CASE STUDY OF PHOBIAS

Introduction
A phobia is an irrational fear of something that's unlikely to cause harm. The word itself comes
from the Greek word phobos, which means fear or horror. Hydrophobia, for example, literally
translates to fear of water. When someone has a phobia, they experience intense fear of a certain
object or situation.

B.HISTORY COLLECTION

HISTORY COLLECTION

I. IDENTIFICATION
Name: U.L
Sex: F
Age: 34years old
Marital status: Single
Place of birth: Western Province
NgomaDistrict
Rukumbeli Sector
Kigese Cell
Ngamba village
Sibling’s position: 3th
Profession: Accountant
Religion: islam
Nationality: Rwandan
Admission date:

II. CHIEF COMPLAINT

The patient has been brought by her brother because of having physical and verbal aggressively,
total insomnia, and logorrhea.
III. ANTECEDENT/PEVIOUS MENTAL HISTORY
It is the 3rd crisis and all were trigged by stopping medications.
IV. FAMILY HISTORY: The client was born in a family of six children, three boys and three
girls, and she occupies the 3th place her both parents and her 2 brothers with 1 sister have been
killed in 1994 Genocide and remained five children who are all married except the client who
lives with her brother who is married having two children.

V. MEDICAL AND SURGICAL: None

VI. GYNECOLOGICAL HISTORY: She is still single with no gynecological problems.
VII. JUDICIAL HISTORY: None

VIII. PERSONAL HISTORY

The patient was born in 1988 in a family of six children and grew up normally with her both
parents. She started primary school on time in 1995 without any difficulty. But 1994 when she
was 6 years old, her parents and her brother have been killed in Genocide. After that she
continued to study and succeeded the primary six examinations and she entered secondary
school. In 2004 when she was in senior three ,she had fallen sick and brought to prayers for this
reason she lost one year of study fortunately she continued until she successfully finished her
senior six in accountancy in 2007 promotion.
After finishing her studies, in 2007 she found a job of being a manager in motel at Rubavu
district. Worked there without any problem .In 2011, she had fallen sick and suspected that she
had been poisoned and she passed about three months at home without working and for that
reason she had been replaced temporally by another. When she came back to her job a control
had been done and found that there was a loss of the money that she was in charge of, saying that
the loss took place before her sickness and that she is the one to pay it from her own. This
brought many conflicts between her and her employer and became the reason of the first crisis
.Since that time she is facing many problem like the loss of money that she lends to her friends
who refused to bring back. Apart from that she doesn’t have the common understanding with her
family members which refused her relationship with some of her boyfriend. After that crisis they
brought at ndera after recovery she back home. The following crisis is because of stopping
medications and start thinking her parents who were died in Genocide.
IX. PHYSICAL EXAMINATIONS
i) General appearance: she is weak due to side effects of drugs.

ii) HEENT: Patient does not have any problem in eyes with no jaundice, moisture mouth;
pink tongue with no sore throat neck is flexed, proper hairs, etc.

iii) Respiratory system: no any problem in respiration presented or observed to the client.
iv) Cardiovascular system: no problem indicated to the heart with normal heart sounds.
v) Nervous system: normal sensations, shaking due to side effects of drugs, pupils are reacting
to light, with GCS of 15/15.
vi) GI: No abdominal tenderness or distended
vii) Urinary system: no complaints of urination with normal urine output.
viii) Integumentary system: she has scars on the legs and left arm due to wounding during 2nd
crisis.

ix. Vital signs: Blood pressure: 118/75mmhg

Pulse: 88 bpm
Temperature: 36.70c
Respiration rate: 18 bpm
X. PSYCHIATRIC CONDITIONS
General appearance: she is a middle size girl who is well dress compared to the time of
admission. She appears her stated age, with no agitation or hyperactivity compared to before.
Affect and mood: Appropriate affect, and labile mood.
Perception: she no longer has hallucinations and no illusion as before.
Thought and speech: Has a normal flow of speech compared to before where she had logorrhea.
Her thoughts full of hopelessness and low self-esteem but no delusions.
Orientation: she is oriented to time, place and to person.
Memory and concentration: she has the ability to recall past and recent history of her life.
Judgment and impulse control: she has ability to plan for his future
Insight: negative
Vegetative symptoms: normal level of energy
Maintains normal sleep cycle

