-Go to this website: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html
-Follow these short steps:
-Decision Point 1: Click \”begin Paxil 10mg\”
-Decision Point 2: Click \”Increase Paxil to 20mg\”
-Decision Point 3: Click \”Maintain current dose\”
*Essay Assignment:
-Page 1:Introduction to the case:
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.
-Page2: Decision #1
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.
-Page 3: Decision #2
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.
-Page 4: Decision #3
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.
-Page 5: Conclusion
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.
Treating Patients with Anxiety Disorders
Student’s Name
Institutional Affiliation
Course
Instructor’s Name
Date
Treating Patients with Anxiety Disorders
Introduction
Generalized anxiety disorder (GAD) is one of the common mental disorders that can have detrimental effects on the health of a patient. The mental illness is marked by excessive or exaggerated anxiety and worries about daily events for no obvious reason (Munir et al., 2022). Individuals experiencing GAD tend to always expect doom and most of them cannot stop worrying about money, health, family, and/or work. About 4 million US adults experience generalized anxiety disorder annually (Munir et al., 2022). Some of the symptoms of GAD include excessive worry, unrealistic view of the problem, restlessness, trouble concentrating, and tiring easily or fatigue, among other symptoms.
In the case study, the patient is a 46-year-old white male who works as a welder at a local steel fabrication factory. The patient was referred by his personal care provider to the emergency room after experiencing what he described as similar to a heart attack. He experienced shortness of breath, chest tightness, and a feeling of impending doom. He does have mild hypertension that is managed by a low sodium diet, and he is also overweight. He admits to the occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. He states that the management at his workplace is harsh and fears losing his job. Mental examination reveals that he is oriented to person, place, time, and event. The patient is appropriately dressed, speech is clear and goal-oriented. Affect is somehow blunted; he denies visual or auditory hallucinations. He also denies overt delusions and suicidal thoughts. The patient was diagnosed with generalized anxiety disorder. In that regard, this paper discusses three treatment options applied to improve the patient’s condition.
Decision Point One
The selected decision is to Begin Paxil 10 mg PO daily. This decision was selected because is widely known as an effective treatment for generalized anxiety disorder. Paxil is an antidepressant medication and FDA approved for the treatment of generalized anxiety disorder (Strawn et al., 2018). the drug belongs to the group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). Paxil works by preventing brain cells from quickly absorbing serotonin to balance the serotonin levels in the brain (Strawn et al., 2018). Paxil can help reduce GAD symptoms by balancing the neurotransmitters in the brain.
The other two decisions were not selected due to one reason or the other. For instance, beginning Tofranil (imipramine) 25 mg orally BID was not selected because it can cause orthostatic hypotension, sudden death, arrhythmias, tachycardia, and QTc prolongation (Mary-Irvin, 2019). Furthermore, it should not be used in clients who have already been identified as having an abnormality of cardiac conduction. The patient has a history of an abnormality of cardiac conduction, therefore, it would cause danger to the patient. On the other hand, Buspirone 10 mg orally BID was not selected because it is associated with detrimental side effects such as nausea, fatigue, diarrhea, dizziness, and others (Mary-Irvin, 2019). It would lead to negative health effects due to side effects.
The patient was expected to return to the clinic in four weeks. The initial symptoms experienced by the patient are expected to reduce. For example, there should be a significant reduction or elimination of chest tightness and shortness of breath (Gerlach & Gloster, 2021). The level of worry should be significantly reduced. The HAM-A score should read lesser than what was initially recorded. The actual results matched the expected ones. The patient returned to the clinic in four weeks. He reported not having chest tightness and shortness of breath (Gerlach & Gloster, 2021). He also reported a significant reduction in worries and the HAM-A score reduced from 26 to 18. Some of the ethical issues to consider when dealing with the patient include autonomy, beneficence, and non-maleficence (Robinson & Doody, 2022). Patients’ preferences must be respected, and the decisions made must be beneficial and harmless to the patient.
Decision Point Two
The selected decision two is to increase the imipramine dose to 20 mg PO daily. The decision was selected because the patient showed promising results with the medication. There was a slight improvement with the lower dose, hence, it is appropriate to increase the dose (Strawn et al., 2018). Additionally, the patient did not report any side effects associated with the drug. He has improved in his mood marked by reduced worries. He also stopped experiencing chest tightness and shortness of breath. The best dose indicated for most adults is Paxil 20 mg; the drugs increase should be gradual (Gerlach & Gloster, 2021). Paxil 40 mg would be a sharp increase in dose adjustment.
