Nursing Clinical Practice Guide
Clinical Scenario: You are a nurse on a medical-surgical unit. Your patient, Mr. Jones, admitted for hypertension, is visibly restless, pacing, and tells you, "I just can't stop thinking about my job, my bills... my shoulders are so tight." He has a history of GAD.
Nursing Intervention Strategy:- 1AssessmentFirst, assess his current anxiety level on a scale of 1-10. Rule out any physiological causes (e.g., pain, hypoxia, medication side effect).
- 2Immediate Intervention"Mr. Jones, I can see you're feeling very worried. Let's sit down together for a moment. I'd like to show you a simple breathing technique that might help calm your body's stress response." This validates his feelings and offers a tool.
- 3Teaching TechniqueGuide him through diaphragmatic breathing: "Place one hand on your chest, one on your belly. Breathe in slowly through your nose for a count of 4, feel your belly rise. Hold for 2. Breathe out slowly through pursed lips for a count of 6." Have him practice with you.
- 4Evaluation & PlanningAfter 5 minutes, reassess his anxiety score. Document the intervention and his response. Plan to reinforce this teaching at later intervals and explore other techniques like PMR.
Patient Safety and Precautions: Always assess for suicidal ideation in clients with anxiety or depression. Do not force relaxation if the client is resistant; offer it as a choice. Be aware that severe anxiety can mimic cardiac symptoms (chest pain, palpitations)—always assess for underlying medical issues first.
Nursing Procedure & Medication Flow
If Administering a PRN Anxiolytic (e.g., Lorazepam):
1. Check the order for dose, route, and frequency.
2. Assess before: Vital signs (especially BP and respirations), level of consciousness, fall risk score, and current anxiety level.
3. Administer as prescribed.
4. Monitor after: Reassess anxiety level in 30-60 minutes. Monitor for excessive sedation, respiratory depression (Respiratory rate < 12), dizziness, and fall risk. Implement fall precautions (bed low, call bell within reach).5. Educate: Advise the client not to drive or operate machinery. Avoid alcohol.
A Word from Your Senior Nurse
"In the real world, patients with chronic anxiety are everywhere—not just in psych units. Your most powerful tool is often your own calm presence and your knowledge of simple, effective techniques. Teaching a patient deep breathing isn't just a 'nice thing to do'; it's a clinical intervention that lowers heart rate, blood pressure, and cortisol levels. On the NCLEX and in practice, always look for the answer that gives power and skills *to the patient*. That's the heart of nursing."