NURS 6630 Assignment Treating Patients With Anxiety Disorders

Walden University NURS 6630 Assignment Treating Patients With Anxiety Disorders-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6630 Assignment Treating Patients With Anxiety Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6630 Assignment Treating Patients With Anxiety Disorders

Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Assignment Treating Patients With Anxiety Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6630 Assignment Treating Patients With Anxiety Disorders

The introduction for the Walden University NURS 6630 Assignment Treating Patients With Anxiety Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6630 Assignment Treating Patients With Anxiety Disorders

After the introduction, move into the main part of the NURS 6630 Assignment Treating Patients With Anxiety Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6630 Assignment Treating Patients With Anxiety Disorders

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6630 Assignment Treating Patients With Anxiety Disorders

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Assignment Treating Patients With Anxiety Disorders

Anxiety disorders are characterized by pathologically elevated levels of anxiety. One of the common anxiety disorders is generalized anxiety disorder (GAD). It is characterized by anxiety, tension, worry, and fears about various day-to-day events and problems. Patients with GAD experience difficulties controlling excessive worries (DeMartini et al., 2019). GAD’s excessive anxiety and worry cannot be accounted for by a medical condition or substance use. The purpose of this paper is to discuss the case scenario of a patient with an anxiety disorder and describe the treatment and ethical considerations that may impact treatment.

Case Overview

The case scenario portrays a 46-year-old white male referred by his PCP after visiting the ER due to the fear of having a heart attack. The client mentions that he experienced chest tightness, dyspnea, and a feeling of impending doom. He has a history of mild hypertension and is overweight by roughly 15 lbs, but the rest of his medical history is unremarkable. His EKG and physical exam findings were normal, and myocardial infarction was ruled out. The client reports that he still experiences chest tightness and episodes of dyspnea, which he calls anxiety attacks. He also has infrequent feelings of impending doom and a need to escape. He scores 26 on the Hamilton Anxiety Rating Scale and is diagnosed with GAD.

The patient factors that may influence medication prescribing include age, the severity of the patient’s GAD, treatment preferences, current medical condition and medications, and previous medication trials (DeMartini et al., 2019). The clinician needs to consider the patient’s current hypertension and overweight and prescribe a drug that will not aggravate the conditions.

Decision #1

Start Zoloft 50 mg orally daily.

Why I Selected This Decision

Sertraline, a selective serotonin reuptake inhibitor (SSRI), was chosen because it is the most cost-effective SSRI. It is also indicated in the first-line treatment of GAD in adults. Strawn et al. (2018) found that the potential side effects of Zoloft are relatively well-tolerated, which leads to a higher compliance rate and better patient outcomes.

Why I Did Not Select the Other Options

Imipramine was not an ideal choice because it is a 2^nd line therapy used when SSRIs are unsuccessful in alleviating GAD symptoms. Besides, Imipramine is associated with anticholinergic unpleasant side effects such as dry mouth, sedation, and constipation (Strawn et al., 2018). The side effects may contribute to a low compliance rate, which delays achieving the desired treatment effects. In addition, Buspirone was not ideal since it has no antipanic activity. Thus, it would not adequately alleviate the anxiety attacks in the client. Furthermore, Buspirone has a prolonged onset of action and is not recommended as monotherapy in treating GAD (Strawn et al., 2018).

What I Was Hoping To Achieve

I hoped that Zoloft would improve the GAD symptoms by at least 50% by the fourth week, and the HAM-A score would improve to 12. According to Garakani et al. (2020), SSRIs such as Zoloft have been established to be efficacious in treating anxiety disorders.

How Ethical Considerations May Impact the Treatment Plan

Ethical principles that may affect the treatment plan include beneficence (duty to do good) and nonmaleficence (duty to cause no harm) (Bipeta, 2019). The PMHNP upheld beneficence and nonmaleficence by prescribing Zoloft, which is associated with the best treatment outcomes and least side effects. The other drugs were not prescribed due to their associated treatment outcomes and side effects.

