Nursing Assessment and Diagnosis

- The nursing assessment for a client with GAD involves collecting data from various sources, such as the client’s history, physical examination, mental status examination, screening tools, laboratory tests, and diagnostic criteria.

- Some of the data that the nurse should obtain include:

• The onset, duration, frequency, severity, and triggers of worry and anxiety symptoms
• The impact of worry and anxiety on daily functioning and quality of life
• The coping strategies and resources that the client uses to manage worry and anxiety
• The presence of any coexisting mental or physical disorders that may affect worry and anxiety
• The client’s medication history, including any prescribed or over-the-counter drugs, herbal supplements, or substances that may affect worry and anxiety
• The client’s family history of anxiety disorders or other mental illnesses
• The client’s personal history of trauma, abuse, or stressful life events that may contribute to worry and anxiety
• The client’s level of insight, motivation, readiness for change, and expectations for treatment outcomes

- The nurse should also perform a physical examination to assess for any signs of anxiety-related symptoms or complications, such as vital signs, cardiovascular system, respiratory system, musculoskeletal system, neurological system, gastrointestinal system, and skin.

- The nurse should also conduct a mental status examination to evaluate the client’s cognitive, emotional, and behavioral aspects, such as orientation, attention, memory, judgment, mood, affect, thought process, thought content, perception, insight, and impulse control.

- The nurse should also use screening tools to measure the severity and impact of worry and anxiety, such as the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Hamilton Anxiety Rating Scale (HAM-A), or the Penn State Worry Questionnaire (PSWQ).

- The nurse should also order laboratory tests to rule out any medical conditions that may cause or mimic anxiety symptoms, such as thyroid function tests, blood glucose levels, electrolyte levels, complete blood count, urine drug screen, or toxicology screen.

- The nurse should also compare the data collected with the diagnostic criteria for GAD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), which are:

• Excessive anxiety and worry about a number of events or activities, occurring more days than not for at least 6 months
• Difficulty controlling the worry
• Anxiety and worry associated with at least three of the following six symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
• Anxiety and worry causing clinically significant distress or impairment in social, occupational, or other important areas of functioning
• Anxiety and worry not attributable to the physiological effects of a substance or another medical condition
• Anxiety and worry not better explained by another mental disorder

- Based on the assessment data, the nurse can formulate nursing diagnoses for the client with GAD. Some of the possible nursing diagnoses are:

• Anxiety related to perceived threats or uncertainties
• Ineffective coping related to inadequate or maladaptive coping skills
• Disturbed sleep pattern related to anxiety symptoms
• Impaired social interaction related to anxiety symptoms
• Chronic pain related to muscle tension
• Risk for self-directed violence related to hopelessness or depression