Nurse's Pocket Guide

Voice quivers or changes pitch
Trembling; increased pulse/respirations
Severe
Range of perception is reduced; anxiety interferes with effective
functioning
Preoccupied with feelings of discomfort/sense of impending
doom
Increased pulse/respirations with reports of dizziness, tingling
sensations, headache, and so forth
Panic
Ability to concentrate is disrupted; behavior is disintegrated; client
distorts the situation and does not have realistic perceptions of
what is happening. Client may be experiencing terror or confusion
or be unable to speak or move (paralyzed with fear)
• Note reports of insomnia or excessive sleeping, limited/avoidance
of interactions with others, use of alcohol or other drugs
of abuse, which may be behavioral indicators of use of withdrawal
to deal with problems.
• Review results of diagnostic tests (e.g., drug screens, cardiac
testing, complete blood count, and chemistry panel), which
may point to physiological sources of anxiety.
• Be aware of defense mechanisms being used (e.g., denial or
regression) that interfere with ability to deal with problem.
• Identify coping skills the individual is currently using, such as
anger, daydreaming, forgetfulness, overeating, smoking, or
lack of problem solving.
• Review coping skills used in past to determine those that
might be helpful in current circumstances.
NURSING PRIORITY NO. 2.To assist client to identify feelings and
begin to deal with problems:
• Establish a therapeutic relationship, conveying empathy and
unconditional positive regard. Note: Nurse needs to be aware
of own feelings of anxiety or uneasiness, exercising care to
avoid the contagious effect/transmission of anxiety.
• Be available to client for listening and talking.
• Encourage client to acknowledge and to express feelings; for
example, crying (sadness), laughing (fear, denial), or swearing
(fear, anger).
• Assist client to develop self-awareness of verbal and nonverbal
behaviors.
• Clarify meaning of feelings/actions by providing feedback
and checking meaning with the client.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 91
ANXIETY