Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example

Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example

Introduction to the Case

The case involves a 46-year-old white male working as a welder at a local steel fabrication factory. The client presented to the emergency room with a feeling of a heart attack: the client reports impending doom, shortness of breath, and chest tightness. The client has a history of mild hypertension, managed through low sodium, and had his tonsils removed at age 8. He is 15lbs overweight. He uses ETOH occasionally and consume+ 3-4 beers every night. He fears for his job, claiming that his workplace management is harsh. HAM-A test administered yields a score of 26. HAM-A scores of 25-30 indicate moderate to severe anxiety (Hamilton, 1959). The client is mildly uncomfortable and feels nervous. These symptoms characterize generalized anxiety disorders, as is his diagnosis.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

Decision #1

Begin Paxil 10mg PO daily. As a PMHNP caring for a GAD patient, Paxil 10mg PO daily was the best pharmacotherapy for the patient. Paxil, a Selective serotonin reuptake inhibitor, is considered the first-line treatment for GAD (Locke et al., 2015). Besides, Paxil is indicated in adults for treating GAD (The Food and Drug Administration [FDA], 2021). Studies have shown that Paxil effectively treats GAD in adults. In an 8-week randomized control and placebo trial with 20-50mg/day with 161 and 163 participants, Paroxetine improved daily functioning and anxiety symptoms in GAD patients (Strawn et al., 2018). In another placebo-controlled trial with 566 participants, the researchers found that paroxetine is well-tolerated and improves HAM-A scores significantly (Strawn et al., 2018).(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

Sertraline is well-tolerated and effective in treating GAS in adults (Strawn et al., 2018). However, sertraline is not recommended for the treatment of GAD by the FDA (FDA, 2016). Wellbutrin was not selected because it is not FDA-approved for managing GAD in adult patients, although studies have shown that it reduces anxiety and panic attacks in MDD patients (2009). For these reasons, Paxil was the ideal pharmacological intervention for the case patient.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

The choice of treatment aims to reduce anxiety symptoms presented by the patient. Therefore, the primary ethical consideration is nonmaleficence, which supports the PMHNP obligation to not harm, including an obligation not to cause pain or incapacitate (Bipeta et al., 2019). In this case, the PMHNP should consider the side effect of the medication, including risks of suicidal thoughts or behaviour during treatment and serotine syndrome (FDA, 2021). The client should be monitored for clinical worsening and emergency symptoms. The client should be informed to contact their local health provider in case of symptoms associated with a serotonin syndrome such as agitation, hallucinations, delirium, tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, nausea, vomiting, and diarrhea.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

Decision #2

The decision chosen at this stage was to increase the dose to 20mg PO daily. The patient’s response to decision point one is positive. However, the client has not achieved an optimal reduction in symptoms. Increasing the dosage improved the client’s response to the medication. The recommended paroxetine dosage is 20mg and has been shown to provide an optimal reduction in anxiety symptoms in adults (Strawn et al., 2018). FDA recommends that in patients with inadequate response, the initial dosage should be increased by 10mg per day at one-week intervals depending on tolerability (FDA, 2021). In this case, the client tolerates the dosage, reducing panic-related symptoms, including shortness of breath and chest tightness, and anxiety symptoms, including worried about work.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

At this point, there was no need to change the medication. Medication change is only recommended when the current medicine is no longer working, there is a need to increase the dosage, or if there are significant side effects (Huiskes et al., 2017). In this case, the patient was responding positively to the current medication. Thus, there was no need to choose the other recommendations.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

At this point, the PMHNP should uphold patient autonomy. The decision to increase the dosage by 10mg should be communicated to the patient. Self-determination is a crucial ethical principle that allows patients to contribute to the decisions regarding their health (Bipeta et al., 2019). The PMHNP should observe appropriate communication to avoid controlling influence or coercing the patient to accept the treatment but rather to communicate the benefits and risks, acknowledge the client’s input in clinical decision and process, and respect the client’s information.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

Decision #3

The decision chosen is to maintain the current dose. The client returns to the clinic with further reductions in symptoms. The HAM-A score is ten, and he reports a 61% reduction in anxiety symptoms. At this point, there is no need to increase the dosage since the client is achieving a significant decrease in symptoms, and there are no side effects or emergency concerns. Therefore, it is ideal for maintaining the dosage for 12 weeks to achieve the full impact (FDA, 2022). Although increased dosage would further reduce the patient’s symptoms, risks of adverse reactions or side effects also increased.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