Decision #2

Increase Zoloft to 75 mg daily.

Why I Selected This Decision

The Zoloft dose was increased because the patient’s anxiety symptoms had not fully abated. Although he reported that the chest tightness and dyspnea had abated, he still experienced some degree of worry, and the HAM-A sore showed a partial response. Increasing the dose was thus an ideal choice to promote full remission of GAD symptoms (Strawn et al., 2018). Besides, the dose increase was gradual since it allows the PMHNP to monitor the drug’s side effects adequately.

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was inappropriate since it is a high dose increase. Thus, it does not allow the clinician to effectively monitor the drug’s effect on the patient and its side effects. It is recommended that the dose is gradually increased to promote successful therapy. In addition, changing the dose was not ideal because the patient exhibited a partial treatment response to the initial dose. Treatment guidelines recommend that the drug be changed only when there is no positive response to therapy after eight weeks or adverse effects (Garakani et al., 2020).

What I Was Hoping To Achieve

I hoped that gradually increasing the dose would help to fully alleviate the depressive symptoms while at the same time monitoring the drug’s associated side effects. The initial dose of Zoloft is 25 to 75 mg daily, while the usual dose range is 50-200 mg daily (Garakani et al., 2020). Thus, 75 mg is an acceptable dose for this patient.

How Ethical Considerations May Impact the Treatment Plan

Nonmaleficence was upheld in this decision by gradually increasing the dose, which would allow the PMHNP to monitor the drug’s effect, thus preventing harm to the patient (Bipeta, 2019). Besides, beneficence was upheld by increasing the dose to promote complete remission of symptoms and better patient outcomes.

Decision #3

Maintain the current dose.

Why I Selected This Decision

The current dose was maintained at 75 mg because the patient demonstrated an adequate positive response to the dose. The patient reported a further decrease in the depressive symptoms with a 61% reduction in symptoms, and the HAM-A score improved to 10. Besides, there were no reported side effects, and thus, maintaining the dose was ideal to avoid adverse effects if the dose was increased (He et al., 2019).

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was not an appropriate choice because the patient had an adequate positive response to the current 75 mg dose. Increasing to 100 mg may alleviate the symptoms further but poses the risk of side effects which may affect the drug compliance rate (He et al., 2019). Besides, an augmenting agent was not added to the plan because the patient had an adequate response with Zoloft monotherapy. Besides, monotherapy is highly recommended to prevent polypharmacy.

What I Was Hoping To Achieve

I was hoping that maintaining the dose would promote a progressive remission of the GAD symptoms and further improve the HAM-A score while at the same time causing no harm to the patient through side effects. Strawn et al. (2018) found that Zoloft continues to improve GAD symptoms over time regardless of a fixed dose.

How Ethical Considerations May Impact the Treatment Plan

The ethical principle of autonomy may impact the treatment plan if the patient does not consent to the medications or requests a change in treatment due to side effects. The PMHNP must obtain informed consent and explain the benefit of the prescribed medication and potential side effects (Bipeta, 2019).

Conclusion

The specific patient factors that may influence decisions on medication in the above patient include age, the severity of GAD, patient’s treatment preferences, current medical condition and medications, and previous medication trials. The patient was initiated with Zoloft 50 mg daily. The drug was selected because it is indicated as a first-line treatment in GAD and is associated with effective treatment outcomes (Strawn et al., 2018). Besides, it is associated with minimal side effects compared to Imipramine. Buspirone was not selected due to the lack of antipanic activity, which is crucial in managing the patient’s anxiety attacks. The initial dose led to a partial decrease in GAD symptoms, which led to increasing Zoloft to 75 mg daily (Strawn et al., 2018). The aim of this decision was to alleviate the GAD symptoms further. The dose was not increased to 100 mg daily to allow monitoring of side effects. Besides, the drug was not changed because the patient demonstrated a positive response to the initial drug, and no side effects were reported.

