Nursing: Health Issues And Increased Panic Attacks

Nursing: Health Issues And Increased Panic Attacks

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Nursing: Health Issues And Increased Panic Attacks

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Nursing: Health Issues And Increased Panic Attacks

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Question:
Discuss about the case study of Nursing for Health Issues and Increased Panic Attacks.
 
 
Answer:

Present problem
While traveling, Ms. B often complained about her health issues and increased panic attacks. Ms. B started focusing on her health when four years back her father died from the stroke and in the very previous year, two aunts of her died due to heart problems. These incidents have made Ms. B to pay attention towards her health and be more attentive. She has regularly started monitoring herself by having a check on her blood pressure, seeing cancer symptoms in her body by examining the changes in the moles, breast’s lumps. She has been so fearful from the past incidences that even a slight headache makes her feel that she has a brain tumor.  These ruminations of Ms. B have made her more paranoid towards her life and the occurrence of the attacks. The major problem faced by her is that she cannot travel without anyone for the medical assistance, and whenever she travels, she has to get one attack, and it takes around several minutes to get herself calm. The main purpose of stating her problem is that in the next six months she would to attend a family function, which requires her to travel both by car and airplane as well. She is terrified because of the panic attacks which happen to her now and then and this concerns her that she might not be able to attend the function.
Symptoms
When the initial check up of Ms. B was done, it was seen that she had a negative impact on her daily life functions because of her fear and past experiences towards the diseases. It was seen that she had increased anxiety and nerves breakdown problem for the past 12 months, and this has lead to the development of panic attacks. This panic attack refrains her from traveling long distances. From her health case, Ms. B was diagnosed with six symptoms of illness. The most common among these was the Anxiety Disorder, which prevailed for the past seven months. Background History
It is very important to know the background history of the patient by inspecting the following relations and cases of the past:
Origin of family
Ms. B belonged to the Mediterranean background and was brought up as a part of the very big family. She was the younger of two daughters in her family. As a child, she was very loving and shared a supportive bonding with her parents and siblings. She was an energetic child during her childhood and possessed the optimistic feeling towards her life. She also shared very close relationship with her grandparents and with the other members of the family as party or other gatherings frequently used to happen at their house. This aspect of Ms B childhood was also seen in the adulthood.
Relationship and family
After the death of her father, which happened four years ago, Ms. B still maintained a supportive relationship with her mother and two sisters, and she was also in contact with her other family members. During her school years, she had few friends in female whom she had maintained contact throughout in the adulthood. These friends have also given the emotional support to her during her bad times. Ms. B has also been famous for establishing a very positive relationship in her workplace and was very well known for socializing with friends and colleagues on a regular basis. In three years of her marriage life, she has been known to be very supportive and loving wife.
Mental Health History
When Ms. B was twelve years of age, she started experiencing the symptoms of anxiety and at the age of nineteen she had her first panic attack. This panic attack happened when she was attending a family wedding and at the time of reception, she nauseated. While traveling back home from the wedding, she was unwell and complained of chest pains. When investigated, she said that her mother has always been a worrier and one of her sister has been diagnosed with General Anxiety Disorder.
When Ms. B started having the anxiety problem, then she consulted a counselor for the Cognitive Behavior Therapy, which could correctly specify the anxiety symptoms, and accordingly the medication could be given. Ms. B did not have any history of any criminal offense or the habit of smoking, drinking or drugs taking. The counselor gave her the medication of Cymbalta of 60 mg, which was proved to be successful in her case. When Ms. B was inspected, then it was found that most of the panic attacks she got were while traveling. Once when she was traveling for the funeral of her aunt which was seven months ago, she had the panic attack after taking the therapy, and the most recent one she experienced was also during traveling. These attacks were so frequent that Ms. B started saying that the strategies which she learned for the management of attacks during Cognitive Behavior Therapy were no longer helping her, and she could not find any benefits from her.
 
Discussion of evidence-based theories
Cognitive behavior therapy was suggested as the efficient treatment for the panic attacks and to help Ms. B physical health so that her anxiety related disorders are reduced. Exposure to Interoceptive was done to recognize the physical sensations, which are usually experienced during the attacks and it, also help in the reduction of the violent behaviors. When the research was done on Ms. B, then it was seen that the strategies for breathing adopted by Ms. B to reduce her attacks were not suitable as it decreased the sustainability of symptom of post reduction treatment.
Intervention plan
The treatment goals for Ms. B were developed after her referral and presentation which was based on the information from DASS 42. These were:

The reduction in the panic and rumination regarding her health.
The family functions to be attended at an interval of six months with no anxiety.
Without experiencing any panic attack, the ability to travel outside her home.

Intervention delivery
Initial phase
This phase generally focuses on the biopsychosocial approach to understand the problem of Ms. B. the previous treatments and therapy and also the expectations from the current therapy were all taken into account and then a therapeutic intervention was established for Ms. B. She was given seven sessions to address her sleep disturbance, ruminations and illness beliefs and these sessions were divided among the three phases. In the first two sessions, she was encouraged to join her yoga classes that were beneficial earlier. The sessions would decrease her stress level and ruminations and increase her sleep activity.
The second part of the approach was the Psycho-education of anxiety, which provides a rationale for the intervention plan.
After the sessions, Ms. B reported that she had immense gain from the yoga classes and mindfulness of breath strategy. Her sleep was restored, with concentration and short-term memory. She was asked to maintain a health dairy to keep a check on the occurrence of the negative thoughts on her health which could be analyzed further in the treatment.
The Middle Phase
In this phase the session three to six mainly focuses on the identification and challenging of the pessimistic thoughts which are associated with physical symptoms. Based on Ms. B health diary, the strategies were developed to further improve the session. To decrease the physical symptom attached with the panic attack, a small experiment was done on Ms B where she was asked to breathe through a straw while holding her nose closed for 2 min so that Ms. B should have some discomfort related to panic attacks, she reported of anxiety but she realized that with the aid of exercise this discomfort dint turned into any panic attacks. After this, Ms. B was advised of Interoceptive exercises for the next four sessions, and she was made to do such exercises at home also. After a short time, she reported the reduction in anxiety and increased tolerance towards the physical discomfort during attacks with the help of such exercises.
Termination phase
The last phase includes the seven and eight phases. Ms. B reported that when she traveled with her husband she dints had any panic attack, but the discomfort was there. Through her health diary, it was observed that there had been a reduction the health checking. It was also revealed that Ms. B maintained her exercises regularly and also the yoga classes which has almost diminished her ruminations. Session eight mainly focused on the reviewing progress of her and also to see that no relapse occurs in the program. When asked about which incidents might cause a panic attack to her after receiving treatment then it was said that airplane traveling could be the reason. This time, she was asked to make a plan by herself where she could solve her problem by taking her own intervention plan. So accordingly, she made the plan by Socratic questioning, followed by Interoceptive exposures exercises and with such plan; she decided to have an airplane trip with her husband on the weekend.
 
Evaluation and reflection
Ms B final report on the whole program was that though she found these exercises to be challenging initially but later on was adapted to these and this therapeutic approach was very much beneficial in decreasing the panic attacks. She was more confident by using such strategies which she learned during the sessions. While traveling she only felt the physical discomfort, and she has been thoroughly engaged with the intervention therapist and said that in future whenever she needs therapist help for the booster, Ms. B would go to her for therapy.

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