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Assessing and Treating Clients with Anxiety Disorders Essay Assignment Paper

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Assessing and Treating Clients with Anxiety Disorders Essay Assignment Paper

Week 5 – NURS 6630 posttraumatic stress disorder (PTSD)

For individuals suffering from 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 mental health 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 clients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies

Assignment:  Assessing and Treating Clients 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 clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.

Learning Objectives

Students will:

–Assess client factors and history to develop personalized plans of anxiolytic therapy for clients

–Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy

–Evaluate efficacy of treatment plans

–Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan

The Decision Tree Assignment

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 client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

Generalized Anxiety Disorder

Middle-Aged White Male with Anxiety

Middle aged male

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.

 

Assessing and Treating Clients with Anxiety Disorders Essay Assignment Paper

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 clear. 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

Select what the PMHNP should do:

Begin Zoloft 50 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po B

INSTRUCTORS COMMENT

At each decision point stop to complete the following:

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest.  I do not need you to tell me the treatment options available to you – I am very familiar with the cases.  Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).

 

Assessing and Treating Clients with Anxiety Disorders Essay Assignment Paper

Decision #1

–Which decision did you select?

–Why did you select this decision? Support your response with evidence (clinically relevant and patient specific) and references to the Learning Resources.  Why did you not select the other treatments?  Defend your choice like you are in the courtroom for a medical malpractice case!

–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 (clinically relevant and patient specific) and references to the Learning Resources. Why did you not select the other treatments?  Defend your choice like you are in the courtroom for a medical malpractice case!

–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?

 

Assessing and Treating Clients with Anxiety Disorders Essay Assignment Paper

Decision #3

Why did you select this decision? Support your response with evidence (clinically relevant and patient specific) references to the Learning Resources. Why did you not select the other treatments?  Defend your choice like you are in the courtroom for a medical malpractice case!

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.

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.

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.

 

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