NURS 6630 Post-Traumatic Stress Disorder (PTSD)
Walden University NURS 6630 Post-Traumatic Stress Disorder (PTSD)-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6630 Post-Traumatic Stress Disorder (PTSD) 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 Post-Traumatic Stress Disorder (PTSD)
Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Post-Traumatic Stress Disorder (PTSD) 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 Post-Traumatic Stress Disorder (PTSD)
The introduction for the Walden University NURS 6630 Post-Traumatic Stress Disorder (PTSD) 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 Post-Traumatic Stress Disorder (PTSD)
After the introduction, move into the main part of the NURS 6630 Post-Traumatic Stress Disorder (PTSD) 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 Post-Traumatic Stress Disorder (PTSD)
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 Post-Traumatic Stress Disorder (PTSD)
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 Post-Traumatic Stress Disorder (PTSD)
The case highlights a 46-year-old white male presenting with chest tightness, shortness of breath and feeling of impending doom. The patient has a history of mild hypertension and tonsillectomy, which has been accompanied by unremarkable medical history. The patient cites occasional shortness of breath, chest tightness, feelings of impending doom and the need to ‘escape’ or ‘run’ from one place. He confesses using ETOH to combat worries about work since the management at his place of work is harsh, and he fears for his job. The patient’s symptoms are characteristic of generalized anxiety disorder.
Anxiety can be a normal part of life, with worries about health, family issues, and money temporarily dominating people’s lives. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder characterized by nightmares, flashbacks, and intrusive thoughts associated with traumatic events in a person’s life (Ostacher & Cifu, 2019). PTSD is triggered by traumatic and terrifying events. It is a potentially debilitating condition that affects direct victims or witnesses of traumatic events such as car accidents, natural disasters, bereavement, violent assaults such as rape, war, and other life-threatening events. The events can set off an obsessive, recurring, and repetitive pattern of behavior that heightens feelings of fear, worry, helplessness, and hopelessness (Ostacher & Cifu, 2019). Nightmares, intrusive memories, and flashbacks are common in people who have had traumatic experiences in the past, increasing the risk of panic disorders.
Adults are more likely to suffer from generalized anxiety disorders, with PTSD manifestations appearing months after the traumatic and terrifying event. The symptoms of anxiety disorders can be harmful, but they do subside, easing the struggle with coping and self-care. Anxiety disorders, according to Holmes (2022), are mental conditions that impair quality of life by altering the action of neurotransmitters. Individuals suffering from anxiety disorders experience increased worry and fear.
Psychopharmacological therapy targets relieving symptoms rather than curing the disorders. The recommended medications in the management of anxiety disorders include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, beta and adrenergic medications, antihistamines and GABAergic medications (Garakani et al., 2020). The treatment decisions will reflect the drug pharmacokinetics, pharmacodynamics, and ethical considerations in using the pharmacotherapeutic approach. The paper highlights three decisions on Generalized Anxiety Disorders.
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
Learning Resources
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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.
Medication Resources (click to expand/reduce)
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:
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Also Read:
NURS 6630 characteristic of generalized anxiety disorder
NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction
APA Writing Checklist
Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.
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Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.
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Sample Answer for NURS 6630 Post-Traumatic Stress Disorder (PTSD)
Anxiety disorder is one of the most common mental illnesses across the world. In the United States, approximately 40 million adults above the age of 18 years are diagnosed with anxiety disorder every year (Curtiss et al., 2017). In most cases, this disorder is diagnosed at a later stage, as most people ignore the symptoms of anxiety disorder. Studies however show that early diagnosis of anxiety disorder promotes early interventions promoting the patient’s quality of life. Through evidence-based practices, several treatment options have been availed comprising of both pharmacological and psychotherapeutic approaches for the management of anxiety disorder (Strawn et al., 2018). The purpose of this paper is to illustrate the care plan of a middle-aged white adult male diagnosed with anxiety disorder. Every decision made on which psychotropic agent is most effective for the patient has been explained with consideration of both pharmacodynamic and pharmacokinetic factors displayed by the patient.
