ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

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A Sample Answer For the Assignment: ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

Title: ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

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. According to Holmes (2022), anxiety disorders are mental conditions that deteriorate the quality of life by altering the action of neurotransmitters. Individuals with anxiety disorders have elevated worry and fear.

Psychopharmacological therapy targets relieving symptoms rather than curing the disorders. The recommended medications in the management of anxiety disorders include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, beta and adrenergic medications, antihistamines and GABAergic medications (Garakani et al., 2020). The treatment decisions will reflect the drug pharmacokinetics, pharmacodynamics, and ethical considerations in using the pharmacotherapeutic approach. The paper highlights three decisions on Generalized Anxiety Disorders.

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ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630
ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

Decision One,

Which Decision did you Select?

The first-line treatment for the patient will be the first-line SSRI, oral paroxetine 10 mg daily.

Why did you select this Decision?

Anxiety disorders are managed using different pharmacological regimens. The approaches focus on alleviating the symptoms and restoring social, mental and physical wellbeing. However, SSRIs and SNRIs are recommended for the treatment of PTSD, although sertraline and paroxetine are FDA-Approved as the first-line medication for PTSD management. According to Ostacher and Cifu (2019), benzodiazepines are contraindicated in PTSD. Paxil is FDA-approved for treating anxiety disorders and PTSD and is considered the first-line pharmacotherapeutic option for anxiety disorders. Paxil is an SSRI that potentiates the serotonin action influencing the serotonergic neurotransmission (Davidson 2016). The medication restores serotonin balance, regulates mood changes, and reduces anxiety, fear, and panic attacks. Paxil has minimal anticholinergic and sedative effects and has a low cardiovascular impact. Its therapeutic window can range from 4-6 weeks and is significant in managing generalized anxiety disorder. It has less anticholinergic, adrenergic and antihistamine activity than tricyclic antidepressants.

Why did you not select the other two options provided in the exercise?

Paxil is safer and tolerable in diverse patients than other medications such as Buspirone and Imipramine, which have adverse reactions such as increased drowsiness, blurry vision, and dizziness. Besides, they are not approved for first-line treatment of anxiety and PTSD hence my choice of Paxil for anxiety treatment.

ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

What were you hoping to achieve with this Decision?

Paxil is slowly absorbed with its half-life ranging between 11 to 20 hours and attains its peak concentration within 4 to 10 hours. It works by elevating the serotonin levels, which establish a mental balance. According to Strawn (2018), Paxil can elicit minimal adverse reactions and alleviate symptoms such as fear, worry, helplessness, chest tightness, and shortness of breath. In light, I targeted alleviating the anxiety symptoms by elevating the serotonin levels.

Explain how ethical considerations may impact your treatment plan and communication with patients

Paxil has minimal adverse effects that undermine individual ethical values and treatment models. Patient safety is at the center of the pharmacological therapeutic approaches hence a key consideration in medical ethics. However, the patient is not incapacitated and capable of making individual decisions; thus, the psychiatrist needs to highlight the psychotherapeutic and pharmacotherapeutic models available and educate the patient appropriately before consenting to the treatment.

Decision Two

The first-line medication for the treatment of anxiety and PTSD is the most likely option for managing the patient. However, I would opt to retain Paxil as my second decision rather than change the medications. However, I will increase the dose from 10mg to 20mg daily to enhance the therapeutic effect.

Why did you select this decision?

The reaction response to Paxil may take long to manifest. To boost the HAM-A score, I would opt for a higher dose. Paxil is well-tolerated in the body and elicits minimum side effects (Strawn, 2018). Although the drug’s reaction is slow, it attains its therapeutic effect after a significantly more longer period. Therefore, increasing the dose can immediately impact mood and anxiety symptoms. According to Slee (2022), using a higher SSRIs dose can elevate serotonin levels in the brain and enhance the treatment outcome. The client’s compliance with the treatment can HAM-A score and attain best results.

Why did you not select other options in this exercise?

