Nursing Diagnosis: ANXIOUS BEHAVIOR

Assessment Desired Outcome Nursing Interventions Rationale Evaluation

● Decreasec Short-term: Independent Independent Short-term:

attention After 12-hour shift of 1. Remain with the client at all 1. The client’s safety is a priority. A After 12-hour shift of
span giving effective times when levels of anxiety are highly anxious client should not be left giving effective
● Restleness, nursing interventions high (severe panic) alone; his or her anxiety will escalate. nursing interventions
irritability the patient will be able 2. Move the client to a quiet are 2. Anxious behavior can be escalated the patient will be able
● Poor to: with minimal or decreased stimuli by external stimuli. In a large area, the to:
impulse - Be free from injury such as a small room or seclusion client can feel lost and panicky, but a - Be free from injury
control throughout area. smaller room can enhance a sense of throughout
● Feelings of hospitalization. 3. Remain calm in your approach security. hospitalization.
discomfort, - Discuss feelings of to the client 3. The client will feel more secure if - Discuss feelings of
apprehensio dread, anxiety, and so 4. Use short, simple, and clear you are calm and if the client feels dread, anxiety, and so
n, or forth within 24 to 48 statement. you are in control of the situation forth within 24 to 48
helplessnes hours 5. Avoid asking or forcing the client 4. The client’s ability to deal with hours
s - Respond to to make choices. abstractions or complexity is impaired - Respond to
● Hyperactivit relaxation techniques 6. Be aware of your own feelings 5. The client may not make sound relaxation techniques
y, pacing with staff assistance and level of discomfort. decisions or may be unable to make with staff assistance
● Wringing and demonstrate a 7. Teach the client to use decisions or solve problems. and demonstrate a
hands decreased anxiety relaxation techniques 6. Anxiety is communicated decreased anxiety
● Perceptual level within 2 to 3 independently. interpersonally. Being with an anxious level within 2 to 3
field deficits days. client can raise your own anxiety days.
● Decreased Long Term: Dependent level. Long Term:
ability to After 24-hour shift of 1. PRN medications may be 7. Using relaxation techniques can After 24-hour shift of
communicat giving effective indicated for high levels of anxiety, give the client confidence in having giving effective
e verbally nursing interventions delusions, disorganized thoughts, control over anxiety. nursing interventions
the patient will be able and so forth. Dependent the patient will be able
to: 2. Instruct the patient in the 1. Medications may be necessary to to:
- Demonstrate the appropriate use of antianxiety decrease anxiety to a level at which - Demonstrate the
ability to perform medications. the client can feel safe. ability to perform
relaxation techniques 3. Benzodiazepines such as:
- Reduce own anxiety ● Diazepam(Valium)
level without staff ● Alprazolam
assistance ● Chlordiazepoxide
- Be free from anxiety ● Clonazepam
attacks ● Lorazepam
- Manage the anxiety ● Oxazepam
response to stress 4. Buspirone (BuSpar)
effectively
Collaborative
1. Encourage the client to identify
supportive resources in the
community or on the internet.
2. Encourage the client to identify
and pursue relationships, personal
interests, hobbies, or recreational
activities that may appeal to the
client.
2. Short-term use of antianxiety relaxation techniques
medications can enhance patient - Reduce own anxiety
coping and reduce physiological level without staff
manifestations of anxiety. assistance
3. Most of these drugs are - Be free from anxiety
benzodiazepines, which are attacks
commonly prescribed for anxiety. - Manage the anxiety
These drugs are designed to relieve response to stress
anxiety so that the person can deal effectively
more effectively with whatever crisis
or situation is causing stress.
4. This drug has fewer side effects
and less risk for dependence than the
benzodiazepines. The drug has a
slower onset of action and may take 1
to 2 weeks to produce a noticeable
therapeutic effect.
Collaborative
1. Supportive resources can assist the
client in the ongoing management of
his or her anxiety and decrease social
isolation.
2. The client’s anxiety may have
prevented him or her from engaging in
relationships or activities recently, but
these can be helpful in building
confidence and having a focus on
something other than anxiety.