Assessing and Treating Clients With Anxiety Disorders

Assessing and Treating Clients With Anxiety Disorders

The Assignment Examine the Case Study below: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Decision #1 • Which decision did you select? • Why did you select this decision? Support your response with evidence and references to the Learning Resources. Assessing and Treating Clients With Anxiety Disorders • 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.

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• 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. Finally: Assessing and Treating Clients With Anxiety Disorders1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen). Case Study: A Middle-Age Caucasian Man 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.Assessing and Treating Clients With Anxiety Disorders 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. 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/t02824-0 Decisions Made and Outcomes (Needed to formulate the paper) Choices for Decision 1 Select what the PMHNP should do: 1. Begin Zoloft 50 mg po daily 2. Begin Imipramine 25 mg po BID 3. Begin Buspirone 10 mg po BID My decision: I chose to begin Zoloft 50 mg po daily. Outcome: RESULTS OF DECISION POINT ONE: Client returns to clinic in four weeks and 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) Choices for Decision 2 Select what the PMHNP should do: 1. Increase dose to 75 mg orally daily 2. Increase dose to 100 mg orally daily 3. No change in drug/dose at this time My decision: I chose to increase dose to 75 mg orally daily. Outcome: RESULTS OF DECISION POINT TWO: Client returns to clinic in four weeks and 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) Assessing and Treating Clients With Anxiety Disorders Choices for Decision 3 Decision Point Three Select what the PMHNP should do next: 1. Maintain current dose 2. Increase current dose of medication to 100 mg orally daily 3. Add augmentation agent such as BuSpar (buspirone) My decision: I choose to educate client regarding diet/weight loss and continue client on the same drug/dose Outcome: 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. ***Write on each decision and answer the questions following the decision. Make sure that this paper has at least 5 References. Please use in-text citations for each section of each decision. Don\’t forget the ethical considerations for this assignment. Make it a section by itself.*** ***Also please make sure when looking at the ethical consideration for this assignment that you look at how Zoloft which is a SSRI is used in Caucasian people (males). What considerations does the drugs have with this ethnicity Assessing and Treating Clients With Anxiety Disorders.

Reasons for the decision

Ordinarily, the patient should not be subjected to higher levels of dosage but should be given other medications that are less aggressive and which are meant to see them progress. Therefore, this reason was settled on to see to it that the patient took the Zoloft 50 mg PO orally on a daily basis to have the anxiety reduced to manageable levels. It is at this level that it is possible for the physicians to observe the drug reactions and the patient responses and be able to determine the outcome. Through this, they can make an informed decision on what to determine next (DiTomasso, & Gosch, 2007).

Anticipated outcomes

By this choice, I was hoping to achieve reduced level of anxiety in the patient given the fact that the prescribed medication acts by slowing the absorption rates of the serotonin substance. Therefore, at least two symptoms of the condition would be reduced. The drug dosage in the amount determined is recommended for the problem. I hoped that the problem be solved to a considerable level.

Explained difference

The expectations were ripe. This was not however, correspondent to the outcome. At the time of the visit, there were notable changes in the patient. The changes were marked by reduced chest pains, tightness and breath. The patient was also less anxious compared to the time of admission (Feinstein, & Eden, 2011). At the onset of the drug administration, the patient registered a HAM-A score of 8 reductions from the initial reading of 26 (Hamilton, 1959). This serves as a referral to the patient and the physician to the following decision that highly depends on the outcomes, decision 1. Assessing and Treating Clients With Anxiety Disorders

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Decision 2: Increase dose to 75 mg orally daily.

 

Reason for the choice

Decision two serves as the most effective for the patient in that the results from decision one do not necessitate the need for another intervention. The drug had a positive effect on the anxiety disorder of the patient (DiTomasso, & Gosch, 2007). The decision to increase the dosage was to ensure that some symptoms of the client’s anxiety will be reduced and that the HAM-A scores would be reduced.

Anticipated outcomes

The past dosage resulted in an improvement on the side of the client in terms of the symptoms exhibited such as breathe shortage and chest complications. Other complications arising from the condition would be corrected to normal levels Assessing and Treating Clients With Anxiety Disorders.

