Assessing and Treating Patients with Anxiety Disorders

A 46-year-old white male client presents to the facility after being referred by his primary care provider. Chief complaints include heart attack, chest tightness, shortness of breath, and impending doom. The patient reports experiencing anxiety attacks and having the need to escape or run from wherever he is. History of presenting illness indicates that the client experienced a heart attack when he visited an emergency room. Socioeconomic history indicates that the client is single and a welder at a local steel fabrication factory. He lives with his parents in his home and attempts to care for them. He also claims the management at work is harsh, and he fears losing his job. Surgical history indicates that the patient had his tonsils removed at the age of 8 years. Medical history indicates the patient has mild hypertension and has never been on any psychotropic medication. The patient, however, admits to using ETOH to compart worries about work and consumes 3-4 bears per night. On weighing the patient, he was found to be overweight. Other findings of the physical examination were within the normal limits. ER tests are done, and myocardial infarction is ruled out. An EKG test is normal. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.

Mental status examination shows that the patient is well dressed, alert, and oriented to person, place, time, and event. The speech is normal but reports a monotone, implying the patient’s feeling as nervous. The effect is blunt but brightens several times. No hallucinations or paranoid behavior was noted. Insight and judgment are intact, and the client denies any homicidal or suicidal ideation. HAM-A scale yields a score of 26. The patient is diagnosed with generalized anxiety disorder. The history of the patient, the assessment findings, and the tests helped to arrive at the diagnosis. The subjective data, objective data, assessment data, and the test also help identify the best medication for the patient based on the findings.

Decision #1

The decision selected is to begin Zoloft 50 mg orally daily. The patient presents with symptoms of anxiety, and he is diagnosed with general anxiety disorder. He should, therefore, be treated with drugs to reduce anxiety. Since the patient has never been on any psychotropic medication, he should be started on first-line agents for treating anxiety. First-line agents for treating anxiety are Zoloft and Paxil (Silvestro, 2021). In this case, there is no Paxil, and therefore, Zoloft was selected. Zoloft is an antidepressant, therapeutically and pharmacologically, a selective serotonin reuptake inhibitor (Kassis, 2020). The drug inhibits the uptake of serotonin by the neurons in the CNS, hence potentiating serotonin activity (Silvestro, 2021). Therefore, the drug leads to antidepressant action, decreased panic attacks, decreased feelings of intense fear, decreased feelings of horror, and decreased social anxiety (Kassis, 2020). The patient presents with panic attacks, fear, and anxiety, and therefore, Zoloft will be the best drug for his anxiety disorder. Zoloft also has fewer side effects compared to other drugs, making it the best choice.

The other two drugs, Imipramine 25 mg PO BD and Buspirone 10 mg PO BD were not selected because they are second-line drugs in the treatment of anxiety. This is the first time the client is starting psychotropic medications, and therefore, he should begin with first-line drugs (Bradley et al., 2018). Based on the assessment findings, the client has cardiovascular and respiration conditions. Giving the patient Imipramine and Buspirone would worsen the symptoms since the adverse effects of the medications include effects such as tachycardia (Bradley et al., 2018). Based on the decision I made, I was hoping to ensure that the patient’s anxiety is reduced with no or fewer adverse effects from the medication. The safest drug was to be given to the patient. Ethical considerations such as safety ensure the client is given the best drug, which leads to better outcomes. For example, the safest drug administered to the patient ensures safety and prevents unwanted effects (Rathi & Rathi, 2019). Ethical considerations also reduce medication errors. Ensuring the patient is given the right drug at the right dosage and time reduces medication errors.

Decision #2

In the second decision, I selected the dosage of Zoloft to be increased to 75 mg orally daily. The client has returned to the clinic after four weeks and reports decreased worries about work for the past 4 to 5 days. This indicates that the medication is working and, therefore, it should continue being used. A reduction in HAM-A score from 26 to 18 also indicates that the medication is working. However, the reduction in the HAM-A from 26 to 18 indicates a partial response. To achieve the required full response, the dosage of the drug should be increased from 50 mg to 75 mg (Kassis, 2020). The increase will reduce the HAM-A score by a large range to achieve the desired outcome.

The option of increasing the dosage to 100 mg was not selected because this would have a lot of adverse effects on the patient. A very high dose of 100 mg would be harmful to the patient since the adverse effects would increase (Kassis, 2020). The choice of no change in drug or dose at the time was not selected because maintaining the dosage of the drug was not achieving the intended outcomes. At a dosage of 50mg, there was only a partial response; hence, the dosage has to be increased to obtain a better response (Kassis, 2020). By selecting the option of increasing the dosage from 50mg to 75 mg, I was hoping to achieve a good response where the signs and symptoms should be reduced by over 50%. Ethical considerations may impact the treatment plan when the patient complains about the current medication and asks the medication to be changed. In case the patient reports adverse effects of the medication, the medication dosage should be reduced or changed (Rathi & Rathi, 2019). The patient also has a right to better, safe treatment, such as increasing the dosage for the good of the patient.

