Subjective data
Chief Complaint
Increased symptoms of General Anxiety Disorder, which resulted in a state of worry and difficulties falling asleep.
History of the Present Illness (HPI)/Demographics
The patient describes herself as being rather tense throughout her life; however, during her senior year in college, the issue escalated to the point where she sought professional treatment. Since then, she has been prescribed Paxil and began therapy, which made some symptoms disappear, yet she felt tired during the day. However, this year her symptoms worsened, causing trouble falling asleep. Anxiety is a common disorder that can affect anyone in society irrespective of age, background, or social group. This mental disease refers to the feeling of worry, tension, or fear about things that either are about to happen or may happen shortly (Anxiety and panic attacks, 2019). Anxiety can, therefore, be said to be an elevated state of mental apprehension, arousal, and vigilance that generally appear because of the absence of clear or immediate danger (Hur et al., 2019).
History of the Present Illness (HPI) includes the presenting problem and the eight dimensions of the problem
The course of Beth’s illness was as follows: its onset was the admission of the patient to grad school when she was too “obsessed” with getting straight A’s. The duration of her illness is unknown; Beth notes that she has been tense for as long as she can remember. Her illness is characterized by excessive worry and anxiety, as well as sleep problems – it takes her two to three hours to fall asleep, which makes her feel tired during the day. Aggravating factors are no basis for the worry; the prescribed treatment included cognitive therapy and taking Paxil, her current medication.
Review of Systems (ROS)
Neurological problems revealed sleep problems characterized by prolonged falling asleep and associated chronic fatigue. No deviations were detected in the other ROS.
Elaborate on this data if it was not provided in the discussion post assignment.
Objective data
Medications
The patient has been placed on Paxil.
Allergies
No allergies reported.
Past medical history
The patient does not have a medical history of mental health disorders other than Generalized Anxiety Disorder.
Family history
There are no reported family members with a history of mental health disorders.
Past surgical history
No surgical history was reported.
Social history
Beth is a graduate student who is successful in her studies and is a straight-A student. Being an Asian American, she might have experienced some situations where she was subjected to prejudice or even bullying.
Labs
No prior lab tests were conducted.
Vital signs
Signs of GAD can be seen in increased feelings of worry and anxiety. This condition also manifests itself in the reported rush of thoughts before falling asleep.
Physical exam
Physical symptoms of Generalized Anxiety Disorder such as tremors, sweating, or tachycardia were not reported. In the general appearance of the patient, signs of chronic fatigue were revealed (bruises under the eyes, inflamed ocular capillaries). The skin is clean.
Assessment
Primary Diagnosis
Generalized anxiety disorder.
Differential diagnosis
A similar disease is obsessive-compulsive disorder; with OCD, the patient, like Beth, suffers from obsessive thoughts and images that are of an alarming nature. To cope with these obsessive images and thoughts, they can begin to perform certain actions, so-called rituals, the purpose of which is to reduce anxiety. Beth does not have such rituals, which makes it possible to exclude this disease. Panic disorder is also similar, in which sleep problems are also observed; however, Beth does not have such a sign of the disease as panic attacks.
Plan
Pharmacologic treatment plan
There are several medical treatment options to deal with GAD and its symptoms. As the client’s condition is of mediocre severity, it is recommended to use the first-line options, such as selective serotonin reuptake inhibitors (SSRIs). Those medications are often referred to as antidepressants. Introducing Zoloft would be the first treatment decision. Zoloft is known for its effectiveness in treating depression. However, it is effective in dealing with anxiety disorders as well.
This treatment is based on a daily oral intake of low dosages of Zoloft. Since the client has never been on any type of psychotropic medication, it is recommended to gradually increase the dosage from 25 to 50 mg during the first week. (Bandelow, Michaelis & Wedekind, 2017). This decision is chosen because it is effective and safe for the client. She does not belong to any of the risk groups, such as pregnant or breastfeeding women or elderly people of 65+ age.
Non-pharmacologic treatment plan
The case of Beth can be subjected to The Transtheoretical Model (TTM). The primary assumption on TTM is that people do not quickly and decisively change behaviors (Application of Social and Behavioral Theories in Public Health Interventions, 2019). Based on the model, there are five stages of change: pre-contemplation, contemplation, preparation, action, and maintenance. People in the pre-contemplation stage do not have the intention of taking action in the foreseeable future, which is usually defined to be six months (“The Transtheoretical Model (Stages of Change),” 2019). The contemplation stage entails people intending to start a healthy behavior. In the preparation stage, people are not ready to take action within the next thirty days, while the action stage comprises people who have changed their behavior within the last six months and are determined to continue with the behavior change (“The Transtheoretical Model (Stages of Change),” 2019). Lastly, the maintenance stage involves people working hard to maintain healthy behavior to avoid relapse to earlier stages. The model can be useful in analyzing and improving Beth’s condition.
Cognitive-behavioral therapy (CBT) is an approach that can be integrated with other approaches to offer a better intervention to Beth. CBT sessions usually involve between 12 to 20 sessions and have been shown to work for a variety of mental health problems (Types of talking therapies, 2019). The CBT therapy will entail involving Beth in several sessions, such as carrying out activities to monitor her thoughts and feelings throughout the week and recording the changes in a diary. The main goal of therapists in CBT is to reveal the cognitive distortions in a patient and replace them with rational thoughts.
Follow up plan
The appointments with the CBT therapist are to be continued with less frequency.
Other
Incorporation of current clinical guidelines
The intervention should adhere to the main ethical principles such as privacy and non-maleficence.
Integration of research articles
The studies on EWAS and its correlation with an anxiety disorder have been examined. In addition, articles about non-pharmaceutical interventions were studied.
Role of the Nurse practitioner
The Nurse practitioner should act in the best interest of the patient and ensure that the prescribed treatment is followed.
References
Anxiety and panic attacks | Mind, the mental health charity – help for mental health problems. (2019). Web.
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93.
Hur, J., Stockbridge, M. D., Fox, A. S., & Shackman, A. J. (2019). Dispositional negativity, cognition, and anxiety disorders: An integrative translational neuroscience framework. Progress in brain research, 247, 375.
The Transtheoretical Model (Stages of Change). (2019). Web.
Types of talking therapies. (2019). Web.