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 * 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?
 * I believe that stabilizing the B/P is first priority. At this point when he is first brought in you would want to stabalize. A blood Pressure of 178/98 is not a pre hypertension state it is REAL hypertension that is putting the circulatory system under stress. Diagnosing the patient with an anxiety attack would come after stabilizing his vitals You absolutely have to get his vitals under control before you can even address the anxiety issues. They don't matter as much if he is unconscious. I also think that stabilizing both his respirations and his blood pressure are the priority. That will lessen his anxiety about possible heart attack and the fear of "not going to make it**

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.

A panic attack is associated with feelings of impending doom.Attacks are often accompanied by uncomfortable symptoms such as palpitations, chest pain, breathing difficulties. Panic attacks may not necessarily be n response to stress and are extremely intense. pg.218 The fact that the patient's shortness of breath and anxiety were resolved by receiving the Lorazepam IV also indicates the panic attack diagnosis is correct.**
 * the patient's presenting symptoms that support the diagnosis of a panic attack are: increased pulse and respirations, difficulty breathing, chest pain/tightness, dizziness, feeling he is going to die, palpitations, and nausea.

3. What additional assessments would be included when assessing a patient for anxiety and pan
 * assessments would be duration of symptoms, frequency of attacks, problem functioning caused by the attack, observe attitude and behavior**
 * Additional assessments for anxety could be the Hamilton Anxiety Scale, a popular tool for measuring anxiety. p. 227**

4. What is the difference between anxiety attack and panic disorder? **The difference between an anxiety attack and panic disorder is that someone with panic attack is unable to process what is going on and may lose touch with reality, such as with hallucinations. This patient's anxiety is at moderate level which is why he is stating that something is wrong. He will be teachable**.
 * The difference between an anxiety attack and a panic disorder is that an anxiety attack is an excessive exaggerated worry about everyday life events( worrying about YOUR LIFE) a panic attack comes out of the blue for no reason and is all about your body and mind. panic attacks usually end up in the ER because of feelings that there is something physically wrong.**

5. What medications are used to treat anxiety and panic disorders and/or attacks? What patient teaching will you include related to these medications.
 * selective serotonin reuptake inhibitors, benzodiazepines, tricyclics, nonbenzodiazepines, and monoamine oxidase inhibitors. pt teaching would be taking the proper dosage, not to stop taking the drug suddenly, what the withdrawal symptoms are if any when pt no longer takes the drug, if meds are taken before,after, or with meals meals, any adverse effects, the drugs effects on young children if the pt is breastfeeding or planning on becoming pregnant, things that may increase or decrease the drugs effectiveness**

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. Long term goal-- patient will use comfort measures to relieve anxiety. examples are calm /quiet environments, soft music, warm baths, back rubs**
 * nursing diagnosis-Anxiety ( level-panic) related to a threat in health status A/E/B fear of having a heart attack**
 * Short term goal-- stabilizing patient's vital signs

8. For each goal, write 5 nursing interventions. 1**)review happenings, thoughts and feelings preceding the attack 2) Identify things that patient has done in the past to cope successfully when feeling anxious 3) Assist patient to learn precipitating factors and new methods of coping with disabling anxiety. 4) List helpful resources/people including " hotline" or crisis managers to provide ongoing timely support. 5) Review strategies, such as role playing, use of visualizations to practice anticipated events. Assist patient in recognizing problem situations and their accompanying anxiety symptoms. Assist patient in choosing ways of decreasing anxiety symptoms that are comfortable and natural for him to incorporate into his life. Teach patient that lower levels of anxiety can be productive rather than harmful by inspiring change in problem areas. Be available to client for listening and talking. Encourage client to express and acknowlege feelings Teach patient about maintaining balance in his life for emotional and physical well being. Assess with patient areas in his life that are out of balance. Look at social** **activities, exercise and outdoor activities, enjoyable nutrition, relaxing and spiritual activities review health and family history to determine any underling conditions that may influence anxiety levels**