Overview When a patient is anxious, could this represent something more than a primary problem of anxiety? In this dilemma, a patient who almost died after surgery is making excellent progress, but something may be wrong. Does his sudden onset of shortness of breath and feelings of anxiety represent a physical, emotional, or a spiritual problem? The nurse needs to think in action and determine the current nursing priority to provide needed care and support. Anxiety or Spiritual Distress Scenario History of Present Problem: John James is a 77-year-old man who had coronary artery bypass graft (CABG) x 4 vessels three days ago for multivessel coronary artery disease. He lost over 1000 mL of blood shortly after surgery due to a bleeding graft site and almost died as a result. He is currently off all vasoactive drips; his arterial line has been discontinued and he is clinically stable. John is scheduled to transfer to the cardiac step-down unit later today. Personal/Social History: Johns wife died six months ago after fifty years of marriage. He lives alone in his own apartment. He has one son who lives in the area and checks in at least once a week to see how he is doing. He is a Vietnam War veteran who is a self-proclaimed atheist since he returned from the war over forty years ago. The Dilemma John puts on his call light and as you enter the room, he states that he feels short of breath and is visibly anxious. His breath
sounds are clear and his O2 saturation is 98% on 2 liters n/c. His respiratory rate is 20/minute and his heart rate is 92/minute-sinus rhythm. He acknowledges that he is anxious and feels like he is having a panic attack and has never felt like this before. When you ask him if there is anything that he may be anxious about, he shares the following, I saw so many of my friends die in Vietnam and was helpless to save them, and, I killed a lot of people myself. I cannot believe in a God who allowed such horrible things to happen. Resolving the Dilemma Identifying data that is RELEVANT, what is the essence of this current dilemma? What additional information is needed by the nurse that would help clarify the current dilemma? What additional members of the healthcare team could be used in this situation? Why? What is the nursing priority? What nursing interventions and/or principles can the nurse use to successfully resolve this clinical dilemma? What is the expected response of the patient that indicate the nursing interventions were effective? What response by the patient would indicate that a change in the plan of care and nursing interventions are needed? What is the patient likely experiencing/feeling right now in this situation? What can I do to engage myself with this patients experience, and show that he matters to me as a person? What was learned from this case study that you will incorporate into your practice?