The patient’s symptoms decreased with Zoloft 75 mg with a 61% remission in symptoms. The dose was then maintained at 75 mg to allow for a progressive decrease in symptoms and monitoring of side effects. Augmentation was not recommended to avoid polypharmacy (Garakani et al., 2020). Ethical principles of beneficence and nonmaleficence influenced the treatment plan. The clinician selected medication known to have the best treatment outcomes and the least adverse effects to promote better health outcomes (Bipeta, 2019). Autonomy should also be respected by considering the client’s decisions when developing the treatment plan.

References

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of internal medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412. https://doi.org/10.1176/appi.focus.19203

He, H., Xiang, Y., Gao, F., Bai, L., Gao, F., Fan, Y., … & Ma, X. (2019). Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: a network meta-analysis. Journal of psychiatric research, 118, 21-30. https://doi.org/10.1016/j.jpsychires.2019.08.009

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966

Sample Answer 2 for NURS 6630 Assignment Treating Patients With Anxiety Disorders

The assigned case study demonstrates a 46-year-old Caucasian male patient who was referred to the psychiatric unit by his primary care physician after reporting to the emergency room for symptoms similar to a heart attack. The patient claims to have experienced shortness of breath, chest tightness, and a feeling of impending doom. He also presents with a history of mild hypertension which he claims to manage using a low sodium diet. He is also overweight with a surgical history at 8 years when his tonsils were removed. The patient’s EKG and ER results were normal, as myocardial infarction was ruled out hence the assessment of anxiety attack. During the patient interview, he confirms taking alcohol every night and finds it overwhelming managing his place of employment, and fears for his job. The HAM-A rating scale was administered and the patient scored 26 with promoted the diagnosis of Generalized Anxiety Disorder.

When prescribing medication to this patient, several factors may impact the decision-making process. Such factors include the patient’s age, gender, Caucasian race, overweight, alcohol use, mild hypertension, and reported symptoms of anxiety. These factors affect may have an impact on the patient’s pharmacokinetic and pharmacodynamic process which is crucial in determining the most effective and safe drug to prescribe. The patient’s diagnosis of GAD and the HAM-A scores will be utilized to monitor the outcome of the treatment plan for necessary adjustments to be made. The purpose of this discussion is to make three decisions concerning the drugs to prescribe to the 46-year-old Caucasian patient with a diagnosis of GAD while considering factors that might affect his pharmacodynamic and pharmacokinetic processes.

Decision #1

Selected Decision and Rationale

The initial intervention was to start the patient on Paxil 10mg orally once daily. Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI) approved by the FDA and recommended in most clinical guidelines for the management of anxiety disorder, posttraumatic stress disorder, and major depression among adults (Williams et al., 2020). Previous evidence report that the drug is highly selective and potent in its inhibition of 5HT reuptake, with minimal effect on other neurotransmitters (Bui et al., 2016: Laux, 2021). As such, the drug is less likely to lead to withdrawal effects once the patient stops taking the drug (‌Li et al., 2020). It is also well-tolerated with limited side effects among most Caucasian patients due to the CYP2B6 and CYP2C19 metabolic enzymes which are responsible for metabolizing the drug hence limiting the risks of toxicity (Strawn et al., 2018).

Imipramine is effective in the management of GAD as an adjunct therapy to another anxiolytic (Strawn et al., 2012). Consequently, the drug could not be used for this patient since he is already overweight and imipramine is associated with side effects of weight gain (Laux, 2021). Buspirone on the other hand is effective but is not appropriate for this patient due to his mild hypertension (‌Li et al., 2020). The drug is known to cause side effects of chest pain and increased heartbeat which would worsen the patient current state (Melaragno, 2021).

Expected Outcome

With great adherence to the treatment plan, the patient will report back to the clinic after four weeks with reduced symptoms of chest tightness, feeling of impending doom, and shortness of breath (Williams et al., 2020). The patient’s HAM-A scores are also expected to reduce by at least 50% (Bui et al., 2016).

Ethical Considerations

The main role of the PMHNP is to promote the patient’s mental health and reduce suffering (Williams et al., 2020). According to the ethical principle of justice and nonmaleficence, the clinician must select a drug that is effective in managing the patient’s condition with limited side effects (‌Li et al., 2020).

