Fear

Fear

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: feeling of apprehension and fright related to a specific, known source. The fear is relieved when the source is removed.

1. Your initials (required):

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis feeling of dread, fright, apprehension attention deficit avoidance of source of fear increased pulse increased BP nausea, vomiting
increased tension increased alertness jittery panic insomnia

3. Related Factors- check those that apply to your client:

loss of body part loss of body function illness death hospitalization invasive procedure
treatments and their side effects (radiation, chemotherapy for example) pain change in environment
separation from support system lack of knowledge phobia injury

4. Goal (ultimate, long term)

5. Outcome Criteria (short term)

6. Evaluation: Was the outcome criteria met?

Yes- Give Evidence:

No- Explain how you would change the plan:

7A. Interventions

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7B. Rationale for each intervention

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