The provided case study demonstrates a 46 years old white male with a chief complaint of anxiety symptoms. He was referred to our clinic from the emergency room which he reported complaining of having a heart attack. Some of the symptoms demonstrated by the patient include shortness of breath, tightened chest, and the feeling of impending doom. He is also overweight. Past medical history reveals mild hypertension which he manages appropriately with a low sodium diet. His surgical history reveals the removal of tonsils at the age of 8 years. He takes 3 to 4 bottles of beer every night to manage his stress. He displayed a score of 26 upon administration of the Hamilton Anxiety Rating Scale (HAM-A). The patient however denies suicidal thoughts, visual or auditory hallucination. Currently, his primary diagnosis is generalized anxiety disorder (GAD).
Decision #1
Selected Decision
Begin Zoloft 50 mg orally daily
Reason for Decision One
Sertraline (Zoloft) belongs to the class of selective serotonin reuptake inhibitors (SSRIs) recommended by the FDA as the first-line medication for the management of GAD among adults (Strawn et al., 2018). The drug is absorbed in the GIT slowly with peak serum levels attained after 6 to 8 hours. Genetic factors such as CYP2B6 and CYP2C19 predominant among white patients, affect the metabolism of the drug with a prolonged half-life of 26 to 32 hours hence the once-daily dose, which promotes patient compliance (Strawn, Poweleit, & Ramsey, 2019). The drug takes between 8 to 12 weeks for complete remission of the patient’s symptoms.
Imipramine was not the best choice for the patient, as tricyclic antidepressant agents are most preferred among patients diagnosed with depression (Williams et al., 2020). Consequently, imipramine is associated with elevated systolic blood pressure, which might worsen the patient’s hypertensive condition.
Buspirone could also not be considered for this patient as a result of its cardiovascular side effects given the patient’s hypertensive condition (Williams et al., 2020). Consequently, the drug is associated with weight gain, which makes it inappropriate for patients who are overweight, just like the one in the provided case study.
Expected Outcome
The patient is expected to report back to the clinic after 4 weeks with at least 50% remission of symptoms such as chest tightness and dyspnea (Curtiss et al., 2017). He should regain confidence in life within this time, with a reduced feeling of impending doom. Lastly, his HAM-A score is expected to display ridings of less than 8.
Ethical Consideration
The PMHNP is expected to provide holistic care for the patient, which requires the involvement of the patient in making choices concerning the best intervention in the management of his mental condition (Williams et al., 2020). As such, the patient must be informed concerning the alternative psychotropic agents, including their benefits and side effects, and the reasons behind choosing a given drug over another.
Decision #2
Selected Decision
Increase Zoloft dose from 50mg to 75mg PO daily
Reason Behind Decision 2
The care outcome based on the first intervention reveals great compliance and adherence by the patient as no side effects were reported. Consequently, the patient displayed greatly managed symptoms, recording a reduced HAM-A score of 18. Studies show that Zoloft takes between 8 to 12 weeks for patients to enjoy complete remission of symptoms (Chen et al., 2019). As such, the recommended initial dose among adults is 50mg, which should be increased at dose intervals of 25 mg weekly as per the treatment outcome in the management of the patient’s symptoms. At this point, it is necessary to increase the dose to 75 mg once daily and monitor the patient for possible side effects.
Increasing the dose of Zoloft to 100mg is not necessary, as this is against the recommended guidelines for dose titration of the drug (Williams et al., 2020). Consequently, high doses of Zoloft are associated with severe side effects such as headache, nausea, dry mouth diarrhea, and nervousness.
Introducing another psychotropic agent is also necessary when the patient demonstrates great tolerance and adherence to the initial regimen (Curtiss et al., 2017). Otherwise, this will affect the patient’s compliance with the medication, as side effects might arise with the new medication.
Expected Outcome
Within the next 4 weeks, the patient is expected to display further remission of symptoms, with a HAM-A score of less than 8 (Williams et al., 2020). He should be able to regain his normal interest in daily activities and increased energy levels within this time.
