Feb 23, 2024 Assignment Assessing and Treating Patients With Anxiety Disorders NURS 6630
Assignment Assessing and Treating Patients With Anxiety Disorders NURS 6630
Assignment Assessing and Treating Patients With Anxiety Disorders NURS 6630
Anxiety disorders make the patients constantly worry and persistently anxious. The patients with the condition present with various symptoms which complicate their daily lives. Some of the symptoms include nervousness, muscle trembling, chest tightness, and shortness of breath. Therefore, there is a need for patients with anxiety disorders to seek medical attention from psychiatric mental health specialists. Various approaches have been used to treat and manage the condition, including pharmacological and psychotherapy approaches (Horenstein & Heimberg, 2020). The implication is that the prescriber should use medications that can be monitored for dose adjustments and potential stoppage or change in case there are adverse reactions. Therefore, the purpose of this assignment is to summarize a case study of a patient with anxiety disorder and explore various decision points upon the administration of appropriate medication.
The Case Summary
The case is of a forty-six-year-old white male patient who presented to the facility after a referral because he felt he was having a heart attack. The patient experiences a feeling of impending doom, breath shortness, and chest tightness. The patient also has mild hypertension and is overweight. The ER ruled out myocardial infarction, and he also had a normal EKG. While in the office, the patient indicated that he consumes alcohol occasionally to help him deal with his worries at work. The patient is single but currently takes care of his aging parent. He indicates that he fears for his job since the management at his workplace is harsh. The patient scored 26 upon administration of HAM-A, hence diagnosed with anxiety disorder.
Decision 1
The Selected Decision
The first decision made was to begin Paxil 10 mg PO daily
Why the Decision Was Selected
The decision was made since Paxil has been approved and widely used as a first-line drug to treat anxiety disorder (Kowalska et al., 2021). While it has similar efficacy as tricyclic antidepressants, Paxil has fewer side effects hence a good choice. In addition, it has a better safety record and a higher response rate compared to other classes of drugs.
Why the Other Options Were Not Selected
The other two options included beginning Buspirone 10 mg Po BID or Begin Imipramine 25 mg Po BID. Buspirone was not chosen since it is recommended for use among patients with anxiety disorder only if the first line of treatment is not effective or presents safety concerns (Wilson & Trip, 2021). Therefore, it should be used as a second line of treatment (Garakani et al., 2020). This medication also has more side effects in comparison to Paxil, and patients also tend to abuse it after use. Imipramine, also an antidepressant, is only considered a second line of treatment for anxiety disorder. In addition, it has various undesirable side effects, such as urinary hesitancy, sedation, and weight gain (Chang et al., 2021). Therefore, it is not a good option since the patient also already has mild hypertension.
What I was Hoping to Achieve by Making the Decision
One of the goals I was hoping to achieve by making the decision was to help the patient have reduced anxiety symptoms and lead a normal life. The medication is expected to act within four weeks. Hence the patient should have fewer worries and experience reduced heart attack-like symptoms (Kowalska et al., 2021). I also expected the HAM-A scores to substantially reduce.
How Ethical Consideration May Impact the Treatment Pan and Communication
One of the ethical considerations at this stage is to offer the patient education regarding the potential side effects of Paxil in addition to informing the patient regarding other available treatment options, such as psychotherapy (Haddad & Geiger, 2020). The patient’s autonomy has to be upheld and be allowed to choose the best option without influence. The patient also needs to be informed of risks connected to not treating the conditions.
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 #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. Assignment Assessing and Treating Patients With Anxiety Disorders NURS 6630
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 #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.
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.
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Grading CriteriaAssignment Assessing and Treating Patients With Anxiety Disorders NURS 6630
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Week 6 Assignment
Midterm Exam
This exam will cover the following topics, which relate to psychopharmacologic approaches to treatment for patients across the life span:
Introduction to neuroscience, including concepts in neuroanatomy, neurotransmitters, and receptor theory
Medication adherence
Pediatric, adult, and geriatric Major Depressive Disorders (MDD)
Bipolar disorder
Anxiety and PTSD treatment
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Prior to starting the exam, you should review all of your materials. There is a 2.5-hour time limit to complete this 50-question exam. You may only attempt this exam once.
This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
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What’s Coming Up in Week 7?
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Next week, you will continue to build on your assessment and treatment skills as you examine patients presenting with signs and symptoms consistent with schizophrenia.
ASSESSING AND TREATING PATIENTS WITH ANXIETY DISORDERS
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
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 formattingLinks to an external site..
Treatment for Insomnia and Depression
Some of the questions I might ask if the patient were in my office include the following;
How has your sleep pattern changed since your husband’s passing? This question helps assess the patient’s current sleep habits and any disruptions in her sleep pattern following the loss of her spouse.
Are you experiencing any other symptoms of depression besides difficulty sleeping? This question aims to gather more information about the patient’s overall mental health and assess the presence of additional depressive symptoms.
