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It was all so hard to explain. He said it took months, yet it has happened so suddenly that it is difficult to say where to start. He had been a very successful contractor, more successful than he had ever expected. Then he underbid a project and lost money; his foreman quit and became a competitor, and slowly he began to doubt himself. Finally, it happened. One morning before leaving the house, his heart started pounding; he began to tremble and felt numb. He felt strange like he was in a movie, so unreal. He started gasping for breath. He thought he was having a heart attack or was about to die. He was terrified. Nothing like this had ever happened to him before.

His wife took him to an urgent care center in town where they did an EKG and told him his heart was fine; he was just stressed. He took the day off. Before he knew it, he couldn’t leave his house and he would shake whenever he tried to get in his truck. Quickly his crew went to work for his competitor, and he could no longer bid on jobs. His business started failing. He started drinking and soon he was drinking a 12 pack of beer a day, just to get by. His wife said if he didn’t do something she was leaving him. Now he was really scared but didn’t know what to do.

When he arrived in the primary care office his appearance was flushed; he was sweating; his hands were shaking; he was breathing rapidly and was very tense. He said he hated what his life had become.

1. What are the stressors that lead to his current condition?

2. What medical and nursing diagnosis do his symptoms suggest?

3. What comorbidity has he developed?

4. What neurotransmitters might be involved in his behavioral responses?

5. Which medications do you think would be helpful to him? Which ones should be avoided and why?

6. What types of education do he and his wife need?

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