Case+Study+1+working+copy+Yellow

 
 * Directions: Working within your assigned teams, answer the following questions. Each team member is expected to contribute to the completion of the case study. Please bring your completed work to class with you on 1/27 so that you are able to contribute to the class discussion of this topic. **
 * Scenario: ** A 24 year old male is brought to the ER via ambulance at 1030 with a complaint of chest pain and tightness; difficulty breathing; dizziness; palpitations; nausea, paresthesia and feeling like he is going to die. He is having difficulty thinking clearly.

The patient tells you “I don’t think I’m going to make it. I must be having a heart attack.” He is diaphoretic and trembling. V/S: B/P 178/98; P 110; R 28 and shallow; T 36.9C. The onset of symptoms was approximately 40 minutes ago during a staff meeting and became progressively worse. The patient has no history of cardiac problems.

1. What is the highest medical priority for this patient? What is your rationale for the answer you have given?

After a full medical work-up, the patient is stable. His SOB and anxiety are resolved after he received Lorazepam 1mg IV push. The medical workup did not reveal an underlying medical condition and a diagnosis of panic attack is given. After further conversation with the patient, he reports having 5 similar episodes in the past 3 weeks, but they were not as severe as this one.

2. Identify the patient’s presenting symptoms that support a diagnosis of panic attack.

3. What additional assessments would be included when assessing a patient for anxiety and panic?

4. What is the difference between anxiety attack and panic disorder? An anxiety attack and Panic disorder are very different. An anxiety attack is a build up or overload of anxiety causing physical symptoms; tachycardia, hyperventilation, dizziness, nausea, and headaches. Behavioral changes like withdrawal, pacing, amd making threats or demands is common. As the anxiety of a person increases, so does the inability to think clearly. An anxiety attack is commonly accompanied by trembling, muscle tension, increased pulse and pounding heart. Panic attacks, on the other hand are sudden, acute anxiety attacks. Physically and mentally draining behavior such as severe shakiness, sleeplessness, hyperactivity, and a state of terror. During a panic attack a person is unable to problem solve, process their environment, and may become erratic. A person may even experience hallucinations or delusions, and are likely to be out of touch with reality, during the attack. The overwhelming feeling of impending doom or death is common. Panic disorder is unexpected recurrent panic attacks; followed by fear of more attacks, overall sense of impending doom, or death and may cause an overall change in behavior.

5. What medications are used to treat anxiety and panic disorders and/or attacks? What patient teaching will you include related to these medications.

6. Write a psychosocial nursing diagnosis for this patient.

7. Write one short term and one long-term goal related to the diagnosis you have identified.

8. For each goal, write 5 nursing interventions.