Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example

Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example

Subjective:

Name: Tony Patelli, Gender: Male,  Age: 18 years, Race: Italian American

CC (chief complaint): “I went to the Emergency Department (ED) last week because I felt like I was dying from a heart attack. TheEKG was normal, but I was sweating, and I was having trouble catching my breath.”

HPI: Patelli is an 18-year-old male of Italian American origin who presented to the client with a complaint of sweating, dyspnea, and a pounding heart that lasts for 12 -15 minutes. A week before visiting the clinic, he reports having gone to the ED after feeling like he would die of a heart attack. An electrocardiogram ( EKG ) test ordered indicated normal cardiac functions. Despite the expected findings, he reports having an episode that lasted for between 10 and 15 minutes, during when he sweats profusely and had trouble catching his breath. The heart was pounding hard, giving him a sickening feeling where he felt like his chest would explode. It felt like that moment in the woods when you sense someone or something is chasing after you. After the 12-15 min, the symptoms resolved of their own accord only to reappear the following day when Patelli was preparing coffee. The symptoms popped all over again for no apparent reason and with no concrete triggers.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Past Psychiatric History:

• General Statement: The client seems to be a healthy teenager who has enjoyed relatively good health until the recent panic attacks.
• Caregivers (if applicable): Not applicable(N/A)
• Hospitalizations: None that he is aware of.
• Medication trials: No medications(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)
• Psychotherapy or Previous Psychiatric Diagnosis: No previous psychiatric history and no history of psychiatric treatment.

Substance Current Use and History:

Denies drugs or alcohol use.

Family Psychiatric/Substance Use History:

Nobody in the client’s family has a history of psychiatric illness or substance use. However, he reports his mother would get those panic attacks probably 3-4 a week, like him for no particular reason.

Psychosocial History:

Lives alone in New York, an only child, raised by both parents in New Jersey. He is a full-time student enrolled in a graphic design course in a local community. He admits he is a teetotaler taking no alcohol or drugs. He reports sleeping 7.5 hours, has a good appetite, and eats three meals a day. He likes to keep a routine schedule.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Medical History:

• Current Medications: Not taking any medications
• Allergies:NKDA
• Reproductive Hx:Deferred

ROS:

• GENERAL:  The patient is nontoxic,  in no acute distress, and T-98.8 P-94 R 20 126/88 Ht 5’4 Wt 131 lbs
• HEENT: Eyes no loss of vision, blurred vision, or double vision, Ears, Nose, Throat, No loss of hearing, sneezing nasal congestion, runny nose, or sore throat(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)
• SKIN: No itching or rash
• CARDIOVASCULAR: Increased chest pressure, chest discomfort, chest pain, palpitations, or edema.pounding heart
• RESPIRATORY: shortness of breath when having an attack.
• GASTROINTESTINAL: No nausea, vomiting, or diarrhea. No anorexia, no abdominal pain, or blood in stool
• GENITOURINARY: No burning sensation on urination
• NEUROLOGICAL:  No headache, dizziness, paralysis, numbness, or tingling in the extremities.
• MUSCULOSKELETAL: No joint,  back, muscle pain, or stiffness
• HEMATOLOGIC: No anemia, bleeding, or bruising
• LYMPHATICS:  No enlarged nodes(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)
• ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance

Objective:

Physical exam: A complete physical exam

Blood test to check patient’s thyroid

EKG

A psychological evaluation

Diagnostic results:

Physical exam reports indicate a normal complete blood count with RBC 5.1 trillion cells/L Hematocrit 42.3 percent WBC 5.2 billion cells/L, a normal complete metabolic panel indicating no issues with the kidneys, liver, blood chemistry, and immune system.

Thyroxine test 3.5mlU/mL

EKG results 180 -197 ms

Assessment:

Mental Status Examination:

Patelli presents as calm, attentive, but on edge. He exhibits a speech that is normal in volume, rate, and articulation. Language skills are intact. Body posture and attitude display an anxious mood, as do facial expression and general demeanor. Manifests appropriate affect, complete range with congruent mood. Apparent signs of bizarre behavior, delusions, or other psychotic process indicators are absent. Thinking is logical, thought content appears appropriate. Denies suicidal ideation, homicidal intentions, or ideas. The patient appears normal; judgment seems fair. No signs of intoxication, withdrawal signs are absent.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Differential Diagnoses