Have you tried any strategies or interventions to improve your sleep? This question helps determine whether the patient has attempted self-help or non-pharmacological approaches to manage her insomnia, providing insight into her coping strategies.
People in the patient’s life, I would need to speak to or get feedback from our
Family members: Speaking with family members can provide a broader understanding of the patient’s social support system, any changes in her behavior or mood, and the impact of her husband’s death on her daily life (Abbott, 2016).
Close friends or neighbors: These individuals may have observed the patient’s sleep patterns or changes in her behavior since the loss of her spouse and can provide additional information on her emotional well-being and daily activities.
The questions I might ask the above people
How would you describe the patient’s sleep patterns and quality since her husband passed away? This question helps gather objective information about the patient’s sleep disturbances from individuals who have observed her sleep habits.
Have you noticed any changes in the patient’s mood or behavior since her husband’s death? This question aims to identify any significant emotional or behavioral changes that may be relevant to her overall mental health assessment.
Physical exams and diagnostic tests that would be appropriate:
Physical exam: A general physical examination would be appropriate to assess the patient’s overall health status, including vital signs, body mass index (BMI), and signs of any physical complications related to her chronic conditions.
Laboratory tests: Conducting a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid function tests can help identify any underlying medical conditions or abnormalities that may contribute to the patient’s sleep disturbances and depressive symptoms.
Differential diagnosis for the patient:
Major depressive disorder (MDD) with insomnia is the most likely diagnosis considering the patient’s recent loss, worsening depression, and sleep disturbances following her husband’s death.
Adjustment disorder with depressed mood: The patient’s depressive symptoms may be attributable to an adjustment disorder, given the significant life stressor of losing her spouse (Abbott, 2016).
Pharmacologic agents and dosing for antidepressant therapy:
Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (current medication): The patient is already taking sertraline, an SSRI commonly prescribed for depression and anxiety. It can be continued or adjusted based on the patient’s response.
Mirtazapine: Mirtazapine, an atypical antidepressant, may be considered as an alternative or adjunctive medication due to its sedating effect, which can help improve sleep and appetite. Starting dosage could be 15 mg at bedtime, with titration as needed.
The rationale for choosing one agent over the other:
Sertraline is a reasonable choice as the patient is already taking it, and has proven efficacy for depression. However, Mirtazapine may be most appropriate due to its sedating properties, which can potentially address the patient’s insomnia and depressive symptoms simultaneously (Abbott, 2016).
Contraindications to use or alterations in dosing:
For both sertraline and Mirtazapine, precautions should be taken regarding the patient’s age and concurrent use of other medications, especially considering her medical conditions (diabetes, hypertension). Lower starting doses or slower titration may be necessary to minimize the risk of adverse effects and drug interactions. One factor that will be problematic with using this drug in individuals based on ethical prescribing guidelines or decision-making is polypharmacy and potential drug interactions.
Individuals with multiple medical conditions, like the patient in this case, may already be taking several medications. Prescribing an antidepressant in such cases raises concerns about potential drug interactions and polypharmacy (Khurshid, 2018). Ethical decision-making involves assessing the overall benefit-to-risk ratio, considering the potential interactions and monitoring for adverse effects.
Checkpoints and therapeutic changes:
Follow-up appointments at Weeks 4, 8, and 12 would be appropriate to assess the patient’s response to treatment (Palagini et al., 2022). Based on possible outcomes, therapeutic changes will include adjusting the dosage of sertraline or Mirtazapine, adding non-pharmacological interventions (e.g., cognitive-behavioral therapy for insomnia), or considering referral to a specialist for further evaluation if symptoms persist or worsen. Regularly monitoring the patient’s sleep pattern, mood, and side effects would be essential during these checkups.
References
Abbott, J. (2016). What is the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
Links to an external site.
Palagini, L., Hertenstein, E., Riemann, D., & Nissen, C. (2022). Sleep, insomnia and mental health. Journal of sleep research, 31(4), e13628.
Khurshid, K. A. (2018). Comorbid insomnia and psychiatric disorders: an update. Innovations in clinical neuroscience, 15(3-4), 28.
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Anxiety disorders are characterized by pathologically elevated levels of anxiety. One of the common anxiety disorders is generalized anxiety disorder (GAD). It is characterized by anxiety, tension, worry, and fears about various day-to-day events and problems. Patients with GAD experience difficulties controlling excessive worries (DeMartini et al., 2019). GAD’s excessive anxiety and worry cannot be accounted for by a medical condition or substance use. The purpose of this paper is to discuss the case scenario of a patient with an anxiety disorder and describe the treatment and ethical considerations that may impact treatment.
Case Overview
The case scenario portrays a 46-year-old white male referred by his PCP after visiting the ER due to the fear of having a heart attack. The client mentions that he experienced chest tightness, dyspnea, and a feeling of impending doom. He has a history of mild hype
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