Anxiety Case Study
Part 1
It is 10:00am in the emergency department (ED) when the ambulance brings in G.G., a 35-yearold
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 9:20am and became
progressively worse. A co-worker called 911 and stayed with the patient until medical help
arrived. The patient has no history of cardiac problems.
1. What initial steps would the you, as the nurse practitioner, take?
Part 2
After a full medical workup, it is determined that G.G. is stable. His shortness of breath and
anxiety are resolved after he is given lorazepam 1mg IV push (IVP). There is no evidence of any
physical disorder, and the diagnosis of panic attack has been made. G.G. admits to having had
three similar episodes in the past 2 weeks; however, they were not nearly as severe or long
lasting.
2. How did you determine this diagnosis?
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?
Part 3
G.G. shares with you, the nurse practitioner, that he has been under severe stress at work and
home. He tells you 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 additional precipitating factors (triggers) that could cause anxiety to build to
the point of panic.
5. G.G. wants to know what causes panic attacks or panic disorder. Using etiologic theories
regarding anxiety, what will you tell him?
6. G.G. has questions regarding the differences between panic attacks and panic disorder.
According to the DSM-V, what are the differences?
Part 4
G.G.’s condition is stable, and you discuss what has happened with him. You give G.G. a
prescription for a “week’s worth” of medication and instructs G.G. to see his primary care
provider for further treatment and evaluation.
7. What medications are used to treat panic attacks? What should the patient teaching include?
8. Why might you give G.G. a prescription for only 1 week?
Part 5
G.G. tells you all about his worries with 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 of panic attacks
returning.
9. What techniques to help him cope will you discuss with him?
10. What other interventions are most indicated in the treatment of panic disorder?
Conclusion
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 provider started him on a low dose of an SSRI. After a few months,
G.G.’s panic attacks have become very rare and he works on preparing a resumé to seek new
employment before his company has another round of job cuts.