Decision #2

Selected Decision and Rationale

The second decision was to increase the dose of paroxetine to 20mg once daily and monitor the patient for continuous management of symptoms. Based on the reported outcome from the initial intervention, the patient seemed to have exhibited great tolerance and adherence to paroxetine, with decreased worries and a HAM-A score of 18 (Laux, 2021). However, this was a partial response to the drug (Bui et al., 2016). Studies show that in patients with inadequate response, the dose of the drug should be increased by 10mg per day at intervals of not less than 1 week, depending on the tolerability of the patient (‌Li et al., 2020: Melaragno, 2021). The optimal dose of the drug is experienced between a dose of 20 to 60mg once a day among adults with GAD (Strawn et al., 2018).

Increasing the dose to 40mg was not necessary as it is against the recommended rate of dose increment due to safety reasons (Williams et al., 2020). Consequently, clinical trials have reported increased risks of adverse effects at doses above 40mg/day (Strawn et al., 2012). Maintaining the same drug at the same dose would lead to similar effects, hence not appropriate (Laux, 2021). Consequently, limited effectiveness will affect the patient’s compliance with the drug due to the lack of patients (Melaragno, 2021).

Expected Outcome

Within the following 4 weeks, the patient is expected to report back to the clinic with further improved anxiety symptoms with HAM-A scores less than 8 (Bui et al., 2016). No side effects are expected at this point (Strawn et al., 2018).

Ethical Consideration

Respecting a patient’s autonomy is crucial in promoting positive outcomes (Williams et al., 2020). Since the patient was quite impressed by the outcome of the previous intervention, the PMHNP needed to exhibit clinical judgment in promoting decision-making by selecting the drug that will promote the patient’s health further, while preventing harm (‌Li et al., 2020).

Decision #3

Selected Decision and Rationale

The final decision was to maintain the same drug at the same dose, and continue observing the patient for a positive outcome. From the reported outcome, it is clear that the patient displayed a good response to the medication evidenced by the more than 50% remission of anxiety symptoms (Laux, 2021). The patient has also not experienced any side effects which proves great tolerance for the drug (Bui et al., 2016). Studies show that with the attainment of the optimal dose, paroxetine takes between 8 to 12 weeks to completely manage the patient’s anxiety symptoms (Strawn et al., 2018). However close monitoring is necessary as long-term therapy can increase the risks of side effects (Melaragno, 2021).

Increasing the dose to 30mg/day was not necessary as this is against the recommended guidelines on titrating the dose of paroxetine among adults with GAD (Laux, 2021). Consequently, higher doses of the drugs have been associated with increased risks of side effects such as drowsiness and vision changes among others (‌Li et al., 2020). Augmenting the drug with buspirone is also not necessary at this point since this intervention is only recommended when the drug has displayed limited effectiveness (Williams et al., 2020). Consequently, as stated earlier, buspirone is associated with an increased risk of chest pain and palpitation hence not recommended among patients with cardiovascular problems like hypertension (Strawn et al., 2018).

Expected Outcome

The patient is expected to come back to the clinic after four weeks, with further improved symptoms. His HAM-A score should be less than 8 (Bui et al., 2016). His shortness of breath, chest pressure, and feeling of impending doom should disappear within this time (‌Li et al., 2020). No side effects are expected.

Ethical Considerations

The patient being an adult gives him the ethical and legal right to make decisions concerning his health (Strawn et al., 2012). As such, the PMHNP must discuss with the patient the outcome of the previous intervention and the best available option to take to promote his health and well-being (Laux, 2021).