Decision #3

The selected decision is to maintain the current dose of 75 mg orally daily. The patient has returned to the clinic, and he claims a further reduction in symptoms. There is a 61% reduction in symptoms, and the HAM-A score has reduced to 10. This indicates that the response is good since there is more than a 50% reduction in the symptoms. There is also no side effect reported, and therefore, the dosage should be maintained at 75 mg (Bradley et al., 2018). Therefore, the current medication should be maintained for at least 12 weeks as the patient’s response is evaluated.

The choice of increasing the current dose of medication to 100 mg orally was not selected because increasing the doses could harm the patient. Although increasing the dosage to 100 mg would reduce the symptoms, this dosage is too high, increasing the risk of adverse effects (Silvestro, 2021). The patient would experience side effects. The dose of 50 mg should be maintained because no side effects are being experienced, and a good response is being achieved. The choice of adding an augmentation agent such as BuSpar was not selected because there is no indication of the need for an extra drug or agent (Bradley et al., 2018). The single drug that the patient is using is able to manage the symptoms effectively, and therefore, there is no need to add an extra drug. Combination therapy or extra drugs are added when the patient is not responding to the current medications. Ethical considerations impact the treatment plan by ensuring that the patient is given the right drug dosage to ensure safety (Rathi & Rathi, 2019). Giving the patient a high dosage would harm the patient. A drug that has a lot of adverse effects should be withdrawn. Additional medications can be added to the current medication only if the current medication is not achieving the intended purpose.

Conclusion

The patient has a general anxiety disorder, and therefore, he needs drugs to reduce his anxiety symptoms. However, the patient cannot take any anxiety drugs because the drugs may worsen the patient’s health instead of making him better (Strawn et al., 2018). Several factors have to be considered in selecting the best medication for the patient (Bradley et al., 2018). These factors include past and present medical conditions, past medical history, and assessment findings (Bradley et al., 2018). The adverse effects of the medications should be compared to the patients’ data to find the best drug for the patient.

The patient, in this case, has never been on any psychotropic medication. The patient has shortness of breath and mild hypertension. This means that the patient should be started on first-line anxiety drugs that have no or fewer effects on the respiratory and cardiovascular systems. Zoloft is the best option since it is a first-line drug in the treatment of anxiety (Strawn et al., 2018). It also has fewer effects compared to other second-line medications given. After an initial dosage of a drug is administered to the patient, the patient should be monitored for adverse effects and evaluate whether the desired outcome of symptom reduction is achieved. In case there are no adverse effects, then the drug is continued, but in case the adverse effects occur, the drug is stopped (Yatham et al., 2018). The dosage should be slightly increased when there are no adverse effects and the drug is not achieving the desired outcome (Strawn et al., 2018). Zoloft had no side effects on the patient, and the dosage was not achieving the desired outcome. Thus, the dosage was increased from 50 mg to 75 mg to achieve the desired outcome, which the drug achieved (Silvestro, 2021). There was no need to add another drug or increase the dosage since the drug was achieving its therapeutic effect without adverse effects. Extra dosage above normal increases the risk of adverse effects since the body is affected when metabolizing, absorbing, and excreting the drug (Strawn et al., 2018). Hence, it was right to use an initial dosage of Zoloft 50 mg orally daily, increase the dosage to 75 mg daily, and then maintain the dosage.

References

Bradley, P., Shiekh, M., Mehra, V., Vrbicky, K., Layle, S., Olson, M. C., … & Lukowiak, A. A. (2018). Improved efficacy with targeted pharmacogenetic-guided treatment of patients with depression and anxiety: a randomized clinical trial demonstrating clinical utility. Journal of psychiatric research, 96, 100-107.

Kassis, K. N. (2020). Is Sertraline Effective At Reducing The Symptoms Of Anxiety In Those Diagnosed With Generalized Anxiety Disorder (GAD)?

Rathi, B., & Rathi, R. (2019). Principals of ethical Ayurveda prescription writing in clinical practice: A literature review. Journal of Datta Meghe Institute of Medical Sciences University, 14(6), 97.

Silvestro, S. (2021). Sertraline (Zoloft): dosage, uses, side effects. Drugs.

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.

Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … & Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar disorders, 20(2), 97-170.

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Question

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_05/index.html
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.

Assessing and Treating Patients with Anxiety Disorders

Decision #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.

Decision #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.

Decision #3 (1 page)

Conclusion (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.

Assessing and Treating Patients with Anxiety Disorders