Sardena, Ma. Mikaela C.

BSN 3-2

1. What is the most important consideration in the care of client with panic?
The most important consideration in the care of client with panic, The nurse will assesses the client’s general appearance and
motor behavior. The client may appear entirely “normal” or may have signs of anxiety if he or she is apprehensive about having a panic
attack in the next few moments. If the client is anxious, speech may increase in rate, pitch, and volume, and he or she may have difficulty
sitting in a chair. Automatisms, which are automatic, unconscious manner- isms, may be apparent. Examples include tapping fingers,
jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client’s
anxiety level. Assessment of mood and affect may reveal that the client is anxious, worried, tense, depressed, serious, or sad. When
discussing the panic attacks, the client may be tearful. He or she may express anger at himself or herself for being “unable to control
myself.” Most clients are distressed about the intrusion of anxiety attacks in their lives. During a panic attack, the client may describe
feelings of being dis- connected from himself or herself (depersonalization) or sensing that things are not real (derealization). During
a panic attack, the client is overwhelmed, believing that he or she is dying, losing control, or “going insane.” The client may even
consider suicide. Thoughts are disorganized, and the client loses the ability to think rationally. At other times, the client may be consumed
with worry about when the next panic attack will occur or how to deal with it. During a panic attack, the client may become confused
and disoriented. She cannot take in environmental cues and respond appropriately. These functions are restored to normal after the panic
attack subsides. Because of the intense anticipation of having another panic attack, the person may report alterations in his or her social,
occupational, or family life. The person typically avoids people, places, and events associated with previous panic attacks. For example,
the person may no longer ride the bus if he or she has had a panic attack on a bus. Although avoiding these objects does not stop the
panic attacks, the person’s sense of helplessness is so great that he or she may take even more restrictive measures to avoid them, such
as quitting work and remaining at home. Panic disorder is an anxiety disorder characterized by reoccurring unexpected panic attacks.
Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a
feeling that something terrible is going to happen. The maximum degree of symptoms occurs within minutes. There may be ongoing
worries about having further attacks and avoidance of places where attacks have occurred in the past. Panic disorder sufferers usually
have a series of intense episodes of extreme anxiety during panic attacks. These attacks typically last about ten minutes, and can be as
short-lived as 1–5 minutes, but can last twenty minutes to more than an hour, or until helpful intervention is made. Panic attacks can
wax and wane for a period of hours (panic attacks rolling into one another), and the intensity and specific symptoms of panic may vary
over the duration. In some cases, the attack may continue at unabated high intensity or seem to be increasing in severity. Common
symptoms of an attack include rapid heartbeat, perspiration, dizziness, dyspnea, trembling, uncontrollable fear such as: the fear of losing
control and going crazy, the fear of dying and hyperventilation. Other symptoms are a sensation of choking, paralysis, chest pain, nausea,
numbness or tingling, chills or hot flashes, faintness, crying and some sense of altered reality. In addition, the person usually has thoughts
of impending doom. Individuals suffering from an episode have often a strong wish of escaping from the situation that provoked the
attack. Other attacks may appear unprovoked. Some individuals deal with these events on a regular basis, sometimes daily or weekly.

2. What would be your plan of care to Mary?

The nurse can teach the client relaxation techniques to use when he or she is experiencing stress or anxiety. Deep breathing is
simple; anyone can do it. Guided imagery and progressive relaxation are methods to relax taut muscles: Guided imagery involves
imagining a safe, enjoyable place to relax. In progressive relaxation, the person progressively tightens, holds, and then relaxes muscle
groups while letting tension flow from the body through rhythmic breathing. Cognitive restructuring techniques (discussed earlier) also
may help the client to manage his or her anxiety response. For any of these techniques, it is important for the client to learn and to
practice them when he or she is relatively calm. When adept at these techniques, the client is more likely to use them successfully during
panic attacks or periods of increased anxiety. Clients are likely to believe that self-control is returning when using these techniques helps
them to manage anxiety. When clients believe they can man- age the panic attack, they spend less time worrying about and anticipating
the next one, which reduces their overall anxiety level. If the client has a panic attack, we have an intervention or plan of care to reduces
their panic attacks. As a nurse, we can teach or instruct the patient for relaxation techniques like :
Stay calm and be nonthreatening Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may
be transferred from staff to client or vice versa. Assure client of safety Reassure client of his or her safety and security; this can be
conveyed by physical presence of the nurse; do not leave client alone at this time. Be clear and concise with words Use simple words
and brief messages, speak calmly and clearly, to explain hospital experiences to client; in an intensely anxious situation, client is unable
to comprehend anything but the most elementary communication. Provide a non-stimulating environment Keep immediate
surroundings low in stimuli (dim lighting, few people, simple decor); a stimulating environment may increase level of anxiety.
Administer medications as prescribed. Administer tranquilizing medication, as ordered by physician; assess medication for
effectiveness and for adverse side effects.
Recognize precipitating factors When level of anxiety has been reduced, explore with client possible reasons for occurrence;
recognition of precipitating factors is the first step in teaching client to interrupt escalation of anxiety. Encourage client to verbalize
feelings Encourage client to talk about traumatic experience under nonthreatening conditions; help client work through feelings of guilt
related to the traumatic event; help client understand that this was an event to which most people would have responded in like manner.
Practice mindfulness Mind fulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of
detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening.

