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Careplan

Anxiety (Adult Inpatient)

Oct.01.2020

Anxiety (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing feelings of apprehension, uneasiness, uncertainty or dread about possible future events and the ability to deal with the events.

Key Information

  • Anxiety is a subjective, individual experience ranging from vague discomfort to feelings of panic. It is a normal response to threatening situations.
  • Anxiety can become excessive and difficult to control; negatively affecting day-to-day living, physical comfort and medical diagnosis symptoms.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Anxiety Reduction or Resolution

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Anxiety

Signs/Symptoms/Presentation

  • acting out
  • agitation
  • anger
  • apprehension
  • crying
  • distress
  • fear
  • helplessness
  • hypervigilance
  • increased dependence
  • irritability
  • joking
  • nervousness
  • panic
  • regressive behavior
  • restlessness
  • sense of impending doom
  • social withdrawal
  • worry

Physical symptoms

  • dry mouth
  • muscle tension
  • shortness of breath
  • skin flushed
  • skin rash
  • sleep disturbance
  • urinary frequency
  • urinary urgency

Vital Signs

  • heart rate increased

Problem Intervention

Promote Anxiety Reduction

  • Maintain a calm and reassuring environment; minimize noise; provide familiar items; cluster care; offer choices.
  • Encourage support system presence and participation.
  • Support expression and identification of feelings and worries; compassionately acknowledge and validate concerns.
  • Utilize existing coping strategies and assist in developing new strategies (e.g., music, deep breathing, relaxation techniques, massage, meditation or pet therapy).
  • Identify thoughts and feelings that led to current anxiety onset to enhance understanding of triggers.
  • Reframe anxiety-provoking situations; provide a new perspective; engage in problem-solving.
  • Utilize anticipatory guidance to enhance sense of control.
  • Consider referral for a comprehensive assessment if there are concerns about the number, severity and duration of symptoms; degree of distress; functional impairment or excessive substance use.

