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Question

Scenario:

Penny, age 61 years, was admitted to the behavioral health center for short-term inpatient treatment following medical evaluation for chest pain, shortness of breath, and experiencing a racing heart rate after a myocardial infarction (MI) workup with a negative stress test ruled out an MI.She was prescribed Wellbutrin and Xanax by her PCP for anxiety attacks and discharged with a prescription to an outpatient therapist to help her cope with her anxiety.It has been identified that Penny has several stressors currently: she is working two full-time jobs to help cover the costs of her older brother's long-term facility care to manage his worsening dementia. Before the admission, Penny had been attempting to care for her brother at home but found that he required more care and supervision than she was able to provide. She feels tremendous guilt that she had to place her brother in a facility. Additionally, her brother has not managed the transition from home to the long-term care facility well, and there have been several incidents of behavioral problems. These have resulted in the administrator of the long-term care facility notifying Penny that they may not be able to continue to provide care for her brother.

Penny began having difficulty focusing at work and was spoken to by her supervisor about her forgetfulness. She became restless and irritable and described periods of apprehension and helplessness to her therapist. Her anxiety attacks have worsened over the past 2 weeks, and she now has difficulty leaving her house. When Penny does leave the house, she often experiences an attack where she feels unsafe, has difficulty prioritizing and making decisions, and feels like running home, where she is "safe."It was decided to readmit Penny for stabilization of her current symptoms.

Upon entering Penny's room to complete the admission paperwork, the nurse finds Penny crying, pacing back and forth, and wringing her hands. She repeats over and over, "I just don't know what to do. I need to get out of here."

Questions:

a.      What nursing assessment supports the diagnosis of anxiety?

b.      What nursing diagnosis would the nurse apply to this client with the above history and behavior?

c.    What nursing interventions should be immediately implemented by the nurse?

Step-by-step answer

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