(1) Marsha Arshad is an 18-year-old female patient presenting with anxiety related to multiple surgeries for scar reduction from burns she experienced over a decade prior. (2) On mental status examination, she displayed sadness, anxiety, ideas of hopelessness and worthlessness, and was diagnosed with anxiety related to her recurrent surgeries. (3) Through nursing interventions like relaxation techniques and cognitive therapy, her anxiety levels decreased from moderate to mild.

1. Running head: Case presentation of patient having anxiety
(Case Study)
ANXIETY DEVELOP OF THE PATIENT HAVING MULTIPLE TIME SURGERY DUE
TO SCAR REDUCTION
By
RAFTAN
Post RN BSc Nursing 1st year 2nd semester
College of nursing PIMS
Islamabad
Facilitator: Madam Saima Sanober
(Nursing Instructor at College of Nursing PIMS)
Date: March 28, 2021
Shaheed Zulfiqar Ali Bhutto Medical University Islamabad

2. Anxiety patient 2
Case presentation of patient having anxiety
Marsha Arshad is 18year old female patient, single, unemployed, educated till year
3rd
of secondary school, date of admission 01, 03, 2021, BED NO 12, department Burn center
presented with chief complain of Anxiety, related to scar, mild pain at surgical site. Patient
experience burn injury from candle flam 13 to 14 years ago that burn her chest, abdomen and left
sided arm and fingers. Patient was taken to local hospital and treated .On 2, 11,2021she was
brought to PIMS hospital for skin grafting which did not respond well .now she has present again
for reduction surgery
By taking her Personal History Social behavior was normal but having minimal social
interactions. She was bor n in Karachi at home with normal mood of deliveryher mother is 58
year old she is known case of diabetic her father was solder in army and is quite healthy. She has
9 siblings they are enjoying good health .By talking Family History there was no history of any
psychiatric illness in first or second degree relatives.She denies any past history of psychiatric
disease
On Physical Examination A lethargic, poorly-nourished femal in the Confusional state is
lying on a bed. Blood pressure 130/90, pulse 110, respirations 20/m and she was hypothermic.
Bodyweight of the patient is 63 kg. No Problems referable to HEENT system (Hair ear,eyes,
nose, teeth). Mucus membranes are dry and rough. Decreased skin turgor pressure, No swelling
on neck, dysphagia, or thyroid disease. S1 + S2 and fourth heart sound S4 is also audible.
Neurological Examination show her higher function Motor system Sensory system all normal
On Mental Status Examination Her General Appearance is good her dressing and
grooming is proper but she is restless there is dark circles around the eyes. She is cooperative in
attitude but limited communication. Eye to eye contact Initiated but could not be maintained.

3. Anxiety patient 3
Attention Arousable & sustained but she can easilydistracted. Mood is Sad & anxious. Affect
appropriate to mood. Speech is Continuous, coherent & relevant and decreasedin amount.
Altered thought proses Patient had ideas of hopelessness, helplessness & worthlessness.She is
feeling that surgery may be harmful for her body images. No per ceptual abnormality is present.
Recent & remote memory is intact. Orientation To time, place and person is present. Intelligence
Average, both social & test judgment intact. Insight is Grade 2( awareness of being ill)
All routine blood & urine investigations have been done
Potassium 3.5. 3.5-5.3 mmol/L
Chloride 102 98-108 mmol/L
Total CO 24 23-27 mmol/L
2
BUN 20 7-22 mg/dl
Creatinine 1.5 0.7-1.5 mg/dl
Glucose 80 70-110 mg/dl
Calcium 7.4 8.9-10.3 mg/dl
Phosphorus 3.5 2.6-6.4 mg/dl
Alkaline
45 30-110 IU/L
Phosphatase
Hemoglobin 8.8 14-17 gm/dl
Hematocrit 28.4 40-54 %

4. Anxiety patient 4
Mean cell
89 85-95 FL
volume
TLC 7800, N: 60, L: 30, ESR: 60 CXR: Clear Lungs fields, LFT: AST: 30, Urea: 60, Anti HCV:
non-reactive.
Medical diagnose : scar Reduction surgery
Nursing diagnoses: On the bases of mental status examination patient is diagnoses as follow
Differential Diagnosis based on nursing process
Anxiety related to recurrent surgery as evidence by insomnia restlessness loss of appetite and
expression of concerns
Disturbed body image related to disease process as evidence by scar on abdomen chest and
left arm
Depressionrelated to disturbed body image as evidence by future concerning altered though
process and low concentration
Insomnia related to disease process as evidence by dark circle around eyes
0n the prioritybases patient is diagnosed as anxiety related to recurrent procedure secondary to
grafting skin
Nursing intervention
Possible nursing intervention done .Built rapport with the patient and ensure
confidentiality, assess the level of anxiety, educate the patient about the importance of surgery
and its benefits and its side effects. Relaxation techniques, correct breathing techniques, dietary
adjustments, exercise, learning to be assertive,building self-esteem, cognitive therapy, exposure
therapy, structured problem solving, medication prescribedby psychiatrist and support given to t

5. Anxiety patient 5
Prognosis
After a good deal of nursing intervention the patient anxiety reduced from moderate to
mild level, patient is feeling now relax ,low expression of concerns and increase in
concentration
A short overview of disease process
Anxiety the natural response to stress. It’s a feeling of fear or appr ehension about what’s
to come. It is an emotion characterized by feelings of tension, worriedthoughts and physical
changes like increasedblood pressure. People with anxiety disorders usually have recurring
intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also
have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat. The first day
of school, going to a job interview, or giving a speechmay cause most people to feel fearful and
nervous. But if their feelings of anxiety are extreme, last for longer than six months, and are
interfering with life it may an anxiety disorder
It is caused by Genetic and environmental factors, as well as brain chemistry.in addition,
researchers believe that the areas of the brainresponsible for controlling fear may be impacted
Types of anxiety
There are different types of anxiety. The most common are:
1. Generalized anxiety disorder ( GAD)
2. Social anxiety
3. Specific phobias
4. Panic disorder

6. Anxiety patient 6
References
https://www.healthline.com/health/anxietynvolved with anxiety
https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety