TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and Universities in
the Philippines

CLINICAL CASE ANALYSIS

Name of Patient Patient X Age: 24 Gender:

female
Address Tarlac Date 9/1/21
Admitted:
Diagnosis Agoraphobia

NURSING HISTORY:

PRESENT HISTORY:
Patient X is referred to a mental health clinic because of “fear of elevators.” She describes being
“afraid” of elevators since adolescence, after being stuck in one for over 1 hour. Since that time,
she has attempted to avoid taking them, either walking stairs or using escalators. However, this
has become increasingly difficult given her recent employment on the upper floor of a skyscraper
downtown. She has tried to use the stairs, but it takes too long, and she is winded by the end. As a
result, she has been late to meetings and has already been reprimanded. She “forced me” to ride
the elevator several days ago, but felt extremely anxious, with sweating, hyperventilation
palpitations, nausea, dizziness, and fears that she would suffocate and die. While she realizes this
is very unlikely, she is unable to tolerate the elevator. She has decided to come in for help so as to
avoid losing her job.

PAST HISTORY
Patient X describes being “afraid” of elevators since adolescence, after being stuck in one for over
1 hour.
PATHOPHYSIOLOGY:
Psychopathology of Agoraphobia

Modifiable:
 Environmental (DSM – 5) A Non – modifiable:
traumatic childhood  Age (20, common in adults)
experiences (being stuck in  Female
elevator for over 1 hour)
 Other phobia (fear of height)

Intense fear

Fear of enclosed spaces and height

Excessive anxiety

Random panic attacks

Overactivated sympathetic
nervous system

Dysregulation in the

Agoraphobia

Cognitive: Behavioral: Physical: Emotional:

Irrational beliefs  Avoiding Flight or fight Feeling of
situations response dread
 Disruption  Increased
of daily life heart rate
 Increased
breathing
 Muscle
tension

DIAGNOSTIC PROCEDURES:
Agoraphobia is diagnosed based on:
  In-depth interview with your doctor or a mental health professional
 Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), published by the American Psychiatric Association

MEDICAL MANAGEMENT:
 Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors
(SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of
panic disorder with agoraphobia. Other types of antidepressants may also effectively treat
agoraphobia.
 Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in
limited circumstances, to temporarily relieve anxiety symptoms. Benzodiazepines are
generally used only for relieving acute anxiety on a short-term basis. Because they can be
habit-forming, these drugs aren't a good choice if you've had long-term problems with
anxiety or problems with alcohol or drug abuse.

Nursing Responsibilities
Assessment & Drug Effects
 Use those drugs with caution in anorexic patient since weight loss is a possible side effect.
 Monitor for S&S of improved affect. Requires approximately 2–3 wk. for therapeutic
effects to be felt.
 Weigh weekly to monitor weight loss, particularly in the older adult or nutritionally
compromised patient. Report significant weight loss to physician.
 Observe for and promptly report rash or urticaria and S&S of fever. Drug may have to be
discontinued or adjunctive therapy instituted with steroids or antihistamines.
 Observe for dizziness and drowsiness and employ safety measures (up with assistance, side
rails, etc.) as indicated.
 Monitor for and report increased anxiety, nervousness, or insomnia; may need
modification of drug dose.
 Monitor for seizures in patients with a history of seizures. Use appropriate safety
precautions.
 Supervise patients closely who are high suicide risks, especially during initial therapy.
 Monitor patients with hepatic or renal impairment carefully for S&S of toxicity (agitation,
restlessness, nausea, vomiting, seizures).

Patient & Family Education

 Notify physician of any rash, possible sign of a serious group of adverse effects.
 Do not drive or engage in potentially hazardous activities until response to drug is known;
especially if dizziness noted.
 Monitor blood glucose for loss of glycemic control if diabetic.

Name of Crizelda Malonga & Ninna Marcelino

Student:
Date 9/2/21 C.I.’s Signature
Submitted:

Form No.: TSU-

Revision No.: 00 Effectivity Date: June 22, 2016 Page 1 of 1
COS-SF-04