Panic attack and panic disorder case study

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Case Study

Caroline, a 19 year old college student from northern Ontario, is attending a large college in another province. Caroline was doing well at the university until she experienced several unexpected panic attacks. She had a panic attack in the library and another one at the gym when she went to work out. The most recent attack occurred about a month ago when she was driving her car. Suddenly and for no reason she could think of, she began feeling short of breath. It felt like someone was smothering her, but she was alone in the care. She was afraid she was going to die.

Her heart was going very fast; she became dizzy and was feeling numbness and tingling in her hands and arms. She felt a sense of impending danger and wanting to escape. She was so panicked that she had to pull over into a convenience store parking lot and wait until she felt better to call her boyfriend and ask him to come and take her home.

Caroline rode the bus to campus to classes for a while after this panic attack. She parked her car and refused to drive anywhere. She began fearing another panic attack and started skipping classes. A big school football game and party is coming and her boyfriend is threatening to break up with her unless she “gets a grip.”

Caroline’s mother receives a call from Caroline’s roommate telling her of the situation. Her mother takes Caroline to see a psychiatrist who prescribes paroxetine (Paxil) 10 mg / day and suggest an outpatient evening treatment program. Treatment in the evening allows Caroline to go to classes in the daytime. Caroline reveals a fear that she has some life threatening illness that the doctor has not found on a recent annual physical exam. Later in a group session, she states “she thinks someone had put a voodoo spell on her.”

On the third night, Caroline is to take a cap or bus to the evening session because her mother has gone back home. It is two hours before the evening program is to begin. Caroline calls the nurse in the outpatient evening treatment program saying: “I am too afraid to the leave the house, I’m sorry, I just can’t come tonight. Perhaps I will be able to come tomorrow.” The nurse responds, “I want you to take several deep breaths and think about relaxing. Now that you feel very relaxed, I want you to Visualize in mind walking to the door and opening it.”

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1. What is the difference between a panic attack and Panic Disorder? What symptoms does Caroline have and do the match the criteria for a diagnosis of Panic Disorder?
2. What is the usual onset of panic attacks and Panic Disorder? Is there a gender difference in the prevalence of panic attacks and Panic Disorder?
3. Caroline has Agoraphobia. What is Agoraphobia and what symptoms of this problem does Caroline exhibit?
4. How can Caroline’s significant others best support her in dealing with panic attacks and Agoraphobia?
5. One of Caroline’s group peers shares with nurse that he thinks Caroline is psychotic and paranoid and delusional about somebody putting a spell on her. If you were the nurse, how would you respond?
6. How would you respond as the nurse if Caroline shares with you that she believes she has a fatal disease that no one has found and that someone is putting a spell on her or choking and putting pins in a voodoo doll that represents her?
7. Why did the nurse respond by encouraging relaxation and visualization when Caroline called to say she would not make it to the evening therapy program?
8. What teaching should the nurse do with Caroline in regard the Paxil? What side effects may have an effect and cause patient’s to stop taking it? What assessments need to be included for a patient taking Paxil?
9. What medications have been found effective in the treatment of panic attacks?

10. What therapies other than medication are currently being used to treat Panic Disorder and Agoraphobia?
11. Complete a full mental status assessment for Caroline.
12. Complete a full physical examination for Caroline.
13. Identify three nursing diagnoses and write a complete care plan including two goals for each diagnosis; three interventions for each goal, rationale for each intervention, and evaluations for all interventions and goals.

PLewis, Heitkemper, Dirksen Medical-Surgical Nursing in Canada Mosby 978-189-742-2014 2nd
Required Resource Potter & Perry Canadian Fundamentals of Nursing Elsevier 978-1-926648-53-8 5th
Required Resource Endelman & Mandle Health Promotion Throughout the Lifespan Mosby 978-032-305-6625 7th Edition
Required Resource Morrison – Valfre Foundations of Mental Health Care Elsevier 978-032-3086-202
Required Resource Pagana Mosby’s Canadian Manual of Diagnostic and Lab Tests Mosby

The following criteria shall be used when you complete the assigned case studies:

a) Answer the questions associated with the case

b) Develop a nursing process report based which will include:

a. Identifying data
b. Past history
c. Recent medical history
d. Medical diagnosis
e. Medications
f. Findings from Physical Assessment
g. Clinical signs / symptoms
h. Diagnostic tests
i. Treatments
j. Psychosocial assessments/ mental status assessments
k. Nursing diagnoses (3)
l. Goals (2)
m. Interventions
n. Discharge needs
o. Format  i. Typed

1. 12 pt. font
2. 1 inch margins
3. Double spaced
4. Title page

ii. Accurate
iii. APA style
iv. Supporting evidence provided

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When completing the case study, not all assessment data will be available, just include the information provided in the case.

Your assessment will be as comprehensive as possible using Gordon’s framework as a guide. The assessment will be typed.

You will identify three nursing diagnoses for each case. All nursing diagnoses will have two goals (one related to patient education or health teaching). For each goal, there will be 3 – 4 evidence based interventions that have been individualized to the specific client. Please provide rationale for interventions as well as the primary source.

Evaluation will include the specific outcomes that you would be evaluating.

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