“I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.”
—P.K. Philips, PTSD patient

For individuals suffering from posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric mental health nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of clients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

Assignment: Assessing and Treating Clients 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 attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.

Learning Objectives

Students will:

• –Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
• –Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
• –Evaluate efficacy of treatment plans
• –Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan.

sample that can be audit and submit with plagiarism less than 15% 

Assessing and Treating Clients with Anxiety Disorder 

  Assessing and Treating Clients with Anxiety Disorders.

Anxiety disorders are the most prevalent category of mental illness and are characterized by chronic anxiety causing distress and interference in the individual’s life. According to DSM-5, excessive anxiety and worry must cause significant distress or impairment and occurs on more days than not for at least six months for diagnostic criteria (Stein et al., 2015) The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities. 

This paper addresses the pharmacology approach in treating a 46 year- old white male who is experiencing anxiety, and the impact pharmacokinetic and pharmadynamic processes will be explored to guide for the appropriate treatment. 

Case Scenario

A 46-year-old white male who initially presented to ER with a complaint of chest pain and cardiac work- up was negative, and a PMHNP consult was sought for psychiatric evaluation. The client ‘s Hamilton Anxiety Rating Scale( HAM-A) was 26 indicating moderate to severe anxiety phase. The PMHNP decides to start the client on medications. 

 Options: Zoloft 50 mg Po Daily, imipramine 25 mg po BID, buspirone 10 mg BID. 

 Decision: Zoloft 50 mg PO daily.

Rationale: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs ) benzodiazepines, buspirone, and α2δ ligands such as pregabalin and gabapentin are recommended as first line treatments for anxiety disorders spectrum (Stahl, 2017) However,  SSRI and SNRIs are efficacious in the treatment of generalized anxiety disorder (GAD) and panic attack as in the case of our patient in the scenario. Additionally, in cases of co-occurring GAD and depression, a common comorbidity, SSRIs can provide effective treatment for both GAD and major depression ( Johnson & Coles, 2014) .

Selecting sertraline (Zoloft) was based on the fact it belongs to the family of SSRI, and well recognized in the treatment of GAD and panic attack. Secondly, possible side effects of Zoloft which include sexual dysfunction, gastrointestinal abnormalities (nausea and diarrhea), insomnia, weight gain, and agitation and/or hyperactivation (Kamo et al.,2016) were explored prior selecting Zoloft. The patient was overweight (15 lb), hence a healthy lifestyle will be important for education, and the rest of side effects can be monitored and managed early in treatment.   

Sertraline affects the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning the remaining serotonin to the presynaptic cell. Sertraline is well absorbed in gastrointestinal tract, highly protein bound, predominantly metabolized by CYP 450 system  with half-life of 24- 26 hrs and removed primarily  by kidneys ( Woo & Wayne, 2013).  

Imipramine, a tricyclic antidepressant was not my first choice because its possible side effects: blurred vision, dry mouth, urinary retention, drowsiness, weight gain, hypotension, and seizures (Stahl,2017)

Buspirone (Buspar), a serotonin receptor partial agonist can be appropriate for augmentation but not as first line treatment of GAD. Additionally, Buspirone takes longer (2 – 4 weeks) to have a full effect, and due to its sedation side effect, it would not be appropriate in our patient who has history of increased alcohol intake.

 The goals of treatment of anxiety disorders are resolution of symptoms and prevention of relapse. 

The client returns in four weeks, responding well to medication, anxiety decreased HAM A 18 from 26. 

Options : Increase dose to 75 mg daily, increase dose to 100 mg daily, no change in drug/ dosage

Decision # 2 Increase dose to 75 mg daily. 

Rationale: Sertraline dosing in panic, PTSD, and social anxiety begin with 25 mg/day; increase to 50 mg/day after 1 week thereafter, usually wait a few weeks to assess drug effects before increasing dose; maximum generally 200 mg/day; single dose (Stahl,2017).

 Moreover, increasing dosage slowly will reduce the possibility of acquiring side effects from the medication (Stein et al., 2014)

The client returns in four weeks, reports further reduction in anxiety symptoms HAM- A 10 (mild anxiety) 

Options: Maintain current dose, increase to 100 mg daily, add Buspirone. 

Decision: Maintain current dose 

Rationale: Major errors in psychopharmacological treatment of anxiety disorders include not achieving full remission of symptoms but instead accepting partial response, and not providing an adequate trial of medications (8 to 12 weeks ) before switching, discontinuing, or augmenting ( Woo & Wayne, 2013) . The patient was responding pretty well to medication ( 50% reduction in symptoms) , and reported no side effects. Therefore, continuing the same dosage, providing regular follow up with the patient to ensure medication adherence would be appropriate to meet the goals of remission. 

