| Course | NUR-7642 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Adult Population, Part B |
|---|---|
| Module | Module 1 |
| Paper type | Case analysis: adult panic disorder |
| Length | About 1,154 words, 7 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7642 Module 1
Three Trips to the Emergency Room: Rating and Treating Panic Disorder in a 29-Year-Old Dental Hygienist
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7642: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Adult Population, Part B
Mentor Name
Month Day, Year
Three Trips to the Emergency Room: Rating and Treating Panic Disorder in a 29-Year-Old Dental Hygienist
The Attacks
Kayla, an invented patient, is 29 and works as a dental hygienist in a practice in Edison. Eight months ago, while driving on the turnpike, her heart began to pound, her chest tightened, her hands tingled and she felt she could not breathe. She pulled over certain she was dying. Since then she has had about two attacks a week, some at work while leaning over a patient, some waking her at night. Each peaks within ten minutes and fades within half an hour.
She has been to the emergency room three times. Each time her electrocardiogram, troponin and chest film were normal. Between attacks she worries constantly about the next one, has stopped driving on highways, takes back roads to work and avoids crowded stores. Long shifts run on three cans of an energy drink a day. She has no history of depression, mania or substance use beyond the caffeine. Her mother had "nerves" and took a pill for them for years.
The visits have cost her more than time. She owes over two thousand dollars after her insurance deductible, and the last physician told her, kindly but briefly, that it was "just anxiety." She left feeling dismissed and more frightened, because no one had explained what was happening in her body. The paper treats that explanation as the first step of treatment.
Ruling Out Medical Causes
Because her symptoms mimic heart and endocrine disease, the paper reviews her emergency workups and adds what they lacked. Her thyroid tests are normal. A Holter monitor, worn for two days, shows sinus tachycardia during one attack and no arrhythmia. She is not pregnant. Her blood sugar is normal. Her caffeine, around 600 milligrams a day, is large enough to provoke attacks in someone prone to them, and cutting it is the first change agreed.
Rating the Severity
Shear et al. (1997) developed the Panic Disorder Severity Scale, a seven-item clinician rating covering how often attacks occur, the distress they cause, worry about future attacks, avoidance of feared situations, avoidance of bodily sensations and the effect on work and social life, each scored from 0 to 4. Ten evaluators used it with 186 patients in a multisite treatment study, and 24 were rated by two evaluators to test agreement. The scale showed excellent agreement between raters, moderate internal consistency, good validity and sensitivity to change after treatment, though the authors called for testing in more diverse groups.
Kayla scores 15, in the moderate to marked range. Her highest items are anticipatory worry and avoidance of highways and stores. The interview confirms panic disorder with agoraphobic avoidance: recurrent unexpected attacks followed by more than a month of worry and change in behavior, not explained by caffeine alone or by a medical condition.
Choosing a Treatment
Barlow et al. (2000) randomly assigned 312 people with panic disorder at four clinics to imipramine, cognitive behavioral therapy, placebo, therapy plus imipramine or therapy plus placebo for three months, followed by six months of monthly maintenance and six months without treatment. In the acute phase, both imipramine and therapy beat placebo on the severity scale, with response rates of 45.8 and 48.7 percent against 21.7 percent. Combining them gave a modest added advantage during treatment, but after treatment stopped, people who had received therapy, with or without placebo, held their gains better than those who had received the drug.
For Kayla, therapy is the first choice. She prefers not to take medicine, she is not depressed, and the trial suggests her gains will last longer after therapy ends. Imipramine, a tricyclic, would bring side effects and overdose risk that newer drugs do not. If her score has not fallen by at least 40 percent after eight sessions, sertraline will be added at a low dose, since it is approved for panic disorder and better tolerated.
A wider view tempers the choice. Bandelow et al. (2015) pooled 234 randomized studies with 37,333 patients across panic disorder, generalized anxiety disorder and social anxiety disorder. Medicines produced larger average improvements from start to finish than psychotherapies, and individual cognitive behavioral therapy beat waiting lists, psychological placebos and pill placebos. Yet the average gain with psychotherapy did not differ from the gain seen with placebo pills, a finding the authors could not explain away. They concluded that the choice between therapy, medicine or both should rest with the patient, since drugs bring side effects, interactions and contraindications. The paper reports this honestly to Kayla: medicine may work faster for some people, therapy may last longer after it ends, and her preference counts.
| Option | Trial finding | Fit for Kayla |
|---|---|---|
| CBT alone | Matched imipramine; gains held after stopping | Chosen |
| Imipramine | Matched CBT; more relapse after stopping | Not chosen; older drug, side effects |
| CBT plus drug | Small added benefit during treatment | Considered if CBT alone stalls |
| Sertraline | Approved for panic disorder | Second step if needed |
| Alprazolam | Fast relief | Declined; dependence, works against exposure |
How the Therapy Runs
Twelve weekly sessions follow a standard panic treatment. She learns how the body's alarm system produces the pounding heart and breathlessness, and how fearful readings of those sensations feed the next attack. Interoceptive exposure deliberately brings on the feared sensations in session, such as running in place to raise her heart rate or breathing through a thin straw, until they lose their power. Cognitive work puts her conviction that a fast pulse signals a coronary to the test, with her three clean cardiac workups as the evidence. Situational exposure follows a ladder she builds, from a short highway drive with a friend to driving alone to the shore.
