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Jill, a 24 y/o Hispanic female arrives in the emergency room where her parents brought her for evaluation. They are worried because she is giving away all of her possessions and says she is planning to move to the South Pole so she can “save the world.” Her parents say that she has hardly been sleeping at all for the last 7 days, but she seems very energetic. They say she has appeared to be “in a frenzy” lately. When you interview Jill you notice that she speaks very rapidly and is laughing uncontrollably. It is hard to get her to be quiet long enough for you to ask questions. She seems agitated and has difficulty sitting still.

Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.

Summarize the clinical case including the significant subjective and objective data.

Generate a primary and two differential diagnoses.  Use the DSM5 to support the assessment.  Include the DSM5 and ICD 10 codes.

Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.

Discuss non-pharmacological treatment would you prescribe?  Use the clinical guidelines to support the rationale for this treatment.

Describe a health promotion intervention that would be appropriate for this patient.

Anxiety Case Study
Juan Carlos Fernandez
Summary of Clinical Case
The patient is Ms. JN, a 24 y/o female, whose chief complaint is excessive worry.
According to the patient, she has been worrying almost about everything as well as being
stressed out regarding her school life and upcoming examinations. Additional complaints include
lack of concentration, excessive fatigue, headaches that occur too often, neck muscle spasms,
and insomnia. She’s been described by the husband as a worrier since she gets worried that he
may be involved in an accident, him getting unemployed, along with some financial worries. As
she reports, her symptoms of anxiety have been overwhelming her in the recent 12 months.
Patient’s Problems in Order of Priority
Anxiety – The patient is concerned and “worried about everything”. She feels
impeding danger/doom. Has neck muscle spasms.
Fear – JN is fearful that her husband might lose his job, and maybe be involved in
an accident.
Fatigue – she is easily fatigued and loses concentration on class work
Ineffective coping – brought about by her being stressed out with her
responsibilities academically.
Insomnia – she has trouble falling asleep.
Pharmacological Treatment with Rationale
Use of Benzodiazepines such as Xanax 0.5mg three times a day. The concentration of a
critical neurotransmitter chemical known as GABA is increased once the patient takes the drug.
GABA works by inhibiting nerve cells from sending chemical messages to other nerve cells,
thereby introducing a sedative, hypnotic anxiolytic effects and muscle relaxant properties
(Rachman, 2019). Additionally, the drugs also cause feelings of drowsiness thereby assisting the
patient to fall asleep. Other medications that can be used include SSRIs such as Zoloft. These
drugs work by slowing the reuptake of serotonin thereby helping in mood stabilization and
anxiety (Rachman, 2019). Zoloft can be administered inform of a tablet at 50 mg once a day, to
be taken in the evening or morning.
Non-pharmacological Treatment with Rationale
First, I would start by trying to put the patient at ease so as to discuss with her the
available therapeutic options. Establishing a trusting relationship with the patient is crucial so as
to contribute to better care experiences (Poulsen, 2017). I would then recommend Cognitive
Behavioral Therapy (CBT), which will teach things such as positive reframing. This will help the
patient interrupt and change the worried thoughts that give rise to anxiety (Poulsen, 2017);
Decatastrophizing, which is also a useful CBT tool that will teach the patient how to challenge
and alleviate catastrophic thinking; and Assertiveness training (Poulsen, 2017). These treatments
will assist the patient in recognizing and correcting negative thinking and behavior associated
with fear and anxiety, allowing them to live a much more optimistic and productive life.
Use of relaxation techniques such as deep breathing exercises, meditation, guided
imagery, and music therapy. These relaxation techniques soothe and relieve the client’s anxious
mind, as well as reducing muscle tension (Poulsen, 2017).
Assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential
for patient adherence.
The appropriateness of treatment can be determined by thoroughly identifying the
patient’s problems and sources. Next is establishing a therapeutic goal that will include steps into
the patient’s treatment plan. Then, I would choose the best drug and non-pharmacologic therapy,
apply and initiate them with sufficient detail, as I provide specifics, instructions, and warnings.
Following that, the effectiveness of the treatment is going to be determined by evaluating the
implemented therapies through quantifiable progress and improvements in the patient’s signs and
symptoms, stalled progression of the disease, and overall improved patient outcomes. Provision
of evidence of drugs’ side effects and toxicity will form part of the safety evaluation of the
pharmacological treatment. Adherence to the medication can be evaluated using a variety of
techniques, including interviews, self-report questionnaires, and tracking disease progression as
well as patient outcomes.
Poulsen, I. A. (2017). Non-pharmacological interventions to reduce anxiety in patients
undergoing conscious surgery.
Rachman, S. (2019). The treatment of anxiety disorders. Anxiety and the Anxiety Disorders, 453462. https://doi.org/10.4324/9780203728215-33

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