Advice for working floor with "attacks" (anxiety?)

Nurses General Nursing

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I am a new nurse, graduated in May and got my license in July. I have been working at a small group home since I began and I am wanting to transition to a hospital floor job such as med/surg to get some acute care experience, skills, etc.

I have been putting it off due to these attacks I suffer from and not knowing how I will be able to handle it when I am on the floor working with patients in stressful situations.

I will describe the attacks as beginning with a thud in my heart, and immediately feeling like my heart is racing super fast, but at the same time like I cannot catch my breath, and it feels to me like my heart beats quick little fast beats, almost like it is not beating adequately. Accompanied by this is usually dizziness, anxiety after attack begins, sweaty palms and feet, and sometimes my feet and palms go numb and tingling. The first several times it occurred I thought it was a heart attack, and even to this day even though I know what to expect it feels like I am about to die every time this occurs. These attacks last anywhere from 2-20 minutes before my heart will randomly just go completely back to normal and I am out of the attack.

I have and do see a cardiologist for this, also been to the ER about 10 times for this with absolutely no answers, no diagnosis. The ER says they are guessing its anxiety attacks as my EKG are always normal. I have worn halter monitors and currently have implanted bluetooth heart monitor that I press when feeling symptoms, still they say nothing ever shows up as abnormal at all. The cardiologist does say I have PVCs and PACs. These began randomly when I was 27 . I am currently 32. These begin typically when I am working out especially running or doing squats. They also will occur if I drink any caffiene. They have happened a few time in stressful situations or when I realized I made a mistake.

I am worried that this issue will affect my ability to provide care on the floor as a nurse, especially when doing anything physical or when in life/death sitautions such as performing CPR etc. I am not looking for any medical advice, but looking for advice on if people do/have work on the floor with similar issues and are ok to do so. Any feedback is welcome, please and thank you in advance.

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I take propranolol as off label use for anxiety. You can ask your doctor about that.

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Yes I did take it for about a year with no success. It didn't keep these attacks from occurring or help them when they'd already begun..I had it prescribed prn. I was at first afraid to try it due to my resting HR being between 45-50 but the cardiologist said it was alright so I tried to take every time before workouts and everytime an attack began with no luck. Tried a couple other beta blockers after that and they actually made it much worse.. So went back to propranolol. Haven't taken it in about a year due it not helping. Cardiologist said.. Well.. At this point i guess either just kinda deal with them since their benign or try an ablation.. Ive been too leary to go down that road.

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I find I have to just take the propranolol at the start of my shift because it's too late once I think I need it. It doesn't last forever but my most stressful time is the beginning of the shift usually. I also don't drink coffee anymore at work but I really should cut it out totally.

Have you seen a psychiatrist? Maybe you could ask if an SSRI/SNRI would help?

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I have not, I had considered it to see if it will help or not. I have been at a complete loss as to the cause of the issues, as have the doctors so far. The first time it ever occurred was playing basketball, then the next time was doing sprints, seems to effect me most when I am exercising which to me is strange, but at this point I would consider any and all options for it to stop happening. I may look into the psychiatrist to see if it would help at all. Thanks you.

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Specializes in Primary Care, LTC, Private Duty.

Not offering medical advice, but has your PCP/Cardiologist/Care Team made sure that your Calcium-Potassium-Magnesium-Vitamin D levels are all WNL? Just going off personal experience, I end up with similar symptoms (even ended up getting the Holter Monitor workup and psych workup) only to find that my Vitamin D levels were severely deficient, which was starting a cascade effect of throwing other crucial minerals out of whack and, therefore, other body systems.

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Well, actually since you mention it I don't believe so. I have had the complete CBC/CMP workup, TSH, Testosterone, heart echo....vitamin D doesn't sound familiar unless they snuck it into one of those but I don't believe they did. I do know my CMP/CBC came back totally normal. Would I just go to my doc and ask for just a vitamin D level if I wanted to give this a shot?

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There are plenty of nurses in acute care with anxiety who manage with pharm and nonpharm strategies. What anxiety management will look like for you is a discussion between you and your providers.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I think with anything that might impact your ability to function in a continuous manner during a shift needs consideration, but it sounds like you deal with it well. I saw an electrophysiologist and had a cardiac MRI this summer to look for any scarring from my cardiomyopathy/heart failure diagnosis last year because I have runs of PVCs that leave me short of breath, and we were looking for reasons to do an ablation - but found none. No rhyme or reason, I can drink 10 espressos and not have a blip, then out of nowhere on a random day, I am in trigeminy or bigeminy. It's frustrating. My EP offered me different meds from the beta blocker I already take that is prescribed by my cardiologist, but I declined - too many potential side effects for my liking. I hope to ultimately come off of the beta blocker too, maybe in a year or two. My situation is different and my symptoms are likely to diminish over time, but I know your frustration. My PVCs have declined in frequency after I changed from one beta blocker to another, but they feel worse when I have them. I guess you would want to consider frequency and duration when deciding if you could be in a hospital setting. For me, I know that nothing feels worse than trying to care for a patient having an emergency when you suddenly find that you cannot breathe yourself, or your heart is conducting things in such a way that you need to take a seat.

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Specializes in CCRN.

Did you have these anxiety attacks while in nursing school? How did you do while you were at clinical sites?

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During some tests I did yes, luckily never at a clinical site fortunately. I have had a couple a long time ago my current job, luckily since it is a small group home there were other workers there to cover for me and I did not have to have someone cover for me while I got sent to the ER.

Typically they happen more when I am doing physical things, lifting, squatting, running or climbing stairs things more active like that that require lifting. They occur most often at the gym or when I am hiking. At my current job I don't lift and I sit a lot of the day. I am skinny, eat healthy and in shape (well appear to be in shape, get me on a treadmill and thats a different story). I guess the main thing I am worried about is if they occur when I need to lift a patient, or help to do so, or do something exhausting like CPR. I worry about my ability to provide adequate life saving measures in those situations. When they occur it feels like I am going to die/pass out along with dizziness and numb hands/arms until the attack passes, sometimes up to 20 minutes.

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Specializes in Neurosciences, stepdown, acute rehab, LTC.

It may not be the right time to work in the hospital yet. I've been having panic attacks since age 19 (I'm 33 now) and also bipolar disorder. I too went to the hospital a lot in the beginning thinking I was dying. I worked at LTC And acute rehab to get my experience and was pretty experienced by the time I got to the hospital. I also had my medication regimen mostly under control. Sometimes I've needed to take a small dose of Xanax at work. Lately I've been having a lot of panic attacks for some reason but I'm so used to them at this point that nobody even knows I'm having one. I usually just finish what I'm doing and rush to the bathroom with a bag (usually a biohazard bag lol). And then I sit in the bathroom for as long as I can and try to relax and ride it out while breathing into the bag once in a while to help the hyperventilation. This is just something that works for me. I would try to get the panic attacks under control as much as you can with some counseling, who can give you exercises to stop the attacks. You shouldn't change jobs when you're already experiencing so much stress. It's not the end of the world if you put the hospital on hold for a little bit. Just to clarify, I'm not telling you to breathe into a bag (in case you are actually having cardiac issues prob not the best idea right off the bat.) also, random fact- my vitamin D levels are super low too. I correct any possible deficiencies with this potent multivitamin, helps improve my focus and energy quite a lot.

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