In the client’s case, no incidence necessitates augmentation with agents such as BuSpar. Augmentation is only recommended for partial response to medication or persistent symptoms. In this case, augmenting paroxetine would be ideal if the client presented treatment-resistant GAD (Ansara, 2020). Although buspirone has shown effectiveness in augmenting SSRIs, no indication in the care necessitates augmentation (Caldiroli et al., 2021). The client is responding well to medication and has achieved an over 50% reduction in clinical symptoms.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

At this point, it is crucial to observe patient autonomy. Discuss with the client the risks and benefits associated with further reduction. Providing patients with information is crucial for their decision-making and self-management of their health (Chan et al., 2018). In this case, the PMHNP should support the patient, provide written information, and foster a good relationship with him. Equally, providing an opportunity for follow-up is important for further evaluation of the client’s symptoms, adherence to medication, and improvement of patient outcomes. Lastly, maintaining patient autonomy allows patients to evaluate whether the medication works well and identify undesired side effects.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

Conclusion

The first recommendation was to start Paxil 10mg PO daily. Paxil is an SSRI, considered the first-line treatment of GAD, and is recommended for treating GAD in adults (Locke et al., 2015; FDA, 2021). The second decision was to increase the dose to 20mg PO daily. The recommended paroxetine dosage is 20mg and has been shown to provide an optimal reduction in anxiety symptoms in adults (Strawn et al., 2018). FDA recommends that in patients with inadequate response, the initial dosage should be increased by 10mg per day at one-week intervals depending on tolerability (FDA, 2021). In this case, the client reported a reduction in symptoms but not optimal. The last decision was to maintain the current dose. The patient reported a significant decrease in symptoms with the medication. Thus, it was ideal to maintain the dosage and observing the patient for another four months. Augmentation is only recommended for partial response to medication or persistent symptoms (Ansara, 2020). In this case, augmenting paroxetine would be ideal if the client presented treatment-resistant GAD.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

References

Ansara, E. D. (2020). Management of treatment-resistant generalized anxiety disorder. Mental Health Clinician, 10(6), 326-334. (Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)https://doi.org/10.9740%2Fmhc.2020.11.326

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian journal of psychological medicine, 41(2), 108-112.https://doi.org/10.4103%2FIJPSYM.IJPSYM_59_19

Caldiroli, A., Capuzzi, E., Tagliabue, I., Capellazzi, M., Marcatili, M., Mucci, F., … & Dakanalis, A. (2021). Augmentative Pharmacological Strategies in Treatment-Resistant Major Depression: A Comprehensive Review. International Journal of Molecular Sciences, 22(23), 13070.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example) https://doi.org/10.3390/ijms222313070

Chan, A. H. Y., Aspden, T., Brackley, K., Ashmore-Price, H., & Honey, M. (2020). What information do patients want about their medicines? An exploration of the perspectives of general medicine inpatients. BMC health services research, 20(1), 1-8. https://doi.org/10.1186/s12913-020-05911-1

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)

Huiskes, V. J. B., Burger, D. M., van den Ende, C. H. M., & van den Bemt, B. J. F. (2017). Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials. BMC family practice, 18(1), 1-15. (Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)https://doi.org/10.1186%2Fs12875-016-0577-x

Locke, A. B., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American Family Physician, 91(9), 617-624. https://pubmed.ncbi.nlm.nih.gov/25955736/  

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. V (Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)https://doi.org/10.1080%2F14656566.2018.1491966

The Food and Drug Administration. (2009). WELLBUTRIN® (bupropion hydrochloride) Tablets(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example). Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/018644s039s040.pdf (Accessed 8 October 2022)

The Food and Drug Administration. (2016). Sertraline (marketed as Zoloft) Information. (Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example)Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839S74S86S87_20990S35S44S45lbl.pdf  (Accessed 8 October 2022)

The Food and Drug Administration. (2021). Drugs@FDA: FDA-Approved Drugs.(Treating patients with Anxiety Disorders Comprehensive Solved Nursing Essay Example) Retrieved 7 October 2022, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/020031s079,020710s047lbl.pdf