Feb 23, 2024 Assignment: Assessing and Treating Patients With Anxiety Disorders NURS 6630C
A Sample Answer For the Assignment:Assignment: Assessing and Treating Patients With Anxiety Disorders NURS 6630C
Anxiety disorders are a group of illnesses with a variety of symptoms that are related to one another. One of their most common symptoms is persistent, excessive worry, particularly in non-threatening situations. Among patients, physical and emotional issues are frequent. Typically, a patient’s bodily symptoms include jitteriness and a rapid heartbeat. There are numerous varieties of anxiety disorders, including social anxiety disorder, agoraphobia, generalized anxiety disorder, and panic disorder (Bandelow et al, .2022).
In this essay, a 46-year-old Caucasian man with anxiety is the subject. He exhibits signs of an anxiety illness, including chest pain, tightness, and shortness of breath. There are no signs of a myocardial infarction, according to the results of the ER and ECK tests, which are both normal. It received a 26 rating. The patient admits that he drinks to put his mind off of some of his work-related worries. In addition, he consumes three to four beers daily.
After the data has been collected, a physical examination of the patient is necessary to confirm that the right criteria have been identified to direct the selection of drugs that will make the patient feel better. Later, the generalized anxiety disorder was identified. Treatment plans were chosen in three different approaches, all of which were based on the pharmacodynamics and pharmacokinetic processes of the patients. The ethical issues and recommendations that will impact patient care will also be discussed (Crocq 2022).
The patient’s medical history, which shows that the patient has been exposed to various medications, is the first thing to be taken into account. The client has been adhering to a low-sodium diet in order to manage his moderate hypertension. The fact that the patient’s tonsils were taken from him when he was a child suggests that he was using an anti-inflammatory drug.
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Assignment: Assessing and Treating Patients With Anxiety Disorders NURS 6630C
The patient affirms that following the surgery, he underwent no additional adverse testing. The patient, on the other hand, is alert and clearly oriented to place, time, and people, demonstrating that his judgment and understanding are normal. The patient denies hearing voices and having paranoid episodes. He also denies having homicidal or suicidal thoughts. Thus, quick self-medication is necessary to help the patient recover from his condition (Fung et al, .2018).
Decision one
Start Taking Lexapro 10mg OD orally
After gathering all the information regarding the medical condition, the first pharmaceutical choice that may be made is to recommend Lexapro 10 mg taken orally once daily. The decision to accept the patient to the Lexapro 10 mg treatment program was based on the patient’s final diagnosis.
Selective Serotonin Reuptake Inhibitor Lexapro is used to treat post-traumatic stress, depression, panic attacks, and generalized anxiety disorder that the patient may be diagnosed with. The severity of the anxiety disorder must be determined; a score of 26 on the scale indicates that the patient’s condition has not gotten worse (Bandelow et al, .2022).
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In order to assess the patient’s development over time, it is recommended to start him on the oral medication Lexapro 10 mg. Other drugs that are available include buspirone 10 mg PO bid and imipramine 25 mg PO bid. However, since the medications must be used in addition to other forms of therapy in order to be effective, they might not be in the best interests of the patients’ advancement.
Lexapro 10 mg would therefore be the ideal choice for any patient with a moderate form of generalized anxiety disorder, like the patient in question. The patient should return to the hospital for a checkup after taking the medication for one month. Making a decision was done with the intention of gauging the patient’s improved disposition and his excitement for carrying out daily chores, notably at work (Andrews et al, .2018).
Decision Point Two
Raise the dosage to 20 mg orally every day from the current level.
After four weeks, the patient must visit the clinic again to assess his development. The results show that the drug has greatly improved the patient’s symptoms. Moreover, the HAM-A score decreased from 26 to 18. The drug proved beneficial, as evidenced by the patient’s decreased concern about his employment. Given the aforementioned findings, it is obvious that the previous medication shouldn’t be stopped. Instead, for an additional four weeks, the amount can be gradually increased. Thereafter, the patient should go back to the emergency hospital for a second assessment (Yatham et al, .2018).
The decision to increase the patient’s current Lexapro dosage to 20 mg was taken to determine whether the patient might completely recover from his illness and resume his regular activities. As a result, increasing the dosage is preferable to the other two possibilities that are currently being evaluated. Second, the unit has a 40 mg Lexapro dosage increase capability. In contrast, the rise would be excessive, making it impossible for healthcare providers to bring about a progressive adjustment in the patient’s life.
