Features Of The Panic Disorder And Major Depressive Disorder

What symptoms are associated with Panic Disorder?

This disorder is characterized by persistent panic attacks, the beginning of which is unpredictable, and expressed by strong apprehension, terror, or fear often associated with feelings of impending doom and go along with intense physical discomfort. The symptoms arise unexpectedly; that is, they do not occur directly before or on exposure to a situation that usually causes anxiety.

Classic symptoms of a panic attack are: palpitations, pounding heart, or accelerated heart rate; sweating, trembling or shaking; sensations of shortness of breath or smothering; feeling of choking; chest pain or discomfort; nausea or abdominal distress feeling dizzy, unsteady, lightheaded, or faint derealization (feelings of unreality) or depersonalization (being detached from oneself); fear of losing control or going crazy; fear of dying; paresthesias (numbness or tingling sensations); chills or hot flashes.

These attacks usually last minutes, or more rarely, hours. The individual often experiences varying degrees of nervousness and apprehension between attacks. Symptoms of depression are common (Townsend & Morgan, 2017).

Describe nursing interventions to help the patient having a Panic Attack.

First, do not leave a client who is experiencing panic attack alone. Stay with him or her and offer reassurance of safety and security. They need the presence and assurance of their safety from a trusted individual. Use simple words and brief messages, spoken calmly and clearly, to explain hospital experiences to the client. In an intensely anxious situation, the client is unable to comprehend anything but the most elementary communication. Keep the immediate surroundings low in stimuli (dim lighting, few people, simple decor). A stimulating environment may increase the level of anxiety. Administer tranquilizing medication, as ordered by the physician. Assess the medication for effectiveness and for adverse side effects. When the level of anxiety has been reduced, explore with the client possible reasons for its occurrence. If the client is going to learn to interrupt escalating panic, he or she must first learn to recognize the factors that precipitate its onset. Teach the client the signs and symptoms of escalating panic. Discuss ways to interrupt its progression, such as relaxation techniques, deep-breathing exercises, physical exercises, brisk walks, jogging, and meditation (Townsend & Morgan, 2017).

What would you assess in a patient that you suspect is going through alcohol withdrawal? What tools are available to assist in monitoring withdrawal level?

Within 4 to 12 hours of cessation of or reduction in heavy and prolonged (several days or longer) alcohol use, the following symptoms may appear: coarse tremor of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; and insomnia. A complicated withdrawal syndrome may progress to alcohol withdrawal delirium. Onset of delirium is usually on the second or third day following cessation of or reduction in prolonged, heavy alcohol use. Use of Librium or Serax is common for substitution therapy.

The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) is an excellent tool that is used by many hospitals to assess risk and severity of withdrawal from alcohol. It may be used for initial assessment as well as ongoing monitoring of alcohol withdrawal symptoms (Townsend & Morgan, 2017).

What education can a nurse provide upon discharge for someone who is unaware of the impact of their drinking?

Factual information presented in a matter-of-fact, nonjudgmental way explaining what behaviors constitute substance-related disorders may help the client focus on his or her own behaviors as an illness that requires help. Identify recent maladaptive behaviors or situations that have occurred in the client’s life and discuss how use of substances may have been a contributing factor. The first step in decreasing use of denial is for client to see the relationship between substance use and personal problems. Explain the effects of substance abuse on the body. Emphasize that the prognosis is closely related to abstinence. Many clients lack knowledge regarding the deleterious effects of substance abuse on the body. Explore with the client the options available to assist with stressful situations rather than resorting to substance abuse (e.g., contacting various members of Alcoholics Anonymous or Narcotics Anonymous; physical exercise; relaxation techniques; meditation). The client may have persistently resorted to chemical abuse and thus may possess little or no knowledge of adaptive responses to stress (Townsend & Morgan, 2017).

What is Audit C and how is it clinically utilized?

The Alcohol Use Disorders Identification Test (AUDIT-C) is an alcohol screen that can help identify patients who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence).

The AUDIT-C is scored on a scale of 0-12 (scores of 0 reflect no alcohol use). In men, a score of 4 or more is considered positive; in women, a score of 3 or more is considered positive. Generally, the higher the AUDIT-C score, the more likely it is that the patient's drinking is affecting his/her health and safety (Screen, 2007).

