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Assignment: Assessing and Treating Clients With An

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 To prepare for this Assignment: • Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy. The 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 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? • Decision #2 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? • Decision #3 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o 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. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. CASE STUDY ASSIGNED: 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 9which is treated with low sodium diet) and is about 15lbs. 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 report occasional feelings of impeding 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 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 not endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect is 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. The PMHNP administers the Hamilton Anxiety Rating Scale (HAM-A) which yield 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 the PMHNP should do  Begin Zoloft 50 mg PO daily  Begin Imipramine 25 mg PO BID  Begin Buspirone 10 mg PO BID Rubric Detail Select Grid View or List View to change the rubric’s layout. Name: NURS_6630_Week5_Assignment_Rubric • Grid View • List View Show Descriptions Quality of Work Submitted: The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.– Excellent 27 (27%) – 30 (30%) Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics. Good 24 (24%) – 26 (26%) Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics. Fair 21 (21%) – 23 (23%) Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed. Poor 0 (0%) – 20 (20%) Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed. Quality of Work Submitted: The purpose of the paper is clear.– Excellent 5 (5%) – 5 (5%) A clear and comprehensive purpose statement is provided which delineates all required criteria. Good 4 (4%) – 4 (4%) Purpose of the assignment is stated, yet is brief and not descriptive. Fair 3.5 (3.5%) – 3.5 (3.5%) Purpose of the assignment is vague or off topic. Poor 0 (0%) – 3 (3%) No purpose statement was provided. Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to: Understand and interpret the assignment’s key concepts.– Excellent 9 (9%) – 10 (10%) Demonstrates the ability to critically appraise and intellectually explore key concepts. Good 8 (8%) – 8 (8%) Demonstrates a clear understanding of key concepts. Fair 7 (7%) – 7 (7%) Shows some degree of understanding of key concepts. Poor 0 (0%) – 6 (6%) Shows a lack of understanding of key concepts, deviates from topics. Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to: Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.– Excellent 18 (18%) – 20 (20%) Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view. Good 16 (16%) – 17 (17%) Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view. Fair 14 (14%) – 15 (15%) Minimally includes and integrates specific information from 2-3 resources to support major points and point of view. Poor 0 (0%) – 13 (13%) Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view. Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to: Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.– Excellent 18 (18%) – 20 (20%) Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice. Good 16 (16%) – 17 (17%) Summarizes information gleaned from sources to support major points, but does not synthesize. Fair 14 (14%) – 15 (15%) Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped. Poor 0 (0%) – 13 (13%) Rarely or does not interpret, apply, and synthesize concepts, and/or strategies. Written Expression and Formatting Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.– Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time. Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time. Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time. Written Expression and Formatting English writing standards: Correct grammar, mechanics, and proper punctuation– Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. Good 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors. Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors. Poor 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.– Excellent 5 (5%) – 5 (5%) Uses correct APA format with no errors. Good 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors. Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors. Poor 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6630_Week5_Assignment_Rubric Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Note: All Stahl resources can be accessed through this link provided. 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. 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 Hamilton, M. (1959). Hamilton Anxiety Rating Scale. PsycTESTS, doi:10.1037/t02824-0 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. 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 Week 5: Anxiolytic Therapy & PTSD Treatment “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.

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