The plan must also allow only reasonable time for documentation and updating (Greenwood 1996). The depth and breadth of the initial assessment and care plan, the tool format and the amount of writing required are the other factors. And the written care plan must, most importantly, be readily accessible. If not, it becomes unusable. The nurse cannot be expected to memorize data or make unrealistically frequent visits to the nurses' station to acquire information. Relying on colleagues and repeated asking for information from the patient can affect the nurse's professional credibility (Greewood).
Part 3 - Drugs and Their Side Effects
The use of drugs in the care of anxiety patients has been associated with falls. These drugs are mostly anti-psychotics and benzodiazepines and other psychoactive ones that affect patient cognition, balance and motor coordination, pulse and blood pressure (Cooper 1993). Reports said that half of nursing home patients experienced a fall in the duration of their stay in such homes at a rate of two episodes per patient per year. The most common consequences are hip fracture, painful soft tissue injuries, bruises, sub-dural hematomas and burns, immobility, hypothermia, deep vein thrombosis, stasis pneumonia, joint contractures, dehydration, urinary tract infection and pressure sores.
Drugs such as anti-hypertensives and psychotropics produce orthosis, which is a fall in systolic blood pressure of 120 mm of the diastolic of 10 mm mercury of more, when moving from supine to upright position (Cooper 1993). The inappropriate use of narcotic analgesics, such as Darvocet-N 100, Talwin, Percocet, Vicodin and Lortabs, for arthritic pain may raise the tendency to a fall or develop confusion. Anticoagulants, such as Dilantin, Depakene and Tegretol, may also increase the incidence of falls, especially in ambulatory patients and may also be toxic as a sedative or in those with ataxic gait.
In summary, the drugs most associated with falls are long-acting benzodiazepines or LABZs, such as Valium, Dalmane, Librium, Tranxene, Centrax, Paxipam and Klonopin (Cooper 1993). These drugs are to be given for no more than 10 consecutive days for sleep or four consecutive months for anxiety unless gradual dose reduction is attempted and if functional improvement is observed or gained from the use of these LABZs. Prevention is still the most preferred approach (Cooper).
Part 4 - Therapies
Recently surveyed nurses mostly agreed that anxiety management is an important and beneficial part of their care (Frazier 2003). Two of their most frequently used interventions are pharmacological, that is, adequate pain relief and administering anti-anxiety drugs. Others are information and communication intervention modes. They also use strategies to reduce anxiety in the presence and assistance or cooperation of the patient's family members and others concerned. They also use stress-reduction techniques, such as biofeedback, music and guided imagery, pharmacological interventions that address pain and anxiety, especially among critical care patients. The Joint Commission on Accreditation of Healthcare Organizations recently added pain assessment, management and education into its accreditation standard. Critical care nurses may also administer anxiolytic and sedative medications to patients primarily to increase comfort, induce amnesia, and prevent incidences of self-injury among agitated and unsettled patients.
Non-pharmacological interventions frequently used focused on providing information to reduce anxiety in these patients (Cooper 1993). These interventions or strategies consisted primarily of safety-oriented information, factual information and optimistic assurances. But the majority of the nurse-respondents said that they used traditional techniques such as a bed bath, massage, humor, education of patients, listening, and consultation with psychiatric or social services, distraction and the promotion of rest (Cooper).
Cooper, James W. Drugs that Cause Falls in the Nursing Home. Nursing Homes: Medquest Communications, LLC, Jan 2003. http://www.findarticles.com/p/articles/mi_m3830/is_n4_v42/ai_14041258
Frazier, Susan K. Critical Care Nurses' Assessment of Patients' Anxiety. American Journal of Critical Care: American Association of Critical-Care Nurses, May 1993. http://www.findarticles.com/p/articles/mi_mONUB/is_1_11/ai_91087518
Critical Care Nurses' Beliefs About and Reported Management of Anxiety. Jan 2003. http://www.findarticles.com/p/articles/mi_mONUB/is_1_2/ai_96695972
Greenwood, Donna. Nursing Care Plans. Nursing Management: Springhouse Corporation, March 1996. http://www.findarticles.com/p/articles/mi_qa3619/is_199603/ai_n8750675
National Institute of Anxiety and Stress, Inc. Anxiety Statistics. ConquerAnxiety.com, 2005. http://www.conqueranxiety.com/anxiety_statistics.asp
Peurifoy, Reneau. The Main Types of Anxiety Disorders. Life Skills Resources, 1999. http://www.rpeurifoy.com/anxiety/anxtypes.htm