Anxiety

Anxiety

(_)Actual (_)
Potential

Related
To:
[Check
those that apply]
(_)
Anesthesia
(_) Anticipated/actual pain
(_) Disease

(_) Invasive/noninvasive procedure:_________
_____________________________________
(_) Loss of significant other
(_) Threat to self-concept
(_) Other:_____________________________
____________________________________

____________________________________

 

As
evidenced by:
[Check
those that apply]
Major:

(
Must be
present
)
[Physiological]
(_) Elevated BP, P, R (_) Insomnia (_) Restlessnes (_)
Dry mouth

(_) Dilated pupils (_) Frequent urination (_) Diarrhea
[Emotional]
(_) Patient complains of apprehension, nervousness,
tension
[Cognitive]
(_) Inability to concentrate (_) Orientation to past

(_) Blocking of thoughts, hyperattentiveness

 

Date &

Sign.

Plan and Outcome
[Check
those that apply]
Target
Date:
Nursing Interventions
[Check
those that apply]
Date
Achieved:
  The
patient will:

(_)
Demonstrate a decrease in anxiety A.E.B.:

  • A reduction in
    presenting physiological, emotional, and/or
    cognitive manifestations of anxiety.
  • Verbalization of
    relief of anxiety.

(_)
Discuss/demonstrate effective coping mechanisms for
dealing with anxiety.

(_) Other:

 

  (_)
Assist patient to reduce present level of anxiety by:
  • Provide
    reassurance and comfort.
  • Stay with person.
  • Don’t make
    demands or request any decisions.
  • Speak slowly and
    calmly.
  • Attend to
    physical symptoms. Describe symptoms:

 

  • Give clear,
    concise explanations regarding impending
    procedures.
  • Focus on present
    situation.
  • Identify and
    reinforce coping strategies patient has used in
    the past.
  • Discuss
    advantages and disadvantages of existing coping
    methods.
  • Discuss alternate
    strategies for handling anxiety. (Eg.: exercise,
    relaxation techniques and exercises, stress
    management classes, directed conversation (by
    nurse), assertiveness training)
  • Set limits on
    manipulation or irrational demands.
  • Help establish
    short term goals that can be attained.
  • Reinforce
    positive responses.
  • Initiate health
    teaching and referrals as indicated:

 

(_)
Other:________________
________________________
________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________

RN signature