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(GRADED) Assessing and Treating Patients with Anxiety Disorders / NURS 6630 Week 6 Assignment: Assessing and Treating Patients With Anxiety Disorders_Examined Case Study: A Middle-Aged Caucasian Man With Anxiety

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NURS6630 Week 6 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. 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. 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) Decision Point Two No change in drug/dose at this time RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Client reports no further decreases in anxiety and is wondering if this means that the medication will not be effective for him Decision Point Three Increase drug to 75 mg po daily Guidance to Student Increasing the drug to 75 mg po daily would be a prudent next step. At 4 weeks follow up, the client already demonstrated a partial response to this medication, so it would be appropriate to increase to 75 mg po daily. Nothing indicates that augmentation would be necessary as the client has not had an adequate trial of this drug at a therapeutic dose (only a starting dose). Similarly, nothing indicates failure of SSRI therapy and there is no compelling evidence that switch to an SNRI should occur at this time.

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Assessing and Treating Patients with Anxiety Disorders



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Assessing and Treating Patients with Anxiety Disorders

Introduction

The patient is a 46-year-old white male who reports to the emergency room complaining

of shortness of breath, chest tightness, and feeling of impending doom. The patient's PCP refers

him to me, and he indicates that he has some mild hypertension that is treated with a low

sodium diet. After reviewing the patient, he is diagnosed with a generalized anxiety disorder.

The patient's Hamilton Anxiety Rating Scale (HAM-A) score of 26 is in the borderline of

moderate and high anxiety severity. He is also slightly obese, with about 15lbs. overweight. The

patient had his tonsils removed when he was eight years old but has had an unremarkable

medical history since that time. At the ER, myocardial infarction was ruled out, and his EKG

was normal. The rest of his physical exam was within normal limits.

The patient's social history predisposes him to the diagnosis of generalized anxiety

disorder. He reports that the management at his workplace is harsh, and he fears for his job. The

client is single and is attempting to take care of his aging parents in his home. To combat the

worries about work, the patient drinks three to four beers every night. He struggles with the

work-life balance since he has to put up with the pressure at work and still take care of his

parents. The symptoms have since aggravated, and the patient reports feelings of impending

doom. However, he reports that he has never been on any type of psychotropic medication. The

client is alert, oriented to person, place, time, and event, and appropriately dressed. His speech

is clear, coherent, and goal-oriented. Affect is somewhat blunted but does brighten several times

throughout the clinical interview. His HEENT assessment is normal.

Decision #1: Begin Zoloft 50 mg orally daily




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