Associated Documentation

  • Complementary Therapy
  • Supportive Measures
  • Family/Support System Care

Education

CPG-Specific Education Topics

Overview

  • risk factors

  • signs/symptoms

Self Management

  • coping strategies

  • resources for support

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • Andrews, G.; Bell, C.; Boyce, P.; Gale, C.; Lampe, L.; Marwat, O.; … Wilkins, G.. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder.. Australian & New Zealand Journal of Psychiatry. 2018;52(12), 1109–1172. doi:10.1177/0004867418799453 Source[Clinical Practice Guidelines]
  • Bandelow, B.; Lichte, T.; Rudolf, S.; Wiltink, J.; Beutel, M. E. The German guidelines for treatment of anxiety disorders.. European Archives of Psychiatry and Clinical Neuroscience . 2015;265(5), 363-373. doi:10.1007/s00406-014-0563-z Source[Clinical Practice Guidelines]
  • Bert, F.; Gualano, M. R.; Camussi, E.; Pieve, G.; Voglino, G.; Siliquini, R. Animal assisted intervention:  A systematic review of benefits and risks. European Journal of Integrative Medicine. 2016;8(5), 695-706. doi:http://dx.doi.org/10.1016/j.eujim.2016.05.005 [Metasynthesis,Meta-analysis,Systematic Review]
  • Bert, F.; Gualano, M. R.; Camussi, E.; Pieve, G.; Voglino, G.; Siliquini, R. Animal assisted intervention:  A systematic review of benefits and risks. European Journal of Integrative Medicine. 2016;8(5), 695-706. doi:http://dx.doi.org/10.1016/j.eujim.2016.05.005 [Metasynthesis,Meta-analysis,Systematic Review]
  • Biddiss, E.; Knibbe, T. J.; McPherson, A. The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces:  A systematic review of randomized and nonrandomized trials. Anesthesia & Analgesia. 2014;119(2), 433-448. doi:10.1213/ANE.0000000000000294 [Metasynthesis,Meta-analysis,Systematic Review]
  • Biddiss, E.; Knibbe, T. J.; McPherson, A. The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces:  A systematic review of randomized and nonrandomized trials. Anesthesia & Analgesia. 2014;119(2), 433-448. doi:10.1213/ANE.0000000000000294 [Metasynthesis,Meta-analysis,Systematic Review]
  • Blanck, P.. Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behaviour Research and Therapy. 2018;102, 25-35. doi:10.1016/j.brat.2017.12.002 [Meta-analysis]
  • Bradt, J.; Dileo, C.; Shim, M. Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews. 2013;(6) doi:10.1002/14651858.CD006908.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
  • Bradt, J.; Dileo, C.; Shim, M. Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews. 2013;(6) doi:10.1002/14651858.CD006908.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
  • Brooke, J.; Hasan, N.; Stark, J.; Sharma, P. Efficacy of information interventions in reducing transfer anxiety from a critical care setting to a general ward:  A systematic review and meta-analysis. Journal of Critical Care. 2012;27(4), 425.e9-425.e15. doi:http://dx.doi.org/10.1016/j.jcrc.2012.01.009 [Metasynthesis,Meta-analysis,Systematic Review]
  • Brooke, J.; Hasan, N.; Stark, J.; Sharma, P. Efficacy of information interventions in reducing transfer anxiety from a critical care setting to a general ward:  A systematic review and meta-analysis. Journal of Critical Care. 2012;27(4), 425.e9-425.e15. doi:http://dx.doi.org/10.1016/j.jcrc.2012.01.009 [Metasynthesis,Meta-analysis,Systematic Review]
  • Carl, E.; Witcraft, S. M.; Kauffman, B. Y.; Gillespie, E. M.; Becker, E. S.; Cuijpers, P.; Van Ameringen, M.; Smits, J. A. J.; Powers, M. B. Psychological and pharmacological treatments for generalized anxiety disorder (GAD): A meta-analysis of randomized controlled trials.. Cognitive Behaviour Therapy. 2020;49(1), 1-21. doi:10.1080/16506073.2018.1560358 Source[Meta-analysis]
  • Chen, K. W.; Berger, C. C.; Manheimer, E.; Forde, D.; Magidson, J.; Dachman, L.; Lejuez, C. Meditative therapies for reducing anxiety:  A systematic review and meta-analysis of randomized controlled trials. Depression and Anxiety. 2012;29(7), 545-562. [Metasynthesis,Meta-analysis,Systematic Review]
  • Chen, K. W.; Berger, C. C.; Manheimer, E.; Forde, D.; Magidson, J.; Dachman, L.; Lejuez, C. Meditative therapies for reducing anxiety:  A systematic review and meta-analysis of randomized controlled trials. Depression and Anxiety. 2012;29(7), 545-562. [Metasynthesis,Meta-analysis,Systematic Review]
  • Chen, T. R.; Huang, H. C.; Hsu, J. H.; Ouyang, W. C.; Lin, K. C. Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis.. Journal of Psychiatric Research. 2019;118, 73-83. doi:10.1016/j.jpsychires.2019.08.014 Source[Metasynthesis,Meta-analysis,Systematic Review]
  • Cuijpers, P.; Gentili, C.; Banos, R. M.; Garcia-Campayo, J.; Botella, C.; Cristea, I. A. Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis.. Journal of Anxiety Disorders. 2016;43, 79-89. doi:10.1016/j.janxdis.2016.09.003 Source[Metasynthesis,Meta-analysis,Systematic Review]
