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NURS 6630 Assignment Case Study A Middle-Aged Caucasian Man With Anxiety

NURS 6630 Case Study A Middle-Aged Caucasian Man With Anxiety Assignment

Assessing and Treating Patients with Anxiety Disorders

Anxiety is an emotional response, such as tension, fear, or uneasiness, to the prospect of danger, the source of which is frequently unknown or unidentified. When anxiety impairs one’s ability to perform, achieve desired goals or fulfillment, or maintain adequate emotional comfort, it may be termed pathologic (Locke, Kirst & Shultz, 2015). Obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and phobias are all examples of anxiety disorders. This project will investigate a case study of a client who suffers from an anxiety illness, outline his treatment plan, and discuss ethical issues that may affect the treatment plan.

Overview of the Case Study

The case scenario depicts a 46-year-old Caucasian male who was referred by his primary care physician following an ER visit for what he considered to be a heart attack. He was admitted to the emergency room with chest pain, shortness of breath, and a sense of impending doom (Laureate Education, 2016). The client has a history of moderate hypertension that is being controlled with a low salt diet and is around 15 pounds overweight. His EKG was normal, ruling out myocardial infarction, and his physical examination revealed no abnormalities. The client describes chest tightness and episodes of shortness of breath as anxiety attacks. He also occasionally has emotions of impending doom and the desire to flee or escape (Laureate Education, 2016). He admits to using alcohol on occasion, 3-4 beers per night, to alleviate his concerns about his job, which he believes will be lost. The client has a Hamilton Anxiety Rating Scale score of 26. He admits to feeling nervous throughout the mental status examination. Although affect is rather muted, it brightens numerous times during the clinical interview.

Decision Point One

Begin Zoloft 50 mg orally daily.

Why I Selected This Decision

I selected the option of Zoloft because it is an FDA approved drug in the treatment of GAD. Zoloft is an antidepressant under the class

of Selective serotonin reuptake inhibitors (SSRIs) and indicated as a first-line drug in GAD treatment (Bandelow, Michaelis & Wedekind, 2017). Zoloft was my drug of choice since SSRIs have a response rate of 30-50% in GAD treatment (Strawn et al., 2018). It acts by inhibiting presynaptic serotonin reuptake causing accumulation of serotonin. In the CNS, Serotonin regulates mood, personality, and wakefulness. Besides, I selected Zoloft because it has few adverse effects, which promotes compliance.

Why I Did Not Select the Other Two Options

Imipramine was not selected because it has high levels of toxicity and is potentially lethal in an overdose. It is only indicated when SSRIs are not effective in treating GAD (Bandelow et al., 2017). Imipramine exerts peripheral anticholinergic and sedative effects, causing side effects such as sedation, dry mouth, and constipation, lowering the patient’s compliance (Strawn et al., 2018). Buspirone was not selected because it has a limitation of lacking antipanic activity (Locke et al., 2015). Consequently, the drug would have been ineffective in alleviating the client’s acute anxiety symptoms. Buspirone has a prolonged onset of action, limiting its use as a sole drug in the treatment of acute anxiety episodes as in the client’s anxiety attacks. NURS 6630 Case Study A Middle-Aged Caucasian Man With Anxiety Assignment

What I Was Hoping To Achieve By Making This Decision

I hoped that Zoloft therapy would alleviate the client’s anxiety symptoms by at least 50% within four weeks. I was hoping that the client’s HAM-A score would decrease to at least 14 after four weeks of treatment.

How Ethical Considerations May Impact the Treatment Plan

Ethical principles of beneficence and nonmaleficence may impact the treatment plan since the practitioner must ensure that the medication will have the best possible outcome and not harm the client (Haddad & Geiger, 2019). For instance, the principles guided my decision since I had to select a drug with the least potential side effects and one that is associated with better outcomes. NURS 6630 Case Study A Middle-Aged Caucasian Man With Anxiety Assignment

Decision Point Two

Increase Zoloft to 75 mg daily.

