NURS 6640 Assessing and Treating Clients With Anxiety Disorders Walden University

NURS 6640 Assessing and Treating Clients with Anxiety Disorders Walden University, Sample Nursing Paper

NURS 6640 Assessing and Treating Clients with Anxiety Disorders Walden University Sample Nursing Paper

NURS 6630 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.

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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.

Decision trees on Anxiety Disorders

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.

The PMHNP administers 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-

Decision Point One

Be RESULTS OF DECISION POINT ONE

 Client returns to clinic in four weeks

 Client informs you that he has no tightness in chest, or shortness of breath

 Client states that he noticed decreased worries about work over the past 4 or 5 days

 HAM-A score has decreased to 18 (partial response)gin Zoloft 50 mg PO daily

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Decision Point two

Increase doze to 75 mg orally

RESULTS OF DECISION POINT TWO

 Client returns to clinic in four weeks

 Client reports an even further reduction in his symptoms

 HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)

Decision Point Three

Maintain current dose

Guidance to Student

At this point, it may be appropriate to continue client at the current dose. It is clear that the client is having a good response (as evidenced by greater than a 50% reduction in symptoms) and the client is currently not experiencing any side effects, the current dose can be maintained for 12 weeks to evaluate full effect of drug. Increasing drug at this point may yield a further decrease in symptoms, but may also increase the risk of side effects. This is a decision that the PMHNP should discuss with the client. Nothing in the client’s case tells us that we should consider adding an augmentation agent at this point as the client is demonstrating response to the drug. Avoid polypharmacy unless symptoms cannot be managed by a single drug: NURS 6640 Assessing and Treating Clients With Anxiety Disorders Walden University Sample Nursing Paper

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Please include the reason why not using this two medication in your assignment

Imipramine

Buspirone

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. NURS 6640 Assessing and Treating Clients With Anxiety Disorders Walden University Sample Nursing Paper

  • Chapter 9, “Anxiety Disorder and Anxiolytics”

Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.

To access the following chapters, click on the Illustrated Guides tab and then the Anxiety, Stress, and PTSD tab.

  • Chapter 4, “First-Line Medications for PTSD”
  • Chapter 5, “Second-Line, Adjunct, and Investigational Medications for PTSD”

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913

Note: Retrieved from Walden Library databases.

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306

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Sample solution paper on NURS 6640 Assessing and Treating Clients With Anxiety Disorders Walden University

Paper Type: Case Study
Course Level: Master
Subject Area: Nursing
# Pages: 6

Introduction

Generalized anxiety disorder is a common psychiatric problem among adults today. The disease is characterized by constant feelings of fear and worries over things that people encounter in their everyday lives. As Munir and Hughes (2017) point out, a patient with a generalized anxiety disorder may have feelings of worry and fear over a wide variety of issues including health, finances, work, and family issues. Common symptoms of the mental condition under discussion include sleep disturbance, restlessness, muscle tension, chest tightness, and fatigue. Effective treatment of generalized anxiety disorder largely depends on the appropriate choice of a treatment strategy. Both pharmacological and non-pharmacological approaches can be used to treat the disorder. In case the physician decides to use pharmacological agents for treatment, he or she must ensure that appropriate dosages of drugs are administered based on the patient’s situation at the time of visit (Stahl, 2013). In this paper, the author has given the rationale for administering specific types of drugs to a 46-year-old white male patient who has been diagnosed with generalized anxiety disorder. During his or her therapeutic relationship with the client, the clinician must understand the impacts of various ethical considerations on the treatment plan and communication.

Decision Point One

Selected Decision

Begin Zoloft 50 mg PO daily

Reason for Selection

Zoloft has been chosen as the best drug to begin the treatment process for the patient due to its effectiveness in improving symptoms of generalized anxiety disorder. The drug belongs to a class of pharmacological agents known as selective serotonin reuptake inhibitors (SSRI), which have been found to be highly effective against the psychiatric problem under discussion (Kavan, Elsasser, & Barone, 2009). According to Kavan, Elsasser, and Barone (2009), SSRIs such as Zoloft are more beneficial for clients with generalized anxiety disorder as compared to Buspirone. This explains why Buspirone has not been selected for treatment in this case. Moreover, Imipramine is known to cause adverse side effects in patients with heart-related problems (Ciraulo & Shader, 2014). Therefore, the medication has not been used because the current patient presents with signs of heart attack and has some mild hypertension.