Ethical Considerations
Legal and ethical requirements for the PMHNP are to promote patient’s well-being and prevent suffering (Chen et al., 2019). Given that the patients displayed great adherence to Zoloft, the PMHNP must maintain the drug and alter the dose as recommended to promote the patient’s safety.
Decision #3
Selected Decision
Maintain Zoloft 75mg PO daily and continue to monitor progress
Reason Behind Decision 3
The patient displayed a 61% remission of symptoms which demonstrates great adherence and compliance with the treatment regimen. He also recorded a HAM-A score of 10 which indicates mild anxiety. According to evidence-based practice, Zoloft can take up to 8 to 12 weeks to attain complete remission of the patient’s symptoms (Williams et al., 2020). The patient’s dose could be increased if he had displayed less than 50% remission of symptoms which is not the case. As such, continuing the same dose is necessary for further management of his symptoms, and to avoid the occurrence of undesired side effects.
Increasing the dose of Zoloft to 100 mg is not necessary, as this will compromise the patient’s compliance and lead to undesired side effects such as fatigue, dizziness, insomnia, and skin rash (Williams et al., 2020). This intervention could be considered if the patient’s symptoms could not have been managed as desired.
Consequently, adding a new medication is not necessary as the drug has displayed great effectiveness as monotherapy (Curtiss et al., 2017). Buspirone is also associated with cardiovascular side effects which could otherwise complicate the patient’s hypertensive condition.
Expected Outcome
Within the next four weeks, the patient is expected to display complete management of anxiety symptoms, and a HAM-A score of less than 8. No side effects are expected at this point given the great adherence and compliance exhibited by the patient in the last 8 weeks (Strawn et al., 2018).
Ethical Considerations
Given that the patient is an adult, he is responsible for making decisions concerning his health (Chen et al., 2019). As such, the PMHNP must inform the patient on the best intervention required at this point and proceed with the patient’s approval to promote patients’ satisfaction and healthy relationship for continuous positive outcomes.
Conclusion
Anxiety is a common mental illness globally with several side effects which compromise the patient’s quality of life. Most patients normally ignore symptoms of anxiety disorder which leads to complications that are expensive and hard to manage. However, with early diagnosis, patients can greatly benefit from psychotherapy and pharmacological interventions (Curtiss et al., 2017). The PMHNP is however required to consider pharmacodynamic and pharmacokinetic factors when choosing the most appropriate psychotropic agent for the management of anxiety disorder. The provided case study displays an adult white male patient diagnosed with GAD. The patient is overweight and hypertensive. The initial intervention for the patient is Zoloft 50mg orally once daily, which is recommended by the FDA as the first line for the management of GAD (Strawn et al., 2018). The other options were not appropriate as a result of side effects that would otherwise worsen the patient’s hypertensive condition. Based on the treatment outcome of the first intervention, the patient displayed great adherence and compliance to the medication with minimal reduction of symptoms which led to the second intervention of increasing the dose to 75mg.
The patient displayed 61% remission of symptoms, which made it necessary to maintain the dose of Zoloft as the third intervention. The patient displayed no symptoms, as the actual outcome was consistent with the expected outcome. Several legal and ethical considerations were observed by the PMHNP such as confidentiality and involving the patient in making decisions concerning his health (Chen et al., 2019). As such, the nurse must ensure that the patient is well informed about the treatment options and their outcome for the patient to be able to contribute to what decision to pick. Consequently, the patient must be educated on the need for psychotherapy in promoting the healing process.
References
Chen, T. R., Huang, H. C., Hsu, J. H., Ouyang, W. C., & Lin, K. C. (2019). Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. Journal of psychiatric research, 118, 73-83. DOI: 10.1016/j.jpsychires.2019.08.014. Epub 2019 Sep 1.
Curtiss, J., Andrews, L., Davis, M., Smits, J., & Hofmann, S. G. (2017). A meta-analysis of pharmacotherapy for social anxiety disorder: an examination of efficacy, moderators, and mediators. Expert opinion on pharmacotherapy, 18(3), 243-251. DOI: 10.1080/14656566.2017.1285907
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. DOI: 10.1080/14656566.2018.1491966.