Patient Tory Clark is prescribed Escitalopram 10mg PO Daily and Lorazepam 0.5mg PO prn anxiety up to 3 times/day. Why are these medications indicated? Is there any contraindications or precautions to taking both?

Escitalopram is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Escitalopram is used to treat anxiety in adults, as well as major depressive disorder in adults and adolescents who are at least 12 years old. Do not use escitalopram if you have taken an MAO inhibitor in the past 14 days. Escitalopram should not be given to a child younger than 12 years old.

Lorazepam is a benzodiazepine that affects chemicals in the brain that may be unbalanced in people with anxiety. It is used to treat anxiety disorders. Do not use lorazepam if you are pregnant. You should not breast-feed while you are using lorazepam. Lorazepam is not approved for use by anyone younger than 18 years old. The sedative effects of lorazepam may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking lorazepam.

If using both medications it is important to monitor respiration rate, use lowest effective doses and shortest duration of concomitant tx: combo may increase risk of profound CNS and respiration depression, psychomotor impairment (Ventola, 2014).

Major depressive disorder

How would a patient with major depressive disorder (MDD) present?

Patient would present with markedly diminished interest or pleasure in most activities most of the day, significant weight loss when not dieting or weight gain, insomnia or hypersomnia, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate and recurrent thoughts of death, suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide (Townsend & Morgan, 2017).

Identify at least 3 factors that are thought to influence an individual’s susceptibility to depression.

Gender (studies indicate that the incidence of depressive disorder is higher in women than it is in men by about 2 to 1);

Age (studies have shown that the incidence of depression is higher in young women and tends to decrease with age and lower in younger men and increasing with age);

Marital status (The highest incidence of depressive symptoms has been indicated in individuals without close interpersonal relationships and in persons who are divorced or separated) (Townsend & Morgan, 2017).

What are the priority nursing interventions when caring for a patient with depression?

The priority intervention would be to find out if a patient has thought about harming him or herself. After, nurse should create a safe environment for the client. Remove all potentially harmful objects from client’s access (sharp objects, straps, belts, ties, glass items, alcohol). As well, nurse should secure a promise from the patient that he or she will seek out a staff member or support person if thoughts of suicide emerge. Finally, nurse should spend time with a patient. This provides a feeling of safety and security, while also conveying the message, “I want to spend time with you because I think you are a worthwhile person” (Townsend & Morgan, 2017).

What questions should a nurse ask to assess a patient’s risk for suicide?

Nurse should ask directly, “Have you thought about killing yourself” or “Have you thought about harming yourself in any way?” “If so, what do you plan to do? Do you have the means to carry out this plan?” It is important to remember that the risk of suicide is greatly increased if the client has developed a plan (Townsend & Morgan, 2017).

What additional steps may be taken if medications do not work?

Cognitive therapy may be used where the individual is taught to control thought distortions that are considered to be a factor in the development and maintenance of mood disorders. As well, Family therapies are used to resolve the symptoms and initiate or restore adaptive family functioning. Moreover, group therapy can provide an atmosphere in which individuals may discuss issues in their lives that cause, maintain, or arise out of having a serious affective disorder.

Lastly, Electroconvulsive therapy (ECT) considered for treatment only after a trial of therapy with antidepressant medication has proved ineffective. ECT is the induction of a grand mal (generalized) seizure through the application of electrical current to the brain. ECT is effective with clients who are acutely suicidal and in the treatment of severe depression, particularly in those clients who are also experiencing psychotic symptoms and those with psychomotor retardation and neurovegetative changes, such as disturbances in sleep, appetite, and energy (Townsend & Morgan, 2017).

Patient Lane Smitz is taking Fluoxetine 20 mg Daily. They complain that ever since they started taking it they feel like they can’t sleep. How would you address these concerns?

One of the common side effects of the Fluoxetine is insomnia, therefore, I would educate my patient on that and if that problem persists I would alert a doctor and try to change that drug to the other without that side effect (Ventola, 2014).