Anxiety Nursing Care Plan

Subjective: "I feel like something terrible is about to happen"; racing thoughts, difficulty concentrating, insomnia, fear of losing control, anticipatory worry about procedures or diagnosis.

Objective: HR 104, RR 24, BP 148/88, diaphoresis, tremor, restlessness, pacing, poor eye contact, pressured speech, GAD-7 score 16 (severe), pupil dilation, cool clammy skin.

1. Anxiety related to situational crisis and threat to health status AEB GAD-7 of 16, HR 104, restlessness, and verbalized fear of losing control.
2. Ineffective coping AEB inability to problem-solve, avoidance of care discussions.
3. Insomnia AEB 3 h sleep per night for 5 nights, reported by patient.
4. Risk for injury (panic-level anxiety, impaired judgment).
5. Deficient knowledge regarding anxiety triggers and self-regulation techniques.

• Patient reports anxiety ≤ 4/10 on a self-rating scale within 48 h.
• HR < 90 and RR < 20 at rest within 24 h.
• Patient demonstrates two grounding or breathing techniques independently before discharge.
• Patient sleeps ≥ 5 uninterrupted hours within 72 h.
• GAD-7 decreases by ≥ 5 points by the 4-week follow-up.

• Stay with the patient during peak anxiety; use short, simple sentences — anxiety narrows perceptual field; complex instruction cannot be processed.
• Reduce environmental stimuli (lights, alarms, roommate traffic) — lowers sympathetic arousal.
• Teach diaphragmatic breathing 4-7-8 and 5-4-3-2-1 grounding — activates parasympathetic tone; gives the patient a portable skill.
• Validate the feeling before correcting the thought — premature reassurance ("you'll be fine") escalates anxiety by signalling the nurse is not listening.
• Administer scheduled SSRI/SNRI as ordered; reserve PRN benzodiazepine for panic-level anxiety only — benzodiazepines are effective acutely but carry dependence, delirium, and fall risk.
• Screen for co-occurring depression and substance use (PHQ-9, AUDIT-C) — comorbidity changes the treatment plan.
• Provide procedural preparation: what, when, how long, how it will feel — predictability reliably reduces anticipatory anxiety.
• Sleep-hygiene bundle: cluster care, no vitals 00:00–04:00 if stable, caffeine cut-off at 14:00.
• Refer to CBT and, when appropriate, a peer-support program — CBT has the strongest evidence base for GAD.

By day 3: patient rates anxiety 3/10, HR 82, RR 18, demonstrates 4-7-8 breathing unprompted during a dressing change, and slept 6 h overnight. GAD-7 repeated at 11. Outcomes 1–4 met; outcome 5 continues at follow-up.