’s ability to focus/concentrate.
Individuals suffering from anxiety may struggle to focus on more than one thing at a time. Difficulty concentrating can further assist the nurse in assessing the severity of the anxiety.

6. Observe and assess patient’s speech.
Patient’s ability to speak may give the nurse another indicator into the level of anxiety one is experiencing. Anxiety may cause the individual the change his or her speech in terms of the rate of speech, words used, repetition, use of humor or laughter, or use of profane language.

7. Assess patient’s perception of the situation.
An individual’s perception affects how the individual will handle the situation.

8. Assess current coping mechanisms.
This can help to guide the nurse’s education later in the treatment plan if having already identified areas of strength and/or areas of improvement for the patient in handling these difficult situations.

Nursing Interventions for Anxiety

1. Acknowledge the feelings the patient is experiencing.
Acknowledging the patient’s feelings will help the patient feel she or he is being heard and can assist the patient in becoming more trusting and comfortable with the nurse.

2. Administer medication as appropriate and as ordered.
Individuals with a history of anxiety may have PRN anxiety medications to assist with breakthrough anxiety/panic attacks.

3. Provide active-listening to patient.
Sometimes patients need to discuss what exactly they are feeling and what is causing them to feel this way. Providing active-listening will allow for a trusting therapeutic relationship between nurse and patient to be developed.

4. Instruct patient through guided imagery or other relaxation techniques/methods.
This will promote relaxation for the patient and the release of endorphins that will further reduce anxiety.

5. Educate patient on new coping mechanisms or previously used ones that were affective for the patient.
This will allow the patient to build confidence in oneself in being able to handle these difficult situations and will gain the individual independence once discharged home.

6. Identify resources the patient can use at home, in the future, along with a plan to follow for breakthrough episodes of anxiety.
This will allow the patient more independence at home and comfort in having already developed a plan to follow if another episode of anxiety occurs.

7. Encourage the patient to engage in regular daily exercise and activity programs.
Research has shown that regular exercise and activity raises endorphin levels resulting in an increase in one’s sense of well-being and reduction of anxiety levels.

8. Instruct/educate patient on how to use positive self-talk.
Often times an individual’s internal dialogue may be negative; by guiding a patient through verbalizing these internal thoughts the nurse can assist the patient with developing ways to speak more positively about oneself which can further decrease anxiety levels.

Prevention

Unfortunately, it is not possible to predict exactly who will develop anxiety and everyone that experiences anxiety may display and handle it differently. Prevention is key though. Individuals experiencing anxiety are more likely to become depressed, misuse substances, have difficulty sleeping, socially isolate themselves, have a poorer quality of life, and are at an increased risk of suicide. It is important to be aware of these possible risks and complications to ensure anxiety is dealt with early and the patient is educated on ways for preventing and/or coping with it in the future.

References and Sources

1. Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span (10th edition). F.A. Davis Company.
2. Marks, J. (2021). Medical definition of anxiety disorder. https://www.medicinenet.com/anxiety_disorder/definition.htm
3. Mayo Clinic. (2018). Anxiety disorders. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

What are three expected findings related to anxiety disorder?

What are the 3 different strategies mentioned to cope up with anxiety?

What clinical findings may be expected when a nurse assesses an individual diagnosed with an anxiety disorder?

Which of the following are symptoms of generalized anxiety disorder?