(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Anesthesia
(_) Anticipated/actual pain
(_) Disease
(_) Invasive/noninvasive procedure:_________
(_) Loss of significant other
(_) Threat to self-concept
(_) Other:_____________________________


As evidenced by:
[Check those that apply]
Must be present)
(_) Elevated BP, P, R (_) Insomnia (_) Restlessnes (_) Dry mouth
(_) Dilated pupils (_) Frequent urination (_) Diarrhea
(_) Patient complains of apprehension, nervousness, tension
(_) Inability to concentrate (_) Orientation to past
(_) Blocking of thoughts, hyperattentiveness


Date &
Plan and Outcome
[Check those that apply]
Nursing Interventions
[Check those that apply]
The patient will:(_) Demonstrate a decrease in anxiety A.E.B.:

  • A reduction in presenting physiological, emotional, and/or cognitive manifestations of anxiety.
  • Verbalization of relief of anxiety.

(_) Discuss/demonstrate effective coping mechanisms for dealing with anxiety.

(_) Other:


(_) Assist patient to reduce present level of anxiety by:

  • Provide reassurance and comfort.
  • Stay with person.
  • Don’t make demands or request any decisions.
  • Speak slowly and calmly.
  • Attend to physical symptoms. Describe symptoms:


  • Give clear, concise explanations regarding impending procedures.
  • Focus on present situation.
  • Identify and reinforce coping strategies patient has used in the past.
  • Discuss advantages and disadvantages of existing coping methods.
  • Discuss alternate strategies for handling anxiety. (Eg.: exercise, relaxation techniques and exercises, stress management classes, directed conversation (by nurse), assertiveness training)
  • Set limits on manipulation or irrational demands.
  • Help establish short term goals that can be attained.
  • Reinforce positive responses.
  • Initiate health teaching and referrals as indicated:


(_) Other:________________


Patient/Significant other signature


RN signature