Conclusion

The provided case study illustrates a 46-year-old Caucasian male patient with symptoms of GAD. Several factors were considered for the selection of the most effective drug in the management of the patient’s symptoms, like his age, race, overweight, presenting symptoms, history of hypertension, and HAM-A score of 26 among others. From the available options, the initial intervention for the patient was to initiate paroxetine 10mg once daily and monitor the outcome after four weeks for necessary adjustment (Bui et al., 2016). The drug has displayed great effectiveness and tolerance in the management of GAD as compared to other anxiolytics. Imipramine and buspirone were not necessary at this point given their increased side effects of weight gain and palpitations respectively (‌Li et al., 2020). The patient exhibited great tolerance but limited effectiveness in the management of his anxiety symptoms with this medication (Williams et al., 2020). It was thus necessary to increase the dose to 20mg/day as recommended by most clinical guidelines at the rate of a 10mg dose increment per day/week (Laux, 2021).

Within four weeks, the patient reported more than 50% remission of symptoms with no side effects which marked the optimal dose for the drug (Strawn et al., 2018). It was thus necessary to promote the use of the same drug at the same dose as the last decision in managing the patient’s anxiety. Several legal and ethical considerations such as justice and nonmaleficence were also impacted in every decision process (Strawn et al., 2012). The PMHNP needed to inform the patient about every treatment option, for them to be able to make sound decisions and respect their autonomy. It is the ethical obligation of the PMHNP to put the patient’s health in interest but at the same time respect their decision.

References

Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e Sá, D., & Simon, N. M. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital Psychopharmacology and neurotherapeutics (pp. 61–71). Elsevier.

Laux, G. (2021). Serotonin Reuptake Inhibitors: Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, and Sertraline. In NeuroPsychopharmacotherapy (pp. 1-13). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-56015-1_413-1

‌Li, X., Hou, Y., Su, Y., Liu, H., Zhang, B., & Fang, S. (2020). Efficacy and tolerability of paroxetine in adults with social anxiety disorder: A meta-analysis of randomized controlled trials. Medicine, 99(14). DOI: 10.1097/MD.0000000000019573

Melaragno, A. J. (2021). Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance. Focus, 19(2), 145-160. https://doi.org/10.1176/appi.focus.20200048

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057-1070. https://doi.org/10.1080/14656566.2018.1491966

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing The Neurobiological Basis Of Treatment In Children And Adolescents With Generalized Anxiety Disorder. Depression and Anxiety, 29(4), 328–339. https://doi.org/10.1002/da.21913

Williams, T., McCaul, M., Schwarzer, G., Cipriani, A., Stein, D. J., & Ipser, J. (2020). Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis. Acta Neuropsychiatrica, 32(4), 169-176. doi:10.1017/neu.2020.6

A 46-year-old white male presented with chest tightness, shortness of breath, and a sense of impending doom in this case. The patient has a history of mild hypertension and tonsillectomy, as well as a nondescript medical history. The patient complains of occasional shortness of breath, chest tightness, feelings of impending doom, and a desire to ‘escape’ or ‘run’ from one location. He admits to using ETOH to deal with work-related stress because his boss is harsh and he fears for his job. The symptoms of the patient are typical of generalized anxiety disorder.

Anxiety can be a normal part of life, with concerns such as health, family challenges and money temporarily dominating individual experiences. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder characterized by nightmares, flashbacks, and intrusive thinking related to catastrophic events in an individual’s life (Ostacher & Cifu, 2019). Exposure to traumatic and terrifying events triggers PTSD. It is a potentially debilitating condition that affects direct victims or witnesses of traumatic events such as accidents, natural disasters, loss of loved ones, violent assaults like rape, war and other life-threatening events. The events can trigger an obsessive, recurrent and repetitive behavior that increases the feeling of fear, worry, helplessness, and hopelessness (Ostacher & Cifu, 2019). Nightmares, intrusive memories and flashbacks are common in individuals with past traumatic experiences increasing the risk of panic disorders.

Generalized anxiety disorders are common in adults with PTSD manifestations evident several months after the exposure to the traumatic and terrifying event. The symptoms of the anxiety disorders can be detrimental, although they subside, reducing the struggle with coping and self-care. According to Holmes (2022), anxiety disorders are mental conditions that deteriorate the quality of life by altering the action of neurotransmitters. Individuals with anxiety disorders have elevated worry and fear.

