ANXIETY DISORDERS
please see attached
3 years ago 40
ptbackground.docx
decisions.pdf
patientsbackgroundinformation.pdf
ptbackground.docx
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 lbs. 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 has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
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 medication.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported 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. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
decisions.pdf
12/31/23, 8:14 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/1.html 1/3
Generalized Anxiety Disorder Middle-Aged White Male With Anxiety
Decision Point One
Begin Paxil 10 mg po daily
RESULTS OF DECISION POINT ONE � Client returns to clinic in four weeks
� Client informs you that he has no tightness in chest, or shortness of breath
12/31/23, 8:14 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/1.html 2/3
� Client states that he noticed decreased worries about work over the past 4 or 5 days
� HAM-A score has decreased to 18 (partial response)
Decision Point Two
Increase dose to 20 mg po daily
RESULTS OF DECISION POINT TWO � Client returns to clinic in four weeks
� Client reports an even further reduction in his symptoms
� HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)
Decision Point Three
Maintain current dose
12/31/23, 8:14 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/1.html 3/3
Guidance to Student
At this point, it may be appropriate to continue client at the current
dose. It is clear that the client is having a good response (as
evidenced by greater than a 50% reduction in symptoms) and the
client is currently not experiencing any side e�ects, the current
dose can be maintained for 12 weeks to evaluate full e�ect of drug.
Increasing drug at this point may yield a further decrease in
symptoms, but may also increase the risk of side e�ects. This is a
decision that you should discuss with the client. Nothing in the
client’s case tells us that we should consider adding an
augmentation agent at this point as the client is demonstrating
response to the drug. Avoid polypharmacy unless symptoms
cannot be managed by a single drug.
Start Over (index.html)
patientsbackgroundinformation.pdf
12/31/23, 8:16 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html 1/3
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 lbs. 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 has problems with tightness in the chest and episodes of
shortness of breath- he now terms these “anxiety attacks.” He will also report occasional
feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
12/31/23, 8:16 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html 2/3
In your o�ce, 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 medication.
MENTAL STATUS EXAM The client is alert, oriented to person, place, time, and event. He is appropriately dressed.
Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he
does endorse feeling “nervous”. A�ect is somewhat blunted, but does brighten several
times throughout the clinical interview. A�ect broad. Client denies visual or auditory
hallucinations, no overt delusional or paranoid thought processes readily apparent.
Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES § Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Decision Point One Select what you should do:
Begin Paxil 10 mg po daily
(1.html)
12/31/23, 8:16 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html 3/3
Begin Imipramine 25 mg po BID
(2.html)
Begin Buspirone 10 mg po BID
(3.html)
ptbackground.docx
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 lbs. 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 has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
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 medication.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported 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. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
decisions.pdf
12/31/23, 8:14 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/1.html 1/3
Generalized Anxiety Disorder Middle-Aged White Male With Anxiety
Decision Point One
Begin Paxil 10 mg po daily
RESULTS OF DECISION POINT ONE � Client returns to clinic in four weeks
� Client informs you that he has no tightness in chest, or shortness of breath
12/31/23, 8:14 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/1.html 2/3
� Client states that he noticed decreased worries about work over the past 4 or 5 days
� HAM-A score has decreased to 18 (partial response)
Decision Point Two
Increase dose to 20 mg po daily
RESULTS OF DECISION POINT TWO � Client returns to clinic in four weeks
� Client reports an even further reduction in his symptoms
� HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)
Decision Point Three
Maintain current dose
12/31/23, 8:14 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/1.html 3/3
Guidance to Student
At this point, it may be appropriate to continue client at the current
dose. It is clear that the client is having a good response (as
evidenced by greater than a 50% reduction in symptoms) and the
client is currently not experiencing any side e�ects, the current
dose can be maintained for 12 weeks to evaluate full e�ect of drug.
Increasing drug at this point may yield a further decrease in
symptoms, but may also increase the risk of side e�ects. This is a
decision that you should discuss with the client. Nothing in the
client’s case tells us that we should consider adding an
augmentation agent at this point as the client is demonstrating
response to the drug. Avoid polypharmacy unless symptoms
cannot be managed by a single drug.
Start Over (index.html)
patientsbackgroundinformation.pdf
12/31/23, 8:16 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html 1/3
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 lbs. 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 has problems with tightness in the chest and episodes of
shortness of breath- he now terms these “anxiety attacks.” He will also report occasional
feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
12/31/23, 8:16 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html 2/3
In your o�ce, 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 medication.
MENTAL STATUS EXAM The client is alert, oriented to person, place, time, and event. He is appropriately dressed.
Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he
does endorse feeling “nervous”. A�ect is somewhat blunted, but does brighten several
times throughout the clinical interview. A�ect broad. Client denies visual or auditory
hallucinations, no overt delusional or paranoid thought processes readily apparent.
Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES § Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Decision Point One Select what you should do:
Begin Paxil 10 mg po daily
(1.html)
12/31/23, 8:16 AM Psychopharmacologic Approaches to Treatment of Psychopathology
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html 3/3
Begin Imipramine 25 mg po BID
(2.html)
Begin Buspirone 10 mg po BID
(3.html)
Nursing ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS (Assignment 2)
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