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Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety

 

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One

Select what you should do:

Begin Paxil 10 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID

• Add references to your posts and be aware that TURNITIN IS ON.
• The purpose of the discussion is to elevate the level of knowledge regarding disease symptom management.  
• Discussion Questions:  MENTION THE CONTEXT YOU WILL BE DISCUSSING AND DEVELOP YOUR POINTS. 

A patient who has Parkinson’s disease takes levodopa and carbidopa. The patient reports experiencing tremors between doses. The primary care NP should:

a. add amantadine.

b. increase the dose of levodopa.

 c. discontinue the carbidopa.

d. add entacapone.

       2. 

A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing freezing episodes between doses.The primary care NP should consider using:

a. selegiline.

b. apomorphine.

c. modified-release levodopa.

d. amantadine.

       3.

A 65-year-old patient is diagnosed with Parkinson’s disease. The patient has emphysema and narrow-angle glaucoma. The primary care NP should consider beginning therapy with:

a. ropinirole hydrochloride.

b. selegiline.

c. carbidopa/levodopa.

d. benztropine.

 

 identify the process for decision-making regarding technology. You will also discuss the nursing role in identifying appropriate technology for practice.

identify the process for decision making regarding technology. Discuss nursing role in identifying appropriate technology for practice.

 should include the following:

1. One technology application used in health care to facilitate decision making.
2. The application’s impact on quality of decision making.
3. The process for selecting and implementing the application.
4. A risk assessment of the application.
5. The costs associated with the application.
6. Nurses’ role(s) in selecting and evaluating the application.

Analyze and evaluate a middle range theory (Comfort theory).  You will select a middle range theory and identify application of nursing theories into clinical practice

Please see the attachment for instructions