Nursing Interventions ^*denotes collaborative interventions

Rationale

Remain with the client at all times when levels of anxiety are high (severe or panic).

The client’s safety is a priority. A highly anxious client should not be left alone—his or her anxiety will escalate.

Move the client to a quiet area with minimal or decreased stimuli such as a small room or seclusion area.

Anxious behavior can be escalated by external stimuli. In a large area, the client can feel lost and panicked, but a smaller room can enhance a sense of security.

PRN medications may be indicated for high levels of anxiety, delusions, disorganized thoughts, and so forth.

Medication may be necessary to decrease anxiety to a level at which the client can feel safe.

Remain calm in your approach to the client.

The client will feel more secure if you are calm and if the client feels you are in control of the situation.

Use short, simple, and clear statements.

The client’s ability to deal with abstractions or complexity is impaired.

Avoid asking or forcing the client to make choices.

The client may not make sound decisions or may be unable to make decisions or solve problems.

Be aware of your own feelings and level of discomfort.

Anxiety is communicated interpersonally. Being with an anxious client can raise your own anxiety level.

^*Teach the client and his or her family or significant others about anxiety, treatment methods, ways in which others can be supportive of treatment and ongoing management, and medications, if any.

The client and his or her significant others may lack knowledge about anxiety and treatment; knowing how to support the client’s self-management and avoid exacerbating anxiety will help the client after discharge from the treatment setting.

Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, meditation, and imagining being in a quiet, peaceful place.

Relaxation exercises are effective, nonchemical ways to reduce anxiety.

Teach the client to use relaxation techniques independently.

Using relaxation techniques can give the client confidence in having control over anxiety.

Help the client see that mild anxiety can be a positive catalyst for change and does not need to be avoided.

The client may feel that all anxiety is bad and not useful.

^*Encourage the client to identify and pursue relationships, personal interests, hobbies, or recreational activities that may appeal to the client. Consultation with a recreational therapist may be indicated.

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.

^*Encourage the client to identify supportive resources in the community or on the internet.

Supportive resources can assist the client in ongoing management of his or her anxiety and decrease social isolation.

Nursing Interventions ^*denotes collaborative interventions

Rationale

Help the client channel energy constructively. Encourage activities using gross motor skills (e.g., walking, running, cleaning, exercising).

Physical activities provide an outlet for excess energy. Use of large muscles, followed by relaxation, also can facilitate sleep.

Encourage the client to have a bedtime routine that includes activities that have been successful for the client (e.g., warm milk, reading). See Care Plan 38: Sleep Disorders.

Relaxing, routine activities facilitate sleep and rest.

^*Teach the client about healthful nutrition, especially regarding foods that can exacerbate gastrointestinal distress or difficulty sleeping, or that can cause anxiety-like symptoms (e.g., acidic or spicy foods, caffeine); Consultation with a dietitian may be helpful.

The client may be unaware of foods that can exacerbate anxiety-related symptoms. For example, caffeine can contribute to epigastric distress and insomnia, and can cause symptoms such as increased heart rate and feelings of nervousness.

Encourage the client to eat nutritious foods. Provide a quiet atmosphere at meal times. Avoid discussing emotional issues before, during, and immediately after meals.

Relaxation around meal times promotes digestion and avoids gastrointestinal distress. The client may have used eating (or not eating) as a way to deal with anxiety.

^*Teach the client and his or her significant others to avoid discussing emotional topics at mealtimes.

The client’s significant others may be unaware of the benefit of separating food from anxiety-provoking issues.

Encourage the client to develop a routine of daily physical activity after discharge.

Ongoing physical activity can be an effective tool in managing anxiety as well as increasing general health.

^*Encourage continued treatment for any related problems (e.g., eating disorders, post-traumatic stress, abuse) or refer the client to support groups.

Anxiety and post-traumatic disorders often require long-term treatment and support.