NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00400 |
|---|---|
| Label | Excessive anxiety |
| Before (2021-2023) | Former code 00146 |
| Spanish label | Ansiedad excesiva |
| Domain | 9. Coping / stress tolerance |
| Class | 2. Coping responses |
| Type | Problem-focused |
| Status | Current |
What changed in 2024-2026
The label adds "excessive" to make clear that normal anxiety in a difficult situation is not a diagnosis: it only becomes one when it goes beyond what is expected. If your nursing program still uses the previous edition, you will see code 00146; for new assignments, use 00400.
What it means
It is intense worry about something the person cannot pin down, stronger than the situation warrants. It shows in what they say, in their body (racing heart, tension, insomnia), and in trouble thinking, sleeping or following instructions.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Before surgery, a procedure or receiving test results.
- Prolonged hospitalization or a stay in the ICU.
- Recent diagnosis of a serious illness.
- Situational crises: job loss, grief, family changes.
- Poorly controlled pain or shortness of breath, which feed the anxiety.
- Family members of critically ill patients waiting for updates.
What to assess
- What the person says: constant worry, a sense that something bad is going to happen, trouble concentrating.
- Physical signs: tachycardia, diaphoresis, tremor, muscle tension, insomnia.
- Behavior: restlessness, repeated questions, irritability, crying.
- What they know about their situation and what specifically worries them.
- Who they can rely on and how they have handled similar situations.
- If there are thoughts of self-harm, ask directly and notify the team.
- Hours of sleep; use of coffee, alcohol, tobacco or other substances.
- Physical causes that mimic anxiety: hypoxemia, hypoglycemia, pain, fever, withdrawal.
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- States they cannot stop worrying and cannot control it.
- Expresses a feeling that something bad is going to happen without being able to say what.
- Paces, wrings their hands or cannot sit still.
- Has trouble concentrating or retaining what is explained.
- Asks the same question several times.
- Irritability or crying easily.
- Resting heart rate and blood pressure above their usual baseline.
- Diaphoresis, fine tremor or cold hands.
- Muscle tension, headache or neck pain.
- Takes a long time to fall asleep or wakes up several times during the night.
- Dry mouth, nausea or urinary frequency.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Insufficient or confusing information about their situation or the procedure.
- Unfamiliar or noisy surroundings with little privacy.
- Uncontrolled pain or shortness of breath.
- Separation from family or their support network.
- Stress-coping strategies that are not working for them.
- High intake of coffee or other stimulants.
- Lack of sleep or abrupt changes in routine.
At-risk populations
- People awaiting surgery or test results.
- ICU patients and their families.
- People with a history of an anxiety disorder.
- Primary caregivers of people with chronic illness.
- People going through losses or financial crises.
Associated conditions
- Anxiety disorders and depression.
- Recently diagnosed serious illness, such as cancer.
- Chronic respiratory diseases: COPD, asthma.
- Hyperthyroidism.
- Alcohol or other substance withdrawal.
- Major surgery.
How to write it (PES)
Excessive Anxiety related to a major stressor (scheduled surgery) and inadequate knowledge of the procedure as evidenced by verbalized constant worry about the outcome, insomnia for two nights, and a resting heart rate of 110 bpm.
Excessive Anxiety (00400).
The stressor and what nursing can change: lack of information, the environment, pain.
What the person expresses and what you observe, with data: hours of sleep, heart rate, behaviors.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Patient identifies what is worrying them and puts it into words during the shift.
- Patient explains in their own words what the procedure involves before surgery.
- Patient practices a breathing or relaxation technique and reports less tension.
- Patient sleeps at least 5 hours the night before surgery.