Why I Selected This Decision

NURS 6630 Assignment Case Study A Middle-Aged Caucasian Man With Anxiety

NURS 6630 Assignment Case Study A Middle-Aged Caucasian Man With Anxiety

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I selected the option of increasing Zoloft since the client demonstrated a positive response with the drug but had not attained a full remission of anxiety symptoms (Locke et al., 2015). The client had a partial decrease in the HAM-A score to 18 from 26. Gradually increasing the dose enables the clinician to monitor the associated adverse effects effectively.

Why I Did Not Select the Other Two Options

I did not select the dose to 100 mg orally daily, because a high dose increase would not allow effective monitoring of the drug’s side effects. Patients with GAD are sensitive to treatment with antidepressants and require slow titration for successful therapy (Locke et al., 2015). I did not also select the option of not changing the dose because the client was only on the starting dose, which had demonstrated a partial response. Failing to increase the drug may result in the lack of a further decrease in anxiety symptoms. NURS 6630 Case Study A Middle-Aged Caucasian Man With Anxiety Assignment

What I Was Hoping To Achieve By Making This Decision

I was hoping that increasing the Zoloft dose would promote remission of anxiety symptoms by at least 75% within four weeks and reduce the HAM-A score to 8.

How Ethical Considerations May Impact the Treatment Plan

Nonmaleficence may impact the treatment plan. The clinician has to evaluate or medication side effects and modify the treatment plan if they interfere with the quality of life (Haddad & Geiger, 2019). The clinician must also assess the client’s response to treatment and modify the treatment plan to promote better patient outcomes. For instance, I increased the dose of Zoloft to promote better patient outcomes since the client had achieved only a partial response with the initial dose.

Decision Point Three

Maintain current dose.

Why I Selected This Decision

I chose to maintain the Zoloft dose at 75 mg/day because the client had a positive response to the current dose. This is demonstrated by a decrease in anxiety symptoms by more than 60% with the dose. I also marinated the dose because the client did not report any associated side effects after titrating the dose to 75 mg.

Why I Did Not Select the Other Two Options

I did not select the option to increase the Zoloft dose to 100 mg daily because the client demonstrated an adequate response with the current dose. Although increasing Zoloft dose at this point may result in a further decrease in anxiety symptoms, it increases the risk of adverse effects, which can reduce compliance (Locke et al., 2015). I did not add an augmentation agent in the treatment plan since the client demonstrated a good response to monotherapy witty Zoloft. I also wanted to avoid polypharmacy as a sole drug had adequately managed the symptoms. NURS 6630 Case Study A Middle-Aged Caucasian Man With Anxiety Assignment

What I Was Hoping To Achieve By Making This Decision

I was hoping that by maintain the Zoloft dose at 75 mg, the anxiety symptoms would progressively reduce to full remission. I also hoped that the client’s HAM-A score would reduce to below 5 within four weeks of therapy.

How Ethical Considerations May Impact the Treatment Plan

Ethical considerations may impact the treatment plan as the practitioner has to uphold principles of autonomy by allowing the client to make decisions concerning his treatment. Beneficence and nonmaleficence have to be maintained to ensure the treatment options selected will promote the best possible outcome and have no potential harm to the client (Haddad & Geiger, 2019). In this case, I did not increase the dose since there is potential harm from the side effects associated with a high Zoloft dose.

Conclusion

In the case scenario, the client presented with symptoms of generalized anxiety disorder such as excessive concerns about his job, nervousness, chest tightness, shortness of breath, and feeling of impending doom. His initial HAM-A score was 26, which indicates severe anxiety. The first decision was to initiate therapy with Zoloft 50 mg daily. Zoloft was selected to alleviate the anxiety symptoms, and since it is useful in managing anxiety disorders.  The drug effectively alleviated the symptoms of chest tightness and shortness of breath and reduced the client’s worries about his work. It also partially decreased the HAM-A score to 18. In decision point two, I increased the Zoloft dose to 75 mg to promote a further remission of anxiety. An increased dose led to a remission of anxiety symptoms by 61% and decreased HAM-A score to 10.

