Nursing Diagnosis
2.5 out of 3
International classification for nursing practice (ICNP) nursing diagnoses (v2019_06_27) [Data set]. (2019). International Council of Nurses (ICN). https://www.icn.ch/what-we-do/projects/ehealth-icnptm/icnp-download
Diagnosis
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| Student Response | Model Answer | Explanation | Points Earned |
| Anxiety | Anxiety John Larsen focused exam anxiety care plan | Anxiety is the most appropriate diagnosis. While it is crucial to consider cardiac issues, given the patient’s history, Mr. Larsen’s exam and lab results suggest he is not currently at risk for impaired cardiac function. The patient’s mood changes and difficulty coping, as well as his recurring physical symptoms and recent panic attack, stem from his anxiety. | 0.5 out of 0.5 |
Signs & Symptoms
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| Student Response | Model Answer | Explanation | Points Earned |
| Excessive worry | Excessive worry | Because “anxiety” is the most appropriate diagnosis for Mr. Larsen, the relevant signs and symptoms are his excessive worry and its effects on his body, including palpitations and restlessness. As Mr. Larsen approaches the age at which his father died from a heart attack, he is concerned about family history and early cardiac mortality. His mind’s and body’s heightened responses to distress have caused a panic attack, and his difficulty in recognizing the signs and symptoms of anxiety have led him to believe he may have instead been experiencing a cardiac event. | 0.5 out of 0.5 |
| History of recent panic attack | History of recent panic attack | Because “anxiety” is the most appropriate diagnosis for Mr. Larsen, the relevant signs and symptoms are his excessive worry and its effects on his body, including palpitations and restlessness. As Mr. Larsen approaches the age at which his father died from a heart attack, he is concerned about family history and early cardiac mortality. His mind’s and body’s heightened responses to distress have caused a panic attack, and his difficulty in recognizing the signs and symptoms of anxiety have led him to believe he may have instead been experiencing a cardiac event. | 0.5 out of 0.5 |
| Restlessness | Restlessness | Because “anxiety” is the most appropriate diagnosis for Mr. Larsen, the relevant signs and symptoms are his excessive worry and its effects on his body, including palpitations and restlessness. As Mr. Larsen approaches the age at which his father died from a heart attack, he is concerned about family history and early cardiac mortality. His mind’s and body’s heightened responses to distress have caused a panic attack, and his difficulty in recognizing the signs and symptoms of anxiety have led him to believe he may have instead been experiencing a cardiac event. | 0.5 out of 0.5 |
| History of palpitations | History of palpitations | Because “anxiety” is the most appropriate diagnosis for Mr. Larsen, the relevant signs and symptoms are his excessive worry and its effects on his body, including palpitations and restlessness. As Mr. Larsen approaches the age at which his father died from a heart attack, he is concerned about family history and early cardiac mortality. His mind’s and body’s heightened responses to distress have caused a panic attack, and his difficulty in recognizing the signs and symptoms of anxiety have led him to believe he may have instead been experiencing a cardiac event. | 0.5 out of 0.5 |
| Occasional alcohol use | Concern of family history and early cardiac mortality | Because “anxiety” is the most appropriate diagnosis for Mr. Larsen, the relevant signs and symptoms are his excessive worry and its effects on his body, including palpitations and restlessness. As Mr. Larsen approaches the age at which his father died from a heart attack, he is concerned about family history and early cardiac mortality. His mind’s and body’s heightened responses to distress have caused a panic attack, and his difficulty in recognizing the signs and symptoms of anxiety have led him to believe he may have instead been experiencing a cardiac event. | 0 out of 0.5 |
Self Assessment
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| Prompt | Student Response | Model Answer | Explanation |
