Case Study Mental Health STUDENT COPY

Scenario
It is 1000 hours in the emergency department (ed) when the ambulance brings
in G.G., 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. ( RECOGNIZE CUES )
Highlight the findings that require immediate follow-up by the nurse.

1A, 6. ( PRIORITIZE HYPOTHESES)

The client most likely is experiencing a/ an____________ as evidenced by
symptoms such as _____________ and _____________

Dropdown 1 Dropdown 2 Dropdown 3

transient Ischemic attack nausea palpitations
myocardial infarction high BP chest pain
Severe Anxiety difficulty thinking feeling of
impending doom
1B. (ANALYZE CUES)
What initial steps would you take and what orders would you expect to
receive?

CASE STUDY PROGRESS

After a full medical workup, it is determined that G.G.'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 GG results are all within
normal parameters and there is no evidence of any physical disorder. The
healthcare provider assigns a diagnosis of panic attack disorder.
G.G. admits to having had three similar episodes in the past 2 weeks;
however, they did not seem bothersome, as they were not as severe,
debilitating, or long-lasting. The client further states the last episode caused
him to ‘borrow medications from his significant other.” Since there were no
after-effects “no other follow-up seemed necessary. “

2. While interviewing the client the nurse identifies defense mechanisms GG has
adopted to effectively cope with this disorder.
In the statement above, GG uses the defense mechanism known as __________
which is best defined as __________________.

Dropdown 1 Dropdown 2
rationalization attempting to avoid emotional conflict by
focusing on concrete, logical events.

denial attempting to justify maintaining self-

respect

intellectualization blocking out painful thoughts/feelings.

2A. How do you think this diagnosis was determined?

3. G.G. 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 STUDY PROGRESS

G.G. 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. G.G. 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?
CASE STUDY PROGRESS
G.G.'s condition is stable, and the ER physician discusses what has happened with
G.G. The physician gives a prescription for a "weeks’ worth" of medication and
instructs G.G. to see his primary care physician for further treatment and
evaluation.

7. The physician gives G.G. a prescription for alprazolam (Xanax) 0.5 mg tid to
last 1 week and instructs G.G. to see his primary care physician for further
treatment and evaluation.
Why do you think the physician gave G.G. a prescription for only 1 week of
Xanax?

8. What medications are used to treat panic attacks? Be

comprehensive
What will your patient teaching include?

CASE STUDY PROGRESS

G.G. tells you all about his worries about 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 panic attacks will return.

9. ( PRIORITIZE HYPOTHESES)
What techniques to help him cope will you discuss with him? Name at least five.
10. (TAKE ACTION)
What actions or interventions are most indicated in the treatment of panic disorder?
Identify at least 5.

CASE STUDY OUTCOME

G.G. makes an appointment with his company's employee assistance Program to

take advantage of the resources offered for counseling to help him work with his
coping strategies. In addition, his primary care physician started him on a low dose
of an SSRI. after a few months, G.G.'s panic attacks become very rare and he
works on preparing a résumé to seek new employment before his company has
another round of job cuts.