The anxiety medications exhibit diverse adverse effects. However, Paxil is well tolerated, with minimal side effects reported. In light, rather than changing to another first-line SSRIs with a similar pharmacokinetic and therapeutic effects, I would rather increase the dose. Besides, it is recommended as the best first-line treatment for anxiety disorders and PTSD. According to Javed and Fountoulakis (2018), Paxil significantly reduces the symptoms more than other medications such as imipramine. Therefore, I did not see the need to change the medication rather than maintain the patient on a higher dose of Paxil.

What were you hoping to achieve by making this decision?

Although the medication might take time for the client to realize a significant decline in the clinical manifestations, the main objective of the decision was to lower the HAM-A score further and stabilize mood and anxiety symptoms.

Explain how ethical considerations may impact your treatment plan and communication with patients

The major ethical concerns in medication include patient consent and safety. The medication should align with the major ethical principles that advocate for the patient’s autonomy, beneficence, and nonmaleficence. Paxil dose is well tolerated; therefore, increasing the dose implies that the medication is likely to be well tolerated. Furthermore, patient education should be advocated to allow the patient to make informed consent.

Decision Three

The third decision will be to shift to an SSRI alternative. However, the drug withdrawal process might be lengthy; hence I would opt for 10 mg of oral buspirone. Buspirone will also need close monitoring to assess the need to alter the treatment plan.

Why did you select this decision?

Buspirone is well tolerated in the body, although it is used in the short-term management of anxiety symptoms. It is also FDA-Approved for the management of Generalized Anxiety Disorder. In light, change from SSRI to Azapirone can attain a higher therapeutic effect than non-responsive paroxetine. The drug is well tolerated in the body, although it might exhibit some adverse effects.

Why did you not select the other two options provided in this exercise?

The rationale for the choice of the medications was entirely based on the efficacy and tolerability of the drugs. Buspirone is well-tolerated, exhibits minimal adverse effects, and is FDA approved for treating anxiety disorders. Therefore, I opted for drug safety and FDA recognition in the decision for combination therapy.

What are you hoping for by making this decision?

Adopting a combined therapy aimed to improve the patient’s experiences by lowering the anxiety symptoms. Buspirone regulates neurotransmitters’ actions, reducing anxiety symptoms (Javed & Fountoulakis, 2018). Changing the medications from non-responsive or slow-responding SSRIs to Azapirones can significantly reduce the HAM-A score alleviating the clinical manifestations of anxiety disorder.

Explain how ethical considerations may impact your treatment plan and communication with patients

The ethical concerns in the medical field are crucial, especially in managing mental health disorders. Patient autonomy may be impaired due to the involvement of the family members in the treatment process. However, the psychiatrist can establish the patient’s competence and compliance to determine the best approach for intervention. According to Javed and Fountoulakis (2018), buspirone elicits side effects such as chest pain, drowsiness, nausea, and increased sweating. However, some severe side effects such as blurred vision, uncontrollable shaking, agitation, hallucinations, confusion, irregular heartbeat and seizures can be reported. Clear communication should be established to allow the patient to make informed consent to the medication.

Conclusion

The management plan involved a shift from Paxil 10 mg to 20 mg once per day and further to Azapirone therapy of 10 mg buspirone twice a day. The selection of Paxil and buspirone was based on the recommendation and approval by the FDA in treating anxiety disorders and PTSD. However, due to the low response and impact on the HAM-A score, increasing the dose increased serotonin concentration, low anxiety, and regulated mood. The third decision opted against change from SSRIs to azapirone. Buspirone has partial agonist properties on serotonin and can improve serotonin levels and reduce the HAM-A score.

 

 

References

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines. BJPsych Open, 2(6), e16-e18. http://bjpo.rcpsych.org/content/2/6/e16

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412. https://doi.org/10.3389/fpsyt.2020.595584

Holmes, L. (2022). The 4 Major Classes of Anxiety Medications. Verywell Mind. Retrieved 2 July 2022, from https://www.verywellmind.com/mental-health-medications-for-anxiety-2337705.

Javed, A., & Fountoulakis, K. N. (Eds.). (2018). Advances in psychiatry. Springer.

