Our Lady of Fatima University

120 McArthur Highway

Valenzuela City, Philippines

CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR (ACUTE&CHRONIC)

Case Study Presented to the
Faculty of the College of Nursing

In Partial Fulfillment of the Requirements in NCMB 317

“GENERALIZED ANXIETY DISORDER”

Submitted by:
Angeles, Floren Anne N.
Bautista, Elisha G.
Cruz, Paola Luz R.
Cueva, Queenie Claire A.
Marquez, Mark Louie F.
Peralta, Melchizedek N.

GROUP 1B

Submitted to:

Aida Bautista RN, MAN

Vilma Miguel RN, MAN
 TABLE OF CONTENTS

I. Learning Objectives

II. Introduction

III. Patient Profile

IV. Patient History

V. Mental Status Exam

VI. Course in the Ward

VII. Gordon’s Functional Health Pattern

VIII. Anatomy and Physiology

IX. Psychopathology

X. Drug Study

XI. Nursing Care Plan

XII. Discharge Planning (Recommendations)

XIII. References
LEARNING OBJECTIVES

General Objectives:

To broaden the students’ understanding of a client with Generalized Anxiety Disorder.

Specific Objective:

 To be able to acquire knowledge regarding G.A.D, its background and epidemiology through
research.
 To trace the psychopathology of G.A.D.
 To render the necessary nursing care and responsibilities to a client with G.A.D.
 To formulate and present drug studies of medications given to the client as a part of treatment
regimen.
 To develop an effective nursing care plan in which the client may benefit.
 To provide health teaching about G.A.D.
INTRODUCTION

Generalized anxiety disorder (or GAD) is marked by excessive, exaggerated anxiety and worry
about everyday life events for no obvious reason. People with symptoms of generalized anxiety disorder
tend to always expect disaster and can't stop worrying about health, money, family, work, or school.

Everyone feels anxiety now and then -- and there can be good reasons why. But in people with
GAD, the worry is often unrealistic or out of proportion for the situation. Daily life becomes a constant
state of worry, fear, and dread. Eventually, anxiety can even dominate a person's thinking so much that
they find it hard to do routine things at work or school, socially, and in their relationships. But there are
treatments to ease anxiety so it’s not running your life.

1 out of 5 Filipinos suffer from generalized anxiety disorder in any given year. It’s more
commonly reported in women than in men.

GAD affects the way a person thinks, and it can lead to physical symptoms. Symptoms of GAD
can include:

● Excessive, ongoing worry and tension

● Unrealistic view of problems
● Restlessness or a feeling of being "edgy"
● Feeling of doom
● Crankiness
● Muscle tension
● Faster heart rate
● Breathing faster
● Headaches
● Sweating
● Trouble concentrating
● Nausea
● A need to go to the bathroom frequently
● Feeling tired or weak
● Trouble falling or staying asleep
● Trembling
● Being easily startled
● Trouble swallowing

People with generalized anxiety disorder often also have other anxiety disorders such as panic
disorder or phobias, obsessive compulsive disorder, clinical depression, or problems with drug or alcohol
misuse.
PATIENT PROFILE

Name of Patient: Patient Mrs. Xenia

Sex: Female
Age: 45 years old 
Religion: Roman Catholic 
Civil Status: Married
Address: Makati City
Nationality: Filipino 
Date Admission: June 12, 2018
Chief Complaint: Constant worrying, insomnia and fatigue.
Admitting Diagnosis: General Anxiety Disorder
Medication; Diazepam, Fluoxetine
Management: Cognitive Behavioral Therapy

PATIENT HISTORY

History of present illness:

