ase Study 148 Panic Disorder
Difficulty: advanced
Setting: emergency department
Index Words: intense fear, physiologic panic reactions, recognizing triggers, medications, coping
techniques, patient education
giddens Concepts: anxiety, Care Coordination, Coping, Patient education
HESI Concepts: anxiety, assessment, Care Coordination, Patient education, Psychological, stress &
Coping
It is 1000 hours in the emergency department (ed) when the ambulance brings in G.G., a 35-year-old
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 0920 and became progressively worse. A co-worker called 911
and stayed with him until medical help arrived. The patient has no history of cardiac problems.
1. What initial steps would you take and what orders would you expect to receive?
- Rule out MI
- Monitor ECG/EKG
- Administer O2 per standing order
- Monitor Pulse Oximetry
- Order to draw cardiac enzyme testing, fluid/electrolytes
- Monitor V/S

CaSE StuDY ProgrESS
After a full medical workup, it is determined that G.G.'s condition is stable. His shortness of breath and
anxiety resolve after he is given lorazepam (Ativan) 1 mg IV push (IVP). The lab work and ECG results
are all within normal parameters and there is no evidence of any physical disorder. a diagnosis of panic
attack is 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 do you think this diagnosis was determined?
If M.I. is ruled out; it is likely, based on G.G.’s clinical symptoms, that G.G. is experiencing a panic
disorder.
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?
It is common for people experiencing panic disorder to suffer memory loss due inability to focus on
anything but the anxiety. Also, people who experience high levels of anxiety produce higher levels of
cortisol, a stress hormone. Cortisol is known to affect the brain and impair memory. Anxiety can also
impair sleep which affects memory.