  • Drahota, A.; Ward, D.; Mackenzie, H.; Stores, R.; Higgins, B.; Gal, D.; Dean, T. P. Sensory environment on health-related outcomes of hospital patients. Cochrane Database of Systematic Reviews. 2012;(3) doi:10.1002/14651858.CD005315.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
  • Drahota, A.; Ward, D.; Mackenzie, H.; Stores, R.; Higgins, B.; Gal, D.; Dean, T. P. Sensory environment on health-related outcomes of hospital patients. Cochrane Database of Systematic Reviews. 2012;(3) doi:10.1002/14651858.CD005315.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
  • Halter, M. J. (2018). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach.. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Halter, M.J.. (2019). Vacarolis' Manual of Psychiatric Nursing Care Planning: An Interprofessional Approach. St. Louis: Elsevier. [Core Curriculum]
  • Hole, J.; Hirsch, M.; Ball, E.; Meads, C. Music as an aid for postoperative recovery in adults:  A systematic review and meta-analysis. The Lancet. 2015;386(10004), 1659-1671. doi:http://dx.doi.org/10.1016/S0140-6736(15)60169-6 [Metasynthesis,Meta-analysis,Systematic Review]
  • Hole, J.; Hirsch, M.; Ball, E.; Meads, C. Music as an aid for postoperative recovery in adults:  A systematic review and meta-analysis. The Lancet. 2015;386(10004), 1659-1671. doi:http://dx.doi.org/10.1016/S0140-6736(15)60169-6 [Metasynthesis,Meta-analysis,Systematic Review]
  • Husson, O.; Mols, F.; van de Poll-Franse, L. V. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors:  A systematic review. Annals of Oncology: Official Journal of the European Society for Medical Oncology. 2011;22(4), 761-772. doi:10.1093/annonc/mdq413 [Metasynthesis,Meta-analysis,Systematic Review]
  • Kim, H. S.; Kim, E. J. Effects of relaxation therapy on anxiety disorders: A systematic review and meta-analysis. Archives of Psychiatric Nursing. 2018;32(2), 278-284. doi:10.1016/j.apnu.2017.11.015 Source[Meta-analysis]
  • Manzoni, G. M.; Pagnini, F.; Castelnuovo, G.; Molinari, E. Relaxation training for anxiety:  A ten-years systematic review with meta-analysis. BMC Psychiatry. 2008;8(1), 41. [Metasynthesis,Meta-analysis,Systematic Review]
  • Miozzo, A. P.; Stein, C.; Bozzetto, C. B.; Plentz, R. D. M. Massage therapy reduces pain and anxiety after cardiac surgery: A systematic review and meta-analysis of randomized clinical trials. Clinical Trials and Regulatory Science in Cardiology. 2016;23-24, 1. doi:10.1016/j.ctrsc.2016.11.003 [Metasynthesis,Meta-analysis,Systematic Review]
  • National Institute for Health and Care Excellence (NICE). (2011, January 26). Generalised anxiety disorder and panic disorder in adults:  Management. Source[Quality Measures,Clinical Practice Guidelines]
  • Nightingale, C. L.; Rodriguez, C.; Carnaby, G. The impact of music interventions on anxiety for adult cancer patients: A meta-analysis and systematic review. Integrative Cancer Therapies. 2013;12(5), 393-403. doi:10.1177/1534735413485817 [Metasynthesis,Meta-analysis,Systematic Review]
  • Nightingale, C. L.; Rodriguez, C.; Carnaby, G. The impact of music interventions on anxiety for adult cancer patients: A meta-analysis and systematic review. Integrative Cancer Therapies. 2013;12(5), 393-403. doi:10.1177/1534735413485817 [Metasynthesis,Meta-analysis,Systematic Review]
  • Schwartze, D.; Barkowski, S.; Strauss, B.; Burlingame, G. M.; Barth, J.; Rosendahl, J. Efficacy of group psychotherapy for panic disorder: Meta-analysis of randomized control trials. Group Dynamics: Theory, Research, and Practice. 2017;21(2), 77. doi:10.1037/gdn0000064 Source[Meta-analysis]
  • Slee, A.. Pharmacological treatments for generalised anxiety disorder: A systematic review and network analysis. 2019;393(10173), 768-777. doi:10.1016/S0140-6736(18)31793-8 [Meta-analysis]
  • Urden, L. D.; Stacy, K. M.; Lough, M. E. (2018). Critical care nursing:  Diagnosis and management. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Urden, L. D.; Stacy, K. M.; Lough, M. E. (2018). Critical care nursing:  Diagnosis and management. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Varcarolis, E. M. (2015). Manual of psychiatric nursing care planning:  Assessment guides, diagnoses, psychopharmacology. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Zimmermann, M.; Chong, A. K.; Vechiu, C.; Papa, A. Modifiable risk and protective factors for anxiety disorders among adults: A systematic review. Psychiatry Research. 2019;285 doi:10.1016/j.psychres.2019.112705 Source[Systematic Review]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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