Two months prior to admission Mrs. Xenia 45 year old a university professor, continued to be tortured
by persistent feelings of anxiety and worry associated with insomnia, irritability, tension, and fatigue.
Over the years, her friends and family chided her for "worrying too much," and she reported difficulty
controlling her anxiety over her financial situation, job security, and her children's safety, despite
evidence that none of these were problematic. Her husband reported that he found her persistent
anxiety and ongoing need for reassurance "exhausting" and that he noticed himself withdrawing from
her, which led to significant tension between them. The high quality of her work at the university was
recognized and she was well-compensated financially, yet she continued to worry about her
performance and was, in fact, passed over for promotion to team leader because, as one of her annual
reviews stated, her "constant anxiety makes everyone else too nervous." Other relevant aspects of her
medical and psychiatric history include the fact that her overall health had been generally good,
although she had presented numerous times to her primary care physician with a variety of somatic
complaints, including headaches, gastrointestinal disturbance, and muscular aches and pains with no
clear etiology. She had repeated thyroid testing with normal results. Her mother had had a history of
menopause in her early 40s and the patient noted that her menstrual cycles had become more irregular
over the last couple of years, and her anxiety and irritability become notably worse premenstrually. Her
doctor treated her intermittently with benzodiazepines at low doses (eg, Diazepam 5-10 mg), which she
took on an as-needed rather than daily basis when the anxiety worsened because of her concerns about
addiction, she was started on fluoxetine 20 mg/day by her primary care doctor. She had been in
supportive therapy on and off since college to help her deal with situational stressors

Past Medical History:

Mrs. Xenia was presented with exacerbation of her chronic generalized anxiety and recurrent depressive
symptoms in March 2010. Mrs. Xenia had a history of anxiety dating back "as far as I can remember."
She was an anxious young girl with separation anxiety and shyness that manifested in elementary
school. As she grew up, she experienced ongoing anxieties about the health of her parents (worrying
that her parents would die, even though they were in good health) and her school performance (though
she was a good student). She remembers marked fears, including fears of the dark and lightning, most of
which she "outgrew" except for a persistent fear of insects, particularly cockroaches. Her anxiety
became more prominent and persistent after she left home at age 19 and entered college. She sought
care at the university health service and received a prescription for Lamotrigine that she used over the
next 5 years on an as-needed basis during periods of increased anxiety such as examinations; she also
met episodically with a therapist at the counseling center. In her freshman year, she experienced her
first major depressive episode following a break-up with a boyfriend. She was prescribed Buspirone,
which she took for a couple of months but then discontinued because of intolerable side effects (nausea
and lightheadedness). The depression gradually resolved over the next 6 months.

Social and Family History

After finishing college, Mrs. Xenia work to a university, where she met her husband. She reported being
attracted to his sense of calm and stability. He reported that part of what drew him to her was the sense
of how much she seemed to need and depend on him. They were married shortly after graduation and
had 2 children over the next 5 years. After the birth of her second child, she developed a postpartum
depression that lasted almost a year and for which she didn't seek treatment. She said that her youngest
child "is just like I was -- she's afraid of her own shadow." She grew up in a middle-class home, the
second of 3 children. She reported that childhood was "generally happy," although she was troubled by
anxiety starting early in life. There was no history of physical or sexual abuse. Both parents were still
alive in January 2005, although they had significant medical conditions and she was worried about their
health. She noted that her mother and father were both "nervous" people, and though never formally
diagnosed and treated, her maternal grandmother had a history of depression.
MENTAL STATUS EXAM

Appearance Casual dress, normal grooming but face shows fatigue and lack of
sleep due to insomnia.

Attitude Cooperative but clearly expressing signs of irritability but

generally, the patient seems calm when being asked questions.

Behavior Starts to fidget when asked about her feelings and worries.

Speech When talking about her worries, her tone changes to a higher
pitch and is talking a little bit faster that her normal pace.

Affect She is tearful at times. Especially when talking about her worries
and fears as well whenever she is feeling powerless over her
situation.
Mood Anxious

Thought Process Starting of as logical but eventually becomes disorganized

Thought Content No suicidal ideation but expresses a lot of fears.