Strawn, J. R., Poweleit, E. A., & Ramsey, L. B. (2019). CYP2C19-guided escitalopram and sertraline dosing in pediatric patients: a pharmacokinetic modeling study. Journal of child and adolescent psychopharmacology, 29(5), 340-347 DOI: 10.1089/cap.2018.0160
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 neuropsychiatric, 32(4), 169-176. DOI: 10.1017/neu.2020.6
Sample Answer 3 for NURS 6630 Post-Traumatic Stress Disorder (PTSD)
Pathophysiology of Post-Traumatic Stress Disorder
Post-traumatic stress disorder is an anxiety disorder that occurs due to repeated and prolonged exposure to stressful situations. The pathophysiology of this disorder mainly involves the central nervous system. Accordingly, magnetic resonance imaging studies have shown that there is the reduction in the volume of the left amygdala, hippocampus, and anterior cingulate cortex in individuals who are suffering from the disorder. The reduction in the size of the amygdala results in over-expression of emotions and modulation of fear responses (Benedek, 2018). There is also the reduction in the size of the medial prefrontal cortex that controls the stress and emotional response of the amygdala. The reduction in size lowers its control over amygdala, hence, hypersensitivity to emotional stimulation. Studies have also revealed that there is down-regulation of the central adrenergic receptors with increased or up-regulation of the central norepinephrine levels. The levels of glucocorticoids are also reduced in chronically diseased patients, which might point towards the association of the disorder with autoimmune disease. The reduction in the levels of the neurotransmitters and neurohormonal functioning imply that there is reduced response to stress, hence, the over-excitation of the central nervous system in the disease (Casey & Strain, 2015). Magnetic resonance imaging scans have also revealed the hemispheric lateralization, which implies failure of the left hemispheric function. The consequence of this failure is increased risk of confusion related to time due to repeated exposure to traumatic events.
Moreover, there is an increased risk of one developing post-traumatic stress disorder due to the influence of genetics. In this case, post-traumatic stress disorder in individuals with susceptible genes occurs through environmental interaction. For instance, there is an increased risk of post-traumatic stress disorder in individuals having one of the four polymorphisms that are located at the stress-related gene FKPB5 (Friedman, 2015).
Pharmacological Treatments
There exists a wide range of pharmacological treatments for post-traumatic stress disorder in my state. One of them is the use of selective serotonin reuptake inhibitors such as sertraline and paroxetine. The use of this group of drugs is effective in reducing the symptoms of post-traumatic stress disorder. It also improves the functioning of the patients suffering from the disorder. The other group of drugs that are used in treating the disorder is serotonin-norepinephrine reuptake inhibitors. An example is the use of venlafaxine extended release, which reduces the symptoms of the disorder. However, fewer studies have explored the use of this group of drugs. Second generation antipsychotics such as Quetiapine are also prescribed to patients suffering from post-traumatic stress disorder. The drugs result in the improvement in functioning and symptoms of the disorder (Forman-Hoffman et al., 2018). However, they are associated with side effects that include metabolic abnormalities and weight gain.
Alpha-adrenergic blockers such as prazosin have also demonstrated some efficacy in the treatment of post-traumatic stress disorder. This group of drugs reduces the symptoms of the disorder, nightmares, as well as sleep disturbance. However, they are associated with side effects that include rebound hypertension in patients with history of orthostatic hypotension. The use of benzodiazepines has also been explored in studies. However, they are not largely utilized due to its effect on impairing the effectiveness of other treatments such as exposure therapy in these patients (Landolt, Cloitre & Schnyder, 2017). Other medications that might be considered in treating post-traumatic stress disorder, though with insufficient recommendation, include antidepressants besides SSRI/SNRIs, beta-adrenergic blockers, and mood stabilizers.