Why Not Alprazolam
She asks for something to carry in her purse. The paper explains that a benzodiazepine would stop an attack but would teach her that she can only survive the sensations with a pill, which works against exposure, and that daily use brings dependence. She agrees to try therapy first.
Work and Follow-Up
Her energy drinks are tapered to one a day over two weeks, to avoid caffeine withdrawal headaches. Her manager agrees to shorter blocks between patients for a month. The severity scale is repeated every four weeks, and the aim is a score under 5 with highway driving resumed. A plan for setbacks names what she will do if attacks return during a stressful period: return to her exposure ladder and call the clinic, not the emergency room.
Conclusion
Kayla has panic disorder with agoraphobic avoidance, found after a complete medical rule-out and rated at 15 on the Panic Disorder Severity Scale. Cognitive behavioral therapy, chosen because a large trial showed its gains held after treatment better than medicine's, is delivered over twelve sessions with interoceptive and situational exposure. The energy drinks are tapered, alprazolam is turned down with reasons she accepts, and sertraline stands by in case her score stalls.
References
Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Psychopharmacology, 30(4), 183-192. https://doi.org/10.1097/YIC.0000000000000078
Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283(19), 2529-2536. https://doi.org/10.1001/jama.283.19.2529
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., Gorman, J. M., & Papp, L. A. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154(11), 1571-1575. https://doi.org/10.1176/ajp.154.11.1571
NUR 7642 Module 1 instructions, in plain terms
Panic and anxiety disorders are among the common adult concerns that TESU names in the catalog paragraph for NUR-7642, and with the syllabus closed to the public, Part B opens here on panic disorder. Expect an analysis that rules out heart, thyroid and substance causes and says how, rates severity with a named clinician scale, confirms the criteria including avoidance, chooses between therapy, medicine or both from trial evidence that includes follow-up after treatment ends, describes the therapy's parts such as interoceptive exposure and takes a reasoned position on benzodiazepines. Some sections assign social anxiety disorder or agoraphobia without panic instead. Check whether your directions require a named scale, a session-by-session therapy plan or a relapse prevention section, and fit the paper to any page limit they set.
Inside the NUR 7642 Module 1 example
Kayla's first attack on the turnpike and her three emergency visits open the paper. Her medical workup is reviewed and completed with a Holter monitor and thyroid tests, and her energy drinks are measured. Shear's multisite validation of the PDSS is summarized before Kayla's 15 is set beside her interview. Barlow's four-clinic trial is reported through its acute, maintenance and off-treatment phases, and the options table lines up five choices against Kayla's situation. Therapy is chosen with a clear rule for adding sertraline. The twelve sessions are described, including interoceptive exposure and an exposure ladder. Her request for alprazolam is answered, and caffeine, work and a setback plan finish the case. Margin notes explain the medical rule-out and the use of the trial's follow-up phase.
Reading the NUR 7642 Module 1 grading rubric
Panic disorder cases are graded on a complete medical rule-out, severity rated with a validated scale, the criteria confirmed including worry and avoidance, a treatment chosen from trial evidence with attention to what lasts after treatment, therapy described in its working parts and a reasoned position on benzodiazepines. Mentors credit a rule for when to add or change treatment, written in advance. Addressing contributors such as caffeine shows careful assessment. A relapse plan that sends the patient back to her skills rather than the emergency room shows practical thinking. Response rates and scale facts need to be quoted exactly, and the citations need APA form; cite the scale's development study as well as the treatment trial and keep each heading tied to a clinical decision rather than a textbook topic.
NUR 7642 Module 1 help: mistakes that cost marks
Students often diagnose panic disorder without stating how heart and thyroid causes were ruled out; list the tests. Another gap is writing "CBT" without its parts; describe interoceptive and situational exposure and the thoughts being tested. Do not prescribe a benzodiazepine as the main treatment, and explain why when the patient asks. Use follow-up data, not only acute results, when comparing therapy and medicine. Ask about caffeine and stimulants. Set a rule for adding an antidepressant if therapy alone is not enough. With a panic or anxiety paper on your calendar, pass along the rubric; the first custom draft is ours to write free.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7642 Module 1 questions, answered
Where can I find a free NUR 7642 Module 1 sample paper?
Kayla's panic disorder case, from three emergency visits to twelve sessions of CBT, is on this page in full.
What is the Panic Disorder Severity Scale?
Seven clinician-rated items, covering how often attacks come, how distressing they are, anticipatory worry, two kinds of avoidance and life impact, add up to a maximum of 28.
Is CBT or medicine better for panic disorder?
In a 312-patient trial, CBT and imipramine worked about equally during treatment, but CBT's gains held better after treatment stopped.
Should benzodiazepines be used for panic disorder?
They relieve attacks quickly but can undermine exposure therapy and cause dependence, so they are not a first-line long-term treatment.
Which medicines are approved for panic disorder?
Several SSRIs, including sertraline, paroxetine and fluoxetine, and the SNRI venlafaxine are approved by the U.S. Food and Drug Administration for panic disorder.