Increasing the dose to 40 mg PO daily was not selected because Paxil 20 mg is safer than 40 mg. Paxil 40 mg would lead to slight impairment of body functions. Additionally, dose adjustments should be gradual, moving from 10mg to 20 mg and so forth (Mary-Irvin, 2019). Possible side effects associated with Paxil 40 mg PO daily include drug intolerance and erection dysfunction. On the other hand, the decision to maintain Paxil 10 mg PO daily would not be appropriate at this time because the patient had not shown significant improvement in his symptoms.
After does adjustment, it was expected that the patient would return to the clinic in four weeks. There should be even further reduction in the symptoms. The chest tightness and shortness of breath should have disappeared completely. Similarly, worries should have disappeared completely (Gerlach & Gloster, 2021). The Harm score should read below 13 and there should be more than a 50% reduction in the GAD symptoms. The actual results matched the expected one because the patient reputed reported even further reduction in the symptoms. The HAM-A score was 10 indicating 61% symptom reduction. Ethical issues to consider when dealing with the patient include autonomy, beneficence, and non-maleficence (Robinson & Doody, 2022). Patients’ preferences must be respected, and the decisions made must be beneficial and harmless to the patient. Patient education is necessary to improve adherence. Principles of beneficence, no maleficence, and autonomy should be respected.
Decision Point Three
The selected decision three is to maintain the current dose (Paxil 20mg PO daily). It is appropriate to maintain the current dose because the patient has more than a 50% reduction. Additionally, he is currently not experiencing any side effects (Strawn et al., 2018). The current dose should be maintained for 12 weeks but progress can be monitored for four weeks.
Increasing Paxil 20 mg to 30 mg PO daily may increase the risk of severe side effects. The dose is currently working well and the patient does not have any side effects, therefore, there is no need to increase the dose. Side effects such as increased anxiety, nausea, diarrhea, and suicidal thoughts may be triggered by higher doses (Mary-Irvin, 2019). Additionally, there is no need to add augmentation at this time because the patient is demonstrating a response to the drug. It is important to avoid polypharmacy unless symptoms cannot be managed by a single dose.
It is expected that the patient would return to the clinic in four weeks. Ninety-eight percent of the symptoms should have resolved at this time. The HAM-A score should read below 5 percent. No side effects are anticipated (Gerlach & Gloster, 2021). Patient education is important to enhance recovery. Other ethical issues to consider include autonomy, beneficence, and non-maleficence.
Conclusion
Generalized anxiety disorder (GAD) can be detrimental to individuals’ health. Symptoms of GAD include excessive worry, unrealistic view of the problem, restlessness, trouble concentrating, and tiring easily or fatigue, among other many symptoms. The patient presented in the case study is a 46-year-old white male diagnosed with generalized anxiety disorder. Mental examination revealed that he is oriented to person, place, time, and event. The patient manifested symptoms of generalized anxiety disorder. In that regard, three treatment decisions have been discussed to improve the patient’s condition.
The selected decision is to Begin Paxil 10 mg PO daily. This decision was selected because is widely used as an effective treatment for generalized anxiety disorder. The selected decision two is to increase the imipramine dose to 20 mg PO daily. There was a slight improvement with the lower dose, hence, it is appropriate to increase the dose. The selected decision three is to maintain the current dose (Paxil 20mg PO daily). The decision was selected because the patient has more than a 50% reduction. Patient education is important to enhance recovery. The therapist should educate the patient about the importance of medication compliance and adherence to medical instructions. The therapist also considered autonomy, beneficence, and non-maleficence. Patients’ preferences must be respected by explaining and educating them about the benefits and dangers of their decisions. Furthermore, all the decisions made must be beneficial to the patient. The treatment regimen should not cause harm to the patient.
References
Gerlach, A., & Gloster, A. T. (2021). Generalized anxiety disorder and worrying: A comprehensive handbook for clinicians and researchers. NJ Chichester Wiley Blackwell.
Munir, S., Takov, V., & Coletti, V. A. (2022). Generalized anxiety disorder (nursing). In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568696/
Mary Irvin, B. S. N. (2019). Psychotropic Medication Side Effects. https://dbhdsqa.virginia.gov/assets/doc/OIH/safety-alert-for-psychotropic-side-effects.final.2.pdf
Robinson, S., & Doody, O. (2022). Nursing & healthcare ethics. Elsevier.
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