Difficulty: Medium
Average Score: 65%
Simulated
Passage / Scenario
Nurse NotesClient: Doug Smith
Patient presents with symptoms of anxiety escalated to a panic attack. Patient reports chest pain, tingling in fingers, and difficulty breathing, with a sense of impending doom. Patient appears anxious and distressed, with rapid shallow breathing. SPO2 levels initially low due to hyperventilation. Provided reassurance to the patient and explained that symptoms are related to a panic attack, not a heart attack.
Vital signs
ÔÇó Temperature: 36.7┬░C (98.1┬░F)
ÔÇó Heart rate: 110 bpm
ÔÇó Respiratory rate: 28 breaths/min
ÔÇó Blood pressure: 140/90 mmHg
ÔÇó Oxygen saturation: 94% on room air (increased to 98% with 2L O2 via nasal cannula)
EKG
Normal sinus rhythm. Mild tachycardia noted.
Provider orders
02 @ 2L keep SPO2 > 92%
ABGS
CBC, BMP
UA with reflex
Psych evaluation and treat
0.5 mg IVP Ativan- One-time order give now
No Caffeine, limit processed foods and sugar/carbs in diet
Doug has been seen in the ER for his anxiety that has escalated to a panic attack. He thought he was dying because his symptoms were very similar to a heart attack with tingling in his fingers, pain in his chest, and difficulty breathing. He was even starting to feel out of sorts due to his lack of oxygen related to his low SPO2 levels related to his hyperventilation. In class we discussed it being caused by respiratory alkalosis. In the left column there are items that will require follow up by either the nurse or Doug to maintain a successful plan of care upon discharge. If they are for the nurse she must educate Doug, if they are for Doug, he must comply with the plan...either way if they require follow up, place a check in the FOLLOW UP Column, if they don't place a check in the N/A Column. Each item will have one check in one of the columns.
Correct answer
B,C,D,E,F
Rationale
A (N/A) Controlling son's success: This does not directly relate to Doug's health or anxiety management plan, so it falls under N/A. Focus on the positives: Encouraging positive thinking can improve Doug's coping skills, making it a follow-up item. Better relationship with son: Addressing family dynamics can improve Doug's overall mental health, requiring follow-up. Techniques to manage stress: Essential for managing anxiety and preventing future panic attacks, requiring follow-up. Energy drinks: Caffeine can exacerbate anxiety symptoms, making this a follow-up item. Conflict resolution: Managing interpersonal conflict is key to reducing stress, requiring follow-up.