Perception No hallucinations or delusions

Orientation Oriented

Memory/Concentration Short term intact

Insight/Judgement Fair
COURSE IN THE WARD
Date and time Doctor’s Note
Patient was seen and examined at
emergency room with chief
DATE: June 12, 2018 complaints constant worrying,
Day 1 insomnia, fatigue with an admitting
TIME: 10:00 AM diagnosis of Generalized Anxiety
Disorder.  consent was served and
The doctor ordered to admit the
patient, serve the consent and
admission management with the
following orders:  with the patient the
 Vital Signs every 4 hours
 Continue medication of
Diazepam 10 mg PO every
12 hours
 Fluoxetine 20 mg PO every
12 hours
 Monitor client for any sign
and symptoms of depression
and suicidal ideation.
 Initiate Cognitive behavioral
therapy.
Nurse’s note
For admission: 
The patient was seen and
examined by the doctor with
orders; admitted the patient,
attached to chart, vital signs
taken and recorded.
Before making any contact
psychiatric nurse begins to
internalize his/herself if she is
deemed fit to care for this
patient (Pre interaction
phase) activities includes: 
Nurses explores feelings,
fantasies, and fear. Assess
readiness for this assignment. 
Orientation Phase: 
Nurses introduced herself and
her role in the management of
care. 
Nurse Developed a mutually
acceptable contract to the
patient, verbalized
expectation, and time frame
of their nurse-client
relationship. 
TIME: 07:30 AM 
Vital Signs: 
Temp: 37.8 
PR: 75 BPM
RR: 22 CPM 
BP 100/70 mmhg
02 SAT: 96%
 Bed side care given. 
Also inspect the room for any
object deemed danger to self
and to other. 
As of this moment patient did
not have any complaints.

06:00 pm  Makes round to patient. Took

patients vitals sign and begin
to talk to patient and get
physical assessment and
history taking in a subtle way
and not pressuring patient.
(Please see history and PE for
results during this activity. 

The nurse tried to explore

relevant stressor that triggers
anxiety attack.  Letting the
client to talk about her
situation. 
Patient was then verbalized
feeling sleepy hence the
conversation was terminated. 

No signs of suicidal noted

during the conversation. 

Patient was given Diazepam as

prescribed by physician. 

Usual Nursing care done. 

DATE: 6/13/2018
Day 2 Working phase: 
TIME: 8:00 AM This time the Nurse again tried
to explore clients feeling and
ways she resolves stress. 

Begin focusing on more

specific problem and helps the
patient to identify coping
mechanism applicable to her
situation. 
 The nurse suggests to the
client to begin taking notes or
having a diary whenever she
experienced stress and note
what she did to resolve it. 

As of this day the patient is

more talkative and verbalized
her feeling that helped her
alleviate stress. 

Continued activity throughout

the day as the patient is
learning to develop problem
solving activities and coping
mechanism. 

No suicidal ideation noted

Clients’ family visit. 

TIME: 4:00 PM 
No complaints at this time. 

Husband and children wish to

be involved in the client’s
behavioral development. 

Nurse provides patient and

family teaching regarding
patient’s condition. Encourage
Client to be independent but
let her family help her. 

Client Rounds: Nurse ask the

Time: 08:00 PM  patient how her day was and
what she thinks about the
activity they did. 

Patient verbalized
independence and compliance
to coping mechanism. 
 Notified physician regarding
Time 10:00 PM  patients’ condition. 

Doctor came in and visited the

patient. 
Time 11:00 PM  With orders to continue medication. 
Patient not DTS/DTO. 
On improved mood and condition. 
May go home
Continue therapy as outpatient. 

The doctor ordered that the patient Continuity of care 

Date: 6/14/2018 was ready to discharge.
Day 3 Nurse and client summarize
Time: 08:00 AM outcome of care (Termination
Phase) the nurse let the
patient verbalized feeling
regarding separation or
termination of their nurse-
client relationship. 
Patient verbalized
understanding no anxiety nor
anger noted. 

6/14/2018 (3:00PM) 
 Discharge plan 

Continue medications
Client was referring to
community group for
continuation of therapy. 
Follow up after 1 week as
outpatient.
GORDON’S FUNCTIONAL HEALTH PATTERN
Pattern Prior Hospitalization
Health The patient is a 45 years old female. She is
perception/ taking medications as prescribed by her
health doctor as she was already diagnosed in the
management past.
The patient is healthy in general, no sickness
Nutritional/ was present however, whenever she
metabolic experience gastric pain, she sometimes tends
to avoid food or she just eats only a few.
Elimination The patient has a normal elimination pattern.
The patient can walk and clean the house and
Activity - exercise
do other activities at work.
Cognitive- The patients have no sign of forgetfulness.
perpetual
She has an irregular sleeping pattern and is
having trouble sleeping most of the time.
Sleep- rest
The patient feels likes she is a burden to her
Self-perception/ family because of her condition.
self-concept
Due to previous issues she had with her
Role- relationship husband, she was starting to question their
marriage and starting to worry about it too.
Sexuality- Not sexually active for the past two months
reproductive
The patient is easily stressed over a lot of
Coping / stress things and is easily being overthrown by her
tolerance emotions resulting to an anxiety attack.
The patient is a Roman Catholic. She and her
Value- belief
family are frequent church goers.
During Hospitalization
The patient is cooperative, she
follows whatever the doctor,
nurses says to make her
condition better.
The patient is only eating a few
as she feels like she is not in the
mood to eat.
The patient has normal
elimination pattern
The patient is now mostly
resting in bed though she can
definitely move without any
issues.
The patient is oriented.
The patient still has irregular
sleeping pattern but has
improved sleeping due to
medications.
The patient would want to get
better and promised herself not
to think that way again.
She would want to get better
and work things out with her
family.
The patient has no sexual
activities.
The patient is learning to cope
by trying to talk to her husband
more about working on her
anxiety attacks.
The patient is praying for
guidance and healing.
ANATOMY AND PHYSIOLOGY

