Case Study 148 Panic Disorder PDF

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Hector Santiago Summer-2205-NUR1460C PART 3 PSYCHIATRIC AND ALTERNATIVE THERAPIES CASES

Case study 148

Case Study 148 Panic Disorder Difficulty: advanced Setting: emergency department Index Words: intense fear, physiologic panic reactions, recognizing triggers, medications, coping techniques, patient education Giddens Concepts: anxiety, Care Coordination, Coping, Patient education HESI Concepts: anxiety, assessment, Care Coordination, Patient education, Psychological, stress & Coping

u Scenario It is 1000 hours in the emergency department (ed) when the ambulance brings in G.G., a 35-year-old man who is having difficulty breathing. He complains of chest pain and tightness, dizziness, palpitations, nausea, paresthesia, and feelings of impending doom and unreality; he is having trouble thinking clearly. He tells you, "I don't think I'm going to make it. I must be having a heart attack." He is diaphoretic and trembling. His vital signs are 184/92, 104, 28, 98.4 ° F (36.9 ° C). this episode began at work during a meeting at approximately 0920 and became progressively worse. a co-worker called 911 and stayed with him until medical help arrived. the patient has no history of cardiac problems.

1. What initial steps would you take and what orders would you expect to receive? I would provide therapeutic communication such as active listening and reassurance, in addition breathing exercises and relaxation techniques to decrease the RR. I would obtain a full set of vitals including SpO2 and SAMPLE Hx. I would expect orders for CBC, CMP, and troponin as well as EKG.

CASE STUDY PROGRESS after a full medical workup, it is determined that G.G.'s condition is stable. His shortness of breath and anxiety resolve after he is given lorazepam (ativan) 1 mg IV push (IVP). the lab work and eCG results are all within normal parameters and there is no evidence of any physical disorder. a diagnosis of panic attack is made. G.G. admits to having had three similar episodes in the past 2weeks; however, they were not nearly as severe or long-lasting.

2. How do you think this diagnosis was determined? Diagnosis of exclusion, absence of diseases process reflected on labs or physical examination. Improvement of symptomatology with the administration of lorazepam (Ativan) 1mg (IVP)

G.G. asks whether there is something wrong with his memory because he has been having trouble remembering things. What effect does panic disorder have on memory? According to Berksun, O. (1999), "it is proposed that patients with panic disorder have a defect in fear-relevant episodic memory, and their panic attacks arise from automaticity in recollecting fear-relevant emotional-autonomic cluster." This particular study showed that most patients were unable to actively recall the events that triggered the panic episodes, and they had dissociative type effects just prior and partially during the panic attack.

PART 3 PSYCHIATRIC AND ALTERNATIVE THERAPIES CASES CASE STUDY PROGRESS G.G. shares with the ed staff that he has been under severe stress at work and home. He tells them he is going through a divorce, he lost a child last summer in a motor vehicle accident, and his company is downsizing. He will probably be out of a job soon. He hasn't been sleeping well for the past couple of months and has lost about 20 pounds.

4. Identify five triggers that could cause anxiety to build to the point of panic. 1. Lost of child 2. Divorce 3. Fear of losing his job 4. Financial Stressors 5. Fear of his own heath deteriorating

G.G. has questions regarding the differences between panic attacks and panic disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), what are the differences? A panic attack is a sudden, intense fear or anxiety that may make you short of breath or dizzy or make yo heart pound usually lasting from 5 to 20 minutes. In contrast panic disorder is the recurrence and occurrence of several panic attacks. Unexpected panic attacks are a diagnostic requirement for Panic Dis

6. Has G.G. had an expected or unexpected panic attack? Explain your answer. To me G.G. had an expected panic attacks, although he is unable to recognize it at the time of the attac several obvious triggers (Ex. work, meeting, location, family) and he admitted that previous similar event duration had occurred.

15 Psychiatric Disorders

CASE STUDY PROGRESS G.G.'s condition is stable and the ed physician discusses what has happened with G.G. the physician gives G.G. a prescription for a "week's worth" of medication and instructs G.G. to see his primary care physician for further treatment and evaluation.

7. The physician gives G.G. a prescription for alprazolam (Xanax) 0.5 mg tid to last 1week and instructs G.G. to see his primary care physician for further treatment and evaluation. Why do you think the physician gave G.G. a prescription for only 1week of Xanax? In order to allow time to make an appointment and follow up with his PCP for definitive care and proper a to follow up. The ER provider won't be able to follow up with the G.G.

8. What medications are used to treat panic attacks? What will your patient teaching include? Benzodiazepines (given to G.G. in the ER), Selective Serotonin Reuptake Inhibitors (SSRIs) Tricyclic Antidepressants (TCAs), Monoamine Oxidase Inhibitors (MAOIs). Education includes support groups potential side-effects: Memory loss, difficulty thinking clearly, Difficult disturbing dreams. Confusion, depression, blurred vision, Drowsiness, feeling tired or weak, Dizziness, c

PART 3 PSYCHIATRIC AND ALTERNATIVE THERAPIES CASES

Case study 148

CASE STUDY PROGRESS G.G. tells you all about his worries with his job and all that has happened to him in the past year. He tells you that he appreciates you listening to him. He expresses fear that the panic attacks will return.

9. What techniques to help him cope will you discuss with him? Name at least five. 1. Use deep breathing, close eyes 2. Recognize that you're having a panic attack 3. Practice mindfulness 4. Use muscle relaxation techniques 5. Picture your happy place.

10. What actions or interventions are most indicated in the treatment of panic disorder? 1. Use therapeutic communication such as active listening, reassurance, silence, focusing, using open end clarification, exploring, paraphrasing, reflecting. 2. CASE Appropriate referral / consult for Psychotherapy / Mental Health 3. STUDY Eduction on support group and coping techniques such as exercise, write in a journal, draw, listen to mu 4. OUTCOME Use of medications

G.G. makes an appointment with his company's employee assistance Program to take advantage of the resources offered for counseling to help him work with his coping strategies. In addition, his primary care physician starts him on a low dose of an ssRI. after a few months, G.G.'s panic attacks have become very rare and he works on preparing a résumé to seek new employment before his company has another round of job cuts....