ASSESSING AND TREATING PATIENTS WITH ANXIETY DISORDERS 1

Assessing and Treating Patients with Anxiety Disorders

Case Study: 46-year-old Caucasian Male
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Introduction

Anxiety disorders can be described as a group of conditions that are related. Each condition has a

peculiar symptom. One common sign which they have is; persistent and excessive worry even in

situations that are not threatening. Patients usually experience emotional and physical symptoms.

Physical symptoms are usually experienced by a patient include; rapid heart rate and shakiness

(Locke et al., 2015). There are various forms of anxiety disorder, such as generalized anxiety

disorder, agoraphobia, social anxiety disorder, panic disorder, among other known disorders.

This assignment focuses on a 46-Year-old middle-aged Caucasian man with anxiety. He is

presented with anxiety disorder symptoms, including; feeling of impending doom, chest

tightness, and shortness of breath. Assessment for ECK and ER results are normal, ruling out any

signs of myocardial infarction. A score of 26 was yielded after conducting (HAM-A). Later the

generalized anxiety disorder (GAD) was done. Three decisions for treatment regimens were

made. The three decisions are based on the Pharmacokinetic and Pharmacodynamic processes of

the patient. Ethical considerations and recommendations that will affect the treatment of the

patient will also be discussed.

Decision #1

Psychiatric Mental Health Nurse Practitioners (PMHNP) Must choose the first decision

they will start with. There are a wide of options that PMHNP will choose from. This first

decision is designed to be a start-up medication for patients who are suffering from an anxiety

disorder. The Nurse can choose from; Wellbutrin (bupropion) 75mg, by mouth two times a day,

every day, Paxil (paroxetine) 10 mg by mouth every day, and Zoloft (sertraline) 25 mg by mouth

every day. The best decision for the patient is Zoloft (sertraline) 25mg. This first step is done

orally daily (Ressler, K. 2015).

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Reasons for decision #1

Selective serotonin reuptake inhibitors (SSRIs) are the recommended first- line of

treatment for anxiety disorders. Zoloft is an SSRI. This is a better decision compared to other

drugs, which are meant for subjective medication. SSRIs are important for mood regulation since

they increase the amount of serotonin in the brain. Serotonin is a chemical involved in mood

regulation. It improves anxiety symptoms. Buspirone (Buspar) 10 mg and Imipramine (Tofranil)

25 mg are not chosen because only SSRIs are recommended as First-line medications.

Expected and the Actual outcomes

The expected results were for the symptoms manifested by the patient to reduce. Another

Expectation was for the HAM-A score to reduce significantly (Patel et al., 2018). This is because

Zoloft is an effective treatment for GAD symptoms. Very minimal side effects were expected.

When SSRIs are tolerated by the patient, very few side effects are experienced (Clevenger et al.,

2018).

The HAM-A score of the patient dropped to 18. It means that the patient was responding

to good treatment. The symptoms had reduced significantly; very few symptoms are being

manifested. Symptoms such as chest tightness and shortness of breath had disappeared

completely. Very little difference Is seen between the Expected and the Actual outcomes.

Decision#2

The results show a drop in the HMA-A score, and the patient is responding to treatment,

and increasing the availability of serotonin from 50 mg to 75 mg will lead to further

improvements from the symptoms. Pieces of evidence by (Jakubovski et al., 2016) show that an

increase in SSRIs dosage leads to satisfactory responses. It is important to increase the dose to

make sure that the response is complete.

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Reasons for Decsision#2

The results show that the patient is showing tremendous progress. Very little side effects

are being experienced. There was an option to increase Zoloft to 100mg. This decision was not

taken to minimize the side effects. Another option was to allow the patient to continue with the

same dosage for four weeks. This would not have resulted in the desired results (Jakubovski et

al., 2016).

Expected and the Actual Outcomes.

There were significant improvements in the previous dosage. Increase the dosage to 75

mg was expected to continue reducing the anxiety symptoms and a significant drop in HAM-A

score. The Actual and expected outcomes did not show any variations. The anxiety symptoms of

the patient had reduced further, indicating a positive response to the treatment. After four weeks,

most of the symptoms had been eradicated. The HAM-A scale rating was now at ten compare to

the previous record of 18.

