Case Study on Generalized Anxiety Disorder (GAD)

Submitted by:
Agravante, Rachel Lynne
Bromo, Shekinah
Casas, Jannen

Submitted to:
Asst. Prof. Mary Nathalie Cata-al

NCM 56: Psychiatric Nursing

April 14, 2021
 Case scenario on Generalized Anxiety Disorder (GAD)

Claire is a 20-year-old female who is in her second year of pharmacy course in a

university in Cebu City.  She feels that she is ‘going crazy’ with anxiety.  Claire has no
significant past medical or mental health history.   

During your interview, she describes feeling anxious much of time. The problem started
in September 2020, a month after the online classes began.  She describes being incapacitated
with anxiety. Despite wanting to finish her degree she felt that she would be unable to cope with
the pressure in school and her family. She thinks her family will be disappointed to know about
this as she has been provided with everything that she needs. 

Claire describes not being able to make decisions as she worries too much about what
would happen if she made the wrong decision. She has never talked to anyone about this for fear
of being judged as just making-up excuses or just being lazy.  She feels that most of her
classmates are coping well except for her.

She also describes having a low mood most of the time but she  has no suicidal thoughts. 
She managed to pass all her subjects during the first semester but she is not sure if she can
survive the second semester.  She finds it hard to accomplish her assignments and have missed
some deadlines already.  Some of her quizzes and long exams are already failing. She also
mentioned that she can’t focus on her readings anymore because once she starts opening her
books, she feels her mind starts “going blank”.  She wakes up in the middle of the night most of
the time and finds it hard to go back to sleep.  Her number of hours of sleep range from 3-4,
which is lesser than her usual (6-7 hrs) 7 months ago.
 Observation Check List for Psychiatric Nursing Clinical Experience
Manifestations
/ Responses
Criteria Observed Evidence / Comments on Observations
( X or )
Appearance and Physical
Condition
1. Facial expression shows:
• Fatigue
Upon observation, it is noticeable that she has
dry facial expressions with no hint of happiness.
• Fear
• Tension X
• Happiness
• Indifference
• Sadness
• Others She also seemed nervous during the assessment.
2. Posture
• Stands erect X
• Slouch
• Dropping shoulders
3. Physical cleanliness
• Hair combed X
X Her hair was not tied. She also verbalized “Wala
• Face washed
X rako naligo kay kapoy man”.
• Full bath
Skin is fair, without scars or wounds.
• Body color
• Clothes changed
• Teeth brushed
4. Movements
• Inappropriate gestures or Eye contact was not maintained. She looks down
mannerisms or looks up as if she was day dreaming most of
• Slow the time.
X
• Rapid
• Restless (moves back and
forth)
• Easily tears
• Rigid
5. Skin
• Clean
X
• Clear
 • Flushed X
• Perspiring
• Blistered X
• Dry Her lips are also dry and patchy.
X
• Warm
6. Legs and ankles
• Swollen X
• Atrophied X
• Others X
7. Complaints of pain
• Specify
Chronic headaches and chest pain.
8. Habits (note if normal or with
disturbance)
• Sleeping She only has 3-4 hours of sleep every night.
• Drinking She normally drinks 3-4 glasses a day. She
• Elimination usually consumed 2-3 cups of coffee a day.
She usually feels constipated.
9. Eating Behavior
X She no longer feels the joy when she is given her
• Eats well and enjoy food
X favorite food.
• Voracious
• Picks on food
• Does not eat at all

Emotive Assessment
1. Characteristics of Affect
• Spontaneous X She verbalized that she’s been feeling anxious
• Appropriate
X much of time. She feels incapacitated with
anxiety. She also describes having a low mood
• Flat
most of the time.
• Ambivalent
• Mood swings
2. Predominant affective
reactions
• Euphoric X She is worried about the decisions to make thus
• Resigned not able to make sound judgments and decisions.
She has never talked to anyone about this
• Anxious
X situation.
• Overactive
• Depressed
• Withdrawn X
• Resentful
• Irritable
3. Affect Observed is
Appropriate to:
She fears that if she shares her situation to
• Speech
others she will be judged and be called lazy or
• Behavior
just making-up excuses.
 • Immediate situation
4. Reactions to:
• Being in hospital X
• Treatments X
X
• Medications
X
• Interviews She verbalized that she’s been feeling anxious
• Visitors much of time. She also mentioned that she fears
when her family finds out about her situation
they might be disappointed since they have
provided her with everything that she needs.
Cognitive Assessment

1. Thought content
• Flight of ideas X She can’t focus on her readings anymore
• Associated looseness X because once she starts opening her books, she
feels her mind starts “going blank.”
• Preoccupations
• Concerns X
• Coherence
2. Thought disturbance
• Delusions X
• Hallucinations X
• Obsessions X
Social phobia (She also mentioned a few fears
• Phobias
such as fear of being judged and disappointing
• Compulsions
X her family). She does not have any suicidal
• Suicidal thoughts/ideas thoughts, but she already has a hard time
• Ideas of reference accomplishing her tasks and assignments. Even
X
• Logical ways of thinking though she hardly passes her subjects, some of
3. Sensorium her quizzes and long exams are already failing.
• Degree of consciousness
• Confused Most of the time, she starts “going blank”.
X She is not sure whether or not she can pass this
• Past and present memory
X second semester of online classes.
• Orientation to time, place and
person
4. Judgment and insight
• Can make appropriate decision X
• Decision making
• Aware of psychiatric problem She is worried about the decisions to make thus
• Understands own motives or X not able to make sound judgments and decisions.
behaviors

