NURS 6630 Assessing and Treating Patients With Anxiety Disorders

NURS 6630 Assessing and Treating Patients With Anxiety Disorders

A Sample Answer For the Assignment: NURS 6630 Assessing and Treating Patients With Anxiety Disorders

Anxiety disorders are a group of illnesses with a variety of symptoms that are related to one another. One of their most common symptoms is persistent, excessive worry, particularly in non-threatening situations. Among patients, physical and emotional issues are frequent. Typically, a patient’s bodily symptoms include jitteriness and a rapid heartbeat. There are numerous varieties of anxiety disorders, including social anxiety disorder, agoraphobia, generalized anxiety disorder, and panic disorder (Bandelow et al, .2022).

In this essay, a 46-year-old Caucasian man with anxiety is the subject. He exhibits signs of an anxiety illness, including chest pain, tightness, and shortness of breath. There are no signs of a myocardial infarction, according to the results of the ER and ECK tests, which are both normal. It received a 26 rating. The patient admits that he drinks to put his mind off of some of his work-related worries. In addition, he consumes three to four beers daily.

After the data has been collected, a physical examination of the patient is necessary to confirm that the right criteria have been identified to direct the selection of drugs that will make the patient feel better. Later, the generalized anxiety disorder was identified. Treatment plans were chosen in three different approaches, all of which were based on the pharmacodynamics and pharmacokinetic processes of the patients. The ethical issues and recommendations that will impact patient care will also be discussed (Crocq 2022).

The patient’s medical history, which shows that the patient has been exposed to various medications, is the first thing to be taken into account. The client has been adhering to a low-sodium diet in order to manage his moderate hypertension. The fact that the patient’s tonsils were taken from him when he was a child suggests that he was using an anti-inflammatory drug. The patient affirms that following the surgery, he underwent no additional adverse testing.

The patient, on the other hand, is alert and clearly oriented to place, time, and people, demonstrating that his judgment and understanding are normal. The patient denies hearing voices and having paranoid episodes. He also denies having homicidal or suicidal thoughts. Thus, quick self-medication is necessary to help the patient recover from his condition (Fung et al, .2018).

Decision one

Start Taking Lexapro 10mg OD orally

After gathering all the information regarding the medical condition, the first pharmaceutical choice that may be made is to recommend Lexapro 10 mg taken orally once daily. The decision to accept the patient to the Lexapro 10 mg treatment program was based on the patient’s final diagnosis.

Selective Serotonin Reuptake Inhibitor Lexapro is used to treat post-traumatic stress, depression, panic attacks, and generalized anxiety disorder that the patient may be diagnosed with. The severity of the anxiety disorder must be determined; a score of 26 on the scale indicates that the patient’s condition has not gotten worse (Bandelow et al, .2022).

In order to assess the patient’s development over time, it is recommended to start him on the oral medication Lexapro 10 mg. Other drugs that are available include buspirone 10 mg PO bid and imipramine 25 mg PO bid. However, since the medications must be used in addition to other forms of therapy in order to be effective, they might not be in the best interests of the patients’ advancement.

Lexapro 10 mg would therefore be the ideal choice for any patient with a moderate form of generalized anxiety disorder, like the patient in question. The patient should return to the hospital for a checkup after taking the medication for one month. Making a decision was done with the intention of gauging the patient’s improved disposition and his excitement for carrying out daily chores, notably at work (Andrews et al, .2018).

Decision Point Two

Raise the dosage to 20 mg orally every day from the current level.

After four weeks, the patient must visit the clinic again to assess his development. The results show that the drug has greatly improved the patient’s symptoms. Moreover, the HAM-A score decreased from 26 to 18. The drug proved beneficial, as evidenced by the patient’s decreased concern about his employment.

Given the aforementioned findings, it is obvious that the previous medication shouldn’t be stopped. Instead, for an additional four weeks, the amount can be gradually increased. Thereafter, the patient should go back to the emergency hospital for a second assessment (Yatham et al, .2018).

