So I'm going out on a limb here since I think this is maybe an oddity, but I'm curious if any of you psych nurses have any input on a situation I encountered last night. I'm a cardiac nurse, so this isn't my forte- my only experience with panic attacks is my personal history of them.
I had a patient last night who was admitted to the hospital last week with SOB, diagnosed with CHF/pulmo HTN, possible SIADH...among other things. Pt has a psych history of SI with two attempts, depression, anxiety, and former sedative addiction, had been refusing psych consults. The pt was on several psych meds (for depression) prior to admission, which were all d/c'd within the last few days- I'm not really sure why. The only thing still ordered was PRN benzo for anxiety.
The pt had two panic attacks during my shift. The pt was very anxious at baseline, has been since admission, and got the benzo after the first attack. The second was about 5 hours later, too soon for a second dose. Both times it occurred when the pt had just sat up from a lying position, and the pt stated to me that things were fine until the rapid position change. No history of vertigo, no dizziness/light-headedness, VS stable...and the patient says this happens every single day. I was able to calm the pt down by coaching through breathing exercises, and showing the pt how to use the button to raise the head of the bed to assist with slowing the pace of the position changes.
Thankfully, the pt has agreed to a psychiatry consult. I won't be back till later this week, at which point the pt will unlikely be on my cardiac unit. Has anybody ever heard of this? It seems bizarre to me that panic attacks might be related to position changes, unless the pt has vertigo or maybe platypnea (or, I guess, orthopnea in cases other than this.)
Any thoughts at all? I would love any and all input. The pt has a lot of strictly medical stuff going on...I'm just wondering if they might be causing this odd (to me, anyway) psych manifestation.