Decision #3

This decision is based on the outcomes of decision #1 and #2. Using the subjective data,

it will be important for the patient to continue with Zoloft 75 mg dosage. It will not be prudent to

abandon the decision since the patient is showing a lot of improvements.

Reasons for Decision #3

The results from subjective data show that the patient is no longer experiencing

symptoms. Continuation of the current dose shows no side effects. The patient no longer

experiencing symptoms. These are significant improvements. The HAM-A score has also lower

compared to the previous one.

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Expected and the Actual Outcomes.

The expected results for decision #3 was for the patient to be in full recovery. The Actual

outcome shows the patient responds well to the treatment as no symptoms are being experienced

and no side effects. Pieces of evidence from (Jakobsen et al., 2017) indicateindicate that no

further titration should be done as there is a patient's positive response. Increasing the dosage to

100mg is abandoned because the results of the treatment are satisfactory. There was also another

option of using Buspar for decision #3, which is also abandoned.

Ethical considerations for the treatment plan

 Correct prescription in a very stage of the disorder.

Choosing the correct prescription helps PMHNP's to administer the most appropriate drug. This

will depend on the mild, moderate, or severity of the symptoms.

 Proper Administration

PMHNP's are reminded of the correct course of drug administration. It means that they are

obliged to follow every instruction on the processes that are involved in taking the dosage.

Whether the patient is expected to take the drug with food, discontinue the dosage, or change the

type of medication (Feinstein, & Eden, 2011). All these are important shifts in drug therapy.

 Modifications in the dosage.

Coming up with the right dosage is also an ethical consideration. The helps PMHNP s change the

amount of dosage anytime that they deem it possible (Feinstein, & Eden, 2011).

 Patient education

Before a patient is put under a prescription is the work of the Nurse to educate the patient about

any potential side effects. It gives them a clear view of the end results, which helps them to

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choose whether to stick with the same prescriptions or change it altogether (Feinstein, & Eden,

2011).

Impacts of ethical considerations

For the patient, it encompasses autonomy, help in making informed consent, and

confidentiality. It makes sure that the patient has all the relevant information before choosing the

correct type of treatment. Information on patient medication should not be disclosed to anyone.

Coercion is not allowed; the patient has the right to choose the type of treatment they deem fit.

Conclusion

The decision to choose Zoloft 50 mg for our treatment was the correct one since it bore

tremendous results. Decsision#1 was Zoloft 50 mg to be taken orally every day. Zoloft is a

Selective serotonin reuptake inhibitor (SSRIs), widely recommended for the treatment of anxiety

disorders. Significant improvement can be seen after decision #1. It takes us to decision #2,

increasing Zoloft 50mg to 75 mg. This decision was arrived at because the patient had shown

partial improvements. The HAM-A score of the patient indicates it. It was expected that

choosing this decision will make the patient show a full response. The HAM-A score after

decision #2 was 10. A satisfactory response from 18 in decision #1. Maintaining the current dose

will ensure that the patient is fully recovered. Actual results for decision #3 show a reduced

HAM-A score, elimination of symptoms. The subjective data is very positive. The ethical

considerations are to improve the patient's outcome and ensure that nurses stick to the best

practices.

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References
Locke A, Faafp M, Krist N & Shultz C. (2015). Diagnosis and Management of Generalized
Anxiety Disorder and Panic Disorder in Adults. Am Fam Physician.  1;91(9),617-624.
Pine, D., Rothbaum, B. O., & In Ressler, K. (2015). Anxiety disorders: Translational perspectives on

diagnosis and treatment.

Patel, D. R., Feucht, C., Brown, K., & Ramsay, J. (2018). Pharmacological treatment of anxiety

disorders in children and adolescents: a review for practitioners. Translational

Pediatrics, 7(1), 23.

Jakubovski, E., Varigonda, A. L., Freemantle, N., Taylor, M. J., & Bloch, M. H. (2016).

Systematic review and meta-analysis: dose-response relationship of selective serotonin

reuptake inhibitors in major depressive disorder. American Journal of

Psychiatry, 173(2), 174-183.

Feinstein, D., & Eden, D. (2011). Ethics handbook for energy healing practitioners. Elite Books.