Nursing Care Plan Karin Pearson
Nursing Diagnosis:
Anxiety r/t surgery, health status, and hospital stay AMB expressed concerns about healing,
respiratory difficulties and distress, increased blood pressure, increased pulse, weakness, worry and
increased wariness and general sympathetic nervous system stimulation.
Expected Outcomes:
Client will state manifestations of an anxiety attack and several techniques to overcome respiratory
effects of an attack within four days.
Nursing Interventions & Rationale:
1. Nurse will teach client and family members signs and symptoms of an anxiety attack. If patient and
family are aware of symptoms, they will be more prepared to combat an attack (Kaufman, 2006).
2. Nurse will offer client all information possible about the course of healing. Keeping the patient well-
informed can help reduce anxiety, especially if presented in terms that the patient can understand and
relate to (Ackley, 2008).
3. Nurse will perform necessary painful tests and dressing changes while patient’s attention is held by
their favorite TV program or a family member. Distraction can help reduce anxiety by refocusing
attention and helping patient forget what is happening (Ackley, 2008).
4. Nurse will provide interventions like deep breathing or yoga breathing to help patient reduce their
respiratory difficulties. Deep breathing from the stomach rather than the chest wall can help reduce
hyperventilation (Kaufman, 2006).
5. Nurse will teach client how to rebreathe to increase carbon dioxide in the body. The patient should
be taught to do pursed-lip breathing or to breathe into a paper bag. This will help reduce oxygen
intake and increase carbon dioxide intake, reestablishing respiratory homeostasis (Kaufman, 2006).
6. Nurse will provide calming, tranquil music for the patient to listen to. 20-30 minutes of classical
music has been shown to reduce heart rate and respiratory rate (Haun, 2001).
7. Nurse will encourage client and family members to use “positive self-talk” to remind themselves
they are going to be okay. Positive self-talk can help reduce respiratory and heart rate (Kaufman,
2006).
8. Nurse will assess patient for depression. Depression and anxiety commonly occur simultaneously
(Healthyplace, 2006).
9. Nurse will teach patient when the respiratory problem may not be just an anxiety attack and she may
need to be seen by a doctor. If patient experiences pain, bleeding, fever, or breathing difficulties get
progressively worse, they should be seen by a doctor (Kaufman, 2006).
10. Nurse will communicate with doctor to see if anti-anxiety medications are needed for the patient.
Beta-blockers (unless contraindicated in the patient) can help reduce physical anxiety symptoms
(Copstead, 2005). SSRIs can also help reduce anxiety in some patients (Ackley, 2008).
11. Nurse and doctor will work together to perform procedures or tests during a time of day when patient
experiences the least attacks or feels the least stress (such as the early morning, before they have time
to think about procedures all day) to minimize attacks. This will help prevent attacks before the
patient has a time to work themselves into an anxious state (Ackley, 2008).
Outcome Evaluation:
Met: Patient successfully identified respiratory effects of an oncoming anxiety attack and
prevented the attack from occurring.
References:
Ackley, B., Ladwig, G. (2008). Nursing Diagnosis Handbook Eighth Edition. Philadelphia: Mosby Elsevier Inc.
Copstead, L. & Banasik, J. (2005). Pathophysiology Third Edition. St. Louis, Missouri. Elsevier Saunders Inc.
Haun, M., Mainous, R., Looney, S. (2001). Effect of music on anxiety of women awaiting breast bioposy. Behavioral
Medicine. Retrieved October 7, 2007 from http://findarticles.com/p/articles/mi_m0GDQ/is_3_27/ai_85462332.
Healthyplace. (2006). The relationship between anxiety and depression. Depression Community. Retrieved October 13, 2007
from http://healthyplace.com/communities/depression/related/depression_anxiety.asp.
Kaufman, D. (2006). Hyperventilation. American Accreditation HealthCare Commission. Retrieved October 7, 2007 from
http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm.