ND Anxiety

JustBeachyNurse, LPN · Oct 11, 2014

It's under the nursing diagnosis domain 9: coping/stress tolerance. Does that help you?

shaunbman · Oct 11, 2014

Thank you for your response JustBeachyNurse, but unfortunately that does not help. I know where to find it in the NANDA list of nursing diagnoses, but we are required to enter the level of the nursing diagnosis on Maslow's hierarchy off needs. I need to know is if ANXIETY would fall in safety needs, or perhaps esteem needs. Someone suggested that it would fall under safety needs, so I may go with that.

JustBeachyNurse, LPN · Oct 12, 2014

What is your full diagnosis statement? Then we can help you better. It might be safety.

Everline · Oct 12, 2014

I would have to know more about the patient. But it may very well be the level of safety and security.

shaunbman · Oct 12, 2014

Moderate Anxiety r/t perceived threat to self concept aeb expressed concerns of changing body image.

The patient is a young lady with Crohn's. Overall she is in good spirits but definitely worried about changes associated with her disease and the many surgeries she has had and will have in the future.

JustBeachyNurse, LPN · Oct 12, 2014

Moderate Anxiety r/t perceived threat to self concept aeb expressed concerns of changing body image.
The patient is a young lady with Crohn's. Overall she is in good spirits but definitely worried about changes associated with her disease and the many surgeries she has had and will have in the future.

Stating moderate anxiety is a medical diagnosis. The nursing diagnosis is just anxiety. In this case Is go with esteem needs based on your description

There is also disturbed body image or (risk for) situational low esteem that may work for your patient

shaunbman · Oct 12, 2014

Thank you for the help.

One of my care plan books that I use most instructs to specify level. I may consider revising my nursing diagnosis altogether. Unfortunately the program I am in gave little to no instruction on care plans. We were given a template and a due date. I have been pretty successful so far but there are a few people in my class that have had the same question regarding anxiety and Maslow's.

Again thank you for the insight.

Esme12, ASN, BSN, RN · Oct 12, 2014

Welcome!

Here is my standard beginning.

Care plans are all about the patient assessment...of the patient. Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE from our Daytonite

Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
Planning (write measurable goals/outcomes and nursing interventions)
Implementation (initiate the care plan)
Evaluation (determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are.

What I would suggest you do is to work the nursing process from step #1.

Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you.

What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient.

Did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list.

This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

assessment consists of gathering data about:

a health history (review of systems) - you've provided more than enough of that
performing a physical exam - you have none and this information is crucial to have
assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) you have none and we nurses are pros at adls--its what we do
reviewing the pathophysiology, signs and symptoms and complications of their medical condition - this information is needed for the etiologies on your nursing diagnostic statements
reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - what its side effects and potential complications are

Esme12, ASN, BSN, RN · Oct 12, 2014

A nursing diagnosis goes like this.... GrnTea say this best......

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."
Related to" means "caused by," not something else.

Look at your NANDA resource.

Each nursing diagnosis has a definition, defining characteristics (symptoms that you patient has), and related factors (what causes it).

All care plans are based off your assessment.

Have you learned about Maslows? Maslow believed that there are needs are similar to instincts and play a major role in motivating behavior. Physiological, security, social, and esteem needs are deficiency needs (also known as D-needs), meaning that these needs arise due to deprivation. Satisfying these lower-level needs is important in order to avoid unpleasant feelings or consequences.

Maslow termed the highest-level of the pyramid as growth needs. Growth needs do not stem from a lack of something, but rather from a desire to grow as a person.Maslow's Hierarchy of Needs | Simply Psychology

Five Levels of the Hierarchy of Needs
There are five different levels in Maslow’s hierarchy of needs:
Physiological Needs
These include the most basic needs that are vital to survival, such as the need for water, air, food, and sleep. Maslow believed that these needs are the most basic and instinctive needs in the hierarchy because all needs become secondary until these physiological needs are met.
Security Needs
These include needs for safety and security. Security needs are important for survival, but they are not as demanding as the physiological needs. Examples of security needs include a desire for steady employment, health care, safe neighborhoods, and shelter from the environment.
Social Needs
These include needs for belonging, love, and affection. Maslow described these needs as less basic than physiological and security needs. Relationships such as friendships, romantic attachments, and families help fulfill this need for companionship and acceptance, as does involvement in social, community, or religious groups.
Esteem Needs
After the first three needs have been satisfied, esteem needs becomes increasingly important. These include the need for things that reflect on self-esteem, personal worth, social recognition, and accomplishment.
Self-actualizing Needs
This is the highest level of Maslow’s hierarchy of needs. Self-actualizing people are self-aware, concerned with personal growth, less concerned with the opinions of others, and interested fulfilling their potential.

maslow's hierarchy of needs - enotes.com virginia henderson's need theory

maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization – e.g. morality, creativity, problem solving. least important
esteem – e.g. confidence, self-esteem, achievement, respect.
belongingness – e.g. love, friendship, intimacy, family.
safety – e.g. security of environment, employment, resources, health, property.
physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis. most important

assumptions

maslow’s theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. abraham lincoln, thomas jefferson, albert einstein, eleanor roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.

Esme12, ASN, BSN, RN · Oct 12, 2014

Where would this apply to your patient? Is this a body image self esteem issue or fear? Or is it both?

JustBeachyNurse, LPN · Oct 12, 2014

Thank you for the help.
One of my care plan books that I use most instructs to specify level. I may consider revising my nursing diagnosis altogether. Unfortunately the program I am in gave little to no instruction on care plans. We were given a template and a due date. I have been pretty successful so far but there are a few people in my class that have had the same question regarding anxiety and Maslow's.
Again thank you for the insight.

A care plan book only has some of the NANDA-I details. According to the NANDA-I there is no "levels" of anxiety. Only qualified physicians, LCSW, LPC, doctoral psychologists and PMHNP are qualified to assign levels to mental health diagnoses as described in the DSM-IV/DSM-V it's out of nursing scope to offer medical or psychiatric diagnoses.

See if your school has a copy of the current NANDA-I in the library or you can get a copy from Amazon for a reasonable price even an Ebook version from kindle or nook. It makes it a lot easier to create a proper and accurate nursing diagnosis. Supplement with your care plan book for goals , interventions, objectives & outcomes. There are other books like NOC/NIC (nursing outcome classifications and nursing intervention classifications ) that can supplement developing a strong and accurate care plan.

I use care plans daily in private duty. & home health.

I would take a look at the other two diagnoses I listed earlier regarding self esteem etc. they may be more applicable to your patient than anxiety.

Good luck