Clinical Guidelines
The clinical guideline by the American Psychological Association and Veterans Affairs Clinical Practice Guideline are utilized in the assessment, diagnosis, and patient education in relation to post-traumatic stress disorder in my state. According to the guidelines, the assessment should be comprehensive including the assessment of the psychological physical and social needs as well as risk assessment of the patient. The assessment comprises of a wide range of aspects. They include safety assessment, relevant medical history, history of trauma and duration, current medication use, mental status examination, physical exam, laboratory tests, and signs of substance abuse, co-occurring disorders, and trauma (American Psychological Association, 2017).
The diagnosis of post-traumatic stress disorder is done using DSM-V. Eight-criterion system is used in the process. In criterion A, the patient must have a history of direct exposure to trauma in ways that include witnessing, participating, learning about the experience of a close person, and being exposed indirectly in the course of professional duties. In criterion B, one must have persistently experienced traumatic events in one or more of ways that include nightmares, intrusive thoughts, emotional distress, and physical reactivity following reminders of traumatic exposure. In criterion C, one must have history of avoidance of trauma due to stimuli related to traumatic events. It can occur through avoidance of thoughts and reminders associated with the trauma. In criterion D, the patient must meet at least two requirements that include negative thoughts being felt after trauma in any of the ways such as negative affect, feeling isolated, difficulties in positive affect, and exaggerated blame of others and self. In criterion E, the patient must experience arousal due to trauma in at least two of the ways such as irritability, destructive behavior, hypervigilance, difficulty in sleeping, and difficulty in concentrating. In criterion F, the symptoms of post-traumatic stress disorder should last for a period of more than a month. In criterion G, the symptoms of the disorder should cause functional impairment and significant distress. In criterion H, the symptoms should not be attributed to medication, other illnesses or substance abuse (Card, 2017). The guidelines also have provisions on patient education. Accordingly, patients should be educated on stress control, trauma reactions, imaginal exposure to the traumatic experiences, and medication adherence as well as effects, side effects, and adverse events. The family should also be educated on the essential support to provide patients with the disorder (American Psychological Association, 2017).
Effects of the Disease Process
Post-traumatic stress disorder has significant effect on the patient, patient’s family and significant others. Firstly, it lowers the productivity of the patients in their societies. Patients affected by the disorder lose their functional roles in the society. The disorder also increases dependence in the family. Patients are highly at a risk of developing functional disabilities. This increases the risk of patient dependence on others in meeting their needs of their daily living. Over time, the ability of the families to meet their needs is affected by the increasing demands from the patients suffering from the disorder. The family of a patient with post-traumatic stress disorder is also subjected to significant psychological stress. This is attributed to the challenges associated with meeting the needs of their sick relatives. The fear of the unknown outcomes of the disease also increases the stress levels among the family members and significant others (Michel, 2018).
The treatment of post-traumatic stress disorder is also associated with significant use of the available resources. This includes the use of resources such as time and money. The patient and the family have to use their financial resources in seeking quality care that will promote their recovery from the disorder. They also incur huge medical expenses if the patients are admitted in the hospital. There is also the loss of valuable time that would have been used in undertaking other productive social and economic activities. Therefore, the loss of resources is likely to increase the risk of poverty among those affected directly by the disorder. Post-traumatic stress disorder also predisposes the patients, their families and significant others to isolation in their societies. The risk of isolation is increased in societies where there are stereotypes associated with mental health problems (McKay, Abramowitz & Storch, 2017). Consequently, rather than recovering from the disease burden, the patient and the family are subjected to social problems that worsens their experiences.