The brain circuits and regions associated with anxiety disorders are beginning to be understood with the
development of functional and structural imaging. The brain amygdala appears key in modulating fear
and anxiety. Patients with anxiety disorders often show heightened amygdala response to anxiety cues.
The amygdala and other limbic system structures are connected to prefrontal cortex regions. Hyper
responsiveness of the amygdala may relate to reduced activation thresholds when responding to
perceived social threat. Prefrontal-limbic activation abnormalities have been shown to reverse with
clinical response to psychologic or pharmacologic interventions.

The limbic system is a collection of structures

involved in processing emotion and memory,
including the hippocampus, the amygdala, and
the hypothalamus. The limbic system is
located within the cerebrum of the brain,
immediately below the temporal lobes, and
buried under the cerebral cortex (the cortex is
the outermost part of the brain).

The limbic system was originally called the

rhinencephalon (meaning ‘smell brain’)
because it was thought to be primarily involved with the sense of smell.

Psychologists now recognize that the limbic system serves a lot more functions than previously believed.
These structures are known to be involved in the processing and regulating of emotions, the formation
and storage of memories, sexual arousal, and learning.

The limbic system is thought to be an important element in the body’s response to stress, being highly
connected to the endocrine and autonomic nervous systems.
PSYCHOPATHOLOGY

Predisposing Factors Precipitating Factors

 History of Anxiety in Parents Stressors such as:

(though not clinically diagnosed)
 Female
 Other mental health disorder
(Major Depressive Disorder) and
PPD
 Tension with husband on the past
few months
 Not getting the promotion due to
over worrying.
 History of stressful life events

Diathesis (vulnerability to mental

disorder)

Stress

Due to life events

Anxious apprehension

(including increased muscle tension and vigilance)