References

Johnson, E. M., & Coles, M. E. (2014). Failure and Delay in Treatment-Seeking Across Anxiety Disorders. Community Mental Health Journal, 49(6), 668-674. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=29&sid=7eabbc3a-b3a4-4cbf-b934-aa75c2e5b6fd%40sessionmgr4007

Kamo, T., Maeda, M., Oe, M., Kato, H., Shigemura, J., Kuribayashi, K., & Hoshino, Y. (2016). Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study. BMC Psychiatry, 16(1). Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=6&sid=2ee0b7c6-b1c7-44e7-9b93-42c3b9a745c3%40sessionmgr102

Stein, D. J., Craske, M. A., Friedman, M. J., & Phillips, K. A. (2014). Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders, and Dissociative Disorders in DSM-5. American Journal of Psychiatry, 171(6), 611-613. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14010003

Woo, T. M., & Wynne, A. L. (2013). Pharmacotherapeutics for nurse practitioner prescribers(3rd ed.). Philadelphia, PA: F.A. Davis Co.

• Decision #1
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

1- What is Policy?

2- Explain each of them:     Public policy— Private policy— Health policy— Social policy— Organizational policy?

3- Who was F lorence Nightingale, and what was her contribution to the Nursing Field? 

4- Who was Lillian Wald?

5- Who was Margaret Sanger, and in what way she helped to the developments of Nursing Field?

6_ what is    (ICN), and what they do?

7- What is  s (NLCA) and they do?

Jeanne Blum, RN, is a nurse on a LDRP unit. Recently, the policy and   procedures manual for Jeanne’s unit included the premature rupturing of membranes of a laboring patient    as a practice acceptable for nurses to perform. Jeanne    and some of her coworkers shared their concern over   lunch about this new responsibility.They felt uncomfortable with the possibility of cord prolapse and    other potential medical complications resulting from    this practice. Jeanne gathered data from her state and    many others states and noted that her hospital was    not in compliance with her professional organizationpractice standards. Jeanne shared this information   with her coworkers. She volunteered to contact the    state board of nursing on their behalf to request a    declaratory statement on the nurse’s role in the initiation of premature rupturing of uterine membranes.    Her state board’s clinical practice committee    reviewed her request for a declaratory statement and    gathered information from other states. A formal    declaratory statement was drafted by the board and    made it available on its Web site. A letter from the    board was sent to Jeanne’s institution, informing it of   the declaratory statement, which stated that the task    nurses were requested to perform was beyond their    scope of practice based on the Nurse Practice Act. 

8-Which stage of the policy model does this scenario    represent?

Question 1

Points: 1.00

Define NursingWhat does the scope and standard of nursing do?The ANA has recognized NANDA, NIC, and NOC as languages that meet its criteria regarding the nursing process.Identify the benefit of standardized language and the nursing process.

Question 2	Points: 1.00

The nurse gathers information to identify the condition of the patient’s health.What does a complete assessment contain? When is a focused assessment necessary?Identify the differences of the LPN/LVN role and the RN role in assessing and diagnosing patients.

Question 3

Points: 1.00

· What is subjective data?· What is objective data?· How might a nurse record subjective data?· How might a nurse record objective data?

Question 4	Points: 1.00

· The patient is considered the primary source of information and is the most accurate.· What type of sources are secondary sources?· In what circumstances would the nurse be required to utilize secondary sources?

Question 5

Points: 1.00

There are two basic methods utilized to collect data.· What is the first method?· What type of data is collected during the interview process?· What is the second method?· What type of data is collected during the physical examination?· When does data clustering occur?· This clustering of data assists in the identification of a nursing diagnosis.· How can categorizing data assist the nurse in developing a plan of care?

Question 6	Points: 1.00

What are NANDA nursing diagnoses?What is the purpose of the nursing diagnosis?Why does the nursing profession utilize nursing diagnosis and interventions?What are the four components of the nursing diagnosis?How is the nursing diagnosis stated to identify a problem?Why is clarity an essential component of the nursing diagnosis?What are contributing factors and risk factors?What type of risk factors might increase a patient’s probability for problems?

Question 7

Points: 1.00

1. What are syndrome nursing diagnoses? In what situations would syndrome nursing diagnosis be utilized?2. What is wellness nursing diagnosis? What terms are used in wellness nursing diagnosis?3. How is medical diagnosis different from nursing diagnosis?4.Why is it important for nurses to prioritize their nursing diagnoses?

