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NUR 112Stress and Coping: Anxiety Disorders Case StudiesCase Study #1Carla is a 35-year-old bank teller. She has been married for 12 years and has as 8-year-old son and a 6 year-old daughter. Over the past eight months, Carla has noticed that she has been having a lot of anxiety and seems to worry all the time about everything. She is worried about her children’s safety while attending public school. She is concerned about the possibility of a bank robbery happening while she is at work. She even worries about her husband’s job and is afraid he will be let go for something he does at work. She has been so overwhelmed with worry that she is having difficulty sleeping at night. During the day, she experiences an inability to concentrate on anything else but the worry. She feels “on edge” most days. These things have caused her to call in sick to work several times. She also declines attending social events with friends and family. Carla’s husband has noticed the changed in her and thinks her excessive worry is unreasonable. She finally seeks assistance for the problem when her children begin to side with her husband about her noticeable change. 1. Based on the history given, what type of disorder is Carla experiencing?2. What data supports this diagnosis?3. What will be done to test or verify this diagnosis?4. What medication will be prescribed for Carla and what teaching should be included?5. What other treatment will be essential in helping improve Carla’s condition?Case Study #2About a year after Carla was seen and treated for her problems, her daughter Emily, now 7-years-old, started exhibiting some behavior that was unusual for her. She started refusing to go to spend the night at her best friend’s house. She complained of headaches and vomiting and missed more than two weeks of school. When she did attend school, the teacher informed Carla that Emily seemed very anxious, especially during their last field trip. Carla was so concerned that she took Emily in to be evaluated.1. Based on the history given, what type of disorder is Emily experiencing?2. What data supports this diagnosis?3. Who must make this diagnosis?4. How will Emily be treated?5. What is she at risk for developing in the future as a result?Case Study #3Mark is a 42-year-old truck driver. Two months ago, while out on the road for work, he began to feel funny. He pulled his truck off to the side of the road. He began to feel extremely hot, developed chest pain with difficulty breathing, and was extremely nauseated. He jumped out of the truck and tried to “walk it off”. After about 15 minutes the symptoms subsided and he felt better. He decided to rest for the rest of the day and head out in the morning. The next day, a few hours into his drive, Mark experiencing the same symptoms again. This time they were so severe, he pulled over and called 911. He was rushed to the nearest emergency department, but all the tests came back negative. Mark called work to have someone finish his route and his wife came and took him home. Since then, Mark has experienced several more of the same episodes. He is afraid to go back to work, because he is afraid he will have another episode while in the truck. It has gotten to the point where he will not even leave his house without his wife. His wife is very concerned and together they decide to seek help.1. Based on the history given, what type of disorder is Mark experiencing?2. What data supports this diagnosis?3. What will be done to test or verify this diagnosis?4. What medication will be prescribed for Mark and what teaching should be included?5. What other treatment will be essential in helping improve Mark’s condition?Case Study #4Gary is a 20-year-old college student. One night, about three weeks ago, Gary was on his way back to his dorm room after studying with some friends at the library. A man in a ski mask held a gun up to Gary’s head and mugged him. The perpetrator left him unharmed, but got away with his wallet and all of his cash. Since the incident, Gary has felt like he is “in a daze”. He is unable to recall the events of the mugging and feels detached from his own body. He dreams of the incidence nightly and has been unable to return to the library. Gary has missed a lot of class since the episode.1. Based on the history given, what type of disorder is Gary experiencing?2. What type of treatment will be beneficial for Gary?3. If the symptoms persist for longer than one month, what does this mean?Case Study AnswersCase Study #11. Based on the history given, what type of disorder is Carla experiencing?Generalized Anxiety Disorder (GAD)2. What data supports this diagnosis?She is experiencing excessive and unreasonable worry about self, husband, and children for 8 months, greater than 6 needed for diagnosis. She is feeling on edge, has an inability to sleep, and difficulty concentrating, which are 3 or more of the 6 diagnostic symptoms according to DSM-IV criteria. It is affecting her functioning as she is missing work and not attending social functions.3. What will be done to test or verify this diagnosis?CBC, UA, and Thyroid tests will be done to rule out a medical diagnosis. Verify there is no substance abuse that may be causing symptoms.4. What medication will be prescribed for Carla and what teaching should be included?Buspirone (Buspar) Takes 2-4 weeks to reach full effect, does not cause dependence, do not discontinue abruptly. She may also be given a benzodiazepine to treat symptoms until Buspar takes effect.5. What other treatment will be essential in helping improve Carla’s condition?Therapy may be one on one or group. Should include thought blocking, relaxation, coping skills and limiting worry to a specific time and place per day to help her feel like she has control of the worry.Case Study #2 1. Based on the history given, what type of disorder is Emily experiencing?Separation Anxiety2. What data supports this diagnosis?Emily is 7-years-old, it peaks between ages 7-9. She doesn’t want to go to school or to her friend’s house for more than two weeks and is complaining of headaches and vomiting.3. Who must make this diagnosis?A mental health specialist4. How will Emily be treated?Fluoxetine (Prozac) and therapy5. What is she at risk for developing in the future as a result?Panic DisorderCase Study #3 1. Based on the history given, what type of disorder is Mark experiencing?Panic Disorder with Agoraphobia2. What data supports this diagnosis?He experienced multiple panic attacks over 2 months, which is longer than one month minimum for diagnosis. He will not go to work for fear of experiencing another attack. He will not leave the house without wife which verifies the agoraphobia component. Tests ruled out heart attack.3. What will be done to test or verify this diagnosis?Tests in emergency department ruled out heart attack. They should have done an EKG, CBC, and thyroid function tests, UA, CT/MRI4. What medication will be prescribed for Mark and what teaching should be included?SSRIs-first line defense, Benzodiazepines short term for anxiety symptoms while SSRIs begin to take effect. SSRIs may take up to 4 weeks to reach effectiveness. Assess for suicidal ideations. Do not stop taking abruptly. Assess for substance abuse, benzos not for those with history of substance abuse. Benzos only for short term use, they have addictive properties. Instruct on signs and symptoms ataxia and decrease cognitive functioning. 5. What other treatment will be essential in helping improve Mark’s condition?Therapy; one on one or group therapy will be included. Systematic desensitization should be included where client slowly gets out of house with wife at first, then eventually without wife. Relaxation techniques should also be included.Case Study #41. Based on the history given, what type of disorder is Gary experiencing?Acute Stress Disorder2. What type of treatment will be beneficial for Gary? Benzos to treat anxiety symptoms and therapy. 3. If the symptoms persist for longer than one month, what does this mean?Post-Traumatic Stress Disorder (PTSD)ReferencesMohr, W. (2009). Psychiatric-mental health nursing: Evidence-based concepts, skills, and practices.(7th ed.). Philadelphia: Lippincott, Wilkins, and Williams. North Carolina Concept-Based Learning Editorial Board. (2011). Nursing: A Concept- Based Approach to Learning. Volume 1. Pearson Publishing. ................
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