For instance, the unit might keep taking Lexapro at the same dose for a further four weeks and get the same results as the first diagnosis. The doctor aims to gradually improve the patient’s condition by raising the dose; this improvement may be much greater than with the previous prescription. But, because the client has not fully recovered, he may still fail to consume the recommended amount, which could have an influence on the care plan at the designated time (Yatham et al, .2018).
Decision Point Three
Continue administering the present dose
After taking the patient medication for four weeks, the patient shows a substantial improvement and is extremely happy to return to the clinic. The patient’s anxiety level reduced to a 10 on the HAM-A scale, and the additional dosage caused his prior symptoms to fade more. This shows that the client would benefit most from taking Lexapro 10 mg daily orally to treat the generalized anxiety disorder that was identified during his initial consultation.
Although the patient has gone through several changes, there is no need to change his current medication. This option implies that the patient will fully recover from his condition if his present prescription is kept up for an additional four weeks (Bandelow et al, 2018).
It might not be beneficial to switch the client from the current prescription to another possible option, such as starting them on an enhancing drug like buspirone. At this point, it’s important to keep in mind that the client hasn’t disclosed any further symptoms he previously experienced. Instead, lowering anxiety levels even further is the aim.
Due to the larger doses that the patient will need to take, the other two medications could end up making the situation worse. In order to ensure that the anxiety level drops even further, as was the case in the third diagnostic when Lexapro dosage was increased to 20 mg taken orally daily, the current medication must be continued for an additional 4 weeks.
Nonetheless, the healthcare professional must proceed with considerable caution before allowing the patient to continue with his current prescription. The client may quit taking the medication because he thinks his illness has improved, so this warning is given. The patient might not want to take the prescribed meds on a daily basis. In order to prevent the treatment plan from being jeopardized, it is crucial to emphasize to the client the necessity to finish the dose even after he has recovered (Latas et al, .2018).
Conclusion
In conclusion, an evaluation revealed that the three drugs mentioned above are the best options for treating the client’s generalized anxiety disorder or bipolar disorder, depending on the assessment. As a result, before recommending any particular medications, mental health professionals must exercise prudence. Instead, the patient’s symptoms and the severity of the anxiety disorder as determined by the HAM-A scale should lead the therapy plan.
For the first time, progressive Lexapro treatment is superior to the use of other prescription medications like imipramine and buspirone. If the patient and the healthcare provider do not interfere with the treatment plan, the Lexapro medicine will unquestionably be successful for the patient (Reddy et al, .2020).
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2022). Treatment of anxiety disorders. Dialogues in clinical neuroscience. Crocq, M. A. (2022). The history of generalized anxiety disorder as a diagnostic category. Dialogues in clinical neuroscience.
Fung, A. W. T., Lee, J. S. W., Lee, A. T. C., & Lam, L. C. W. (2018). Anxiety symptoms predicted decline in episodic memory in cognitively healthy older adults: A 3‐year prospective study. International journal of geriatric psychiatry, 33(5), 748-754.
Bandelow, B., Werner, A. M., Kopp, I., Rudolf, S., Wiltink, J., & Beutel, M. E. (2022). The German Guidelines for the treatment of anxiety disorders: first revision. European archives of psychiatry and clinical neuroscience, 1-12.
Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O. … & Wilkins, G. (2018). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Australian & NewZealand Journal of Psychiatry, 52(12), 1109-1172
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … & Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders, 20(2), 97-170.
Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. D. C., Denys, D., Dilbaz, N. … & Zohar, J. (2022). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders–Version 3. Part I: Anxiety disorders. The World Journal of Biological Psychiatry, 1-39
Latas, M., Trajković, G., Bonevski, D., Naumovska, A., Vučinić Latas, D., Bukumirić, Z., & Starčević, V. (2018). Psychiatrists’ treatment preferences for generalized anxiety disorder. Human Psychopharmacology: Clinical and Experimental, 33(1), e2643.
Reddy, Y. J., Sudhir, P. M., Manjula, M., Arumugham, S. S., & Narayanaswamy, J. C. (2020). Clinical practice guidelines for cognitive-behavioral therapies in anxiety disorders and obsessive- compulsive and related disorders. Indian journal of psychiatry, 62(Suppl 2), S230.
