Outcome Identification and Nursing Goals (ANXIETY)

Protecting the patient. Do not force severely anxious patients into situations they are not able to handle. Do not ask why questions. Patients don t understand why their symptoms have developed.

The patient will demonstrate adaptive ways of coping with stress. Short-term goals can break the expected outcome down into readily attainable steps.This allows the patient and nurse to see progress even if the ultimate goal appears distant. The highest priority short-term goal should address safety and lowering the anxiety level. The reduced level of anxiety should be evident in a reduction of behaviors associated with severe or panic levels. Nursing Outcome Indicators for Anxiety Self-Control Monitors intensity of anxiety Plans coping strategies for stressful situations Uses effective coping strategies Monitors duration of episodes Monitors length of time between episodes Maintains adequate sleep Seeks information to reduce anxiety Controls anxiety response

Practice Guidelines (cont) (Severe levels of anxiety) Modifying the environment- identify anxiety-producing situations and attempt to reduce them.Assume a quiet,calm manner and decrease environmental stimulation. Limiting the patient s interaction with other patients will minimize the contagious aspects of anxiety. Supportive measures include warm baths, massages, and whirlpool baths. Encouraging patient s interest in activities.(walking, hobbies, physical exercise) Medications Benzodiazepines: ie. Xanax, Librium, Valium, Ativan, Serax, Tranxene) Anxiolytic: BuSpar SSRI s: Celexa, Prozac, Paxil, Zoloft Tricyclics: Elavil, Norpramin, Anafranil, Tofranil, Pamelor MAOI s: Nardil

Practice Guidelines (Severe &Panic Levels of Anxiety) Establishing a trusting relationship Be aware of your own feelings of anxiety, as a nurse. These can interfere with the therapeutic process.

Nursing Practice Guidelines ( For Moderate Levels of Anxiety) When patient s anxiety is reduced to a moderate level, the nurse can help with problem-solving efforts to cope with stress.

Long term goals focus on helping the patient understand the cause of the anxiety and learn new ways of controlling it. Goals include pt. education, recognition of the anxiety, insight into the anxiety, and coping with the threat. C.B.T. can be used and promotion of the relaxation response. Cognitive Behavioral Therapy

Involves 3 therapeutic strategies: Anxiety reduction: relaxation, biofeedback, systematic desensitization. Cognitive Restructuring: monitor thoughts and feelings, examining alternatives, reframing. Learning new behavior: rolemodeling, role playing, social skills training, learning new ways of coping with stress.