NURS 6640 Assessing and Treating Clients with Anxiety Disorders Walden University Sample Nursing Paper

Expected Results

The patient should start to realize an improvement in anxiety symptoms within the first two weeks of medication. Specifically, symptoms related to shortness of breath, affect, and tightness of chest should disappear after two weeks of drug administration. Additionally, feelings of impending doom and nervousness should reduce significantly (Strawn et al., 2012). It is also expected that the client will start to realize a reduction in worries and fear about work within two weeks of drug use. Furthermore, the Hamilton Anxiety Rating Scale (HAM-A) is expected to yield a score below 26 within three weeks of drug use (Stahl, 2013; Hamilton, 1959).

Difference between Expected Results and Actual Results

The actual results perfectly resemble the expected ones. The client visits the clinic within four weeks of drug use. He reports that shortness of breath and tightness of chest have disappeared completely. It was anticipated that symptoms related to shortness of breath, affect, and tightness of chest should disappear after two weeks of drug administration. Therefore, the outcome is similar to what was anticipated. Additionally, the client has noticed a reduction in feelings of fear and worries about work as initially predicted. Furthermore, the HAM-A score was expected to fall below 26 after the patient will have used the drug for about three weeks. Surprisingly, the score has dropped to 18 which indicate a partial response to 50 mg of Zoloft administered PO daily (Munir & Hughes, 2017).

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Decision Point Two

Selected Decision

Increase dose to 75 mg orally

Reason for Selection

The patient’s clinical presentations after using 50 mg of Zoloft for four weeks indicate that he is responding positively to the drug. The reason in that there is an improvement in symptoms and the client is not experiencing any side effects. However, it is important to note that the mild feelings of fear and worry about work still exist and that the HAM-A score still stands at 18. These results demonstrate that 50 mg of Zoloft is promoting recovery at a very slow rate. Therefore, in order to accelerate the disappearance of disease symptoms, it is appropriate to increase the drug dosage to 75 mg administered orally (Stahl, 2013). Considering the health status of the patient, a dose of 100 mg may yield unpleasant side effects that may eventually result in more serious complications (Strawn et al., 2012).

Expected Results

It is anticipated that 75 mg of Zoloft will yield more positive outcomes than 50 mg. Therefore, the patient should continue to breathe comfortably without recurrence of symptoms related to the tightness of chest (Stahl & Grady, 2010). Moreover, the new drug dosage is expected to completely eliminate feelings of nervousness as well as those of fear and worry about work. As Stahl (2013) explains, one of the best ways to enhance a drug’s effectiveness with a patient is to increase its dose while at the same time monitoring the client’s progress. Therefore, it is expected that 75 mg of Zoloft will generally result in an overall improvement of anxiety symptoms with a HAM-A score which is less than 18 (Strawn et al., 2012).

Difference between Expected Results and Actual Results

There is an agreement between the expected outcomes and the actual results. The client has visited the clinic after using 75 mg of Zoloft for a period of four weeks. He reports a significant reduction in disease symptoms. This result is similar to the expected outcomes because it was anticipated that the patient should continue to breathe comfortably without recurrence of symptoms related to the tightness of chest after using the drug for some time. Additionally, it was predicted that feelings of nervousness as well as those of fear and worry about work, should disappear. The other similarity in results is observed in the HAM-A score. As it was predicted, the HAM-A score has decreased to 10, which is a value below 18. This is a 61% reduction in anxiety symptoms with 75 mg of Zoloft (Hamilton, 1959). NURS 6640 Assessing and Treating Clients with Anxiety Disorders Walden University Sample Nursing Paper

