Please I need a response to this case study.

1 page

zero plagiarism

three references

The Case:

The sleepy woman with anxiety

This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.

Client Questions

Question 1. Are you having feelings of harming yourself or harming someone else?

Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).

Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?

Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children. Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).

Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.

Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).

Support System

            The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permission, speaking to her husband may assist us in this situation. Learning how the patient functions at home, what critical changes have occurred with this recent bout of depression and what coping mechanisms are utilized by the couple may assist us in reaching a state of remission. In addition, these disorders are associated with significant decreases in patient well-being and social functioning and can cause considerable pain and suffering, not only for affected individuals but for their family and friends as well. Despite the availability of proven treatments, both disorders remain underrecognized and undertreated (Ballenger, 2000).

1. Are you aware of when your wife is entering a state of anxiety or depression?
2. What have you noticed happening in your lives when this occurs?
3. When these events occur, what response does that create for you?
4. What coping mechanisms do you utilize for yourself and your relationship when these events occur?

Physical Exams and Diagnostic Tests

First a complete physical assessment of the patient is required to rule out any underlying medical issues. This would also include a full blood panel with CBC, CMP, TSH and urinalysis and toxicology. Research findings suggest that mood and anxiety symptoms result from a disruption in the balance of impulses from the brain’s limbic system. A 2015 study reported that individuals with comorbid depression and anxiety have increased resting-state functional connectivity of the limbic network when compared with depression or anxiety alone. FK506 binding protein 51 (FKBP5) is a co-chaperone binding protein which modulates the function of glucocorticoid receptors. In a study examining allelic variants of FKBP5, the T allele was more frequent among patients with comorbid depression and anxiety (Pannekoek et al., 2015). Additionally, rating scales have shown good reliability for assessing anxiety and depression. The Depression and Anxiety Stress Scale (DASS) is suitable for assessing clients with co-occurring depression and anxiety.

Differential Diagnoses

1. Post-Traumatic Stress Disorder (PTSD)- This patient could be showing physical manifestations of PTSD. Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are prevalent and frequently co-occurring psychiatric illnesses that are both highly associated with disturbed sleep. PTSD affects an estimated 5 million people in the U.S. each year and is characterized by an inability to recover from a stress reaction following exposure to a traumatic event (Vandrey et al., 2014).
2. Generalized Anxiety Disorder (GAD)- This patient falls into the DSM-V criteria for anxiety. Generalized anxiety disorder produces fear, worry, and a constant feeling of being overwhelmed. Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health, and the future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms (Munir & Takov, 2019).
3. Polypharmacy and (GAD)- This patient may be suffering issues relating to polypharmacy as evidenced by sleep disturbances combined with anxiety disorder. As the number of available medication options increases, so does the potential for polypharmacy, a practice with possible complications. Such complications include a greater number of side effects with the initiation of additional medications and the consequences of drug-drug interactions.

Pharmacologic

            This patient does not appear to be a good self-historian regarding medication, compliance and lacks the ability to determine medication effectiveness. It is the thought of the PMHNP that the patients issue with narcolepsy is related to medication and polypharmacy issues. Simplifying the patients eight medications by discontinuing sodium oxybate, pramipaxole and DDAVP seem to improve her daytime sleepiness. This patient was taking several medication relating to sleep, causing other issues including bed-wetting for which she was prescribed DDAVP (Desmopressin), and reports it is not very helpful. By tapering and discontinuing these medications and educating the patient on sleep hygiene and perhaps sleep studies, we can assist this patient into improved sleep at night without excessive daytime sleepiness.

Lessons Learned

 This case is an excellent example of long term mental health issues and polypharmacy. This patient seemed to be a good candidate for Vagus Nerve Stimulation (VNS) to which she received relief from sleep disturbances. Many patients with chronic anxiety have a poor quality of life. The education of both the patient and family by the pharmacist, nurse, and provider as a team is important to reduce the high morbidity and addiction problems with treatment medications. Family members should help ensure medication compliance and provide a supportive environment. Unfortunately, despite optimal treatment, relapse rates are high (Dold et al., 2017).

References

Ballenger J. C. (2000). Anxiety and Depression: Optimizing Treatments. Primary care companion to the Journal of clinical psychiatry, 2(3), 71–79. https://doi.org/10.4088/pcc.v02n0301

Dold M, Bartova L, Souery D, Mendlewicz J, Serretti A, Porcelli S, Zohar J, Montgomery S, Kasper S. Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders – results from a European multicenter study. J Psychiatr Res. 2017 Aug;91:1-13.

McLaughlin, K. A., & Hatzenbuehler, M. L. (2009). Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents. Journal of abnormal psychology, 118(3), 659–669. https://doi.org/10.1037/a0016499

Munir S, Takov V. Generalized Anxiety Disorder (GAD) [Updated 2019 Nov 22]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/

Rapee RM. Preschool environment and temperament as predictors of social and nonsocial anxiety disorders in middle adolescence. J Am Acad Child Adolesc Psychiatry 2014; 53:320.

Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health 2019; 47:9.

Pannekoek JN, van der Werff SJ, van Tol MJ, et al. Investigating distinct and common abnormalities of resting-state functional connectivity in depression, anxiety, and their comorbid states. Eur Neuropsychopharmacol 2015; 25:1933.

Vandrey, R., Babson, K. A., Herrmann, E. S., & Bonn-Miller, M. O. (2014). Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. International review of psychiatry (Abingdon, England), 26(2), 237–247. https://doi.org/10.3109/09540261.2014.901300

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.  

Photo Credit: Getty Images/Caiaimage

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

• Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
• Review the scenario assigned by your Instructor for this Assignment.
• Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
• Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation. 
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

four references not more than 5years

zero plagiarism

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

• Chapter 1, “Prescriptive Authority” (pp. 1–3)
• Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 5–9)
• Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 11–16)
• Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)
• Chapter 5, “Adverse Drug Reactions and Medical Errors” (pp. 41–49)
• Chapter 6, “Individual Variation in Drug Response” (pp. 51–56)

What are social determinants of health? 

How do social determinants of health contribute to the development of illness? 

What is a communicable disease chain? 

Are there steps that a nurse can take to break a link within the communicable disease chain?

Give a specific example.

Readings within your text covering international/global health and the following websites will assist you in answering these questions:

1. U.S. Centers for Disease Control and Prevention (CDC) Global Health website: http://www.cdc.gov/cogh/index.htm
2. U.S. Department of Health & Human Services (HHS) Global Health website: http://www.globalhealth.gov/index.html
3. Families USA – Why Global Health Matters—Here and Abroad website: http://www.familiesusa.org/
4. World Health Organization (WHO) website: http://www.who.int

500 words, 3 APA format reference style.

Let’s reflect upon the events that are taking place in healthcare today (Covid-19 Pandemic). Which theorist would you select to construct a framework for care of your staff and patients? Please explain why with examples.

***Think about some of the concepts involved. Examples include fear, isolation, family separation, being pregnant and exposed to the virus, psychological issues, guilt, impacted care standards.

I work in the Miami area in Florida State. My hospital is starting to colapse due to the pandemic situation and a lot of patient are dying with no one at the bedside to hold their hand.