Ostacher, M. J., & Cifu, A. S. (2019). Management of post-traumatic stress disorder. JAMA321(2), 200-201. https://doi.org/10.1001/jama.2018.19290

Slee, A. (2022). Generalized Anxiety Disorder: Incidence and Drug Treatment (Doctoral dissertation, UCL (University College London)). https://discovery.ucl.ac.uk/id/eprint/10146430

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy19(10), 1057-1070. https://doi.org/10.1080%2F14656566.2018.1491966

A Sample Answer 2 For the Assignment: ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

Title: ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

Anxiety disorders are characterized by pathologically elevated levels of anxiety. One of the common anxiety disorders is generalized anxiety disorder (GAD). It is characterized by anxiety, tension, worry, and fears about various day-to-day events and problems. Patients with GAD experience difficulties controlling excessive worries (DeMartini et al., 2019). GAD’s excessive anxiety and worry cannot be accounted for by a medical condition or substance use. The purpose of this paper is to discuss the case scenario of a patient with an anxiety disorder and describe the treatment and ethical considerations that may impact treatment.

Case Overview

The case scenario portrays a 46-year-old white male referred by his PCP after visiting the ER due to the fear of having a heart attack. The client mentions that he experienced chest tightness, dyspnea, and a feeling of impending doom. He has a history of mild hypertension and is overweight by roughly 15 lbs, but the rest of his medical history is unremarkable. His EKG and physical exam findings were normal, and myocardial infarction was ruled out. The client reports that he still experiences chest tightness and episodes of dyspnea, which he calls anxiety attacks. He also has infrequent feelings of impending doom and a need to escape. He scores 26 on the Hamilton Anxiety Rating Scale and is diagnosed with GAD.

The patient factors that may influence medication prescribing include age, the severity of the patient’s GAD, treatment preferences, current medical condition and medications, and previous medication trials (DeMartini et al., 2019). The clinician needs to consider the patient’s current hypertension and overweight and prescribe a drug that will not aggravate the conditions.

Decision #1

Start Zoloft 50 mg orally daily.

Why I Selected This Decision

Sertraline, a selective serotonin reuptake inhibitor (SSRI), was chosen because it is the most cost-effective SSRI. It is also indicated in the first-line treatment of GAD in adults. Strawn et al. (2018) found that the potential side effects of Zoloft are relatively well-tolerated, which leads to a higher compliance rate and better patient outcomes.

Why I Did Not Select the Other Options

Imipramine was not an ideal choice because it is a 2nd line therapy used when SSRIs are unsuccessful in alleviating GAD symptoms. Besides, Imipramine is associated with anticholinergic unpleasant side effects such as dry mouth, sedation, and constipation (Strawn et al., 2018). The side effects may contribute to a low compliance rate, which delays achieving the desired treatment effects. In addition, Buspirone was not ideal since it has no antipanic activity. Thus, it would not adequately alleviate the anxiety attacks in the client. Furthermore, Buspirone has a prolonged onset of action and is not recommended as monotherapy in treating GAD (Strawn et al., 2018).

What I Was Hoping To Achieve

I hoped that Zoloft would improve the GAD symptoms by at least 50% by the fourth week, and the HAM-A score would improve to 12. According to Garakani et al. (2020), SSRIs such as Zoloft have been established to be efficacious in treating anxiety disorders.

How Ethical Considerations May Impact the Treatment Plan

Ethical principles that may affect the treatment plan include beneficence (duty to do good) and nonmaleficence (duty to cause no harm) (Bipeta, 2019). The PMHNP upheld beneficence and nonmaleficence by prescribing Zoloft, which is associated with the best treatment outcomes and least side effects. The other drugs were not prescribed due to their associated treatment outcomes and side effects.

Decision #2

Increase Zoloft to 75 mg daily.