MULTIAXIAL DIAGNOSIS
Axis I: Bipolar disorder
Axis II: neither mental retardation nor personality disorder
Axis III: NONE
AXIS IV: Job stress and excessive losses
XI. COMPLEMENTARY EXAMS
-Full blood count (FBC): NORMAL RESULTS
-HIV Test: Neg.

Causes

Genetic and environmental factors can cause phobias. Children who have a close relative with
an anxiety disorder are at risk of developing a phobia. Distressing events, such as nearly
drowning, can bring on a phobia. Exposure to confined spaces, extreme heights,
and animal or insect bites can all be sources of phobias.

People with ongoing medical conditions or health concerns often have phobias. There’s a high
incidence of people developing phobias after traumatic brain injuries. Substance
abuse and depression are also connected to phobias.

Phobias have different symptoms from serious mental illnesses such as schizophrenia. In
schizophrenia, people have visual and auditory hallucinations, delusions, paranoia, negative
symptoms such as anhedonia, and disorganized symptoms. Phobias may be irrational, but people
with phobias do not fail reality testing.
Risk factors

People with a genetic predisposition to anxiety may be at high risk of developing a phobia. Age,
socioeconomic status, and gender seem to be risk factors only for certain phobias. For example,
women are more likely to have animal phobias. Children or people with a low socioeconomic
status are more likely to have social phobias. Men make up the majority of those with dentist and
doctor phobias

Symptoms of phobias

The most common and disabling symptom of a phobia is a panic attack. Features of a panic
attack include:

 pounding or racing heart
 shortness of breath
 rapid speech or inability to speak
 dry mouth
 upset stomach
 nausea
 elevated blood pressure
 trembling or shaking
 chest pain or tightness
 a choking sensation
 dizziness or lightheadedness
 profuse sweating
 a sense of impending doom
A person with a phobia doesn’t have to have panic attacks for accurate diagnosis, however.
Treatment options
Treatment for phobias can involve therapeutic techniques, medications, or a combination of both.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is the most commonly used therapeutic treatment for
phobias. It involves exposure to the source of the fear in a controlled setting. This treatment can
decondition people and reduce anxiety.The therapy focuses on identifying and changing negative
thoughts, dysfunctional beliefs, and negative reactions to the phobic situation. New CBT
techniques use virtual reality technology to expose people to the sources of their phobias safely.
 Medication
Antidepressants and anti-anxiety medications can help calm emotional and physical reactions to
fear. Often, a combination of medication and professional therapy is the most helpful.