Differences in Outcome

The changes registered from the outcome of administering this medication were rather unexpected. Four weeks after the client paid a visit to the physician; there were no chest tightness and shortage of breath. His anxieties on the job issue were also at reduced levels. The remarkable outcome of the medication was drawn from the HAM-A scale that had significantly reduced to ten from the previous eighteen (DiTomasso, & Gosch, 2007).
Decision 3

The third decision is a unique one as it makes use of the special approaches such as choosing to educate the patients on such pertinent issues as what importance, working on their weight and balancing diet among others while working on the same drug would serve them.

 

Reasons of the choice

When a prescribe medication does not bear any positive changes on a client, then it is in the best interest of the patient to be subjected to new medications. Sometimes it becomes useful to alter dosage from previous prescriptions. In this case however, there are no such desired changes. This is rooted to make the client have an understanding of the behavioral patterns of weight loss and diet and why they should not abandon their medications on the mere fact that they lost weight (Pine, Ressler, & Rothbaum, 2015)Assessing and Treating Clients With Anxiety Disorders.

Anticipated results

This is vital condition to the sense that if at all there were other medical interventions to cater for the overweight issues, then no doubt the side effects would be pronounced and the issue would be more complex. This leaves the patient with only once condition, to stick to their medications and diets unabated as this will ensure that they get the desired weight loss in a natural manner (Aschenbrenner, & Venable, 2009)Assessing and Treating Clients With Anxiety Disorders.

Differences in results

The intimation by the PMHNP that the clients are not likely to cope with the aspects of constant dosage quantity of Zoloft is not an effective way that would help reduce weight. The patient has to stick to his prescribed medication religiously. This is premised on the fact that an increased dosage would definitely alter the body weight of the patient and this can be a crisis on its entirety. Diet would therefore not help cut weight but a desired medication (Aschenbrenner, & Venable, 2009)Assessing and Treating Clients With Anxiety Disorders.

Ethical considerations in communication with clients and in treatment plan

Appropriate Prescriptions for individual levels of disorders

In bipolar disorder treatment, ethical considerations are important in that they help the physicians in administering the most appropriate medications to the case of anxiety disorder at hand, be they mild, moderate or even severe conditions (Aschenbrenner, & Venable, 2009).

Proper administration of medication

This aspect reminds every physician that they ought to make the right decisions while administering drugs to ensure that the right instructions are given and followed (Feinstein, & Eden, 2011). For instance, patients may have to take their medication with food or even be subjected to taper dosage when they discontinue the drugs. It could also be a case of changed type of medication in question, or if they have to shift from the previously prescribed medication Assessing and Treating Clients With Anxiety Disorders.

Dosage modifications

A patient requiring having their prescribed medication changed is an ethical consideration and is useful in that it helps physicians by providing a guide on how to reduce the dosages on the basis of the present condition (Aschenbrenner, & Venable, 2009)Assessing and Treating Clients With Anxiety Disorders.

Patient Education

Physicians also provide education to patients on what to do or expect when under certain medications. It is also through the same studies that nurses are able to highlight to the patients the possible side effects of the drugs administered (Feinstein, & Eden, 2011). This education also helps patients in understanding the need to stick to one medication as prescribed by the physician.

References

Aschenbrenner, D. S., & Venable, S. J. (2009). Drug therapy in nursing. Lippincott Williams & Wilkins.

DiTomasso, R. A., & Gosch, E. A. (Eds.). (2007). Anxiety disorders: a practitioner’s guide to comparative treatments. Springer Publishing Company.

Feinstein, D., & Eden, D. (2011). Ethics handbook for energy healing practitioners. Elite Books.

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

Pine, D., Ressler, K., & Rothbaum, B. O. (Eds.). (2015). Anxiety disorders: translational perspectives on diagnosis and treatment. Primer on.

Wurtzel, E. (1994). Prozac nation: Young and depressed in America. Penguin Assessing and Treating Clients With Anxiety Disorders.