Worry process

A failed attempt to cope and problem solve

Intense cognitive processing Avoidance of imagery

Inadequate problem-solving skills Restricted autonomic rsponse

 Generalized Anxiety Disorder

DRUG STUDY

GENERIC NAME MECHANISM OF INDICATION CONTRAINDICATION  COMMON NURSING

BRAND NAME  ACTION  SIDE EFFECT  CONSIDERATION 
CLASSIFICATION

BRAND NAME: Fluoxetine is a Fluoxetine Gastrointestinal Nervousness, No routine

Magrilan, Prozac, selective serotonin (Magrilan) 20 disorders: for the insomnia, laboratory testing is
Sarafem reuptake inhibitor mg capsule is opinion that the SSRIs anxiety, necessary for
(SSRI) and as the indicated as may produce a headache, healthy individuals.
GENERIC NAME: name suggests, it part of the clinically important tremor, However, in elderly
Fluoxetine exerts its management increase in the risk of drowsiness, and population-
therapeutic effect of upper gastrointestinal dry mouth, specific patients,
PHARMACOLOGI by inhibiting the generalized bleeding in patients nausea, they may order
C CLASS: presynaptic anxiety with a high risk of vomiting, blood glucose and
Antidepressant, reuptake of the disorder. such bleeding. sweating, liver function tests.
neurotransmitter   diarrhea.
ROUTE:Oral serotonin. Fluoxetine Withdrawal: In Seizures,
(Magrilan) is general, withdrawal mania,  -  Administer drug in
May be taken As a result, levels also used in reactions tend to hypomania or
of 5- the morning. If dose
with or without the occur within 3 days of mixed manic of > 20 mg/day is
food. hydroxytryptamin treatment of stopping an SSRI or states
e (5-HT) are needed, administer
premenstrual related reported. in divided doses.
DOSE:20  mg/day  increased in dysphoric antidepressant Hyponatremia;
various parts of disorder. although delay of up elevation of
May be taken the brain. to 2 weeks may be hepatic ·   Monitor patient
with or without noted with Fluoxetine enzymes. for response to
food. (Magrilan). Common therapy for up to 4
symptoms include wk before increasing
dizziness, numbness dose.
and tingling,
gastrointestinal
disturbances
·  Switch to once a
(particularly nausea
week therapy by
and vomiting),
starting a weekly
headache, sweating,
dose 7 days after the
anxiety and sleep
last 20 mg/day dose.
disorders
If response is not
satisfactory,
reconsider daily
dosing.
GENERIC NAME MECHANISM OF INDICATION CONTRAINDICATION  COMMON SIDE NURSING
BRAND NAME  ACTION  EFFECT  CONSIDERATION 
CLASSIFICATION

BRAND NAME: Diazepam is a Diazepam Hypersensitivity to. Drowsiness and Assess vital signs
Pamizep benzodiazepine Benzodiazepines lightheadedness. for baseline
GENERIC NAME: tranquilliser with is used to treat comparison.
anxiety and
Diazepam anticonvulsant,
other mental - Confusion,
sedative, muscle Chronic psychosis, -Instruct patient
illnesses. ataxia.
PHARMACOLOGI relaxant and phobic or obsessional to avoid driving
C CLASS: amnesic This states. As or any other
Benzodiazepines properties  medication monotherapy in - Dependence. activities
works by depression or anxiety requiring
ROUTE:Oral Benzodiazepines, calming the associated w/ - Increased alertness due to 
such as brain and depression. aggression. drowsiness and
DOSE:5mg/OD diazepam, bind nerves. sedative effects.
to receptors in Diazepam
various regions belongs to a - Amnesia. -Educate  patient
of the brain and class of drugs with GI upset to
spinal cord. This known as - Muscle take drug with
binding increases benzodiazepin weakness. food and
the inhibitory e as an increase fluids
effects of alternative. and fibre for
gamma- -GI disturbances constipation.
aminobutyric (constipation)
acid (GABA) -Monitor liver
GABAs functions and renal
include CNS function, CBC
involvement in during long-term
sleep induction. therapy.
Also involved in
the control of -Educate patient
hypnosis, to rise slowly as
memory, fainting may
anxiety, epilepsy occur.
and neuronal
excitability
NURSING CARE PLAN 1
ASSESSMENT
“Parati ko iniisip na may
mangyayari na masama o hindi
ayon sa aking gusto kaya dapat
lagi ako handa sa lahat kasi
nakakatakot lahat” as
verbalized by the client
Objective:
 Restlessness
 Fatigue
 Irritability
 Faster breathing
 Sweat Increase
General Anxiety Disorder
Obsessive Thoughts and Worrying
NURSING DIAGNOSIS
Fear Related to Phobic
Stimulus as Evidenced by
Obsessive Thoughts and
Worrying About Every
Situation.
INFERENCE
Phobic Stimulus
Fear
PLANNING/ GOALS OF CARE
Short Term Goal:
Within an hour and a half of
nursing and patient
interaction/intervention, the
client will be able to know
some relaxation exercises on
how to control and lessen
her fear.
Long Term Goal:
After one to two weeks of
nursing intervention, the
client will be able to
function in the presence of a
phobic situation without
experiencing excessive fear
and some symptoms of it
such as tense muscles and
excessive sweating by time
of discharge from
treatment.
 INTERVENTION
Independent
1. Determine the type of the patient’s fear
by thorough, rational questioning and
active listening.
2. Assess the behavioral and verbal
expression of fear.
3. Present and discuss reality of the
situation with client in order to recognize
aspects that can be changed and those
that cannot.
4. Encourage client to explore underlying
feelings that may be contributing to
irrational fears. Help client to understand
how facing these feelings, rather than
suppressing them, can result in more
adaptive coping abilities.
5. Encourage to stop, wait, and not rush out
of feared situation as soon as
experienced. Support use of relaxation
exercises.
6. Explore things that may lower fear level
and keep it manageable (e.g., singing
while dressing, repeating a mantra,
practicing positive self-talk while in a
fearful situation).
7. Expose client to a predetermined list of
anxiety-provoking stimuli rated in
hierarchy from the least frightening to
the most frightening.
RATIONALE
Independent
1. The external cause of fear can be known.
Patients who find it unacceptable to
expose fear may find it convenient to
know that someone is willing to listen if
they choose to share their feelings.
2. This information provides a foundation
for planning interventions to support the
patient’s coping strategies.
3. The client must accept the reality of the
situation before the work of reducing the
fear.
4. Verbalization of feelings in a
nonthreatening environment may help
client come to terms with unresolved
issues.
5. Client fears disorganization and loss of
control of body and mind when exposed
to the fear producing stimulus. This fear
leads to an avoidance response, and
reality is never tested. If client waits out
the beginnings of anxiety and decreases
it with relaxation exercises, then she may
be ready to continue confronting the
fear.
6. Provides the client with a sense of
control over the fear. Distracts the client
so that fear is not totally focused on and
allowed to escalate
7. Allows client to realize that dangerous
consequences will not occur. Helps
extinguish conditioned avoidance
response
 8. Help client to learn how to use
techniques when confronting an actual
anxiety-provoking situation. Provide for
practice sessions (e.g., Role-play), deal
with phobic reactions in real- life
situations.
Dependent
Administer anti-anxiety medications as indicated;
watch out for any adverse effects.
Benzodiazepines - Diazepam
8. Client needs continued confrontation to
gain control over fear. Practice helps the
body become accustomed to the feeling
of relaxation, enabling the individual to
handle feared object/situation
Dependent
Biological factors may be involved in
phobic/panic reactions, and these medications
produce a rapid calming effect and may help
client change behavior by keeping anxiety low
during learning and desensitization sessions.
Addictive tendencies of CNS depressants need to
be weighed against benefit from the medication