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 patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.
To prepare for this Assignment:
• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring anxiolytic therapy.
NURS 6630 Assignment Treating Patients With Anxiety DisordersThe Assignment: 5 pages
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 patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

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NURS 6630 Assignment Treating Patients With Anxiety DisordersTo participate in this Assignment:
Week 6 Assignment

________________________________________
Midterm Exam
This exam will cover the following topics, which relate to psychopharmacologic approaches to treatment for patients across the life span:
o Introduction to neuroscience, including concepts in neuroanatomy, neurotransmitters, and receptor theory
o Medication adherence
o Pediatric, adult, and geriatric Major Depressive Disorders (MDD)
o Bipolar disorder
o Anxiety and PTSD treatment

Photo Credit: [Vergeles_Andrey]/[iStock / Getty Images Plus]/Getty Images
Prior to starting the exam, you should review all of your materials. There is a 2.5-hour time limit to complete this 50-question exam. You may only attempt this exam once.
This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
By Day 7
Submit your Midterm Exam by Day 7.
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Submit Your Exam by Day 7

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Week 6 Midterm Exam

________________________________________
What’s Coming Up in Week 7?

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Next week, you will continue to build on your assessment and treatment skills as you examine patients presenting with signs and symptoms consistent with schizophrenia.
Next Week

To go to the next week:
Week 7
Week 6: Therapy for Patients With Anxiety Disorders and 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 presenting with 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 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 patients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.

Reference:

Philips, P. K. (n.d.). My story of survival: Battling PTSD. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd
Learning Objectives
Students will:
• Assess patient factors and history to develop personalized plans of anxiolytic therapy for patients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring anxiolytic therapy
• Synthesize knowledge of providing care to patients presenting with anxiolytic therapy
• Analyze ethical and legal implications related to prescribing anxiolytic therapy to patients across the lifespan
• Assess psychopharmacologic approaches to treatment for patients across the lifespan
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Learning Resources

Required Readings (click to expand/reduce)

Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e Sá, D., & Simon, N. M. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 61–71). Elsevier.

American Psychiatric Association. (2010a). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

American Psychiatric Association. (2010c). Practice guideline for the treatment of patients with panic disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf

Bendek, D. M., Friedman, M. J., Zatzick, D., & Ursano, R. J. (n.d.). Guideline watch (March 2009): Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd-watch.pdf

Cohen, J. A. (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49(4), 414–430. https://jaacap.org/action/showPdf?pii=S0890-8567%2810%2900082-1

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16–e18. 10.1192/bjpo.bp.116.003707. http://bjpo.rcpsych.org/content/2/6/e16

Hamilton, M. (1959). Hamilton Anxiety Rating Scale (HAM-A). PsycTESTS. https://doi.org/10.1037/t02824-0

Ostacher, M. J., & Cifu, A. S. (2019). Management of posttraumatic stress disorder. JAMA, 321(2), 200–201. https://doi.org/10.1001/jama.2018.19290

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. https://doi.org/10.1002/da.21913

Medication Resources (click to expand/reduce)

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
Review the following medications:
• benzodiazepines
• citalopram
• desvenlafaxine
• duloxetine
• escitalopram
• fluoxetine
• paroxetine • sertraline
• venlafaxine
• vilazodone
• vortioxetine
• propranolol
• prazosin

Required Media (click to expand/reduce)

Case Study: A Middle-aged Caucasian Man with Anxiety
Note: This case study will serve as the foundation for this week’s Assignment.

Rubric Detail
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Content
Name: NURS_6630_Week6_Assignment_Rubric
• Grid View
• List View
Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point range: 0–69
Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Points Range: 9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. Points Range: 8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. Points Range: 7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. Points Range: 0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1–2 pages)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Points Range: 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

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Examples provided fully support the decisions and responses provided. Points Range: 16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided. Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided. Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
NURS 6630 Assignment Treating Patients With Anxiety DisordersDecision #2 (1–2 pages)