The decision to increase the patient’s current Lexapro dosage to 20 mg was taken to determine whether the patient might completely recover from his illness and resume his regular activities. As a result, increasing the dosage is preferable to the other two possibilities that are currently being evaluated. Second, the unit has a 40 mg Lexapro dosage increase capability. In contrast, the rise would be excessive, making it impossible for healthcare providers to bring about a progressive adjustment in the patient’s life.

For instance, the unit might keep taking Lexapro at the same dose for a further four weeks and get the same results as the first diagnosis. The doctor aims to gradually improve the patient’s condition by raising the dose; this improvement may be much greater than with the previous prescription. But, because the client has not fully recovered, he may still fail to consume the recommended amount, which could have an influence on the care plan at the designated time (Yatham et al, .2018).

Decision Point Three

Continue administering the present dose

After taking the patient medication for four weeks, the patient shows a substantial improvement and is extremely happy to return to the clinic. The patient’s anxiety level reduced to a 10 on the HAM-A scale, and the additional dosage caused his prior symptoms to fade more. This shows that the client would benefit most from taking Lexapro 10 mg daily orally to treat the generalized anxiety disorder that was identified during his initial consultation.

Although the patient has gone through several changes, there is no need to change his current medication. This option implies that the patient will fully recover from his condition if his present prescription is kept up for an additional four weeks (Bandelow et al, 2018).

It might not be beneficial to switch the client from the current prescription to another possible option, such as starting them on an enhancing drug like buspirone. At this point, it’s important to keep in mind that the client hasn’t disclosed any further symptoms he previously experienced. Instead, lowering anxiety levels even further is the aim.

Due to the larger doses that the patient will need to take, the other two medications could end up making the situation worse. In order to ensure that the anxiety level drops even further, as was the case in the third diagnostic when Lexapro dosage was increased to 20 mg taken orally daily, the current medication must be continued for an additional 4 weeks.

Nonetheless, the healthcare professional must proceed with considerable caution before allowing the patient to continue with his current prescription. The client may quit taking the medication because he thinks his illness has improved, so this warning is given. The patient might not want to take the prescribed meds on a daily basis. In order to prevent the treatment plan from being jeopardized, it is crucial to emphasize to the client the necessity to finish the dose even after he has recovered (Latas et al, .2018).

Conclusion

In conclusion, an evaluation revealed that the three drugs mentioned above are the best options for treating the client’s generalized anxiety disorder or bipolar disorder, depending on the assessment. As a result, before recommending any particular medications, mental health professionals must exercise prudence. Instead, the patient’s symptoms and the severity of the anxiety disorder as determined by the HAM-A scale should lead the therapy plan.

For the first time, progressive Lexapro treatment is superior to the use of other prescription medications like imipramine and buspirone. If the patient and the healthcare provider do not interfere with the treatment plan, the Lexapro medicine will unquestionably be successful for the patient (Reddy et al, .2020).

References

Bandelow, B., Michaelis, S., & Wedekind, D. (2022). Treatment of anxiety disorders. Dialogues in clinical neuroscience. Crocq, M. A. (2022). The history of generalized anxiety       disorder as a diagnostic category. Dialogues in clinical neuroscience.

Fung, A. W. T., Lee, J. S. W., Lee, A. T. C., & Lam, L. C. W. (2018). Anxiety symptoms predicted             decline in episodic memory in cognitively healthy older adults: A 3‐year    prospective             study. International    journal of geriatric psychiatry, 33(5), 748-754.

Bandelow, B., Werner, A. M., Kopp, I., Rudolf, S., Wiltink, J., & Beutel, M. E. (2022). The  German Guidelines for the treatment of anxiety disorders: first revision. European archives of psychiatry and clinical neuroscience, 1-12.
Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O. … & Wilkins, G. (2018). Royal             Australian and New Zealand College of Psychiatrists clinical practice guidelines for the    treatment of panic disorder, social anxiety disorder and generalised anxiety    disorder. Australian & New Zealand Journal of Psychiatry, 52(12), 1109-1172

Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … & Berk,    M. (2018).Canadian Network for Mood and Anxiety Treatments (CANMAT) and      International Society for  Bipolar Disorders (ISBD) 2018 guidelines for the   management of patients with bipolar             disorder. Bipolar disorders, 20(2), 97-170.

Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. D. C., Denys, D., Dilbaz, N. … &   Zohar, J.    (2022). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress   disorders–Version 3. Part I: Anxiety  disorders. The World Journal of Biological   Psychiatry, 1-39

Latas, M., Trajković, G., Bonevski, D., Naumovska, A., Vučinić Latas, D., Bukumirić, Z., &       Starčević, V.(2018). Psychiatrists’ treatment preferences for generalized anxiety             disorder. Human Psychopharmacology: Clinical and Experimental, 33(1), e2643.

Reddy, Y. J., Sudhir, P. M., Manjula, M., Arumugham, S. S., & Narayanaswamy, J. C. (2020).    Clinical practice guidelines for cognitive-behavioral therapies in anxiety disorders and obsessive- compulsive and related disorders. Indian journal of psychiatry, 62(Suppl 2), S230.

Bipolar disorder has been a common illness in the recent past. The increase in the cases of patients suffering from this disorder has been compelling scientists to delve much into clinical and evidence-based practices that could be significant in addressing the health issue. Bipolar disorder is severe, affecting about 1 to 2% of adults.

The symptoms of this disorder range contingent on the episode type. While other patients could be showing signs and symptoms related to maniac bipolar, others might show signs related to depressive bipolar (Chen et al., 2015).

Each episode or stage defines a definite change in the action and moods of an individual. The disorder could be defined by a sudden change in the patient’s general moods, thinking, and behavior. Therefore, a patient facing these bipolar symptoms needs close monitoring for a better outcome (Van Meter et al., 2019).

PMHNP nurses should therefore be able to assess their patients comprehensively to discover the prevailing symptoms resulting from developmental or psychological issues. Therefore, the purpose of this assignment is to look into a 26-year-old female with Korean ancestry presenting symptoms of bipolar and make decisions related to medications

Introduction to the Case

The case in question is about a 26-year-old female of Korean lineage. The client presented herself to the clinic after 21-day hospitalization with a condition of acute mania. bipolar 1 disorder was later confirmed. The patient reported a fantastic mood and a five-hour sleep at night. The patient’s hospital records showed good health.

The patient had genetic testing that showed that she was CYP2D6*10 positive. The patient is an alert and oriented person. She had rapid speech and denied visual or auditory hallucinations. The patient refutes being suicidal or murderous.  A score of twenty two was shown on the YMRS

Decision #1

The selected decision

The first decision made on the patient was to begin the treatment with Risperdal 2mg taken orally in the morning and evening. Risperdal is one of the best medications for treating severe bipolar disorder. This drug belongs to the chemical class of benzisoxazole derivatives, which is an antipsychotic (Nestsiarovich et al., 2021). The FDA has approved this drug, which helps patients think clearly and perform their daily activities normally. These features of Risperdal make it effective in treating bipolar disorder.

Why the Other Two Decisions were Not Selected

The other two decisions were to use lithium 300mg orally and Seroquel XR 300mg orally at HS. The patient had been introduced to lithium 300mg, and it did not change her condition. Again, Seroquel XR 300mg could not be used because of the immense side effects that would affect the patient’s condition because she is of Asian origin. I selected Risperdal because it has been effective in treating schizophrenia, and evidence proves that its works effectively with the brain by enabling the brain to stabilize.

For instance, Risperdal restabilizes serotonin and dopamine levels, further improving mood, thinking, and behavior (Hodkinson et al., 2021). While the drug belongs to the class of drugs called antipsychotics, it has been effective in treating patients diagnosed with bipolar disorder and irritability. The patient shows the severe effect of bipolar disorder that would first need a strong to stabilize her dopamine levels.

