Nursing process for a patient with needle phobia: a case study / Proceso de enfermería para paciente con fobia a las agujas: estudio de caso / Processo de enfermagem para paciente com fobia de agulha: estudo de caso

ABSTRACT Objectives: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework. Methods: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear. Results: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear. Final Considerations: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.

RESUMEN Objetivos: informar sobre un caso clínico de fobia a las agujas derivado en paro cardiorrespiratorio, describir los resultados de un plan de atención orientado a diagnósticos de miedo y ansiedad, sobre referencial del Modelo de Adaptación de Roy. Métodos: estudio de caso observado en ambulatorio de quimioterapia de Rio de Janeiro. El trabajo profesional estuvo orientado por el proceso de enfermería, respaldado por utilización de instrumentos evaluadores de la red venosa, ansiedad y miedo. Resultados: el Modelo de Adaptación de Roy ofreció la propuesta de intervenciones de enfermería que le faciliten al sujeto estudiado adaptación a los estímulos externos e internos disparadores del síncope vasovagal. Los instrumentos indicaron que el catéter semiimplantado es el dispositivo de acceso venoso más adecuado, resultando en mejoras de los niveles de ansiedad y miedo. Consideraciones Finales: una vez realizadas las actividades de enfermería, la ansiedad disminuyó y el paciente obtuvo mayor autocontrol del miedo.

RESUMO Objetivos: reportar um caso clínico de fobia de agulha que culminou em parada cardiorrespiratória e descrever os resultados de um plano assistencial voltado aos diagnósticos de medo e ansiedade, tendo como referencial o Modelo de Adaptação de Roy. Métodos: estudo de caso, desenvolvido em ambulatório de quimioterapia do Rio de Janeiro. A atuação profissional foi orientada pelo processo de enfermagem e subsidiada pelo uso de instrumentos de avaliação da rede venosa, ansiedade e medo. Resultados: o Modelo de Adaptação de Roy facultou a proposição de intervenções de enfermagem que permitiram ao sujeito do estudo uma adaptação aos estímulos externos e internos desencadeadores de síndrome vasovagal. Os instrumentos indicaram a escolha de um cateter semi-implantado como dispositivo de acesso venoso adequado que resultou na melhora dos níveis de ansiedade e medo. Considerações Finais: após o desenvolvimento das atividades de enfermagem, a ansiedade diminuiu e o paciente obteve maior autocontrole do medo.

Some notes on a historical perspective of panic disorder

This article aims to describe important points in the history of panic disorder concept, as well as to highlight the importance of its diagnosis for clinical and research developments. Panic disorder has been described in several literary reports and folklore. One of the oldest examples lies in Greek mythology - the god Pan, responsable for the term panic. The first half of the 19th century witnessed the culmination of medical approach. During the second half of the 19th century came the psychological approach of anxiety. The 20th century associated panic disorder to hereditary, organic and psychological factors, dividing anxiety into simple and phobic anxious states. Therapeutic development was also observed in psychopharmacological and psychotherapeutic fields. Official classification began to include panic disorder as a category since the third edition of the American Classification Manual (1980). Some biological theories dealing with etiology were widely discussed during the last decades of the 20th century. They were based on laboratory studies of physiological, cognitive and biochemical tests, as the false suffocation alarm theory and the fear network. Such theories were important in creating new diagnostic paradigms to modern psychiatry. That suggests the need to consider a wide range of historical variables to understand how particular features for panic disorder diagnosis have been developed and how treatment has emerged.