- Patient's resting heart rate drops below 100 bpm within the next 12 hours.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Introduce yourself, sit at the patient's eye level and listen without interrupting. | Feeling heard lowers tension and gives you information for the plan. |
| Explain the procedure in plain language: what they will feel and how long it takes. | The unknown increases anxiety; concrete information reduces it. |
| Give information in short pieces and ask the patient to repeat it back in their own words (teach-back). | People with high anxiety retain little; checking understanding prevents misunderstandings. |
| Teach slow breathing: inhale for 4 seconds and exhale for 6. | Triggers the relaxation response and lowers heart rate. |
| Reduce noise, light and unnecessary visitors. | A calm environment helps the patient fall asleep. |
| Involve family or a trusted person. | Close support provides a sense of security. |
| Manage pain and dyspnea if present. | They are physical causes that keep the anxiety going. |
| Advise avoiding coffee and energy drinks while the crisis lasts. | Stimulants worsen tachycardia and insomnia. |
| Notify the team if the anxiety does not ease or there are thoughts of self-harm. | The patient may need a mental health evaluation or treatment. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 1211Anxiety Level
- 1402Anxiety Self-Control
NIC interventions
- 5820Anxiety Reduction
- 6040Relaxation Therapy
- 5340Presence
- 4920Active Listening
Linkages drawn from care plans published by health services, universities and nursing journals, originally set for the previous diagnosis (00146 Anxiety). Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Patient the night before a mastectomy
Patient. 38-year-old woman admitted the afternoon before a mastectomy for breast cancer. It is her first surgery, and she is alone at the hospital because her partner is caring for their children.
Assessment
- Resting HR 108 bpm; BP 142/88 mmHg (baseline 118/76).
- RR 22 breaths/min, SpO2 98% and fingerstick glucose 96 mg/dL.
- Slept 3 hours the night before.
- States: "I can't stop thinking about everything that could go wrong."
- Asks four times in one hour what time the surgery is.
- Wrings her hands, has a fine tremor and does not know what the postoperative period will be like.
Nursing diagnosis
Excessive Anxiety related to a major stressor (scheduled surgery), insufficient information about the postoperative period, and separation from her support network as evidenced by verbalized constant worry, repeated questions, 3 hours of sleep, and a resting heart rate of 108 bpm.
Goal
Before going to the OR, patient explains in her own words what will happen after surgery, and her resting heart rate is below 100 bpm.
Interventions
- Listen to what worries her without interrupting or minimizing it.
- Explain in short pieces the transfer to the OR, waking up and pain management.
- Teach 4-6 slow breathing and practice it with her.
- Arrange a video call with her partner before bedtime.
- Reduce light and noise in the room overnight.
Evaluation
At 12 hours she reports sleeping 5 hours, her heart rate is 90 bpm, and she explains what the postoperative period will be like. She says she is still nervous but "calmer." The diagnosis remains active and will be reassessed after surgery.
How it differs from similar diagnoses
- Excessive fear (00390): Excessive fear: the threat is specific and identifiable (fear of anesthesia, of a needle). In anxiety, the threat is vague.
- Excessive death anxiety (00399): Excessive death anxiety: the worry centers on one's own death or the death of a loved one.
Common mistakes
- Still using code 00146 in assignments based on the 2024-2026 edition.
- Diagnosing excessive anxiety for worry that is proportionate and short-lived.
- Writing vague cues like "patient is anxious" without observable data.
- Attributing tachycardia or agitation to anxiety without ruling out hypoxemia, pain or hypoglycemia.
- Using it when the person knows exactly what they are afraid of: that is excessive fear.
Used in these conditions
Other diagnoses in the Coping responses class
Domain 9, Coping / stress tolerance. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for excessive anxiety?
00400, in Domain 9 (Coping/stress tolerance), Class 2 (Coping responses). It replaces the old 00146 in the 2024-2026 edition.
What happened to the Anxiety 00146 nursing diagnosis?
In NANDA-I 2024-2026 it is called Excessive Anxiety, and its code is 00400.
What is the difference between anxiety and fear in nursing diagnosis?
With fear, the person knows what they are afraid of; with anxiety, the threat is vague or nonspecific.
Is all preoperative anxiety a nursing diagnosis?
No. Some nervousness is expected. It is diagnosed when the worry is out of proportion and affects sleep, comprehension or vital signs.
Can I use this diagnosis for a family member instead of the patient?
Yes. If the family member is under your care or part of the plan, the diagnosis is written for that person.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Excessive anxiety (00400) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2, source 3. Reviewed November 2, 2026.