NURS 6630 Week 5 Assignment

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.Assignment: Assessing and Treating Clients With Anxiety Disorders – NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment.

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Assignment: Assessing and Treating Clients With Anxiety Disorders Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 9, “Anxiety Disorder and Anxiolytics”

Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

To access the following chapters, click on the Illustrated Guides tab and then the Anxiety, Stress, and PTSD tab.

Chapter 4, “First-Line Medications for PTSD”

Chapter 5, “Second-Line, Adjunct, and Investigational Medications for PTSD”

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913

Note: Retrieved from Walden Library databases.

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Note: Retrieved from Walden Library databases.

Assignment: Assessing and Treating Clients With Anxiety Disorders Required Media

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Assignment: Assessing and Treating Clients With Anxiety Disorders Optional Resources

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306

To prepare for this Assignment:NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment: Assessing and Treating Clients With Anxiety Disorders Assignment

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1 NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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?

Also include how ethical considerations might impact your treatment plan and communication with clients.

A Middle-Aged Caucasian Man with Anxiety

The case study is about a 46-year old white male who works as a welder. His primary care physician refers the man to psychiatry after a trip to the emergency room where he showed symptoms of a heart attack. The patient indicated instances of chest tightness, shortness of breath, and a feeling of impending doom. He has light hypertension but manages it with low sodium diet; he is also a little overweight. The possibility of myocardial infarction was ruled out in the emergency room, and the electrocardiogram did not reveal significant results. The client admits that he occasionally consumes 3-4 beers to counter work-related stress. The patient takes care of his aging parents and encounters stress at the workplace. The mental health exam reveals that the client is alert and oriented; however, he does not have any suicidal or homicidal thoughts. The psychiatric-mental health practitioner (PMHNP) administered the Hamilton Anxiety Rating Scale (HAM-A) and revealed a score of 26. The PMHNP diagnosed the client with generalized anxiety disorder. The PMHNP made three treatment decisions for the patient; the first was to apply Zoloft 50 mg po daily, start Imipramine 25 mg po BID, and useBuspirone.

The first treatment option was Zoloft that was taken orally at 50 milligrams daily. Zoloft is used to treat depression, panic attacks, obsessive-compulsive disorders, post-traumatic stress disorder, and anxiety. The medication was chosen because of its ability to lessen anxiety attacks within the shortest time possible. Pharmacodynamics is the impact that medication has on the body while pharmacokinetics is the way the body reacts to the drug. Pharmacokinetics involves the processes of absorption, distribution, metabolism, and excretion of medications (Jann et al., 2016). Their mechanism of action typically describes them as selective serotonin reuptake inhibitors (SSRIs) with the binding ability towards the serotonin transporter. The treatment works by restoring the balance of serotonin, which is a natural substance in the brain. The treatment undergoes an extensive first-pass metabolism, its principal initial pathway of metabolism being N-demethylation. It has a plasma termination half-life of 62-104 hours (Devane et al. 2016, p. 250). The 50 mg dosage was chosen because of the weight of the client. His weight would make it possible to absorb the medication. The expected result for the drug was the reduction in panic attacks; the outcomes were achieved after taking the medication for the first few months. The medication increased the client’s appetite, thus resulting in significant weight gain, and he experienced constant change in moods while on the drug. The PMHNP informed the client that whenever he felt that he was having an anxiety attack, he was free to call at any time. He was also advised that if his calls were not picked he could be called back immediately. The client was notified of the benefits and side effects of the medication as required by the code of ethics.

The second treatment option was to begin Imipramine at 25 mg, which is taken orally twice in a day. Imipramine belongs to the tricyclic group of antidepressants and it is known to be useful in the treatment of anxiety attacks (Almatura et al., 2013). The expected results of the medication are reduced panic or anxiety attacks and elevated moods. However, the results differed with the desired results since the client experienced insomnia. Notably, insomnia ensured that the patient did not get enough sleep; therefore, he was always fatigued, thus increasing the risk of panic attacks triggered by stress. As noted earlier, the client’s management at work is harsh; therefore, if his productivity was lowered, it would stress him out; hence, leading to more anxiety attacks. Apart from insomnia, the patient also experienced constipation, weight gain, frequent sleepiness, and increased sweating. Imipramine works by preventing the neuronal reuptake of neurotransmitters, norepinephrine, and serotonin (Devane 2016, p. 258).

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