Patient: Gerald Gib It is 1000 hours

Patient: Gerald Gib It is 1000 hours in the emergency department (ED) when the ambulance brings in Gerald, 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? Case Progression: After a full medical workup, it is determined that Mr. Gib.’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. Gerald 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? 3. MR. GIB 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? Case Progression: MR. GIB 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. 5. MR. GIB 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? 6. Has MR. GIB had an expected or unexpected panic attack? Explain your answer. MR. GIB’s condition is stable and the ED physician discusses what has happened with MR. GIB The physician gives MR. GIB a prescription for a “weeks’ worth” of medication and instructs MR. GIB to see his primary care physician for further treatment and evaluation. 7. The physician gives MR. GIB a prescription for alprazolam (Xanax) 0.5 mg tid to last 1 week and instructs MR. GIB to see his primary care physician for further treatment and evaluation. Why do you think the physician gave MR. GIB a prescription for only 1 week of Xanax? 8. What populations might use of benzodiazepines be contraindicated/cautioned in? 9. What three drug classes are used to treat panic attacks? What will your patient teaching include? Case Progression MR. GIB 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. 10. What techniques to help him cope will you discuss with him? Name at least five. 11. What actions or interventions are most indicated in the treatment of panic disorder? SCIENCE HEALTH SCIENCE NURSING NUR 4837

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