Why I Selected This Decision

The Zoloft dose was increased because the patient’s anxiety symptoms had not fully abated. Although he reported that the chest tightness and dyspnea had abated, he still experienced some degree of worry, and the HAM-A sore showed a partial response. Increasing the dose was thus an ideal choice to promote full remission of GAD symptoms (Strawn et al., 2018). Besides, the dose increase was gradual since it allows the PMHNP to monitor the drug’s side effects adequately.

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was inappropriate since it is a high dose increase. Thus, it does not allow the clinician to effectively monitor the drug’s effect on the patient and its side effects. It is recommended that the dose is gradually increased to promote successful therapy. In addition, changing the dose was not ideal because the patient exhibited a partial treatment response to the initial dose. Treatment guidelines recommend that the drug be changed only when there is no positive response to therapy after eight weeks or adverse effects (Garakani et al., 2020).

What I Was Hoping To Achieve

I hoped that gradually increasing the dose would help to fully alleviate the depressive symptoms while at the same time monitoring the drug’s associated side effects. The initial dose of Zoloft is 25 to 75 mg daily, while the usual dose range is 50-200 mg daily (Garakani et al., 2020). Thus, 75 mg is an acceptable dose for this patient.

How Ethical Considerations May Impact the Treatment Plan

Nonmaleficence was upheld in this decision by gradually increasing the dose, which would allow the PMHNP to monitor the drug’s effect, thus preventing harm to the patient (Bipeta, 2019). Besides, beneficence was upheld by increasing the dose to promote complete remission of symptoms and better patient outcomes.

Decision #3

Maintain the current dose.

Why I Selected This Decision

The current dose was maintained at 75 mg because the patient demonstrated an adequate positive response to the dose. The patient reported a further decrease in the depressive symptoms with a 61% reduction in symptoms, and the HAM-A score improved to 10. Besides, there were no reported side effects, and thus, maintaining the dose was ideal to avoid adverse effects if the dose was increased (He et al., 2019).

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was not an appropriate choice because the patient had an adequate positive response to the current 75 mg dose. Increasing to 100 mg may alleviate the symptoms further but poses the risk of side effects which may affect the drug compliance rate (He et al., 2019). Besides, an augmenting agent was not added to the plan because the patient had an adequate response with Zoloft monotherapy. Besides, monotherapy is highly recommended to prevent polypharmacy.

What I Was Hoping To Achieve

I was hoping that maintaining the dose would promote a progressive remission of the GAD symptoms and further improve the HAM-A score while at the same time causing no harm to the patient through side effects. Strawn et al. (2018) found that Zoloft continues to improve GAD symptoms over time regardless of a fixed dose.

How Ethical Considerations May Impact the Treatment Plan

The ethical principle of autonomy may impact the treatment plan if the patient does not consent to the medications or requests a change in treatment due to side effects. The PMHNP must obtain informed consent and explain the benefit of the prescribed medication and potential side effects (Bipeta, 2019).

Conclusion

The specific patient factors that may influence decisions on medication in the above patient include age, the severity of GAD, patient’s treatment preferences, current medical condition and medications, and previous medication trials. The patient was initiated with Zoloft 50 mg daily. The drug was selected because it is indicated as a first-line treatment in GAD and is associated with effective treatment outcomes (Strawn et al., 2018). Besides, it is associated with minimal side effects compared to Imipramine. Buspirone was not selected due to the lack of antipanic activity, which is crucial in managing the patient’s anxiety attacks. The initial dose led to a partial decrease in GAD symptoms, which led to increasing Zoloft to 75 mg daily (Strawn et al., 2018). The aim of this decision was to alleviate the GAD symptoms further. The dose was not increased to 100 mg daily to allow monitoring of side effects. Besides, the drug was not changed because the patient demonstrated a positive response to the initial drug, and no side effects were reported.

The patient’s symptoms decreased with Zoloft 75 mg with a 61% remission in symptoms. The dose was then maintained at 75 mg to allow for a progressive decrease in symptoms and monitoring of side effects. Augmentation was not recommended to avoid polypharmacy (Garakani et al., 2020). Ethical principles of beneficence and nonmaleficence influenced the treatment plan. The clinician selected medication known to have the best treatment outcomes and the least adverse effects to promote better health outcomes (Bipeta, 2019). Autonomy should also be respected by considering the client’s decisions when developing the treatment plan.

