The Treatment for Anxiety Essay Assignment

The Treatment for Anxiety Essay Assignment

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.

At each decision point stop to complete the following The Treatment for Anxiety Essay Assignment:

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?The Treatment for Anxiety Essay Assignment
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?

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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.The Treatment for Anxiety Essay Assignment
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.

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.The Treatment for Anxiety Essay Assignment. 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.The Treatment for Anxiety Essay Assignment

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.The Treatment for Anxiety Essay Assignment 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

 

Select what the PMHNP should do;The Treatment for Anxiety Essay Assignment

Begin Zoloft 50mg PO daily

Begin imipramine 25mg po BID

Begin Buspirone 10mg PO BID

 

Use the Decision tree below;

 

Decision Point One

Begin buspirone 10mg po BID

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client reports slight decrease in symptoms
  • Client states that he still feels very anxious
  • HAM-A score decreased from 26 to 23

Decision Point Two

The Treatment for Anxiety Essay Assignment

Increase buspirone to 20 mg orally TID

 

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client reports nausea, dizziness, nervousness, headaches, and dry mouth
  • HAM-A score reveals no change and he reports that he still feels anxious

Decision Point Three

 

Discontinue buspirone and begin Zoloft 50 mg orally daily

 

Guidance to Student
It is apparent that the higher dose of buspirone was successful only in causing side effects and offered minimal therapeutic benefit to the client.The Treatment for Anxiety Essay Assignment Decreasing buspirone to 15 mg orally TID may alleviate some of the side effects, but would also likely result in decreased therapeutic effect (which in this case was minimal). The goal of therapy is to treat the client’s anxiety- not just alleviate side effects.

It would not be appropriate to explain to the client that these are “normal side effects” and continue the same dose with a plan to reassess in 4 weeks. Recall that the onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work at all. The Treatment for Anxiety Essay Assignment

The buspirone at this point meets the criteria for treatment failure (as it failed to result in at least a 25% decrease in symptoms), thus it would be appropriate to discontinue and begin a first line agent such as an SSIR (like Zoloft 50 mg orally daily) at this point.

 Guidelines

In summary: What needs to be in your essay.

Introduction regarding disease state
High-level summary of patient case
Purpose of the essay statement

Decision 1
What options were listed
What option did you choose?
Why did you select that option?
Why didn’t you select the other two options?
What was your goal of treatment
Was the outcome what you expected?The Treatment for Anxiety Essay Assignment Why?

Decision 2
What options were listed
What option did you choose?
Why did you select that option?
Why didn’t you select the other two options?
What was your goal of treatment
Was the outcome what you expected?The Treatment for Anxiety Essay Assignment Why?

Decision 3
What options were listed
What option did you choose?
Why did you select that option?
Why didn’t you select the other two options?
What was your goal of treatment
Was the outcome what you expected? Why?

Conclusion with Ethical considerations.The Treatment for Anxiety Essay Assignment