Case Study, Managing Anxiety
Patient Case: A 46-year-old patient with Generalized Anxiety Disorder
Decision Point 1
The management of the patient’s anxiety disorder is dependent on beginning a medication therapy for the patient. The medications that have been suggested in the case study include Zoloft 50mg PO, Imipramine 25mg PO BID, and Buspirone 10mg PO. The best decision in the management of the patient’s anxiety is to begin Zoloft 50mg
The rationale for the decision
To properly manage the patient’s anxiety, introducing the patient to a high dose of Zoloft or other medications may not be appropriate (Crocco et al., 2017). However, the introduction of a low dose of Zoloft (50mg PO BID) to relieve the signs of anxiety is appropriate. The introduction of a low dose of the medication makes it possible to observe the patient’s reaction with the medication thus giving room for necessary readjustments.
Expected Results
One of the expectations that I had while beginning the medication was to improve the patient’s signs and symptoms by a slight margin. I was optimistic that the medication would relieve at least one of the symptoms of anxiety disorder. Zoloft is the first-line medication thus the expected results (Delli et al., 2018).
Differences between the expected results and the reported Patient Results
As stated, the goal for the decision was to reduce a few symptoms of the anxiety. While assessing the patient who returned to the clinic after four weeks, the 46-year-old man reported that he noticed changes in his symptoms. Some of the improvements that he noticed include a reduction in chest tightness and shortness of breath. The patient’s worries equally decreased over the past 4 to 5 days. HAM-A score also decreased from 26 to 18. My expectations were closely related to the results.
Decision 2
The management of the patient’s anxiety signs is dependent on the second decision. Being that the patient noticed changes in the signs and symptoms when 50mg Zoloft was prescribed, it is not effective to begin another medication. Instead, increasing the dose to 75 mg orally daily is appropriate in reducing more symptoms of the anxiety disorder.
The rationale for the Decision
The reason why it is appropriate to increase the dosage to 75mg is because of the registered improvement of the patient’s symptoms upon starting a lower dose of Zoloft. Increasing the dosage may as well be effective in reducing HAM-A score and further decrease worries.
Expected Results
Being that the first dosage relieved the patient of the signs and symptoms such as reduction of worries and chest tightness, the second decision of increasing the dosage of the medication is appropriate in improving the symptoms further to attain normal body functioning.
Difference between expected results and the Patient’s Results
As expected, the patient registered an improvement in the signs and symptoms upon making the second critical decision. When he visited the health facility after four weeks, the patient stated that he experienced further improvements in the signs and symptoms of anxiety. The HAM-A score had equally reduced from 18 to 10. The patient had recorded a 61% improvement in the anxiety symptoms. The results for this decision call for critical decision making in the next step.
Decision three: Maintain the Current Dose and Propose an Effective Diet
The third decision is critical to further improvements in the patient’s symptoms. Due to the efficacy recorded with the medication in the first two decisions, it is appropriate to maintain the dosage and educate the patient on the need for a proper diet (Clifford et al., 2017).
The rationale for the Decision
Maintaining the dosage is important because the patient is recording great progress with the signs and symptoms of anxiety. In case the patient recorded limited improvements in the signs and symptoms of the medication, it would be appropriate to shift to another medication. However, the case is different because the patient has improvements in the symptoms. I feel that as the dosage is maintained, the patient should receive education on the need for observing a proper diet and engaging in physical activities to prevent weight gain.
Expected Results
The expected results associated with the medication are a reduction in further signs and symptoms of the medication as well as observation of an appropriate diet and physical activities to avoid weight gain which is a side effect of Zoloft.
Differences in the expected results and Patient’s Results
With an increase in weight, the patient may not be willing to continue the Zoloft dosage. Therefore, the PMHNP should engage the patient through an educative session and help him identify the types of foods that he should eat and the kind of physical activities that he should engage in. A combination of diet and physical exercise should be effective in managing the patient’s weight (Clifford et al., 2017). It is important to note that the reason for avoiding the other two medications is because Zoloft is more effective (first-line) in managing anxiety symptoms compared to buspirone and imipramine.
Ethical Considerations
Nurses should see to the proper education of the client on medication administration and the side effects of Zoloft. Letting the patient know about the influence that the medication has is critical in managing the side effects. Additionally, educating the patient about medication administration as well as appropriate dosages is essential in limiting errors that the patient might make. The education equally ensures that the patient adheres to the prescribed medication. It is equally important to engage the patient in the decision making process as the principle of autonomy demands.
References
Clifford, K. M., Duncan, N. A., Heinrich, K., & Shaw, J. (2015). Update on managing generalized anxiety disorder in older adults. Journal of Gerontological Nursing, 41(4), 10-20.
Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological management of anxiety disorders in the elderly. Current treatment options in psychiatry, 4(1), 33-46.
Delli, C. K. S., Polychronopoulou, S. A., Kolaitis, G. A., & Antoniou, A. S. G. (2018). Review of interventions for the management of anxiety symptoms in children with ASD. Neuroscience & Biobehavioral Reviews, 95, 449-463.