Strategies to Implement Best Practices
One of the strategies that I would use to implement best practices in the management of post-traumatic stress disorder in my institution is training the healthcare providers on ways of providing best care to these patients. The ability of the healthcare providers to give care that matches the health needs of patients with the disorder is dependent on their knowledge, skills, and experience. It is therefore important that they be provided with up-to-date training on new developments in the management of post-traumatic stress disorder. It is also important that they receive training that aim at building the desired cultural competencies among them as a way providing care that meets the needs of the diverse populations they serve. The second way in which I will implement best practices in the hospital I work in is through advocating for the use of evidence-based practice. Evidence-based practice entails the utilization of best available clinical evidence in providing care to the patients. Through it, outcomes of care such as quality, safety, and efficiency are achieved. Therefore, I will strengthen the utilization of evidence-based practice in caring for the patients with post-traumatic stress disorder to ensure that their prioritized and perceived health needs are met. The last way in which I will ensure best practices are utilized in the provision of care is the adoption of teamwork. I will encourage the healthcare providers to utilize teamwork in assessing, planning, implementing, and evaluating the care given to the patients. Teamwork will ensure that the barriers to access to and utilization of care experienced by the patients with the disorder are eliminated (Hall & Hall, 2016). Consequently, the desired health outcomes are achieved by the patients and the healthcare providers.
Conclusion
Post-traumatic stress disorder is one of the health problems affecting a significant proportion of people in America. It arises from repeated exposure of an individual to traumatizing situations. The experience results in structural changes in the brain as well as neuro-hormonal and neurotransmitter imbalance in the brain. These changes predispose individuals to the disorder. Pharmacological therapies are effective in treating the disorder. Therefore, best strategies should be embraced in the clinical settings to reduce the burden of the disease to the patients, families and communities as a whole.
References
American Psychological Association (2017). Clinical Practice Guideline for the Treatment of PTSD. Retrieved on 25th Feb. 2020 from https://www.apa.org/images/ptsd_tcm7-220858.pdf
Benedek, D. M. (2018). Epidemiology of trauma-and stressor-related disorders. Oxford University Press.
Card, P. (2017). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder.
Casey, P. R., & Strain, J. J. (Eds.). (2015). Trauma-and Stressor-related Disorders: A Handbook for Clinicians. American Psychiatric Pub.
Forman-Hoffman, V., Middleton, J. C., Feltner, C., Gaynes, B. N., Weber, R. P., Bann, C., … & Green, J. (2018). Psychological and pharmacological treatments for adults with posttraumatic stress disorder: a systematic review update.
Hall, M. F., & Hall, S. E. (2016). Managing the psychological impact of medical trauma: A guide for mental health and health care professionals. Springer Publishing Company.
Friedman, M. J. (2015). Posttraumatic and acute stress disorders. Springer.
Landolt, M. A., Cloitre, M., & Schnyder, U. (Eds.). (2017). Evidence-based treatments for trauma related disorders in children and adolescents (pp. 507-517). Cham, CN: Springer.
McKay, D., Abramowitz, J. S., & Storch, E. A. (Eds.). (2017). Treatments for Psychological Problems and Syndromes. John Wiley & Sons.
Michel, P. O. (2018). Textbook of disaster psychiatry. European journal of psychotraumatology, 9(1).
Sample Answer 4 for NURS 6630 Post-Traumatic Stress Disorder (PTSD)
Anxiety disorder is one of the most common mental illnesses across the world. In the United States, approximately 40 million adults above the age of 18 years are diagnosed with anxiety disorder every year (Curtiss et al., 2017). In most cases, this disorder is diagnosed at a later stage, as most people ignore the symptoms of anxiety disorder. Studies however show that early diagnosis of anxiety disorder promotes early interventions promoting the patient’s quality of life. Through evidence-based practices, several treatment options have been availed comprising of both pharmacological and psychotherapeutic approaches for the management of anxiety disorder (Strawn et al., 2018). The purpose of this paper is to illustrate the care plan of a middle-aged white adult male diagnosed with anxiety disorder. Every decision made on which psychotropic agent is most effective for the patient has been explained with consideration of both pharmacodynamic and pharmacokinetic factors displayed by the patient.
The provided case study demonstrates a 46 years old white male with a chief complaint of anxiety symptoms. He was referred to our clinic from the emergency room which he reported complaining of having a heart attack. Some of the symptoms demonstrated by the patient include shortness of breath, tightened chest, and the feeling of impending doom. He is also overweight. Past medical history reveals mild hypertension which he manages appropriately with a low sodium diet. His surgical history reveals the removal of tonsils at the age of 8 years. He takes 3 to 4 bottles of beer every night to manage his stress. He displayed a score of 26 upon administration of the Hamilton Anxiety Rating Scale (HAM-A). The patient however denies suicidal thoughts, visual or auditory hallucination. Currently, his primary diagnosis is generalized anxiety disorder (GAD).