3. Is the client with panic disorder have high incidence for suicide? Why?
As stated to my research, the Suicidal ideation is common in patients suffering from panic disorder. The present study
investigated rates of suicidal ideation and risk factors for suicidal ideation in a sample of primary care patients suffering from panic
disorder with or without agoraphobia. One of the strongest risk factors for suicidal ideation and behavior is the presence of a mental
disorder, most prominently affective disorders, schizophrenia and substance use disorders, but also anxiety disorders. Taken together,
there is strong evidence that patients suffering from panic disorder display heightened risk for suicidal ideation, which underscores the
debilitating character of the disorder. Yet, most information concerning suicidal ideation in panic disorder stems from studies on the
general population or psychiatric services and may not apply to primary care settings. The prevalence of anxiety disorders is higher in
primary care settings than in the general population and current panic disorder/agoraphobia diagnoses are found in about 4% of primary
care patients. Mental health care for panic disorder/agoraphobia is sought and obtained mostly from general practitioners. Yet, suicidal
ideation often goes unrecognized in these settings, even though almost 50% of patients who died through suicide had seen their general
practitioner in the month preceding their death and up to 20% visit a primary care provider within 1 day of their death. In light of these
findings, primary care settings have been emphasized as an essential component of effective and comprehensive suicide prevention.
Therefore, the first aim of this study was to identify rates of suicidal ideation in primary care patients diagnosed with panic disorder
with or without agoraphobia. The second aim was to identify characteristic symptoms that are associated with suicidal ideation and may
therefore guide risk assessment in primary care patients. Anxiety severity, anxiety symptoms, agoraphobic avoidance as well as
depression diagnosis, depression severity, demographic markers (age, sex, living alone, unemployment) previously shown to be
associated with suicidal ideation, and frequency of visits at the general practitioner, as an alternative measure of general distress, were
considered as potential predictors of suicidal ideation.
4. Make a nursing care plan of Mary based from the problem identified.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective data: Anxiety may be After 30 minutes of  Maintain  Anxiety is After 30 minutes
A client complaining related to, lack nursing a calm, contagious of nursing
of chest pains, of knowledge intervention the non and may be intervention the
palpitations and regarding client will appear threateni transferred client has
shortness of breath, symptoms, relax and report ng from health appeared to be
diaphoresis, light progression of anxiety is reduced manner care provider relaxed and
headedness and condition, and to manageable while to client or reported anxiety
fears of dying. treatment level. working vice versa. is reduced to
regimen, with the Client manageable
Objective data: Feelings of client. develops level.
physician order discomfort, feeling of
 cardiac apprehension or security in
enzymes helplessness, presence of
 chemistry Restlessness, calm staff
profile Poor impulse person.
 toxicology control.
screen.
 ECG
 CBC
 Remain  The client’s
with the safety is
client at all utmost
times when priority. A
levels of highly
anxiety are anxious
high client should
(severe or not be left
 panic); alone as his
reassure anxiety will
client of his escalate.
or her
safety and
security.
 Maintain
calmness in  The client will
your feel more
approach to secure if you
the client. are calm and
if the client
feels you are
in control of
 Stay with the situation.
the patient  During a
during panic attack,
panic the patient
attacks. needs
Use short, reassurance
simple that he is not
directions. dying and the
symptoms
will resolve
spontaneousl
y. In anxiety,
the client’s
ability to deal
with
abstractions
or complexity
 Encourage is impaired.
the client’s
participation  Relaxation
in relaxation exercises are
exercises effective
such as nonchemical
deep ways to
breathing, reduce
progressive anxiety.
muscle rela
xation,
guided
imagery,
meditation
and so
forth.