Question 8	Points: 1.00

What is the difference between a goal statement and an outcome statement?What components are necessary in the outcome statement to determine the patient’s progress? Identify potential patient outcomes.Identify criteria that are required to achieve a well-written goal or outcome statement.

Question 9

Points: 1.00

What is the purpose of nursing interventions?What is the difference between interventions that are classified as physician prescribed or nurse prescribed? Identify physician-prescribed interventions.What are nursing orders?What criteria are contained in nursing orders?

Question 10	Points: 1.00

What is the fifth phase of the nursing process? This phase provides ongoing evaluation and adjustments to the plan of care to promote continuity and achievement of the desired outcome. Why is documentation required to validate the outcome?Distinguish situations in which progression or lack of progression towards the desired outcome is not communicated to other nursing staff and the effects on continuity of patient care.

Question 11

Points: 1.00

What is a clinical pathway? What are variances? What are the potential complications for miscommunication amongst the various disciplines when a patient does not fit the typical clinical pathway?

Question 12	Points: 1.00

Following the gathering of subjective and objective data, performing a health history and a physical assessment, the nurse sets up a plan of care. The first step is to identify the problem with a(n):

Question 13

Points: 1.00

“Ambulate the patient three times a day at 0900, 1400, 1900 as tolerated” is an example of:

Question 14	Points: 1.00

Your patient has returned from surgery and has a history of smoking. The physician has orders for the use of incentive spirometry (IS) every 2 hours. The patient asks why he has to do IS so often. You teach your patient about the importance of breathing deeply, to clear any secretions and its prevention of pneumonia. This teaching is an example of:

Question 15

Points: 1.00

The role of the Licensed Practical Nurse in writing a nursing diagnosis is:·

Scroll to the

Medical diagnosis

Nursing intervention

Nursing diagnosis

Evaluation

Nursing order

Nursing diagnosis

Patient goal

Evaluation

A nursing diagnosis

An outcome statement

Implementation of a nursing interven

The nursing process

To assist with the determination of ac

To leave the writing of the nursing dia

To be responsible for writing the nurs

Not involved in the nursing process

To support your work, use your course and text readings and also use the —————–University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

This week’s discussion focuses on the federal government’s role in protecting the public’s health using the ACA and current efforts to “repeal and replace” the ACA. Please note that the government’s role in protecting the public’s health did not begin with the ACA. In the late 1800s, Lilian Wald brought health care to the community. And in 1965, Congress passed bills authorizing Medicare and Medicaid. Since 1965, Congress has expanded government-sponsored health care to pregnant women and children.

Answer the following question:

· Compare the current provisions in the ACA with those in the failed first version of the AHCA. Share your opinions about why the AHCA failed in the first attempt at passage.

Continue to read daily from one of the policy briefs that are included in your weekly readings list. POLITICO Pulse is a daily briefing from POLITICO, and the Kaiser Health News Morning Briefing is a daily briefing from the Kaiser Family Foundation. Both focus on health care. Either one will keep you abreast of what is happening in health care policies and politics.

In addition, subscribe to the “HealthCetera” podcast and listen to the podcast weekly. This is a production of WBAI, free speech radio of Pacifica Foundation Radio in New York City. Diana Mason and Barbara Glickstein are founders and codirectors of the Center for Health Media Policy (CHMP). Both are recognized as experts in media, nursing, health, and health policy. They have a longstanding relationship as producers and moderators of HealthCetera (https://www.wbai.org/index.php?option=content&task=view&id=384&Itemid=42), a live, award-winning radio program on public radio and iTunes. They are bloggers for Disruptive Women in Health Care( http://www.disruptivewomen.net/)and for the American Journal of Nursing (AJN) (https://journals.lww.com/ajnonline/pages/default.aspx). The CHMP is an interdisciplinary initiative for advancing the health of the public and healthy public policies through media, research, education, and public forums. Listen to the podcast throughout the course and think on the topics that are discussed, especially as they relate to how we advocate for issues of importance in this contemporary political environment.

In a short essay (500-750 words), answer the Question at the end of Case Study 1. Cite references to support your positions.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin.

Case Study 1

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

Hemoglobin = 8 g/dl

Hematocrit = 32%

Erythrocyte count = 3.1 x 10/mm

RBC smear showed microcytic and hypochromic cells

Reticulocyte count = 1.5%

Other laboratory values were within normal limits.

Question

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale 

Case Study 2

Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him.

Question

Considering Mr. P’s condition and circumstance, write an essay of 500-750 words that includes the following:

· Describe your approach to care.

· Recommend a treatment plan.

· Describe a method for providing both the patient and family with education and explain your rationale.

· Provide a teaching plan (avoid using terminology that the patient and family may not understand).