Impact of Teenage Pregnancy on School Attendance and Performance
Among Nursing Students of Medical Colleges of Northern Philippines
BUHISAN, MARIA JOSEPHINE P.
BUTACAN, APRIL A.
PALLE, JULIE ANNE H.
RABANAL, LEA ABIGAIL T.
UTAYDE, CASSEY FAITH S.
NAME: ORPILLA, JOMARK C.
GROUP- 2
BSN-3A
Activity: Application of Psychotherapy
Guidelines:
1. The student will select one (1) client among the clinical scenarios given.
2. Provide a brief background of the disease
3. Identify the priority needs and treatment goals of the patient
4. The student will decide on the appropriate psychotherapy for the case of the
patient
5. Provide a timeline for the treatment progress and the focus of care for each
session.
6. Follow the format below
Clinical Scenario:
Sarah, age 25, was taken to the emergency department by her friends. They
were at a dinner party when Sarah suddenly clasped her chest and started
having difficulty breathing. She complained of nausea and was perspiring
profusely. She had calmed down some by the time they reached the hospital.
She denied any pain, and electrocardiogram and laboratory results were
unremarkable. Sarah told the admitting nurse that she had a history of these
“attacks.” She began having them in her sophomore year of college. She knew
her parents had expectations that she should follow in their footsteps and
become an attorney. They also expected her to earn grades that would
promote acceptance by a top university. Sarah experienced her first attack
when she made a “B” in English during her third semester of college. Since
that time, she has experienced these symptoms sporadically, often in
conjunction with her perception of the need to excel. She graduated with top
honors from Harvard. Last week Sarah was promoted within her law firm. She
was assigned her first solo case of representing a couple whose baby had died
at birth and who were suing the physician for malpractice. She has
experienced these panic symptoms daily for the past week, stating, “I feel like
I’m going crazy!” Sarah is transferred to the psychiatric unit. The psychiatrist
diagnoses panic disorder.
Background of the study
Panic disorder is composed of discrete episodes of panic attacks, that is, 15 to
30 minutes of rapid, intense, escalating anxiety in which the person
experiences great emotional fear as well as physiological discomfort. DSM 5 is
generally used as its diagnostic tool. This is diagnosed when the person has
recurrent, unexpected panic attacks followed by at least 1 month of persistent
concern or worry about future attacks or their meaning or a significant
behavioral change related to them. Slightly more than 75% of people with
panic disorder have spontaneous initial attacks with no environmental trigger
(De La Vega, Giner, & Courtet, 2018). During a panic attack, the person has
overwhelmingly intense anxiety and displays four or more of the following
symptoms: palpitations, sweating, tremors, and shortness of breath, sense of
suffocation, chest pain, nausea, abdominal distress, dizziness, paresthesias,
chills, or hot flashes. Despite the fact that the symptoms of this disorder can be
quite overwhelming and frightening, treatment can help to manage and
improve them. The most important step in reducing symptoms and improving
your quality of life is to seek treatment.
Psychotherapy:
Cognitive behavioral therapy
Time Frame:
20 Sessions
Session and Focus of Care Interventions and Evaluation
Session 1 Together with the psychiatrist, we begun
Establishing a therapeutic alliance by establishing and maintaining a
therapeutic alliance so that the patient’s
care is a collaborative endeavour. Careful
attention to the patient’s preferences and
concerns with regard to treatment is
essential to fostering a strong alliance. In
addition, education about panic disorder
and its treatment should be provided in
language that is readily understandable to
the patient. Many patients with panic
disorder are fearful of certain aspects of
treatment (e.g., medication side effects,
confronting agoraphobic situations). A
strong therapeutic alliance is important in
supporting the patient through phases of
treatment that may be anxiety provoking.
Session 2-3 Consequentl, I identify what causes
Understanding the patient’s anxiety Sarah's panic attacks based on her
symptoms of chest pain, difficulty
breathing, nausea, sweating, and a
feeling of being insane. The most
important nursing diagnosis would be
panic anxiety associated to a conflict with
life objectives, as shown by her parents'
expectations that she would follow in their
footsteps and become an attorney while
maintaining outstanding grades in order
to be accepted into a prominent Ivy
League university. Despite the fact that
she has not been diagnosed with anxiety
disorder, the psychiatrist's diagnosis of
panic disorder, based on the DSM-5
diagnostic criteria, makes this nursing
diagnosis more obvious. Sarah explains
that she has a history of these attacks,
which began in her sophomore year as a
result of her parents' high expectations for
her. Assuming Sarah is now in her mid- to
late-twenties, these attacks are
remissions spaced out over a length of
time.