Decision Point Three

Selected Decision

Maintain current dose

Reason for Selection

A decision to maintain the current dose of 75 mg administered orally has been made due to the drug’s effectiveness in improving symptoms of generalized anxiety disorder. Moreover, the drug does not have any side effects on the patient. Specifically, 75 mg of Zoloft has resulted in a 61% reduction in disease symptoms. It is therefore apparent that maintaining the dose will generate further improvement in symptoms of generalized anxiety disorder (Strawn et al., 2012). According to Stahl (2013), increasing drug dosage may not only cause a reduction in disease symptoms but it can also cause severe side effects. Therefore, the dosage of the drug has not been increased in the current scenario in order to avoid potential side effects. Moreover, adding an augmentation agent is not necessary because the current therapy has proven to be effective against the targeted symptoms (Stahl & Grady, 2010; Stahl, 2013).

Expected Results

It is expected that the patient should fully recover from generalized anxiety disorder if he visits the clinic by the end of the twelfth week. Symptoms related to shortness of breath and tightness of chest should disappear completely (Kavan, Elsasser, & Barone, 2009). Moreover, the patient should not experience any feelings of fear and worry about work. Again, feelings of nervousness should be absent in the client after using the drug for another four weeks. By maintaining an oral administration of 75 mg of Zoloft, the patient should have a HAM-A score of less than 10. Essentially, there should be a more than 61% reduction in symptoms of generalized anxiety disorder (Stahl, 2013).

Difference between Expected Results and Actual Results

The actual results perfectly match the expected outcomes. The patient has fully recovered from the generalized anxiety disorder. This demonstrates the effectiveness of the drug in improving symptoms of the disease. The efficacy of Zoloft is proved by its ability to clear tightness of chest and shortness of breath (Stahl, 2013; Strawn et al., 2012). Additional symptoms that the drug has been able to eliminate as anticipated include feelings of nervousness as well as those of fear and worries about work. The absence of generalized anxiety disorder is evidenced by an extremely low value of HAM-A score (Hamilton, 1959).

Impacts of Ethical Considerations on the Treatment Plan and Communication

            Effective treatment of the current patient greatly depends on the clinician’s understanding of the impacts of ethical considerations on the treatment plan and communication process. For instance, the clinician has applied the principles of beneficence and non-maleficence to select the most appropriate pharmacological agents for the client. From the patient’s subjective data, it is evident that he sometimes sees the need to run away whenever he develops feelings of impending doom (Laureate Education, 2016b). Based on this data, the healthcare professional may state the presence of post-traumatic stress disorder (PTSD) that occurs together with generalized anxiety disorder. However, using the principles of beneficence, the clinician has chosen to treat generalized anxiety disorder using Zoloft as this will maximize benefits for the client by eliminating symptoms that resemble those of PTSD (Kavan, Elsasser, & Barone, 2009; Lupi et al., 2014). Additionally, by basing his or her reasoning on the principle of non-maleficence, the clinician has decided not to use Imipramine in order to avoid the side effects that are associated with the drug, thereby minimizing harm for the patient (Stahl, 2013).

Conclusion

            In summary, clinicians must choose the right therapeutic approach to treat patients who have been diagnosed with a generalized anxiety disorder. The effectiveness of drug therapy for anxiety relies on the appropriate selection of pharmacological agents. A patient’s situation and disease severity at the time of visit will determine the drug dosages that will be administered to the patient. In addition, it is important to note that a given drug and its dosage should be maintained if it is yielding the expected results. Moreover, clinician’s must understand the impacts of ethical considerations on the treatment plan and communication process in order to promote quick recovery for their clients with generalized anxiety disorder.

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References: NURS 6640 Assessing and Treating Clients with Anxiety Disorders Walden University Sample Nursing Paper

Ciraulo, D. A., & Shader, R. I. (2014). Pharmacotherapy of depression. Totowa, NJ: Springer Publishing Company

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi: 10.1037/t02824-0

Kavan, M., Elsasser, G., & Barone, E. (2009). Generalized anxiety disorder: Practical assessment and management. American Family Physician, 79(9), 785-791.

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 1(1), doi:10.1155/2014/537306

Munir, S., & Hughes, J. (2017). Anxiety, generalized anxiety disorder (GAD). Treasure Island, FL: StatPearls Publishing.

Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913

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