Behavioral Assessment
1. General attitude
• Confident X She no longer feels confident about herself
• Fearful because of her anxiety.
She fears disappointment.
• Friendly
X
 • Evasive X She is still able to be social and talk to her
• Demanding friends and student nurses but lesser compared
to before. Claire verbalized that the “whole
online class situation” has changed the way she
interacts with other people.
Spiritual Assessment
1. Religion X Not stated or observed
2. Beliefs X
 NURSING CARE PLAN

CUES/EVIDENCES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS
INDEPENDENT:
SUBJECTIVE: Ineffective After 2 weeks of our 1. Establish a A trusting
“Murag hapit nako coping r/t care, the patient will trusting relationship
mabuang ani akong situational be able to: relationship allows the client
anxiety” crisis as with the client. to freely express
“Sige rakog ka anxious evidenced by 1. Demonstrate his/her feelings
most of the time” disturbed ways and and does not see
“Nagsugod akong anxiety thought ability to cope the student nurse
mga 1 month pagsugod sa processes effectively. as a threat.
online class, feel nako di 2. Report a 2. Maintain the
ko ka cope tungod decrease in trusting To enhance
pressured kayko sa acads restlessness. relationship therapeutic
ug sa family.” 3. Verbalize a with the client relationship and to
“Feel nako gi control nakos return to by being provide for
anxiety” normal available to meeting
“Di kayko ka decide ug number hours her; answer psychological
tarong kay mabalaka ko if of sleep (6-8 her questions needs.
sakto ba or sayop akong hours) and queries,
gihimo” 4. Verbalize and respecting
“Dili napod tarong akong signs and her decisions/
pag tulog karon, mga 3-4 symptoms of 3. Discuss with
hours nalang ako tulog increasing the client the
kada gabii” anxiety and situations that
intervene to trigger This is the first
OBJECTIVE: maintain anxiety. step in teaching
- Shaky & sweaty anxiety at the client to
hands manageable 4. Provide a interrupt the
- Feet constantly level. quiet escalation of
tapping the floor 5. Maintain eye environment anxiety.
- Restless contact when as much as
- Diaphoresis talking to possible. Anxiety might be
- Dry skin, and student nurses increased by noisy
patchy lips and family surroundings and
- Unable to maintain members. cause panic to the
eye contact 5. Teach client.
- Easily distracted relaxation
- exercises such Anxiety is
as deep minimized when
breathing the patient is
techniques, relaxed and these
music therapy, are effective non-
or guided pharmacological
imagery. ways to decrease
anxiety.
6. Encourage
verbalization To assist client in
of fears and dealing with
anxieties and anxiety.
expression of
feelings of
depression and
anger. Let the
client know
that these are
normal
reactions.
7. Remain with Safety of the
the client client is a priority.
when anxiety A highly anxious
attacks are client should not
severe. be left alone.

DEPENDENT:
1. Administer Stimulate serotonin
anxiolytics as and dopamine
prescribed by receptors on
the physician nerves, thereby
 altering the
chemical messages
2. Administer that nerves receive.
SSRIs as
prescribed by Increases levels of
the physician serotonin in the
brain. SSRIs block
the reabsorption of
serotonin into
neurons.

CUES/EVIDENCES NURSING OBJECTIVES INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Subjective data: Disturbed Independent:
At the end of the 2-
sleep pattern week nursing care,
Awakens earlier than desired; related to 1. Determine type of Identification of
the client will be
wakes up in the middle of the psychological sleep pattern individual situation and
able to:
night most of the time stress disturbance present, degree of interference
 Verbalize including usual with functioning
Report of difficulty in falling understanding bedtime, determines need
asleep of rituals/routines, for/appropriate
relationship number of hours of interventions.
Her number of hours of sleep of anxiety sleep, time of
range from 3-4, which is lesser and sleep arising,
than her usual (6-7 hrs) 7 disturbance. environmental
months ago  Identify needs, and how
much of a problem
appropriate
it is to client.
interventions
to promote
Objective data: 2. Provide quiet Promotes relaxation and
sleep.
Dark circles under eyes environment, cues for falling asleep.
 Report comfort measures Stimulating effects of
Frequent yawning improvement (e.g., caffeine/alcohol interfere
Restless in sleep back rub, wash with ability to fall
pattern, hands/face, bath), asleep.
increased and sleep aids, such
 as warm milk .
sense of well-
Restrict use of
being, and
caffeine and alcohol
feeling well-
before bedtime.
rested.
Promotes reduction of
3. Discuss use of
anxious feelings,
relaxation
resulting in improved
techniques/thoughts,
sleep/rest.
visualization.

4. Suggest ways to
Having a plan can reduce
handle waking/not
anxiety about not
sleeping (e.g.,do not
sleeping.
lie in bed and think,
but get up and
remain inactive, or
do something
boring).

Increases fatigue,
5. Involve client in promotes sleep but
exercise program, avoids excessive
avoiding exercise stimulation from activity
within 2 hours of before bedtime.
going to bed.

Sedative drugs interfere

6. Avoid use of
with REM sleep and
sedatives, when
affect quality of rest. A
possible.
rebound effect may lead
to intense dreaming,
nightmares, and more
disturbed sleep.

Collaborative
1. Administer Although drug is
medications as recommended for short-
indicated, e.g., term use  only, it may be
zolpidem (Ambien) beneficial until other
therapeutic interventions
are successful.