 

 

References

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of internal medicine170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412. https://doi.org/10.1176/appi.focus.19203

He, H., Xiang, Y., Gao, F., Bai, L., Gao, F., Fan, Y., … & Ma, X. (2019). Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: a network meta-analysis. Journal of psychiatric research118, 21-30. https://doi.org/10.1016/j.jpsychires.2019.08.009

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966

 

A Sample Answer For the Assignment: ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

Title: ASSESSING ANSD TREATING PATIENTS WITH ANXIENTY DISORDERS NURS 6630

This case study is about a 46-ar-old white male who came to the clinic as a referral by his primary care provider for what he felt as a heart attack. The patient reported symptoms that included chest tightness, shortness of breath, and feeling of impending doom. His medical history is significant for mid hypertension, overweight, and tonsillectomy. EKG results were normal. According to the patient, the shortness of breath and chest tightness are anxiety attacks. He reports occasional use of ETOH, consumes 3-4 beers per night, single, and fears losing his job. The HAM-A score is 26. The client denied any use of psychotropic medications.  

A mental status examination was administered to the patient. It showed that the patient was oriented to place, time, person, and events. His speech was clear, goal-oriented, and coherent. The client reported feeling nervous, bleh mood, blunted affect, with no visual or auditory hallucinations. There were no paranoid or delusional thought processes, homicidal or suicidal ideation. The client was diagnosed with generalized anxiety disorder based on these findings. Therefore, this paper focuses on three treatment decisions that will be adopted for this patient. The factors that will affect the selected treatments will include his HAM-A score, medical history, treatment response, and substance use.  

Decision 1 

Selected Decision 

Begin Paxil 10 mg po daily  

Reason for the Selection  

Paxil is a selective serotonin inhibitor that has been recommended in America for use in anxiety disorders. Paxil inhibits the reuptake of serotonin, which increases its synaptic concentration, extra-synaptic diffusion, and mood. Paxil has broad spectrum efficacy in treating anxiety disorders both in short and long-term. Its tolerance level is also high (Strawn et al., 2018). Besides improving anxiety symptoms, Paxil also enhances daily functioning and improvement in HAM-A score.  

Why the other Two were not Selected 

The decision to begin with Imipramine 25 mg po BID was not selected since Imipramine is considered in patients that have proven unresponsive to first-line treatments such as selective serotonin reuptake inhibitors. It also has the side effect of weight gain, which may worsen the currently overweight patient’s status. It can also cause QT prolongation and cardiac arrythmias. Buspirone 10 mg po BID was not selected since it is a second line of treatment for generalized anxiety disorder (Strawn et al., 2018).  

What I was hoping to Achieve  

I was hoping to achieve a reduction in the client’s symptoms of generalized anxiety disorder. I was also hoping to lower the client’s HAM-A score by at least 25% within the first four weeks. I was also hoping to improve the client’s functioning since studies have demonstrated symptom improvements with the use of Paxil (Strawn et al., 2018).  

Ethical Considerations  

Psychiatric mental health nurse practitioners must prioritize safety and quality in treating mental health problems. They make their decisions based on evidence-based data, patient factors, and their expertise. Evidence-based data supports Paxil use as first-line treatment in generalized anxiety disorder (Strawn et al., 2018). Therefore, by adopting Paxil, I anticipated enhanced outcomes such as safety, quality, and efficiency, hence, the influence of ethics in the treatment process. 

Decision 2 

Selected Decision 

Increase dose to 20 mg po daily  

Reason for the Selection  

The initial decision to start the patient on Paxil 10 mg po daily led to moderate improvement in symptoms. The client came after four weeks reporting that he no longer has chest tightness or shortness of breath. He also reports decreased worries about work over the last 4 or 5 days and reduction in HAM-A score to 18. An effective decision would be to increase the dosage of Paxil to 20 mg po daily to improve symptoms of generalized anxiety disorder. A systematic titration of the dose is recommended until optimum symptom improvement is achieved. For example, the study by Serdarević et al., (2018) investigated the effectiveness of Paxil 20 mg dose in generalized anxiety disorder over 12-months period. The results showed statistically significant reduction in the severity of anxiety disorder among the participants. Therefore, increasing the dose to 20 mg is safe, tolerable, and efficient in improving the patient’s symptoms.  