How Ethical Considerations May Impact the Treatment Plan

While the treatment plan focuses on improving the patient’s condition, the choice of the treatment plan is affected by ethical principles (American Psychiatric Association, 2018). For example, autonomy and anonymity would affect the treatment plan in this case. Healthcare professionals must do everything in their power to change the patient’s condition.

Decision #2

The decision at this point is to lower the dosage for Risperdal to 1mg HS.

Reasons for Picking the Decision

When the she came for her second appointment after four weeks, she reported an improvement except for the increased drowsiness as side effects. In my second option, I will continue using the Risperdal drug but lower its dosage to 1mg because the expected outcome was not met in the first treatment.

The patient had reported drowsiness the first day because 2mg was a high dose for her. Another reason to prompt my use of this drug is that it already showed positive outcomes as the patient confirmed improvement of her symptoms (Sun et al., 2019). The reduction of the Risperdal dosage from 2mg to 1mg will be under close examination to determine its effect on the patient.

Why the Other Two Decisions were Not Selected

In managing Bipolar, drowsiness is a symptom of increased dosage of Risperdal. Therefore, changing the medication to lithium 300mg orally or Seroquel XR 300mg could affect the original expectation. The expected outcome from Risperdal 1mg administered orally in the evening was improved outcomes related to the medication being toxic and the patient being drowsy, thus fewer symptoms.

The variation between the expected and actual outcome within the four weeks shows that the patient had reduced symptoms of bipolar. These results indicated that giving the patient Risperdal 1mg once a day positively impacted the patient, and she was adjusting to the medication positively (Sun et al., 2019). The patient did not receive any severe side effects implying that the expected outcome and expected results were the same.

How Ethical Considerations May Impact the Treatment Plan

One of the ethical concerns, in this case, is informed consent because the patient already has the stability of the mind and can think effectively (American Psychiatric Association, 2018). The patient would need to be involved in this second decision would align with the continuation of the dosage and close monitoring of the patient in the next four weeks.

Decision #3

The decision at this point is to continue giving the patient Risperdal 1mg orally HS.

Reasons for Selecting this Decision

This choice was chosen because the desired and actual outcomes were the same. Changing the current medication on the patient would have an adverse effect on her recovery and affect the journey of treatment that the patient had been undergoing (Hodkinson et al., 2021).

For instance, changing the current dosage may destabilize the healing process. The patient is still under close assessment to examine changes she might exhibit in her process or treatment journey until the next day of the scheduled appointment.

Why the Other Two Decisions were Not Selected

The patient showed positive improvement, and there was no urgent need to change the treatment plan. The patient is expected to increase her mental stability and reduce bipolar symptoms with a single dose of Risperdal of 1mg at night. The patient is anticipated to have improved her sleeping cycle at night and developed interaction between her family and friends (Hodkinson et al., 2021). Again, the patient is expected to start concentrating on matters concerning her work.

What I Expect to Achieve

The therapeutic decision is positive for the patient as expected. This change implies that there is no significant difference between the expected and actual outcomes. The treatment offered aligns with the standard way of treating a Korean descendant, starting from the procedural treatment of this disorder to the daily maintenance of the patient (American Psychiatric Association, 2018). Her ethnic origin can also explain the side effect of drowsiness. The patient will continue with the same medication until the next scheduled appointment.

How Ethical Considerations May Impact the Treatment Plan

Ethics demands that an individual consents to treatment prior to its administration. However, the law of offering the patient a chance to decide on their treatment is overlooked when facing serious mental illness (American Psychiatric Association, 2018).

This is the same decision I applied to this patient because she could not make rational life decisions at the time of her clinic administration. A PMNHP faced with the ethical conflict of helping a mentally patient achieve the desired outcome needs to depend on their autonomy, which is the choice of the healthcare workers.

