{
  "name": "Anxiety & Panic Disorders",
  "slug": "anxiety",
  "url": "https://nursingplex.com/care-plans/anxiety",
  "category": "Mental Health & Psychiatric",
  "summary": "Excess worry or panic episodes; grounding, calm environment, therapy and medication teaching.",
  "nursing_diagnoses": [
    "Anxiety",
    "Ineffective coping",
    "Disturbed sleep pattern"
  ],
  "overview": [
    "Anxiety is a vague, uneasy feeling of dread whose source is often non-specific or unknown to the person experiencing it. Unlike fear, which has an identifiable object, anxiety is generated internally and is best understood as the body's alarm system firing without a clearly visible threat. In small amounts it sharpens attention and drives problem-solving; beyond that point it narrows perception and disorganizes thinking.",
    "Nurses grade anxiety by level. Mild anxiety widens the perceptual field and improves learning. Moderate anxiety narrows attention to the immediate concern, so the person hears only part of what is said and needs information repeated. Severe anxiety reduces focus to scattered details, with headache, nausea, trembling and rapid speech. Panic is disorganized terror with loss of rational thought, sometimes hallucination, and a real risk of harm; a person in panic cannot learn and must never be left alone.",
    "Because the physical signs of anxiety — tachycardia, tachypnea, restlessness, diaphoresis — are the same signs produced by hypoxia, hypoglycemia, pain, alcohol withdrawal and impending shock, the first nursing responsibility is always to rule out a physiologic cause before labeling the presentation psychological."
  ],
  "key_facts": [
    {
      "label": "Anxiety vs. fear",
      "text": "Fear has a known, external object; anxiety is internal and often has no identifiable source."
    },
    {
      "label": "Learning threshold",
      "text": "Teaching only works at mild to moderate levels; at severe and panic levels, reduce stimuli first."
    },
    {
      "label": "Rule out first",
      "text": "Hypoxia, hypoglycemia, pain, arrhythmia, thyroid excess and withdrawal all mimic anxiety."
    },
    {
      "label": "Panic safety",
      "text": "Stay with the patient, use short simple sentences, keep the environment quiet, never leave them alone."
    },
    {
      "label": "Medication onset",
      "text": "SSRIs need 2–6 weeks for full anxiolytic effect; benzodiazepines are short-term bridges only."
    }
  ],
  "nursing_priorities": [
    "Rule out physiologic causes before treating the presentation as psychological.",
    "Determine the level of anxiety, since it dictates every other intervention.",
    "Maintain safety of the patient and others during severe anxiety or panic.",
    "Reduce environmental stimuli and stay physically present.",
    "Help the patient name the feeling and identify triggers and early warning signs.",
    "Teach and rehearse coping skills while anxiety is low enough to learn.",
    "Administer and teach anxiolytic therapy safely, including realistic onset expectations.",
    "Build an ongoing support and follow-up plan rather than relying on crisis management."
  ],
  "assessment": {
    "subjective": [
      "Reports of dread, apprehension, or feeling that 'something bad is going to happen'",
      "Worry that is difficult to control and intrudes on daily activity",
      "Chest tightness, palpitations, shortness of breath, lump in the throat",
      "Nausea, abdominal discomfort, urinary frequency, dry mouth",
      "Difficulty concentrating, mind going blank, insomnia",
      "Fear of dying or losing control during panic episodes"
    ],
    "objective": [
      "Tachycardia, tachypnea, elevated blood pressure, diaphoresis, tremor",
      "Restlessness, pacing, hand-wringing, fidgeting, startle response",
      "Rapid or pressured speech, repeated questioning, poor eye contact",
      "Narrowed attention, inability to follow instructions, scattered thinking",
      "Hyperventilation with circumoral or fingertip tingling and carpopedal spasm",
      "Avoidance of the feared situation, procedure or place",
      "Sleep disturbance documented over consecutive nights"
    ],
    "related_factors": [
      "Threat to health status, body integrity, role function or self-concept",
      "Unfamiliar environment, procedures and equipment",
      "Situational or maturational crisis and unmet needs",
      "Uncertainty of diagnosis, prognosis or finances",
      "Substance intoxication or withdrawal",
      "Physiologic states such as hypoxia, hypoglycemia, arrhythmia and hyperthyroidism"
    ]
  },
  "goals": [
    "The client will identify and verbalize the feeling of anxiety and at least two personal triggers.",
    "The client will demonstrate a reduction in anxiety to a manageable level, evidenced by heart rate and respiratory rate returning toward baseline and relaxed posture.",
    "The client will use at least two coping techniques independently when anxiety rises.",
    "The client will remain safe, with no self-harm or harm to others during episodes of severe anxiety.",
    "The client will report improved sleep and ability to participate in usual activities.",
    "The client will state the purpose, onset time and side effects of prescribed anxiolytic therapy."