EVALUATION

Short Term Goal:

After an hour and a half of nursing and patient interaction/intervention, the client is able to know and
execute some relaxation exercises on how to control and lessen her fear.

Long Term Goal:

After one to two weeks of nursing intervention, the client is able to function in the presence of a
phobic situation without experiencing excessive fear and some symptoms of it such as tense muscles
and excessive sweating by time of discharge from treatment.
NURSING CARE PLAN 2

ASSESSMENT NURSING DIAGNOSIS PLANNING/ GOALS OF CARE

Subjective: 
“Palagi ako nag-aalala at di
ako mapakali pag iniisip ko
Short Term goal:
ang mga gastusin, trabaho, at
Powerlessness related to the Within 1 hour of nursing
mga anak ko at pakiramdam
intervention the patient will be
ko wala akong magawa.” as lifestyle of helplessness as able to identify areas over
verbalized by the client.
evidenced by verbal expression which the individual has control.
As verbalized by the patient.  of having no control of anxiety Long Term goal:
Objective: 
- insomnia  over life situations.
Within 7-14 days of nursing
- fatigue 
intervention the patient will be
- tense 
able to express a sense of
- nervous 
control over the present  
- sweating 
situation and hopefulness to
- trouble in concentrating 
future outcomes
- restless

INFERENCE
History of trauma and depression

Feelings of helplessness in an incident

Powerlessness

INTERVENTION RATIONALE
Independent Independent
 1. Identified situational circumstances that 1. To assess causative factors that lead and
made her feel powerless. affect the problem.

2. Encouraged patient to rest. 2. To promote adequate rest and sleep.

3. Determined client’s perception and 3. Perception and knowledge of the

knowledge of condition. condition serves as the basis for
appropriate nursing interventions.

4. Listened to verbalization of feelings and 4. To determine the degree of

note negative expressions like “giving up” powerlessness.
and “I’m tired”.

5. Noted nonverbal behavioral responses.

5. Gestures and nonverbal cues are
significant in looking deeper into what a
person feels. It is one important way of
6. Showed concern for the client as a expressing one’s feelings.
person.
6. To make the client feel that she is not
alone and increase her self-esteem.