NURSING CARE PLAN

Assessment Nursing Objectives Planning Rationale Intervention Evaluation
diagnosis
 Objective data: Disturbed Encourage Be sincere and Anxiety is Medication
feeling Thought client to talk honest when contagious and Maintain a calm, non may be
unsteady, dizzy, Processes about traumatic communicating may be threatening manner necessary to
lightheaded or faint. related to experience with the client. transferred from while working with decrease
feeling like disease under Avoid vague or health care the client. anxiety to a
you are choking. process. nonthreatening evasive remarks. provider to client Establish and maintain level at which
conditions. Help or vice versa. a trusting relationship the client can
a pounding Verbalization client work Be consistent Client develops by listening to the feel safe.
heart, palpitations or of feelings in a through feelings in setting feeling of client; displaying Relaxation
accelerated heart nonthreatening of guilt related expectations, security in warmth, answering exercises are
rate. environment to the traumatic enforcing presence of calm questions directly, effective
chest pain may help event. Help rules, and so staff person. offering unconditional nonchemical
or tightness in the client come to client forth acceptance; being ways to
chest. terms with understand that Teach signs and Therapeutic available and reduce
sweating. unresolved this was an symptoms of skills need to be respecting the client’s anxiety.
issues. event to which escalating directed toward use of personal space. The client
hot or cold most people anxiety, and ways putting the client Remain with the client may feel that
flushes. would have to interrupt its at ease, because at all times when all anxiety is
shortness responded in progression (e.g., the nurse who is levels of anxiety are bad and not
of breath or a like manner. relaxation a stranger may high (severe or panic); useful
smothering Support client techniques, deep- pose a threat to reassure client of his
sensation. during breathing the highly or her safety and
nausea, flashbacks of exercises, anxious client. security.
vomiting or the experience. physical The client’s Educate the patient
diarrhoea. exercises, brisk safety is utmost and/or SO that anxiety
Early detection walks, jogging, priority. A highly disorders are treatable.
and intervention meditation). anxious client Encourage the client’s
facilitate should not be left participation in
modifying alone as his relaxation exercises
client’s anxiety will such as deep
behavior by escalate. breathing,
changing the Helps relieve progressive muscle rel
environment anxiety. axation, guided
and the client’s The client uses imagery, meditation
interaction with defenses in an and so forth.
it, to minimize attempt to deal
the spread of with an
anxiety. unconscious
conflict, and
giving up these
defenses
prematurely may
cause increased
anxiety.
Assessment Nursing Objectives Planning/interve Rationale Implementation Evaluation
diagnosis ntion
Subjective Panic disorders After 2 weeks of Introduce self This will All planed After 2 weeks
Data: and phobias are nursing and intention help client intervention were of nursing
“I am such a expounded to be interaction, during the first build his done. interaction,
failure. My a disabling client will be phase of trust with To feel fear in a the client can
parents never condition that able to view self interaction. the nurse; specific situation verbalize
loved me...” presents a positively ensuring is a normal positive
verbatim of profound impact through Interact with the that it is a human concept of
client in life to a point realization of client in a slow professional experience, self, know his
that it can impair strengths and pace, using a low type of however, when strengths and
Objective the social, family, limits as a firm tone. interaction this fear or limits as a
Data: *Lack and working lives person. 3. Do not hurry and that will aversion becomes person. At the
of eye contact of the individual client into an ensure the excessive and end of nursing
*Guarding suffering from interaction, confidentiali disrupts the day interaction,
behavior it.These instead maintain ty of to day life of an the client is
(closed commonly a therapeutic and interaction. individual, it is participative
posture) transpire among reassuring 2. This will said the person in daily
*Rejects young adults, and atmosphere that promote a suffers from a activities,
negative such conditions you are available positive and type of anxiety shows
feedback should not be if he is already trusting disorder called eagerness to
when praised marginalized ready to talk or environment phobia. One socialize with
for good because a simple share his with the common type of other people,
grooming manifestation of thoughts with client treatment for copes well
*Stooped gait, panic or fear you. considering phobias is with problems
slightly could be the start that exposure therapy through
unkempt hair of a more depressed (professionals omission of
and nails dreadful clients expose the negative
*Some experience. sometimes patient thinking,
agitations Below are communicat acceptance of
observed detailed e with some honest
because of explanation of gaps or may appraisal, and
frequent panic disorders be express
wringing of and phobias that unresponsiv emotions
hands can help us better e for some productively.
understand their reasons.
discrepancies

Health education
specific phobias, cognitive-behavioral therapy (CBT) with exposure treatment is advised. In
exposure therapy, people are gradually exposed to what frightens them until the fear starts to
fade. Relaxation and breathing exercises also help to ease symptoms.
alking with a mental health professional can help you manage your specific phobia. Exposure
therapy and cognitive behavioral therapy are the most effective treatments. Exposure therapy
focuses on changing your response to the object or situation that you
Talking treatments, such as counselling, are often very effective at treating phobias. In
particular, cognitive behavioural therapy (CBT) and mindfulness have been found to be very
effective for treating phobias.