Conclusion

Treating and assessing patients with bipolar require good healthcare experience and a decision-making process that would not affect the overall condition of the patient. The life of a bipolar patient lies in the hands of the healthcare worker as they are ethically mandated to make decisions that would lead to a better outcome for the patient. The psychiatric nurses need to assess during admission and any other readmission or appointment they give such patients.

The rehabilitation plan also needs to be in place because functioning is a complex task demanding to improve the patient’s condition. While the clinical approach is important in stabilizing the patient, full recovery to normal life can be achieved from effective planning of psychoeducation on the illness. Various drugs are available for treating bipolar, but healthcare professionals need to carefully select the medication that would bring a positive outcome to the patient.

The patient’s genetics is also significant in designing the treatment plan for bipolar patients. Genetics affects issues like drug absorption, excretion, metabolism, and distribution. In the case study, the women of Korean origin with a positive CYP2D6 will show certain side effects that cannot be seen in a patient who is CYP2D6 negative. Again, the safety and well-being of patients is a paramount concerns of healthcare professionals. Thus, they must apply measures that would positively change the condition of patients.

References

Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype & affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype & activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

American Psychiatric Association. (2018). Diagnostic and statistical manuals of mental disorders (6th ed.). https://doi.org/10.1176/appi.books.9780890425596.

Hodkinson, A., Heneghan, C., Mahtani, K. R., Kontopantelis, E., & Panagioti, M. (2021). Benefits and harms of Risperidone and Paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports. BMC medicine, 19(1), 1-15. https://doi.org/10.1186/s12916-021-02062-w

Nestsiarovich, A., Gaudiot, C. E., Baldessarini, R. J., Vieta, E., Zhu, Y., & Tohen, M. (2021). Preventing new episodes of bipolar disorder in adults: systematic review and meta-analysis of randomized controlled trials. European Neuropsychopharmacology. https://doi.org/10.1016/j.euroneuro.2021.08.264

Sun, A. Y., Woods, S., Findling, R. L., & Stepanova, E. (2019). Safety considerations in the psychopharmacology of pediatric bipolar disorder. Expert Opinion on Drug Safety, 18(9), 777-794. https://doi.org/10.1080/14740338.2019.1637416

Van Meter, A., Moreira, A. L. R., & Youngstrom, E. (2019). Updated meta-analysis of epidemiologic studies of pediatric bipolar disorder. The Journal of Clinical Psychiatry, 80(3), 21938. https://doi.org/10.1016 21938

The case highlights a 46-year-old white male presenting with chest tightness, shortness of breath and feeling of impending doom. The patient has a history of mild hypertension and tonsillectomy, which has been accompanied by unremarkable medical history.

The patient cites occasional shortness of breath, chest tightness, feelings of impending doom and the need to ‘escape’ or ‘run’ from one place. He confesses using ETOH to combat worries about work since the management at his place of work is harsh, and he fears for his job. The patient’s symptoms are characteristic of generalized anxiety disorder.

Anxiety can be a normal part of life, with concerns such as health, family challenges and money temporarily dominating individual experiences. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder characterized by nightmares, flashbacks, and intrusive thinking related to catastrophic events in an individual’s life (Ostacher & Cifu, 2019).

Exposure to traumatic and terrifying events triggers PTSD. It is a potentially debilitating condition that affects direct victims or witnesses of traumatic events such as accidents, natural disasters, loss of loved ones, violent assaults like rape, war and other life-threatening events.

The events can trigger an obsessive, recurrent and repetitive behavior that increases the feeling of fear, worry, helplessness, and hopelessness (Ostacher & Cifu, 2019). Nightmares, intrusive memories and flashbacks are common in individuals with past traumatic experiences increasing the risk of panic disorders.

Generalized anxiety disorders are common in adults with PTSD manifestations evident several months after the exposure to the traumatic and terrifying event. The symptoms of the anxiety disorders can be detrimental, although they subside, reducing the struggle with coping and self-care.

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.
• Refl