Case+Study+1+working+copy+Green

 
 * 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?

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. Inneffective coping mechanisms r/t panic disorder. 

7. Write one short term and one long-term goal related to the diagnosis you have identified. ST Goal: Patient's anxiety will decrease/diminish for remainder of hospital stay. LT Goal: Patient will be able to identify 5 means of self control.

8. For each goal, write 5 nursing interventions. ST: 1) Teach patient abdonimal breathing techniques and instruct patient to use when anxiety is detected. 2) Provide a calm environment for the patient. 3) Encourage patient to be invloved with his care and decision making.   4) Establish a trusting relationship with patient 5) Ensure patient safety in his environment.

LT: 1) Patient will be able to use positive self talk. 2) Patient will be able to identify stress factors in his life and what can be done to alleviate these stressors. 3) Patient will plan coping mechanisms for future stressful situations. 4) Patient will maintain a sleep diary. 5) Patient will seek information/receive information about panic attacks and ways to reduce anxiety.