NURS 6630 Assignment: Assessing and Treating Patients With Anxiety Disorders
Assignment: Assessing and Treating Patients With Anxiety Disorders NURS 6630C
Assessing and Treating Pediatric Patients With Mood Disorders
Anxiety is among the predominant mental health issues globally. According to Curtiss et al., (2017), nearly 40 million adults in US aged 18 years and above are diagnosed with anxiety annually. In most cases, this disorder is diagnosed at a later stage, as most people ignore the symptoms of anxiety disorder. Studies however show that early diagnosis of anxiety disorder promotes early interventions promoting the patient’s quality of life. Through evidence-based practices, several treatment options have been availed comprising of both pharmacological and psychotherapeutic approaches for the management of anxiety disorder (Strawn et al., 2018). The purpose of this paper is to illustrate the care plan of a middle-aged white adult male diagnosed with anxiety disorder. Every decision made on which psychotropic agent is most effective for the patient has been explained with consideration of both pharmacodynamic and pharmacokinetic factors displayed by the patient.
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The case study at hand involves a white male aged 46 years who presents to the health facility with a major complaint of symptoms of anxiety. He was referred to our clinic from the emergency room which he reported complaining of having a heart attack. The patient showed symptoms such as stiffen chest, shortness of breath, and feeling of imminent doom. The patient is also obese. The patient’s medical history disclosed gentle hypertension that he has effectively managed through dietary intervention involving low sodium. The patient also had surgery at the age of eight years to remove the tonsils. He takes 3 to 4 bottles of beer every night to manage his stress. When the Hamilton Anxiety Rating Scale (HAM-A) was conducted on the patient, he recorded a score of 26. However, he rubbishes suicide ideation, auditory or visual hallucinations. The patient’s chief diagnosis at the moment is generalized anxiety disorder (GAD).
Decision #1
Selected Decision
Start with Zoloft 50 mg orally every day.
Reason for Decision One
Sertraline (Zoloft) is categorized under the selective serotonin reuptake inhibitors (SSRIs) class and approved by the FDA as effective drug for managing GAD in adults (Strawn et al., 2018). The medication is gradually absorbed in the GIT for about 6 to 8 hours to reach the optimal serum levels.
In white patients, there is widespread genetic factors including CYP2C19 and CYP2B6, which has the potential to affect the metabolism of the medication with a protracted half-life of between 26-32 hours. This is the idea behind prescribing the medication one in a day, which also enhances compliance in patients (Strawn, Poweleit, & Ramsey, 2019). The drug takes between 8 to 12 weeks for complete remission of the patient’s symptoms.
Imipramine was not the best choice for the patient, as tricyclic antidepressant agents are most preferred among patients diagnosed with depression (Williams et al., 2020). Consequently, imipramine is associated with elevated systolic blood pressure, which might worsen the patient’s hypertensive condition.
Buspirone could also not be considered for this patient as a result of its cardiovascular side effects given the patient’s hypertensive condition (Williams et al., 2020). Consequently, the drug is associated with weight gain, which makes it inappropriate for patients who are overweight, just like the one in the provided case study.
Expected Outcome
The patient is expected back to the facility four months later with remission of symptoms such as dyspnea and stiffen chest by 50% (Curtiss et al., 2017). He should regain confidence in life within this time, with a reduced feeling of impending doom. Finally, the patient’s HAM-A score is projected to demonstrate a rating of below eight.
Ethical Consideration
The PMHNP is expected to provide holistic care for the patient, which requires the involvement of the patient in making choices concerning the best intervention in the management of his mental condition (Williams et al., 2020). As such, the patient must be informed concerning the alternative psychotropic agents, including their benefits and side effects, and the reasons behind choosing a given drug over another.
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.
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To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring anxiolytic therapy.
The Assignment: 5 pages
Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Assignment: Assessing and Treating Patients With Anxiety Disorders NURS 6630C Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Generalized Anxiety Disorder Middle-Aged White Male With Anxiety
BACKGROUND INFORMATION
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom.
He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.
Client has never been on any type of psychotropic medication.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Decision Point OneSelect what you should do:
Begin Zoloft 50 mg po dailyBegin Imipramine 25 mg po BIDBegin Buspirone 10 mg po BID Week 6: Therapy for Patients With Anxiety Disorders and PTSD Treatment I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help. —P.K. Philips, PTSD patient For individuals presenting with posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders. This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of patients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies. Assignment: Assessing and Treating Patients With Anxiety Disorders NURS 6630C Reference: Philips, P. K. (n.d.). My story of survival: Battling PTSD. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd Learning ObjectivesStudents will: Assess patient factors and history to develop personalized plans of anxiolytic therapy for patients Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring anxiolytic therapy Synthesize knowledge of providing care to patients presenting with anxiolytic therapy Analyze ethical and legal implications related
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