  ],
  "interventions": [
    {
      "title": "1. Assessing anxiety and excluding physical causes",
      "points": [
        "Check oxygen saturation, glucose, vital signs and pain score before attributing symptoms to anxiety — hypoxia and hypoglycemia present identically and are immediately correctable.",
        "Ask directly what the patient is feeling and rate it with a simple 0–10 scale so change can be measured objectively rather than by impression.",
        "Determine the level — mild, moderate, severe or panic — because interventions that work at one level fail at another.",
        "Review medications and substances: caffeine, decongestants, corticosteroids, thyroid replacement, stimulant use and alcohol or benzodiazepine withdrawal all provoke anxiety.",
        "Ask about suicidal thoughts plainly; anxiety with hopelessness or panic carries real risk and asking does not plant the idea."
      ]
    },
    {
      "title": "2. Providing immediate presence and a calm environment",
      "points": [
        "Stay with the patient during severe anxiety and panic; the presence of a calm person is itself the intervention and abandonment escalates panic.",
        "Speak in short, simple, concrete sentences and repeat them without irritation; a narrowed perceptual field cannot process long explanations.",
        "Reduce stimuli — dim lights, lower noise, limit visitors, move to a quieter room — since sensory overload compounds the alarm response.",
        "Use a calm, unhurried manner and keep your own voice low; anxiety is contagious in both directions.",
        "Avoid asking a panicking patient to make decisions; take charge temporarily and return choice as control comes back."
      ]
    },
    {
      "title": "3. Helping the patient recognize and manage the feeling",
      "points": [
        "Help the patient name the emotion — 'you look tense; are you feeling anxious?' — because unnamed distress is harder to control.",
        "Explore what preceded the episode to build a trigger list the patient can use for early recognition.",
        "Teach diaphragmatic breathing and coach it in real time during an episode; slowing the breath directly interrupts hyperventilation and its tingling and dizziness.",
        "Teach progressive muscle relaxation, grounding techniques and guided imagery while anxiety is mild enough for learning to occur.",
        "Encourage physical activity as tolerated; regular exercise measurably reduces baseline anxiety.",
        "Help reframe catastrophic thinking by examining the evidence for and against the feared outcome rather than reassuring falsely."
      ]
    },
    {
      "title": "4. Preparing patients for procedures and unfamiliar care",
      "points": [
        "Give honest, specific sensory information about what the patient will feel, hear and see; unknowns generate more anxiety than unpleasant facts.",
        "Explain equipment and alarms before they are used, and orient the patient to the unit routine and call system.",
        "Break teaching into short segments and confirm understanding with teach-back; anxious patients retain far less than they appear to.",
        "Offer realistic choices — timing, position, who is present — since restored control lowers anxiety directly.",
        "Provide written or recorded material to review later when the patient is calmer."
      ]
    },
    {
      "title": "5. Maintaining safety in severe anxiety and panic",
      "points": [
        "Remove hazardous objects and stay between the patient and any exit only if it does not escalate the situation.",
        "Do not touch a panicking patient without permission; unexpected touch can be perceived as threat.",
        "Set clear, non-punitive limits on unsafe behavior and state the expected behavior simply.",
        "Use PRN medication early rather than after full escalation, and reserve restraint or seclusion for imminent danger when all else has failed.",
        "Debrief with the patient afterward to identify what helped, building the plan for the next episode."
      ]
    },
    {
      "title": "6. Pharmacologic management and teaching",
      "points": [
        "SSRIs and SNRIs are first-line for chronic anxiety; teach that benefit takes 2–6 weeks and that early jitteriness usually passes.",
        "Benzodiazepines relieve acute anxiety within minutes but carry sedation, fall risk, tolerance and dependence — they are a bridge, not a plan.",
        "Warn against combining benzodiazepines with alcohol or opioids, and never stop them abruptly after long use because of withdrawal seizure risk.",
        "Buspirone is non-sedating and non-addictive but requires several weeks and consistent daily dosing to work.",
        "Beta blockers may be prescribed for the physical symptoms of performance anxiety; monitor heart rate and blood pressure.",
        "Emphasize that medication works best combined with therapy, especially cognitive behavioral therapy."
      ]
    },
    {
      "title": "7. Building coping and long-term support",
      "points": [
        "Identify coping strategies that have worked for this patient before and reinforce them rather than imposing new ones.",
        "Encourage a consistent sleep schedule, limited caffeine and alcohol, and regular meals; all three raise anxiety threshold.",
        "Involve family in learning the early warning signs and the agreed response plan.",
        "Refer to counseling, cognitive behavioral therapy or support groups and confirm the first appointment before discharge.",
        "Document what level of anxiety triggered which intervention and its effect so the team responds consistently."
      ]
    }
  ],
  "patient_teaching": [
    "Recognize your personal early warning signs and act at the mild stage rather than waiting for panic.",
    "Practice breathing and relaxation daily when calm, so the skill is automatic when it is needed.",
    "Take antidepressant anxiolytics every day as prescribed and expect 2–6 weeks before full benefit; do not stop them on your own.",
    "Limit caffeine, nicotine, alcohol and energy drinks, all of which mimic and worsen anxiety.",
    "Keep a regular sleep and activity schedule and include exercise most days.",
    "Call your provider for worsening anxiety, new suicidal thoughts, or side effects that interfere with daily life.",
    "Go to the emergency department for chest pain, fainting, or symptoms you have not had before — do not assume it is only anxiety."
  ]
}