Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment
Introduction
A PMHNP (psychiatric-mental health nurse practitioner) is a professional who is responsible for providing mental health care to patients and their families in a range of settings. A patient and their family may require the PMHNP to make a number of decisions while delivering services to them. These decisions are usually designed to improve the condition of the patient and their family. Also important to the PMHNP is ensuring that their patients receive safe, competent, and ethical care. For example, there are three medical decisions that a PMHNP should make for a middle-aged white male who is showing signs of Generalized Anxiety Disorder (GAD). These decisions will be described in this paper Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment.
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Decision 1
Provide the patient with the finest start-up medication that will improve his conditions by having the desired influence on Generalized Anxiety Disorder (GAD) symptoms. This is the first step in the process of treating GAD. Patients suffering from anxiety disorders will benefit from this decision, which is primarily intended for the administration of first-line medication. As a result, because the primary symptoms of GAD that the patient is experiencing, which include chest tightness and shortness of breath, as well as a sense of impending doom, can be addressed with one type of medication, Paxil 10 mg administered orally daily, the patient will be prescribed this medication.
Reasons for the above decision
The authors of Allan, McCormack, and Virani (2011) state that it is critical to begin any drug treatment with low doses to reduce the likelihood of a patient experiencing side effects from the medication. In most cases, the patient will not be exposed to a greater number of prescriptions for oral dosages right away but will instead be exposed to other pharmaceuticals intended for progressive management. As a result, low-dose Paxil 10 mg was provided, which is the recommended dosage for a patient suffering from generalized anxiety disorder (GAD) (Khalsa, Bystritsky, Cameron & Schiffman, 2013). Because of the modest doses that have been advised, the drug is often taken orally, and the patient will be needed to take it daily. Additionally, this is where physicians can assess drug reactions and outcomes in order to decide on another course of action if the first one does not materialize Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment.
Anticipated outcome
According to Khalsa, Bystritsky, Cameron, and Schiffman (2013), Paxil is critical in regulating serotonergic pathways and, as a result, has a positive impact on the symptoms of generalized anxiety disorder. As a result, the predicted benefits include the patient no longer experiencing tightness in the chest or shortness of breath, a reduction in anxieties, as well as a reduction in the HAM-A score.
Difference between what was expected and the results of the decision.
A number of factors contributed to the similarity between the expected and actual results of the decision. First, after four weeks, the patient no longer had any of the symptoms of GAD that she had been experiencing, which included chest tightness and shortness of breath. Aside from that, the patient indicated that he had seen a drop in his anxiety about work during the previous 4 or 5 days and that his HAM-A score had decreased to 18 from 20 (partial response).
Decision 2
As stated by Farach et al. (2012), the second intervention, which is, in this case, the second decision, is critical in improving the conditions of a patient because the practitioner will be cognizant of the outcomes realized from the first intervention, allowing him to make a more effective decision in the end. Therefore, the second decision will be to increase the dosage of Paxil, which will be delivered orally once a day, from 10 mg to 20 mg per day. This is unquestionably the most successful therapy technique for the patient because further symptoms will be lessened while other symptoms will be permanently eliminated.
Reason for decision 2
Because Paxil 10 mg delivered orally once a day was beneficial in alleviating the patient’s symptoms, I did not see the need to change the medicine. This was the primary reason for increasing the amount of medication provided when making the original decision. Nonetheless, since the patient was still having symptoms of GAD, the dosage was increased from 10 mg to 20 mg per day.
Anticipated outcomes
Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment According to Blanchfield (2007), increasing the dosage of a beneficial medicine enhances the likelihood of a positive response. As a result, the increase in the dosage to 20 mg was meant to alleviate further the symptoms of GAD that the patient was experiencing, as well as to lower the HAM-A rating.
Difference between what was expected and the results of the decision.
The projected outcomes of the second option, like the first, were comparable to the results of the decisions for a variety of reasons. First, the patient reported an even greater reduction in his symptoms after another four weeks, and his HAM-A score had dropped to ten. This was a 61 percent reduction in symptoms, indicating that the same drug should be continued.