In decision point three, I chose to maintain the Zoloft dose at 75 mg because the client had demonstrated a good response to the current dose. Increasing the dose would not have been appropriate because it put the client at risk of side effects. Besides, adding an augmenting agent would have led to polypharmacy. Ethical principles that might impact the treatment plan include autonomy, beneficence, and nonmaleficence. The clinician should uphold the principles by involving the client in decision making and choosing a therapy that will promote the best possible outcome and have minimal side effects.

References

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow

Haddad, L. M., & Geiger, R. A. (2019). Nursing Ethical Considerations. In StatPearls [Internet]. StatPearls Publishing.

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Locke, A., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American Family Physician91(9), 617-624.

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

Name:  Assignment Rubric

  Excellent Good Fair Poor
Summarize your interpretation of the frequency data provided in the output for respondent’s age, highest school grade completed, and family income from prior month. 32 (32%) – 35 (35%)

The response accurately and clearly explains, in detail, a summary of the frequency distributions for the variables presented.

The response accurately and clearly explains, in detail, the number of times the value occurs in the data.

The response accurately and clearly explains, in detail, the appearance of the data, the range of data values, and an explanation of extreme values in describing intervals that sufficiently provides an analysis that fully supports the categorization of each variable value.

The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the areas described.

28 (28%) – 31 (31%)

The response accurately summarizes the frequency distributions for the variables presented.

The response accurately explains the number of times the value occurs in the data.

The response accurately explains the appearance of the data, the range of data values, and explains extreme values in describing intervals that provides an analysis which supports the categorization of each variable value.

The response includes relevant, specific, and accurate examples that support the explanations provided for each of the areas described.

25 (25%) – 27 (27%)

The response inaccurately or vaguely summarizes the frequency distributions for the variables presented.

The response inaccurately or vaguely explains the number of times the value occurs in the data.

The response inaccurately or vaguely explains the appearance of the data, the range of data values, and inaccurately or vaguely explains extreme values.

An analysis that may support the categorization of each variable value is inaccurate or vague.

The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the areas described.

0 (0%) – 24 (24%)

The response inaccurately and vaguely summarizes the frequency distributions for the variables presented, or it is missing.

The response inaccurately and vaguely explains the number of times the value occurs in the data, or it is missing.

The response inaccurately and vaguely explains the appearance of the data, the range of data values, and an explanation of extreme values, or it is missing.

An analysis that does not support the categorization of each variable values is provided, or it is missing.

The response includes inaccurate and vague examples that do not support the explanations provided for each of the areas described, or it is missing.

Summarize your interpretation of the descriptive statistics provided in the output for respondent’s age, highest school grade completed, race and ethnicity, currently employed, and family income from prior month. 45 (45%) – 50 (50%)

The response accurately and clearly summarizes in detail the interpretation of the descriptive statistics provided.

The response accurately and clearly evaluates in detail each of the variables presented, including an accurate and complete description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

40 (40%) – 44 (44%)

The response accurately summarizes the interpretation of the descriptive statistics provided.

The response accurately explains evaluates each of the variables presented, including an accurate description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

35 (35%) – 39 (39%)

The response inaccurately or vaguely summarizes the interpretation of the descriptive statistics provided.

The response inaccurately or vaguely evaluates each of the variables presented, including an inaccurate or vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data.

0 (0%) – 34 (34%)

The response inaccurately and vaguely summarizes the interpretation of the descriptive statistics provided, or it is missing.

The response inaccurately and vaguely evaluates each of the variables presented, including an inaccurate and vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data, or it 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 is provided which delineates 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 is provided which delineates 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 is stated, yet is brief and not descriptive.

3 (3%) – 3 (3%)

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%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was 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 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

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 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.

Total Points: 100

Name:  Assignment Rubric

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