ASSESSING AND TREATING PATIENTS WITH ANXIETY DISORDERS Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attac

ASSESSING AND TREATING PATIENTS WITH ANXIETY DISORDERS Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attac
ntroduction to the case (1 page) You must briefly summarize the case. You must also highlight the specific patient factors that will impact your decision making when prescribing medication for this patient. To clearly identify patient-specific factors, please begin your sentence with, “The patient-specific factors I will consider as I make my decisions are…”  Beginning your sentence with this phrase will help me recognize it and will ensure that you get credit for it.  You will not get credit for simply mentioning patient-specific factors within your case summary; they must be clearly identified and revisited within the body of your document. Please note that background information on the diagnosis, diagnostic criteria, diagnostic testing, or epidemiology is NOT required.  It is assumed that you know this; therefore, you should devote yourself to summarizing the case and highlighting specific patient factors that will impact your decisions rather than discussing the aforementioned items.  After all, you only have one page (or less) to cover the required information. Be aware that the writing template and grading rubric require your introduction to end with ONE sentence that is your thesis statement.  See the week 6 writing template for format and the grading rubric for details on how you are graded on this statement. Body of your document The body of your document should contain three sections that are labeled as follows:  decision point 1, decision point 2, and decision point 3.  Each section should be one page and address the topics below.  In your writing, you should be concise, clear, and thorough.  Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit. Decision Point 1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. *In order to receive full credit here, your ethical considerations must be clearly identified as such.  You can identify them in one of two ways:  (1)  You can identify them within each “decision” section.  For example, “My ethical considerations are….”  (2)  Or you can identify them separately in a new section labeled “Ethical Considerations.”  This new section should be inserted after the section entitled Decision Point 3 and before the Conclusion section.  Either one of these options is acceptable. Decision Point 2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.  *See Decision #1 for more information. Decision Point 3 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.  *See Decision #1 for more information. Conclusion (1 page) Summarize your recommendations on the treatment options you selected for this patient. As stated in the writing template, “The conclusion section should recap the major points of your paper. Do not introduce new information in this paragraph.”
ASSESSING AND TREATING PATIENTS WITH ANXIETY DISORDERS Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attac
NURS_6630_Week6_Assignment_Rubric NURS_6630_Week6_Assignment_Rubric Criteria Ratings Pts This criterion is linked to a Learning OutcomeIntroduction to the case (1 page)Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. 10 to >8.0 pts Excellent Point range: 90–100 The response accurately, clearly, and fully summarizes in detail the case for the Assignment…. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. 8 to >7.0 pts Good Point range: 80–89 The response accurately summarizes the case for the Assignment…. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. 7 to >6.0 pts Fair Point range: 70–79 The response inaccurately or vaguely summarizes the case for the Assignment…. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 6 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely summarizes the case for the Assignment, or is missing…. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. 10 pts This criterion is linked to a Learning OutcomeDecision #1 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 20 to >17.0 pts Excellent Point range: 90–100 The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts Good Point range: 80–89 The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts Fair Point range: 70–79 The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely explains the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing. 20 pts This criterion is linked to a Learning OutcomeDecision #2 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 20 to >17.0 pts Excellent Point range: 90–100 The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts Good Point range: 80–89 The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts Fair Point range: 70–79 The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing. 20 pts This criterion is linked to a Learning OutcomeDecision #3 (1–2 pages)• Which decision did you select?• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. 20 to >17.0 pts Excellent Point range: 90–100 The response accurately and clearly explains in detail the decision selected…. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected…. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response…. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients…. Examples provided fully support the decisions and responses provided. 17 to >15.0 pts Good Point range: 80–89 The response accurately explains the decision selected…. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected…. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response…. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response…. The response accurately explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided support the decisions and responses provided. 15 to >13.0 pts Fair Point range: 70–79 The response inaccurately or vaguely explains the decision selected…. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected…. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response…. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients…. Examples provided may support the decisions and responses provided. 13 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely explains in detail the decision selected…. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing…. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing…. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing…. Examples provided do not support the decisions and responses provided, or is missing. 20 pts This criterion is linked to a Learning OutcomeConclusion (1 page)• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. 15 to >13.0 pts Excellent Point range: 90–100 The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient…. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. 13 to >11.0 pts Good Point range: 80–89 The response accurately summarizes the recommendations on the treatment options selected for this patient…. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. 11 to >10.0 pts Fair Point range: 70–79 The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient…. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. 10 to >0 pts Poor Point range: 0–69 The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing…. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing. 15 pts This criterion is linked to a Learning OutcomeWritten 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 are provided that delineate all required criteria. 5 to >4.0 pts Excellent Point range: 90–100 Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.5 pts Good Point range: 80–89 Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time….Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 to >3.0 pts Fair Point range: 70–79 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. 3 to >0 pts Poor Point range: 0–69 Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided. 5 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts Excellent Point range: 90–100 Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.5 pts Good Point range: 80–89 Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5 to >3.0 pts Fair Point range: 70–79 Contains several (3 or 4) grammar, spelling, and punctuation errors. 3 to >0 pts Poor Point range: 0–69 Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. 5 pts This criterion is linked to a Learning OutcomeWritten 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 to >4.0 pts Excellent Point range: 90–100 Uses correct APA format with no errors. 4 to >3.5 pts Good Point range: 80–89 Contains a few (1 or 2) APA format errors. 3.5 to >3.0 pts Fair Point range: 70–79 Contains several (3 or 4) APA format errors. 3 to >0 pts Poor Point range: 0–69 Contains many (≥ 5) APA format errors. 5 pts Total Points: 100 PreviousNext
ASSESSING AND TREATING PATIENTS WITH ANXIETY DISORDERS Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attac
Generalized Anxiety Disorder Middle -Aged White Male with Anxiety BACKGROUND INFORMATION: The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack He stated that he felt chest tightness, shortness of breath and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 pounds overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL. He admits that he still have problems with tightness in his chest and episodes of shortness of breath-he now terms these “anxiety attacks”. He will also report occasional feeling of impending doom and the need to “run: or “escape” from whatever it is. In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A which yields a score of 26. Client has never been on any type of psychotropic medications. MENTAL STATUS EXAM The client is alert and oriented to person place time and event. He is dressed appropriately. Speech is clear, coherent and goal oriented. Client’s self-reporting mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgement is grossly intact, as is insight. He denies suicidal or homicidal ideations. You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26. Diagnosis: General Anxiety Disorder DECISION POINT ONE Select what you should do: Begin Paxil 10mg PO daily Begin Imipramine 25mg PO BID Begin Buspar 10mg PO BID Results of Decision Point One Client returns to clinic within 4 weeks Client reports slight decrease in symptoms Client states that he still feels very anxious HAM_A score decreased from 26 to 23 DECISION POINT TWO Select what you should do: Increase buspirone to 10mg orally TID Increase buspirone to 20mg orally TID Discontinue buspirone and begin Lexapro 10mg orally daily Results of Decision Point Two Client returns to the clinic in 4weeks Client reports no change in his anxiety HAM-A score decreased from 23 to 22 DECISION POINT THREE Select what you should do: Continue current dose and reassess in 4 more weeks Augment with Ativan (lorazepam) 0.5mg orally TID Discontinue buspirone and begin Zoloft 50mg orally daily GUIDENCE TO STUDENT (OUTCOME) It is clear that Buspar has resulted in treatment failure as the client’s original HAM-A score was 26- a change in score from 26 to22 is less than25% in improvement of symptoms which constitutes treatment failure. It would not be appropriate to continue the same dose and reassess in 4 weeks as onset of therapeutic action of buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work. If the client is having no side effects, you can discuss the possibility of increasing dose and reevaluating in another 4 weeks. However, if the client remains distressed by his symptoms, the appropriate course of action would be to discontinue the buspirone and begin SSRI therapy with as agent such as Zoloft 50mg orally daily. Augmentation with an agent such as lorazepam 0.5mg orally TID would not be appropriate at this time as the client needs a treatment plan for the long term. You should never start someone on a benzodiazepine for an indefinite course of treatment as this could lead to addiction. Benzodiazepine should be used for a limited course of treatment for very specific therapeutic endpoints (for instance, to combat the initial activation of which may be seen in the first few weeks after beginning an SSRI or SNRI)