Why the other Two were not Selected 

I did not select the decision to increase the dose of Paxil to 40 mg po daily because of safety concerns. A sharp quadrupling of the dosage increases the risk of the patient developing adverse effects of Paxil such as erectile dysfunction, xerostomia, and insomnia. I did not select the decision not to change the drug/dose at this time because it would not yield further improvement in symptoms (Baldwin, 2020). The required plasma concentration of Paxil has not been achieved. As a result, maintaining the current dose is not recommended.  

What I was hoping to Achieve  

I was hoping to further reduce symptoms of generalized anxiety disorder. I was also hoping for at least 50% reduction in HAM-A score. I also anticipated improved patient’s functioning (Strawn et al., 2018).  

Ethical Considerations  

The ethical principle of ensuring non-maleficence informed the decision made in this step. Psychiatric mental health nurses must ensure that the adopted treatments minimize patient harm while optimizing on its benefits. As a result, I selected the decision to titrate the dosage upwards with the aim of improving symptoms and minimizing harm (Butts & Rich, 2022). Quadrupling the dosage could have increased the risk of adverse events.  

Decision 3 

Selected Decision 

Maintain the current dose  

Reason for the Selection  

The client returned to the clinic after four weeks with reports of further symptom improvement. The HAM-A score decreased to 10, translating into 61% reduction in symptoms. The assessment findings demonstrate that the treatment outcomes have been achieved. Therefore, it is appropriate to maintain the current dosage for optimum symptom management. The client has also demonstrated tolerance to the treatment (He et al., 2019). A further increase in dosage may led to the development of adverse reactions and potential poor treatment adherence by the patient.  

Why the other Two were not Selected 

I did not select the decision to increase the dosage to 30 mg po daily due to safety concerns. As noted above, the desired treatment outcomes have been achieved. Increasing the dosage further may lead to unwanted side and adverse effects, which will affect safety and quality of treatment, as well as adherence. I did no select the decision to add augmentation agent such as buspirone since Paxil has been effective in improving symptoms of generalized anxiety disorder. Adding another drug at this stage is not recommended (Baldwin, 2020).  

What I was hoping to Achieve  

I was hoping to witness a further reduction in symptoms. I was also hoping to see a decrease in HAM-A score to almost zero. I was also hoping that the patient will report return to his previous level of functioning.  

Ethical Considerations  

Patients have a right to informed care when receiving psychiatry services. As a result, the patient in this case study should be informed about any treatment decisions made and changes in the current regime. The patient should also be involved in his care for empowerment, sustainable change, and satisfaction with the care given to him (Butts & Rich, 2022).  

Conclusion 

In summary, the decision to begin the patient on Paxil was effective. Its effectiveness could be seen from the evidence that Paxil is the recommended first-line drug of choice for generalized anxiety disorder. The drug has enhanced efficacy in symptom improvement and enhancing patient’s functioning (Strawn et al., 2018). The other options such as starting the patient on Imipramine and buspirone were not selected in the first step because of their associated safety issues. The decision to increase the dosage of Paxil in the second step was effective. It led to optimum symptom improvement, as evidenced by the reduction in HAM-A score by more than 50% and symptoms of generalized anxiety disorder. The decisions to maintain the current dose and quadruple the dosage of Paxil were not selected due to safety concerns and the potential of minimal symptom improvements. The optimum improvement in symptoms informed the decision to maintain the dose of Paxil in the third step (Baldwin, 2020). It also informed the decision not to increase the dosage further or augment the treatment.  

