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.

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?

I need a paper, please address all questions based on instruction.  this is instruction:

Now that you’ve nearly completed the course, let’s re-visit the week 1 discussion topic. You were asked to formulate a position on nursing as discipline, profession and science. Describe your position now; has it changed? Are all RNs responsible for advancing the nursing discipline, profession, and science? What are our responsibilities as a collective discipline and profession and as individuals? One way to contribute as a Baccalaureate-prepared nurse is to use a nursing conceptual framework to guide clinical practice. At the institutional-level, some clinical agencies have adopted nursing conceptual frameworks to guide nurses’ practice. Another way to contribute is by being active and/or belonging to professional nursing organization(s). What else can you do to advance the nursing discipline, profession, and science? Include your reference(s) in both your initial post and your reply posts. You should include the following:Re-visit the week 1 discussion. Have your positions on or understanding of the nursing discipline, profession, and science changed? If so, how? Identify and discuss the responsibilities of RNs in terms of contributing to and advancing the nursing discipline, profession, and science.One way to contribute to and advance nursing is to apply a nursing conceptual framework to clinical practice situations. Identify a nursing conceptual framework that appeals to you or makes sense to you. Briefly describe a clinical practice situation you have encountered and how you would apply the nursing conceptual framework. Explain how this advances the nursing discipline.Identify any professional nursing organizations you are active in and/or maintain membership in. If you currently have no memberships, what are some that interest you? What does belonging to a professional nursing organization have to do with advancing nursing?Are there any other ways you can advance the nursing discipline, profession, and science?

FYI: i put the first week discussion to know what was in first week discussion:

Nurse scholars have claimed that nursing is both a discipline and a profession. In order to understand these claims, we must first know what it means for nursing to have a “unique body of knowledge.” If we assume that nursing does, indeed, possess a unique body of knowledge, we can claim that nursing is a “basic science,” rather than an “applied science.” Despite these claims, debate continues about nursing as discipline, profession, and science. Is nursing a discipline? A profession? Is nursing a basic science and/or applied science? In your initial post, state what you think about nursing as discipline, profession, and science. Explore the literature beyond that assigned to you for this week’s readings to help you formulate your position. Include your reference(s) in both your initial post and your reply posts. You should include the following:What is a discipline? What is a profession? What’s the difference? What are examples of each?Does nursing fit the criteria for a “discipline” and “profession”?What is a “basic science”? What is an “applied science”? What’s the difference?Is nursing a “basic” or “applied” science? Support your statements with scholarly references. You may use those from the assigned readings on the course Blackboard site, but you must also select and use (via your literature search) a minimum of 1 reference outside of assigned readings.
Present your posts and replies in a professional, scholarly manner. Use the APA publication manual to format citations and references

Also i am member of ANA( American Nursing Association)

The answer for first week discussion:

Nursing

To answer the question of whether nursing is a discipline or a profession or whether it is a basic science or an applied science, it is important to first understand these terms and their difference.

Nursing as a discipline vs. a profession 

The difference between a discipline and a profession can clearly be seen from their definitions. On one hand, a discipline is an area that is involved in the generation of knowledge and the procedures used in attaining this knowledge is mainly standardized. On the other hand, a profession is defined as the unit where the knowledge is applied and it is a field which has a lot of regulation in the manner in which the knowledge is applied. The main area of difference between these two is in the role and purpose. The discipline serves the purpose of generating knowledge which is then applied in the profession. The truth about these two is that they are interdependent. A profession without discipline is ineffective ad a discipline with profession does not any value (DeNisco & Barker, 2016).

For this reason, nursing is both a discipline and also a profession. This means that in nursing there are activities that involve the generation of knowledge which falls under the discipline area and those that involve the application of this knowledge that is the profession. Nursing being a discipline and a profession is so much so prevalent in today’s world of healthcare which emphasizes on the use of evidence-based practices in nursing. The nursing field today is therefore proactively involved in generating evidence through research and in this sense nursing is a discipline. Further, the evidence acquired is embedded in nursing procedures and methods and the application of the knowledge from research makes nursing a profession as well. In the context of nursing, the essence of the discipline is knowledge expansion and the essence of the profession is to provide services to individuals using knowledge from the discipline to enhance quality and outcome of care (DeNisco & Barker, 2016).

Nursing as a basic science vs. an applied science

On one hand, basic science is defined as a branch of science that is concerned with understanding the manner in which things work. Basic science helps to come up with theories and discoveries in science. Applied science, on the other hand, is a field in science that is involved with the application of the theories and discoveries of science developed for example from basic science to help solve problems in the field of healthcare practically (DeNisco & Barker, 2016). Similar to the case of the discipline and the profession basic science and applied science differ in the purpose they serve as basic science helps in the development of new information on how things work while applied science applies this information and knowledge in a practical setting and they are both dependent on one another.

As the aspect of preventive care and evidence-based practice is greatly being incorporated into the field of nursing, the field has incorporated both basic and applied science practices. Nursing is considered as a basic science when nurses are involved in the development of new knowledge about how things work and this has become common as they try to understand the prevalence of diseases among the populations that they serve. Nursing is also an applied science and has long been considered so because nurses are engaged in the application of scientific knowledge to help enhance the health status of individuals at the hospital and the community level. Nursing as a basic science is a new phenomenon that falls in place following the involvement of nurses in scientific research.

In general, there is a link on whether nursing is a discipline or a profession and whether it is a basic or an applied science. The link is that is nursing is that it cannot be a discipline by being involved in scientific research without falling under basic sciences and it cannot be a profession without falling as an applied science.

View the scenario called “Critical Decision Making for Providers” found in the Allied Health Community media (http://lc.gcumedia.com/hlt307v/allied-health-community/allied-health-community-v1.1.html)

In a 1,200 word paper, describe the scenario involving Mike, the lab technician, and answer the following questions:

1. What were the consequences of a failure to report?
2. What impact did his decision have on patient safety, on the risk for litigation, on the organization’s quality metrics, and on the workload of other hospital departments?
3. As Mike’s manager, what will you do to address the issue with him and ensure other staff members do not repeat the same mistakes?
4. Conclusion

A minimum of three academic references from credible sources are required for this assignment.

Prepare this assignment according to the APA guidelines. CHECK PLAGIARISM