NURSING INTERVENTIONS IN

ANXIETY
GENERAL
PRINCIPLES

NURSING CONSIDERATIONS

Assess level of
anxiety

Look at body language, speech patterns, facial expressions,

defence mechanism, and behaviour used.
Distinguish levels of anxiety.

Keep environmental
stresses/ stimulation
low when anxiety is
high

First action
Need to intervene with severe or panic level
Brief orientation to unit or procedures
Written information to read later, when anxiety is lower
Pleasant, attractive, uncluttered environment
Provide privacy if presence of other patients is over
stimulating
Provide physical care necessary
Avoid offering several alternative or decisions when
anxiety is high
Acknowledge anxious behaviour; reflects and clarify
Always remain with client who is moderately or severely
anxious
Assist client to clarify own thoughts and feelings
Encourage measures to reduce anxiety, e.g., exercise,
activities, taking with friends, hobbies
Assist client to recognize his/her strengths and capabilities
realistically
Provide therapy to develop more effective coping and
interpersonal skills, e.g., individual, group
May need to administer antianxiety medications
Use an unhurried approach
Acknowledge clients distress and concern about problem
Encourage clarification of feelings and thoughts
Evaluate and manage own anxiety while working with client
Recognize the value of defence mechanism and realize that
clients is attempting to make the anxiety tolerable in the
best
way possible
Acknowledge defence but provide reality, e.g., You do not
see
that you have a problem with alcohol but your blood level is
high
Do not attempt to remove a defence mechanism at any
time

Assist client to cope

with anxiety more
effectively

Maintain accepting
and helpful attitude
toward client

NURSING CARE OF CLIENT WHO

ACTS WITHDRAWN
Problem
Lack of trust and feeling of safety and
security

Hallucinations

Interventions
Keep interactions brief, especially
orientation
Structure environment
Be consistent and reliable; notify
patient of
anticipated schedule changes
Decrease physical contact
Eye contact during greeting
Maintain attentiveness with head
slightly leaning toward patient and
nonintrusive attitude
Allow physical distance
Accept patients behaviour, e.g.,
silence; maintain matter-of-fact
attitude towards behaviour
Maintain accepting attitude
Do not argue with patient about
reality of
hallucinations
Comment on feeling, tone of
hallucination,
e.g., That must be frightening to
you.
Encourage diversional activities in
which patient can gain a sense of
mastery, e.g., artwork
Encourage discussions of reality
based interests

Lack of attention to personal needs, e.g.,

nutrition, hygiene

Assess adequacy of hydration,

nutrition
Structure routine for bathing,
mealtime
Offer encouragement or assistance if
necessary, e.g., sit with patient or
feed patient if appropriate
Decrease environmental stimuli at
mealtime, e.g., suggest early dinner
before dining room crowds
Positioning and skin care for care for
catatonic patient

NURSING CARE OF A PATIENT WHO

ACTS SUSPICIOUS
Problem
Mistrust and feeling of rejection

Interventions
Keep appointments with patients
Clear consistent communication
Allow patient physical distance and
keep door
open when interviewing
Genuineness and honesty in
interactions
Recognize testing behaviour and show
persistence of interest in patient

Delusions

Allow patient to verbalize the delusion

in a limited way
Do not argue with patient or try to
convince that delusion are not real
Point out feeling tone of delusion
Provide activities to divert attention
from delusions
Solitary activities best at first and then
may
progress to non-competitive games or
activities
Do not reinforce delusion by validating
them
Focus on potential real concerns of
patient

ALCOHOL WITHDRAWAL
WITHDRAWA
L

DELIRIUM TREMENS

NURSING
CONSIDERATION

Tremors
Easily startled
Insomnia
Anxiety
Anorexia
Alcoholic
Hallucinations

Tremors
Anxiety
Panic
Disorientation
Hallucination
Vomiting
Diarrhea
Paranoia
Delusional symptoms
Ideas of reference
Suicide attempts
Grand mal convulsion
(esp. first 48H after
drinking stopped)
Potential coma/death

Administer benzodiazepines,
Chlordiazepoxide, Diazepam
Monitor VS- PR, BP, Temp.
Seizure precautions
Provide quiet, well lit
environment
Orient patient frequently
Dont leave hallucinating,
confused patient alone
Administer thiamine IV or IM
as needed
Administer IV glucose as
needed
10% morality rate