Decision #1
Selected Decision
Begin Zoloft 50 mg orally daily
Reason for Decision One
Sertraline (Zoloft) belongs to the class of selective serotonin reuptake inhibitors (SSRIs) recommended by the FDA as the first-line medication for the management of GAD among adults (Strawn et al., 2018). The drug is absorbed in the GIT slowly with peak serum levels attained after 6 to 8 hours. Genetic factors such as CYP2B6 and CYP2C19 predominant among white patients, affect the metabolism of the drug with a prolonged half-life of 26 to 32 hours hence the once-daily dose, which promotes patient compliance (Strawn, Poweleit, & Ramsey, 2019). The drug takes between 8 to 12 weeks for complete remission of the patient’s symptoms.
Imipramine was not the best choice for the patient, as tricyclic antidepressant agents are most preferred among patients diagnosed with depression (Williams et al., 2020). Consequently, imipramine is associated with elevated systolic blood pressure, which might worsen the patient’s hypertensive condition.
Buspirone could also not be considered for this patient as a result of its cardiovascular side effects given the patient’s hypertensive condition (Williams et al., 2020). Consequently, the drug is associated with weight gain, which makes it inappropriate for patients who are overweight, just like the one in the provided case study.
Expected Outcome
The patient is expected to report back to the clinic after 4 weeks with at least 50% remission of symptoms such as chest tightness and dyspnea (Curtiss et al., 2017). He should regain confidence in life within this time, with a reduced feeling of impending doom. Lastly, his HAM-A score is expected to display ridings of less than 8.
Ethical Consideration
The PMHNP is expected to provide holistic care for the patient, which requires the involvement of the patient in making choices concerning the best intervention in the management of his mental condition (Williams et al., 2020). As such, the patient must be informed concerning the alternative psychotropic agents, including their benefits and side effects, and the reasons behind choosing a given drug over another.
Decision #2
Selected Decision
Increase Zoloft dose from 50mg to 75mg PO daily
Reason Behind Decision 2
The care outcome based on the first intervention reveals great compliance and adherence by the patient as no side effects were reported. Consequently, the patient displayed greatly managed symptoms, recording a reduced HAM-A score of 18. Studies show that Zoloft takes between 8 to 12 weeks for patients to enjoy complete remission of symptoms (Chen et al., 2019). As such, the recommended initial dose among adults is 50mg, which should be increased at dose intervals of 25 mg weekly as per the treatment outcome in the management of the patient’s symptoms. At this point, it is necessary to increase the dose to 75 mg once daily and monitor the patient for possible side effects.
Increasing the dose of Zoloft to 100mg is not necessary, as this is against the recommended guidelines for dose titration of the drug (Williams et al., 2020). Consequently, high doses of Zoloft are associated with severe side effects such as headache, nausea, dry mouth diarrhea, and nervousness.
Introducing another psychotropic agent is also necessary when the patient demonstrates great tolerance and adherence to the initial regimen (Curtiss et al., 2017). Otherwise, this will affect the patient’s compliance with the medication, as side effects might arise with the new medication.
Expected Outcome
Within the next 4 weeks, the patient is expected to display further remission of symptoms, with a HAM-A score of less than 8 (Williams et al., 2020). He should be able to regain his normal interest in daily activities and increased energy levels within this time.
Ethical Considerations
Legal and ethical requirements for the PMHNP are to promote patient’s well-being and prevent suffering (Chen et al., 2019). Given that the patients displayed great adherence to Zoloft, the PMHNP must maintain the drug and alter the dose as recommended to promote the patient’s safety.