| Why should the patient’s anxiety be addressed before his issues with agitation, difficulty coping, or risk for impaired cardiac function? | His symptoms of agitation, difficulty coping, and risk for impaired cardiac function all emanate from his anxiety, therefore adressing the anxiety component will halt the symptoms form occurring. | Your nursing diagnosis should always take into account what condition is most serious and urgent, so the patient can receive the greatest benefit from your help. Although Mr. Larsen may have difficulty coping and issues with agitation, as well as a perceived risk for cardiac impairment, his current signs and symptoms suggest anxiety is the root cause. Mr. Larsen’s concern regarding what he perceives as cardiac symptoms is a result of the physical manifestation of his anxiety. Patients presenting with possible cardiac issues should always be given the appropriate consideration in order to rule them out. Risk for impaired cardiac function has been ruled out in his lab reports. Mr. Larsen’s agitation, coping issues, and perceived cardiac issues are a result of unmanaged anxiety. | Addressing the diagnosis that is the most serious and urgent will have the greatest overall impact on the patient. Interventions made toward one diagnosis may ultimately help other related diagnoses. It is important to focus on the diagnosis that is a root cause before moving onto related diagnoses. |
Planning
3.5 out of 3.5
Short-Term Goal
| Student Response | Model Answer | Explanation | Points Earned |
| Patient will verbalize understanding of an anxiety management plan by end of shift | Patient will verbalize understanding of an anxiety management plan by end of shift | In a short time frame, it is not realistic to expect a patient to understand, accept, or effectively treat their mental illness. It is important that Mr. Larsen one day understands the scope of his anxiety, but this is a long-term goal. Given that you are creating a care plan within a short time frame, the primary goal is to give your patient basic tools for anxiety management. These will help him recognize and manage the signs and symptoms of anxiety and reduce or prevent panic attacks. | 0.5 out of 0.5 |
Interventions
| Student Response | Model Answer | Explanation | Points Earned |
| Educate patient on anxiety management techniques for distraction, such as changing environments and engaging in physical activity or favorite pastimes | Educate patient on anxiety management techniques for distraction, such as changing environments and engaging in physical activity or favorite pastimes | For a patient experiencing an acute anxiety episode with panic attack, focus on a few techniques that the patient can use to help manage their anxiety in the future. You can supplement your discussion with written materials to provide the patient with something concrete to take home and refer to in the future. Educate Mr. Larsen on techniques to help reduce anxiety, such as distraction, calming, and grounding. Additionally, educate the patient on the signs and symptoms that preceded his panic attack, as well as his stressors. Awareness of signs and symptoms and a concrete toolkit can help the patient better manage his anxiety. Finally, educate the patient on continued care with a therapist to manage his anxiety. On-going care can help the patient develop additional techniques and skills and offer resources for long-term anxiety management. | 0.5 out of 0.5 |
| Educate patient on anxiety management techniques for grounding themselves and disrupting anxious thought patterns, such as the “5-4-3-2-1” technique | Educate patient on anxiety management techniques for grounding themselves and disrupting anxious thought patterns, such as the “5-4-3-2-1” technique | For a patient experiencing an acute anxiety episode with panic attack, focus on a few techniques that the patient can use to help manage their anxiety in the future. You can supplement your discussion with written materials to provide the patient with something concrete to take home and refer to in the future. Educate Mr. Larsen on techniques to help reduce anxiety, such as distraction, calming, and grounding. Additionally, educate the patient on the signs and symptoms that preceded his panic attack, as well as his stressors. Awareness of signs and symptoms and a concrete toolkit can help the patient better manage his anxiety. Finally, educate the patient on continued care with a therapist to manage his anxiety. On-going care can help the patient develop additional techniques and skills and offer resources for long-term anxiety management. | 0.5 out of 0.5 |
| Educate patient on anxiety management techniques for relaxation, such as meditation and deep breathing John Larsen focused exam anxiety care plan | Educate patient on anxiety management techniques for relaxation, such as meditation and deep breathing John Larsen focused exam anxiety care plan | For a patient experiencing an acute anxiety episode with panic attack, focus on a few techniques that the patient can use to help manage their anxiety in the future. You can supplement your discussion with written materials to provide the patient with something concrete to take home and refer to in the future. Educate Mr. Larsen on techniques to help reduce anxiety, such as distraction, calming, and grounding. Additionally, educate the patient on the signs and symptoms that preceded his panic attack, as well as his stressors. Awareness of signs and symptoms and a concrete toolkit can help the patient better manage his anxiety. Finally, educate the patient on continued care with a therapist to manage his anxiety. On-going care can help the patient develop additional techniques and skills and offer resources for long-term anxiety management. | 0.5 out of 0.5 |