7. Expressed hope for the client.

7. To show that there is always hope in
everything.

8. Identified the areas that she can control

and areas that are beyond her control.
8. To help the client recognize her own
ability.
9. Encouraged client to maintain a sense of
perspective about the situation.

9. To promote optimism and a positive

10. Encouraged use of anxiety and stress- outlook towards life.
reduction techniques such as thinking of
happy thoughts and positive self- 10. To promote wellness.
recitation.

EVALUATION
STG: 
 After 1 hour of nursing intervention the patient was able to identify the areas over which
the patient has control. 

LTG: 

After 7-14 days of nursing intervention the patient was able to express a sense of control over
the present situation and hopefulness to future outcomes.

DISCHARGE PLANNING (RECOMMENDATIONS)

M - Medication  Take Diazepam 5-10 mg prn.

 Take fluoxetine 20 mg/day.

E-  Do isometric exercises.
Exercise/Environment
 Do progressive muscle relaxation to help lessen anxiousness.

 Divert attention by increasing physical activities to release energy

like stationary bicycling

 Avoid situations that may provoke anxiety.

 If doing exercises outside, walk with someone so you do not get

too far away and have a hard time to go back.

T - Treatment  Take medication exactly as ordered by the health care provider.

 Practice distraction techniques like performing repetitive

activities.

 Practice positive self-talk.

 Participate in cognitive behavioral therapy for cognitive

 restructuring, breathing training, and psychoeducation.

H - Health Teaching  Take medicines exactly as directed. Call your doctor or nurse call
line if you think you are having a problem with your medicine.

 Go to your counselling sessions and follow-up appointments.

 Be kind to your body. Relieve tension with exercise or a massage,

get enough rest, avoid alcohol, caffeine, nicotine, and illegal
drugs. They can increase your anxiety level and cause sleep
problems. Learn and do relaxation techniques.

 Engage your mind. Get out and do something you enjoy. Plan
your day. Having too much or too little to do can make you
anxious.

 Keep a record of your symptoms. Discuss your fears with a good

friend or family member, or join a support group for people with
similar problems. Talking to others sometimes relieves stress.

 Get involved in social groups, or volunteer to help others. Being

alone sometimes makes things seem worse than they are.

 Get at least 2½ hours of exercise a week to relieve stress. Walking

is a good choice.

O-  Call your physician if you:

 You have new symptoms since your last visit.
Outpatient/Observation
 Your anxiety keeps you from doing your daily activities, such
as self-care, family, or work.
 You have problems that you think may be caused by the
medicine you are taking.
 Your symptoms are getting worse.
D - Diet  Eat a breakfast that includes some protein. Eating protein at
breakfast can help you feel fuller longer and help keep your blood
sugar steady so that you have more energy as you start your day.

 Eat complex carbohydrates. Carbohydrates are thought to

increase the amount of serotonin in your brain, which has a
calming effect. Eat foods rich in complex carbohydrates, such as
whole grains — for example, oatmeal, quinoa, whole-grain breads
and whole-grain cereals. Steer clear of foods that contain simple
carbohydrates, such as sugary foods and drinks.
 Drink plenty of water. Even mild dehydration can affect your
mood.
 Limit or avoid alcohol. The immediate effect of alcohol may be
calming. But as alcohol is processed by your body, it can make you
edgy. Alcohol can also interfere with sleep.
 Limit or avoid caffeine. Avoid caffeinated beverages. They can
make you feel jittery and nervous and can interfere with sleep.
 Try to eat healthy, balanced meals. Healthy eating is important for
overall physical and mental health. Eat lots of fresh fruits and
vegetables, and don't overeat. It may also help to eat fish high in
omega-3 fatty acids, on a regular basis.

S - Spiritual  Take time to provide support and encouragement to patients,

especially at times of need. 
 Support and show respect to a patient's religious and spiritual
beliefs and practices and then modify a treatment plan based on
their preferences and decision.
REFERENCES

Marilyn Doenges et.al – Nursing Care Plans 10th Edition

NANDA 2018-2020 Edition

Psychiatric Mental Health nursing 8th Edition Sheila L. Videbeck

https://nurseslabs.com/anxiety-panic-disorders-nursing-care-plans/

https://www.semanticscholar.org/topic/Generalized-Anxiety-Disorder/3747

https://www.sciencedirect.com/science/article/abs/pii/S1476179307000390