            Panic disorder( episodic paroxysmal anxiety) F41,0(ICD-10) Active- confirmed the patient reports sudden episodes of intense fear and anxiety that last for between 12- 15 minutes. The patient reports physical symptoms like chest pain, rapid heartbeat, and shortness of breath that resolve independently. The panic attack in Patelli’s case happens sporadically and for no apparent reason. In some cases, panic attacks occur due to a stressful or scary situation like a car accident (Cackovic et al., 2020). A panic disorder test confirmed that chest discomfort, a pounding heartbeat, shortness of breath, and sweating are not secondary to a physical condition like a heart attack (Locke et al.,2015). DSM-5 guidelines for panic disorder informed the confirmation as the patient, like his mother, reports frequent unexpected attacks(two in less than 48 hours), ongoing worry about having another panic attack, Fear of losing control, and the absence of any other probable cause for a panic attack like a stressful situation, physical disorder, or drug use. Additionally, the mnemonic STUDENTS FEAR the 3C’s was utilized with the client confirming most of these symptoms Sweating, Trembling. Unsteadiness, dizziness, Depersonalization, derealization, Excessive heart rate or palpitations, Nausea, Tingling, Shortness of breath, Fear of Dying, Fear of losing control, fear of going crazy, and the presence of Chest, Chills, Choking (Davies et al., 2017).(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

            I want Patelli, if life stressors could have triggered the attacks, like relationship issues with his girlfriend or academic pressure to excel. Other questions will target if he has suicidal ideations. I would also ask the patient his family history since genes influence health and behavior besides the mother. I would also do an anxiety screening exam and a suicide screening exam.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Generalized Anxiety Disorder (GAD) F41.1 (ICD-10) (Active)- Refuted

            The patient presents panic attacks that could also indicate GAD (Curth et al., 2017). However. However, Patelli’s panic attacks have no apparent trigger, like drug or substance, and no presence of another mental health condition like post-traumatic stress disorder (Patriquin & Msathew, 2017). Similarly, the client answers negatively to the GAD mnemonic of WATCHERS. Before the attack, despite the presence of a robust and fast heartbeat, excessive sweating, and shortness of breath, Patelli reports no Worry, Anxiety, Tension in muscles, Concentration challenges, Hyperarousal or irritability, Energy loss, Restlessness, or Sleep disturbance, thus guiding me to refute a GAD diagnosis. (Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Acute Myocardial infarction (ICD-10) 121.9(unspecified) –Refuted

            The patient indeed reports shortness of breath, sweating, and chest discomfort that lasts for some minutes. However, Patelli does not complain of nausea, vomiting, or coughing. Most importantly, cardiac troponins elevations in peripheral blood is a mandatory requirement to establish a diagnosis of myocardial infarction(Mythili & Malathi, 2015) The EKG results of ST elevation, ST depressions, and T- wave inversions, and pathological Q- waves could have indicated myocardial ischemia and infarction were absent. All these lab findings and symptoms helped me refute a diagnosis of AMI.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

 Reflections:

            Studies indicate that youth who experience panic attacks may progress and develop mood disorders like major depressive disorder, personality disorders, eating disorders, bipolar disorder, and psychotic disorders if the panic disorder is untreated and poorly managed (Narmandakh et al., 2020). Panic disorder can negatively impact an individual’s psychological and physical function besides the stress on interpersonal (Karthikeyan et al., 2020). Individuals diagnosed with panic disorders also have a higher risk for suicide, meaning Patelli’s condition should be managed effectively. (Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

References

Cackovic, C., Nazir, S., & Marwaha, R. (2020). Panic disorder (attack). StatPearls [Internet].

Curth, N. K., Brinck-Claussen, U. Ø., Davidsen, A. S., Lau, M. E., Lundsteen, M., Mikkelsen, J. H., … & Eplov, L. F. (2017). Collaborative care for panic disorder, generalized anxiety disorder and social phobia in general practice: study protocol for three cluster-randomized, superiority trials. Trials, 18(1), 1-13.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Davies, S. J., Nash, J., & Nutt, D. J. (2017). Management of panic disorder in primary care. Prescriber, 28(1), 19-26.

Karthikeyan, V., Nalinashini, G., & Raja, E. A. (2020). A Study of Panic Attack Disorder in Human Beings and Different Treatment Methods. Journal of Critical Reviews, 7(8), 1166-1169.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Locke, A., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American family physician, 91(9), 617-624.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Mythili, S., & Malathi, N. (2015). Diagnostic markers of acute myocardial infarction. Biomedical Reports, 3(6), 743-748.

Narmandakh, A., Roest, A. M., de Jonge, P., & Oldehinkel, A. J. (2020). Psychosocial and biological risk factors of anxiety disorders in adolescents: a TRAILS report. European Child & Adolescent Psychiatry, 1-14.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

Patriquin, M. A., & Mathew, S. J. (2017). The neurobiological mechanisms of generalized anxiety disorder and chronic stress. Chronic Stress, 1, 2470547017703993.(Assessing and Diagnosing Patients With Anxiety Disorders Comprehensive Nursing Paper Example)

https://www.ncbi.nlm.nih.gov/