| Educate patient on the need for follow-up therapy to continue to explore and reinforce techniques for managing symptoms of anxiety John Larsen focused exam anxiety care plan | Educate patient on the need for follow-up therapy to continue to explore and reinforce techniques for managing symptoms of anxiety | For a patient experiencing an acute anxiety episode with panic attack, focus on a few techniques that the patient can use to help manage their anxiety in the future. You can supplement your discussion with written materials to provide the patient with something concrete to take home and refer to in the future. Educate Mr. Larsen on techniques to help reduce anxiety, such as distraction, calming, and grounding. Additionally, educate the patient on the signs and symptoms that preceded his panic attack, as well as his stressors. Awareness of signs and symptoms and a concrete toolkit can help the patient better manage his anxiety. Finally, educate the patient on continued care with a therapist to manage his anxiety. On-going care can help the patient develop additional techniques and skills and offer resources for long-term anxiety management. | 0.5 out of 0.5 |
| Educate patient on the signs and symptoms of elevating anxiety levels and oncoming panic John Larsen focused exam anxiety care plan | Educate patient on the signs and symptoms of elevating anxiety levels and oncoming panic | For a patient experiencing an acute anxiety episode with panic attack, focus on a few techniques that the patient can use to help manage their anxiety in the future. You can supplement your discussion with written materials to provide the patient with something concrete to take home and refer to in the future. Educate Mr. Larsen on techniques to help reduce anxiety, such as distraction, calming, and grounding. Additionally, educate the patient on the signs and symptoms that preceded his panic attack, as well as his stressors. Awareness of signs and symptoms and a concrete toolkit can help the patient better manage his anxiety. Finally, educate the patient on continued care with a therapist to manage his anxiety. On-going care can help the patient develop additional techniques and skills and offer resources for long-term anxiety management. | 0.5 out of 0.5 |
Intervention Rationale
Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.
| Prompt | Student Response | Model Answer | Explanation |
| In 1 or 2 sentences, explain how your selected interventions work to accomplish your goal. | Education and awareness is key. | The selected interventions will provide Mr. Larsen with a toolkit he can rely on to manage his anxiety in the future. Educating the patient on how to use anxiety management techniques, such as methods for distraction, calming, and grounding, can help Mr. Larsen feel more in control and help mitigate panic attacks in the future. Additionally, educating the patient on keeping track of his signs and symptoms will help him identify the patterns of, and stressors for, his anxiety. Providing the patient with education on on-going care and long-term anxiety management will help the patient continue to build his toolkit. | The most important thing you can do is help prepare Mr. Larsen for future panic attacks and give him some of the tools needed to manage or prevent them. However, anxiety can be difficult to manage alone. Educating the patient on seeking follow-up therapy and on-going care will help him better manage his anxiety long-term. |
Data Collections
| Student Response | Model Answer | Explanation | Points Earned |
| Patient will restate and verbalize understanding of anxiety management plan | John Larsen focused exam anxiety care plan The patient will restate and verbalize understanding of anxiety management plan | Your data collection should help you determine if the goal was met or not. By asking Mr. Larsen to restate and verbalize understanding of the anxiety management plan you provide, you will have objective data that can be used to evaluate your goal and determine whether or not you have done your best to prepare Mr. Larsen in managing his anxiety. | 0.5 out of 0.5 |
Discussion Of Care
Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor.