Session 4-6 During panic anxiety, Sarah' s safety is
the primary concern. She cannot perceive
Evaluating the safety of the patient potential harm and may have no capacity
for rational thought. I kept talking to the
person in a comforting manner, even
though the client cannot process what I
was saying. Going to a small, quiet, and
nonstimulating environment may help
reduce anxiety. I used simple words and
brief messages, spoken calmly and
clearly, to explain hospital experiences to
client. In an intensely anxious situation,
Sarah is unable to comprehend anything
but the most elementary communication.
Keep immediate surroundings low in
stimuli (dim lighting, few people, simple
decor). A stimulating environment may
increase her level of anxiety. I
administered tranquilizing medication, as
ordered by physician. I remained with the
client until the panic recedes. Panic-level
anxiety is not indefinite, but it can last
from 5 to 30 minutes. When level of
anxiety has been reduced, explore with
client possible reasons for occurrence.
Recognition of precipitating factor(s) was
the first step in teaching Sarah to
interrupt escalation of the anxiety. I
encouraged client to talk about her
traumatic experience under
nonthreatening conditions. I helped client
work through her feelings of guilt related
to the traumatic event that she have
experienced. We as nurses can reassure
the person that this is in anxiety, it will
pass, and she is in a safe place
Session 7- 12 Education alone may relieve some of the
symptoms of panic disorder by helping
Providing education to the patient and, Sarah realized that her symptoms are
when appropriate, to the family neither life-threatening nor uncommon.
Since the latient has been diagnosed with
panic disorder, the patient should be
informed of the diagnosis and educated
about panic disorder and treatment
options. Regardless of the treatment
modality selected, it is important to inform
the patient that in almost all cases the
physical sensations that characterize
panic attacks are not acutely dangerous
and will abate . Educational tools such as
books, pamphlets, and trusted web sites
can augment the face-toface education
provided by the psychiatrist.Providing the
family with accurate information about
panic disorder and its treatment is also
important for many patients. Education
includes discussion of how changes in the
patient’s status affect the family system
(parents expectations to follow in their
footsteps, becoming an attorney, and
maintaining high grades to be accepted
into a top Ivy League university is the
reasn why she's experiencing attack) and
of how responses of family members
could help or hinder treatment of the
patient’s panic disorder.Patient education
also included general promotion of
healthy behaviors such as exercise, good
sleep hygiene, and decreased use of
caffeine, tobacco, alcohol, and other
potentially deleterious substances.
Furthermore, I also encouraged her to
used relaxation techniques such as deep
breathing exercises, getting
your breathing under control can relax
both her body and mind.
Session 13- 15 Many patients with panic disorder will be
evaluated by or receive treatment from
Coordinating the patient’s care with other health care professionals in addition
other clinicians to the psychiatrist. With Sarah’s
permission, contact was made with the
other professionals involved in her care
and a co-ordinated care plan was
developed. Once Sarah had developed
her relapse prevention plan, this was
circulated to the other professionals in her
network with her permission. Under such
circumstances, the clinicians should
communicate periodically to ensure that
care is coordinated and that treatments
are working in synchrony
It is important to ensure that a general
medical evaluation has been done (either
by the psychiatrist or by another health
care professional) to rule out medical
causes of panic symptoms. Extensive or
specialized testing for medical causes of
panic symptoms is usually not indicated
but may be conducted based on
individual characteristics of the patient.
Session 16-18 Problems with treatment adherence can
result from a variety of factors (e.g.,
Enhancing treatment adherence avoidance that is a manifestation of panic
disorder, logistical barriers, cultural or
language barriers, problems in the
therapeutic relationship). Whenever
possible, the psychiatrist should assess
and acknowledge potential barriers to
treatment adherence and should work
collaboratively with the patient to
minimize their influence. Many standard
pharmacological and psychosocial
treatments for panic disorder can be
associated with short-term intensification
of anxiety (e.g., because of medication
side effects or exposure to fear cues
during therapy). These temporary
increases in anxiety may contribute to
decreased treatment adherence. The
psychiatrist adopted a stance that
encouraged Sarah to articulate her fears
about treatment and provided her with a
realistic notion of what she could expect
at different points in treatment. In
particular, Sarah also informed about
when a positive response to treatment
can be expected so that she was not
prematurely abandon treatment due to
misconceptions about the time frame for
response. Sarah also be encouraged to
contact the psychiatrist (e.g., by
telephone if between visits) if they had
concerns or questions, as these could
often be readily addressed and lead to
enhanced treatment adherence
Session 19-20 Although standard treatments effectively
reduce the burden of panic disorder for
Working with the patient to address the majority of patients with a good
early signs of relapses treatment response may continue to have
lingering symptoms (e.g., occasional
panic attacks) or have a recurrence of
symptoms after remission. Sarah
reassured that fluctuations in symptoms
could occur during the course of
treatment before an acceptable level of
remission is reached. Sarah also
informed that symptoms of panic disorder
may recur even after remission and be
provided with a plan for how to respond.