Decision 3
In light of the significant reduction in GAD symptoms that the patient was experiencing, the current Paxil dosage of 20 mg, which will be delivered orally once a day, was decided to be maintained. The medicine will be kept in place for a total of 12 weeks in order to conduct a thorough study of its effects on the patient. First, however, it is necessary to discuss with the patient whether the dosage should be increased in order to shorten the amount of time he will be required to take the drug. During the discussion, the patient will be made aware of the greater likelihood of experiencing side effects with Paxil.
Reason for decision 3
There are several reasons for keeping the current dosage of Paxil in place, the most important of which is that not only is the patient experiencing an excellent response to the medication as evidenced by the significant reduction in symptoms (more than 50% reduction in symptoms), but he is also not experiencing any side effects from the medication. Also, because the patient is responding to the medicine and there is nothing in the patient’s situation that indicates the necessity for an augmentation agent, there is no reason to add an augmentation agent.
Anticipated outcomes
The decision to maintain the existing Paxil dosage of 20 mg was made with the goal of not only minimizing the symptoms of GAD even further but also ensuring that the patient does not wind up experiencing any of the medication’s side effects.
Difference between what was expected and the results of the decision.
The projected outcomes of the third decision were similar to the outcomes of the first and second decisions. In addition, symptoms of a generalized anxiety disorder (GAD) were reported to be completely gone after twelve weeks of the patient.
Ethical considerations that impacted the treatment plan and communication with the patient.
In making treatment decisions and communicating with the patient, we took into account an ethical factor relating to the necessity of respecting the patient’s right to autonomy (Rpnas, 2019). As a result, because it ultimately affects the patient’s life, all decisions had to be based on what he wanted. For example, a patient might need to know that raising his medicine dosage could improve his condition more quickly, allowing him to spend less time on medication overall, but that he might also end up suffering from one or more negative effects as a result.
Conclusion
In conclusion, Paxil, which is taken orally, was the most effective medicine for the patient who was suffering from a generalized anxiety disorder. However, to avoid the patient being exposed to the negative effects of Paxil, it was necessary to prescribe low doses that were gradually increased over a period of time. Furthermore, to ensure that all decisions were made ethically, it was necessary to discuss with the patient the risks and benefits of every possible alternative treatment option. As a result of my efforts, the patient’s autonomy was recognized and respected. The treatment that was provided as a result was not only effective but also ethical.
References
Blanchefield, C. (2007). Increase the Dose or Give it a Few More Weeks. SSRN Electronic Journal. DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922351/
McCormack, J., Allan, G., & Virani, A. (2011). Is bigger better? An argument for very low starting doses. Canadian Medical Association Journal, 183(1), 65-69. DOI: 10.1503/cmaj.091481
Rpnas. (2019). Code of Ethics | RPNAS. Retrieved 28 December 2019, from https://www.rpnas.com/about/code-of-ethics/
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. P & T: a Peer-Reviewed Journal for Formulary Management, 38, 1, 30-57.
Farach, F. J., Pruitt, L. D., Jun, J. J., Jerud, A. B., Zoellner, L. A., & Roy-Byrne, P. P. (2012). Pharmacological treatment of anxiety disorders: Current treatments and future directions. Journal of Anxiety Disorders, 26, 8, 833-843 Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment.
Assignment: 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.
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. Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment
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. Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment
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.
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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.
| Excellent
Point range: 90–100 |
Good
Point range: 80–89 |
Fair
Point range: 70–79 |
Poor
Point range: 0–69 |
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|---|---|---|---|---|
| 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. |
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. |
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. |
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
| Decision #1 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected. Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| Decision #2 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| Decision #3 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| 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. |
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. |
12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. |
11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. |
0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing. |
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. |
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. |
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. |
| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
|
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
|
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
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0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
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| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
|
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
|
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
|
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
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| Total Points: 100 |
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Name: NURS_6630_Week6_Assignment_Rubric
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 Assessing and Treating Patients With Anxiety Disorders : Middle-Aged Caucasian Man Case Study Assignment.
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 One
Select what you should do:
Begin Paxil 10 mg po daily
Begin Imipramine 25 mg po BID
Begin Buspirone 10 mg po BI