Question

A.P. is a 73-year-old female who presents to the women’s health clinic for an annual physical examination. She states that she is having difficulty sleeping and has been having panic attacks for the past year, since the death of her son. Subjective Data Lives with husband Daughter, age 50, lives nearby Had a son, age 52, who died in the past year from a drug overdose Objective Data Vital signs: T 37 P 80 R 18 BP 140/68 Weight: 140 HT: 5 feet, 5 inches Questions

1. On which components of the health history should the nurse focus the mental health exam?

2. What specific observations should the nurse make with regard to mental status?

3. Why is it important to obtain a thorough past medical history for this patient?

4. What specific questions should the nurse consider asking when obtaining the past medical history?

5. What specific questions should the nurse ask regarding the panic attacks?

6. Create a problems list from the data provided. 7. What teaching and nursing interventions should be included in the plan of care for this patient?

Answer 1

1.Nurse can conduct mental health exam of this patient based on the her statement about

   panic attacks due to death her family members and difficulty in sleeping it may due to anxiety.

2.Specific observations regard to mental status

              * Assess for cognitive disturbances like

                                * Poor judgement.

                                * Blocking on important details.

                                * Forgetfulness.

                                * Loss of attention.

                                * Decreased concentration.

             * Assess for emotional disturbances like,

                                 * Depression.

                                 * Restlessness.

                                 * Social withdrawl.

                                 * Crying.

                                 * Decreased motivation.

3. Obtain a detailed past medical history is important in the case of this patient because

                                  * Patient is a victim of panic attack.

                                  * Chances of developing cognitive and emotional problems is higher in

                                      her age group (75 years).

                                   * Sleeplessness is a important sign of altered mental status.

4.Questions asked when taking past medical history of this patient.

                                  * How many days you struggled with sleep problem.

                                   * Are you feel stress in doing daily activities.

                                    * Are you taking any psychotropic medications.

                                    * Do you have any family history of anxiety disorders.

                                     * Are you use acohol or drugs during the time of stress.

5.Specific questions about panic attack.

                                  * How many times you develop panic attacks.

                                  * Are you taking any antianxiety drugs.

                                  * How you cope up with stressful situvation in life.

                                   * Are you feel fear in communicate with people in society.

6. Problem list

               * Difficulty in sleeping.

                * Anxiety.

                * Ioneliness.

                * Age related cognitive and emotional problems.

7. Nursing interventions including teaching

                 * Communicate with the client in an effective way using soft voice and provide reassurance

                     if she is panic be very diractive.

                  * Listen to clients needs and alllow express her feelings to reduce stress.

                  * Provide a peaceful environment to maintain good mental status.

                  * Assist in doing daily activities and exercises to cope up with stress.

                  * Administer antianxiety medications.

                  * Teach patient to avoid take caffine,nicotine and other addictive drugs which increase

                     anxiety.

                   * Encourage patient in group activities with other patient to reduce stress level and get

                      comfort.

                   * Individual and group counselling and interaction sessions help to maintain good

                      mental health.

                   * Participaion of relatives in patient care to promote the recovery process.

                   * Teaching of relaxation techniques like breathing exercises,muscle relaxation to

                      overcome stress in the life.