Ethical considerations informed the decisions made in this case study. Accordingly, evidence-based data was used to select the best treatment for the patient. Sources of evidence-based data such as journals provided insights into the safety and efficacy of the different drugs used for treating generalized anxiety. Evidence-based decisions optimize on outcomes such as safety, quality, and efficiency in disease management. The other ethical considerations that informed the treatment decisions included non-maleficence and justice (Butts & Rich, 2022). Justice was maintained by informing and involving the patient in the treatment process.  

 

References 

Baldwin, D. S. (2020). Pharmacological Treatment of Generalized Anxiety Disorder (GAD). In Generalized Anxiety Disorder and Worrying (pp. 297–318). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119189909.ch14 

Butts, J. B., & Rich, K. L. (2022). Nursing Ethics: Across the Curriculum and Into Practice. Jones & Bartlett Learning. 

He, H., Xiang, Y., Gao, F., Bai, L., Gao, F., Fan, Y., Lyu, J., & Ma, X. (2019). Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: A network meta-analysis. Journal of Psychiatric Research, 118, 21–30. https://doi.org/10.1016/j.jpsychires.2019.08.009 

Serdarević, A. M., Halilović, Z., Bahto, A., Kapo, B., & Delić, D. (2018). Observational multicenter study of efficacy of paroxetine film-coated tablet in the treatment of anxiety disorder. Medicinski Glasnik, 15(2). 

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: An evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966 

 

Grading Rubric

Performance Category 100% or highest level of performance

100%

16 points

Very good or high level of performance

88%

14 points

Acceptable level of performance

81%

13 points

Inadequate demonstration of expectations

68%

11 points

Deficient level of performance

56%

9 points

 

Failing level

of performance

55% or less

0 points

 Total Points Possible= 50           16 Points    14 Points 13 Points        11 Points           9 Points          0 Points
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic topics.

Presentation of information was exceptional and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was minimally demonstrated in all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in one of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in two of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in three or more of the following elements

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
 16 Points  14 Points  13 Points 11 Points 9 Points  0 Points
Application of Course Knowledge

Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations

Presentation of information was exceptional and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was minimally demonstrated in the all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in one of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from and scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in two of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in three of the following elements

  • Applies principles, knowledge and information and scholarly resources to the required topic.
  • Applies facts, principles or concepts learned scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
   10 Points 9 Points  6 Points  0 Points
Interactive Dialogue

Initial post should be a minimum of 300 words (references do not count toward word count)

The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count)

Responses are substantive and relate to the topic.

Demonstrated all of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 3 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 2 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 1 or less of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
  8 Points 7 Points  6 Points         5 Points          4 Points  0 Points
Grammar, Syntax, APA

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

Error is defined to be a unique APA error. Same type of error is only counted as one error.

The following was present:

  • 0-3 errors in APA format

AND

  • Responses have 0-3 grammatical, spelling or punctuation errors

AND

  • Writing style is generally clear, focused on topic,and facilitates communication.
The following was present:

  • 4-6 errors in APA format.

AND/OR

  • Responses have 4-5 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is somewhat focused on topic.
The following was present:

  • 7-9 errors in APA format.

AND/OR

  • Responses have 6-7 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is slightly focused on topic making discussion difficult to understand.
 

The following was present:

  • 10- 12 errors in APA format

AND/OR

  • Responses have 8-9 grammatical, spelling and punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.
 

The following was present:

  • 13 – 15 errors in APA format

AND/OR

  • Responses have 8-10 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.

AND/OR

  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.
The following was present:

  • 16 to greater errors in APA format.

AND/OR

  • Responses have more than 10 grammatical, spelling or punctuation errors.

AND/OR

  • Writing style does not facilitate communication
  0 Points Deducted 5 Points Lost
Participation

Requirements

Demonstrated the following:

  • Initial, peer, and faculty postings were made on 3 separate days
Failed to demonstrate the following:

  • Initial, peer, and faculty postings were made on 3 separate days
  0 Points Lost 5 Points Lost
Due Date Requirements Demonstrated all of the following:

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.

Demonstrates one or less of the following.

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.