| Prompt | Student Response | Model Answer | Explanation |
| Explain the rationale behind your nursing diagnosis. | Based on your symptoms you are displaying anxiety. | Mr. Larsen, though the signs and symptoms you recently experienced are alarming, your lab results suggest that they were caused by anxiety and not an underlying cardiac problem. Anxiety can cause a wide variety of physical symptoms and can even mimic symptoms associated with heart problems, like chest pain, chest tightness, and difficulty breathing. Without coping strategies to help manage symptoms, anxiety can cause episodes of panic which is what you experienced early this morning. However, there are things we can do to help you manage your anxiety in order to reduce these symptoms and prevent future panic attacks. | You should practice therapeutic communication with all patients. This includes providing clear and thorough explanations of diagnoses and empathizing with the patient. For patients experiencing acute anxiety, it is critical to not dismiss the physical manifestation of their symptoms. The symptoms are very real and often alarming, but you should clearly distinguish what is life-threatening and what is not. |
| Explain your goal for Mr. Larsen, as well as the interventions and data collections you’ll use to achieve the goal. | You will verbalize understanding of an anxiety management plan by the end of the shift | We’re going to talk about how to identify the signs and symptoms of anxiety and oncoming panic attacks, so you’ll know when it’s appropriate to use coping strategies. We’ll also go over techniques you can use to reduce, manage, and prevent your anxiety. Our discussion will touch on techniques that are focused on the following: distracting you from anxiety and feelings of panic, grounding you and disrupting negative thought patterns, and relaxation. I’d also like to talk to you about establishing regular care with a therapist in order to more fully explore these and other coping strategies to manage your anxiety. My goal is that you understand your anxiety management plan and can state your instructions back thoroughly and correctly. | You should communicate the Care Plan to the patient, so they understand their diagnosis, interventions, and healthcare goals. Discussing this with the patient allows them to be involved and have agency in their healthcare. |
| Evaluate Mr. Larsen’s readiness to move forward with the Care Plan. | Do you want to have your anxiety under control | Mr. Larsen, are you ready to move forward with the Care Plan? | Before proceeding with interventions, it is important to assess a patient’s readiness to listen, learn, and participate in the Care Plan. |
Intervention & Evaluation
0 out of 2.5
| Student Response | Model Answer | Explanation | Points Earned |
| Partially | Fully | The goal of having Mr. Larsen restate and verbalize understanding of his anxiety management plan has been fully met. The selected interventions educated the patient on the importance of developing an awareness of his signs and symptoms and using reliable techniques to help manage those symptoms. Additionally, advising Mr. Larsen to seek follow-up therapy helps to show that understanding the scope of one’s anxiety takes time, as does one’s ability to manage it, and there are avenues of care available to your patient to help. Your goal has been fully met. | 0 out of 2.5 |
Intervention & Evaluation Rationale
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| Prompt | Student Response | Model Answer | Explanation |
| Did you achieve your goal of having the patient restate and verbalize understanding of his anxiety management plan? | Patient is willing to carry on care plan for anxiety, however still needs some reinforcement. | The goal of having Mr. Larsen restate and verbalize understanding of his anxiety management plan has been fully met. The selected interventions educated the patient on the importance of developing an awareness of his signs and symptoms and using reliable techniques to help manage those symptoms. Additionally, advising Mr. Larsen to seek follow-up therapy helps to show that understanding the scope of one’s anxiety takes time, as does one’s ability to manage it, and there are avenues of care available to your patient to help. Your goal has been fully met. | Given that Mr. Larsen’s care plan requires education on anxiety and anxiety management techniques, it’s important that the patient verbalizes an understanding of everything you’ve discussed. Having the patient repeat back the steps of your care plan may help ensure that they can remember key parts. If the patient is receptive to education and exhibits understanding, they may be more likely to follow through, improving their chances for success once they leave your care. John Larsen focused exam anxiety care plan |