Decision #3
Selected Decision
Maintain Zoloft 75mg PO daily and continue to monitor progress
Reason Behind Decision 3
The patient displayed a 61% remission of symptoms which demonstrates great adherence and compliance with the treatment regimen. He also recorded a HAM-A score of 10 which indicates mild anxiety. According to evidence-based practice, Zoloft can take up to 8 to 12 weeks to attain complete remission of the patient’s symptoms (Williams et al., 2020). The patient’s dose could be increased if he had displayed less than 50% remission of symptoms which is not the case. As such, continuing the same dose is necessary for further management of his symptoms, and to avoid the occurrence of undesired side effects.
Increasing the dose of Zoloft to 100 mg is not necessary, as this will compromise the patient’s compliance and lead to undesired side effects such as fatigue, dizziness, insomnia, and skin rash (Williams et al., 2020). This intervention could be considered if the patient’s symptoms could not have been managed as desired.
Consequently, adding a new medication is not necessary as the drug has displayed great effectiveness as monotherapy (Curtiss et al., 2017). Buspirone is also associated with cardiovascular side effects which could otherwise complicate the patient’s hypertensive condition.
Expected Outcome
Within the next four weeks, the patient is expected to display complete management of anxiety symptoms, and a HAM-A score of less than 8. No side effects are expected at this point given the great adherence and compliance exhibited by the patient in the last 8 weeks (Strawn et al., 2018).
Ethical Considerations
Given that the patient is an adult, he is responsible for making decisions concerning his health (Chen et al., 2019). As such, the PMHNP must inform the patient on the best intervention required at this point and proceed with the patient’s approval to promote patients’ satisfaction and healthy relationship for continuous positive outcomes.
Conclusion
Anxiety is a common mental illness globally with several side effects which compromise the patient’s quality of life. Most patients normally ignore symptoms of anxiety disorder which leads to complications that are expensive and hard to manage. However, with early diagnosis, patients can greatly benefit from psychotherapy and pharmacological interventions (Curtiss et al., 2017). The PMHNP is however required to consider pharmacodynamic and pharmacokinetic factors when choosing the most appropriate psychotropic agent for the management of anxiety disorder. The provided case study displays an adult white male patient diagnosed with GAD. The patient is overweight and hypertensive. The initial intervention for the patient is Zoloft 50mg orally once daily, which is recommended by the FDA as the first line for the management of GAD (Strawn et al., 2018). The other options were not appropriate as a result of side effects that would otherwise worsen the patient’s hypertensive condition. Based on the treatment outcome of the first intervention, the patient displayed great adherence and compliance to the medication with minimal reduction of symptoms which led to the second intervention of increasing the dose to 75mg.
The patient displayed 61% remission of symptoms, which made it necessary to maintain the dose of Zoloft as the third intervention. The patient displayed no symptoms, as the actual outcome was consistent with the expected outcome. Several legal and ethical considerations were observed by the PMHNP such as confidentiality and involving the patient in making decisions concerning his health (Chen et al., 2019). As such, the nurse must ensure that the patient is well informed about the treatment options and their outcome for the patient to be able to contribute to what decision to pick. Consequently, the patient must be educated on the need for psychotherapy in promoting the healing process.
References
Chen, T. R., Huang, H. C., Hsu, J. H., Ouyang, W. C., & Lin, K. C. (2019). Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. Journal of psychiatric research, 118, 73-83. DOI: 10.1016/j.jpsychires.2019.08.014. Epub 2019 Sep 1.
Curtiss, J., Andrews, L., Davis, M., Smits, J., & Hofmann, S. G. (2017). A meta-analysis of pharmacotherapy for social anxiety disorder: an examination of efficacy, moderators, and mediators. Expert opinion on pharmacotherapy, 18(3), 243-251. DOI: 10.1080/14656566.2017.1285907
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. DOI: 10.1080/14656566.2018.1491966.
Strawn, J. R., Poweleit, E. A., & Ramsey, L. B. (2019). CYP2C19-guided escitalopram and sertraline dosing in pediatric patients: a pharmacokinetic modeling study. Journal of child and adolescent psychopharmacology, 29(5), 340-347 DOI: 10.1089/cap.2018.0160
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 neuropsychiatric, 32(4), 169-176. DOI: 10.1017/neu.2020.6