A 24 year old male has arrived on the unit to be admitted for depression and
feelings of anxiety and occasional panic attacks (palpitations,
hyperventilation, "cold sweat", and shaking).

On admission the patient states that he feels that he has little control
over the "attacks", that is, when they occur and has had very little success
with controlling their pattern or length.   

His history reveals two parents who are educated, competent and have high
expectations of their son. No matter what the patient does, he says, it
never seems to satisfy them. His affect is downcast, shoulders slumped and
he says that both eating and sleep patterns have deteriorated over the past
three months.

He reports that he has recently stopped seeing a girlfriend who he has been
seeing for eleven months and that he has dropped his university courses half
way through this past term. He has also just lost his part-time job,
returning books to shelves at the university library, because they felt that
he was too slow and making too many mistakes.  

When asked about feelings of self harm, he states that he has no plans to
hurt or kill himself - "I probably couldn't do that right either." He
describes himself as a loser, a person with few friends, although he does
have two close ones, one of whom brought him to hospital today. He says that
coming to hospital seemed to be the logical thing for him to do since there
seems to be nothing else left.  

Regarding plans for the future the patient states that he is uncertain about
whether he can return to school, how many courses he will be able to take,
and whether he will be able to manage the requirements of even one.

Please communicate with your partner about this case.  The two of
you should attempt to establish at least two nursing diagnoses and
determine which has highest priority.  Discuss the nursing care
plan that would follow from your diagnosis.