CHRONIC CNS DIORDERS

ASSOCIATED WITH ALCOHOLISM
ALCOHOLIC
CHRONIC BRAIN
SYNDROME
(DEMENTIA)

WERNICKES
SYNDROME

KORSAKOFFS
PSYCHOSIS

Symptoms

Fatigue, anxiety,
personality changes,
depression,
confusion
Loss of memory of
recent events
Can progress to
dependent,
debridden state

Confusion,
diplopia,
nystagmus, ataxia
Disorientation,
apathy

Memory
disturbance
with
confabulation,
loss of memory
of recent
events, learning
problem
Possible
problem with
taste, loss of
reality testing

Nursing
considerat
ion

Balanced diet,
abstinence from
alcohol

IV or IM thiamine,
abstinence from
alcohol

Balanced diet,
thiamine,
abstinence

NONALCOHOLIC SUBSTANCE ABUSE

MEDICATION/DR
UG

SYMPTOMS OF
ABUSE

SYMPTOMS OF
WITHDRAWAL

NURSING
CONSIDREATION

Barbiturates
(downers, barbs,
pink ladies,
rainbows, yellow
jackets)
Phenobarbital
Numbutal

Respiratory
depression
Decreased BP and
pulse
Coma, ataxia,
seizures
Increasing
nystagmus
Poor muscle
coordination
Decreased mental
alertness

Anxiety, insomnia
Tremors, delirium
Convulsion

Maintain airway
(intubate,
suction)
Check LOC and
vital signs
Start IV with
large-gauge
needle
Give activated
charcoal, use
gastric lavage
Hemodialysis

Narcotics
Morphine
Heroin (horse,
junk, smack)
Codeine
Dilaudid
Meperidine
(Demerol)
Methadonefor detoxification
and
maintenance

Hyperpyrexia
Seizures, ventricular
dysrhythmias
Euphoria, then
anxiety, sadness,
insomnia, sexual
indifference
Overdose-severe
respiratory
dipression, pinpoint
pupils, coma

Watery eyes,
runny nose
Loss of appitite
Irritability,
tremors, panic
Cramps, nausea
Chills an sweating
Elevated BP
Hallucinations,
delusions

Maintain airway
(intubate,
suction)
Control seizures
Check LOC and
vital signs
Start IV, may be
given bolus of
glocuse
Have lidocaine
and defibrillator
available
Treat for
hyperthermia
Give Narcan to
reverse
respiratory
depression
Hemodialysis

Stimulants
(uppers, pep
pills, speed,
crystal meth)
Cocaine (crack)
Amphetamine
Benzedrine
Dexedrine

Tachycardia,
increased BP,
tachypnea, anxiety
Irritability, insomnia,
agitation
Seizures, coma,
hyperpyrexia,
euphoria
Naussea, vomiting
Hyperactivity, rapid
speech
Hallucinations
Nasal septum
perforation (cocaine)

Apathy
Long period of
sleep
Irritability
Depression,
disorientation

Maintain airway
(intubate,
suction)
Start IV
Use cardiac
monitoring
Check LOC and
vital signs
Give activated
charcoal, use
gastric lavage
Monitor for
suicidal odeation
Keep in calm,
quiet envirnment

Cannabis
derivatives
(pot, weed,
grass, reefer,
joint, mary jane)
Marijuana
Hashish
Hallucinogens
LSD (acid)
PCP (large dust,
rocket fuel)
Mescaline
(buttons, cactus)

Fatigue
Paranoia, psychosis
Euphoria, relaxed
inhabitations
Increased appetite
Disoriented
behaviour
Nystagmus, marked
confusion,
hyperactivity
Incoherence,
hallucinations,
distorted body image
Delirium, mania, selfinjury
Hypertension,
hyperthermia
Flashbacks,
convulsions, coma

Insomnia.
Hyperactivity
Decreased
appetite

Most effects
disappear
in 5-8 hr as drug
wears off
May cause
psychosis

None

Maintain airway
(intubate,
suction)
Control seizures
Check LOC and
vital signs
talk down
patient
Reduce sensory
stimuli
Small doses of
Valium
Check for
trauma, protect
from self-injury