Assessment Of A Patent With Anxiety Disorder Student Name PM
Assessment Of A Patent With Anxiety Disorderstudent Namepmhnp Care A
Assessing a patient with anxiety disorder requires a comprehensive understanding of their subjective complaints, medical history, mental status, and potential differential diagnoses. The core focus is to determine the primary mental health problem, identify appropriate treatment interventions, and explore possible underlying or co-occurring disorders that could influence the patient's presentation and response to treatment.
In this case, the patient, B. L., a 59-year-old female, presents with anxiety symptoms following traumatic carjacking incidents at gunpoint. Her chief complaint revolves around increased paranoia, heightened anxiety episodes, and physical symptoms such as weight loss and uncontrolled blood sugar levels. The subjective data reveal that her anxiety worsens when she is outside or traveling, especially in situations reminiscent of her past trauma, triggering panic symptoms like sweating, heart palpitations, and chest pains.
The patient's medical history indicates no known current medical conditions but highlights issues such as significant weight loss and elevated blood sugar levels, which may be stress-related or indicative of comorbid metabolic disorders. Her current medication, Vistaril (hydroxyzine), suggests her healthcare provider aimed at managing her anxiety symptoms through antihistamine-based anxiolytic therapy. The absence of substance use and allergies simplifies the clinical picture, directing focus primarily on her mental health diagnosis.
The mental status examination confirms her alertness, cooperation, and orientation, but her physical appearance—marked by weight loss—and her reports of high anxiety levels and paranoia indicate a significant psychological impact of her traumatic experiences. Her neurovascular and organ systems appear unaffected, except for occasional sweating and subjective feelings of fear, which further support a diagnosis of an anxiety disorder, possibly panic disorder triggered by traumatic exposure.
The patient's symptoms align with the criteria for panic disorder, characterized by recurrent panic attacks linked to specific trauma-related triggers. Such panic attacks involve intense physical sensations, including chest tightness, palpations, and sweating, consistent with the findings in her assessment, and supported by literature indicating that traumatic events, such as carjacking, could precipitate panic disorder (Gensichen & Domschke, 2018).
In addition to panic disorder, differential diagnoses include depression and adjustment disorder. Depression presents with persistent low mood, anhedonia, and cognitive disturbances, whereas adjustment disorder involves emotional and behavioral responses to identifiable stressors in excess of what is typically expected, leading to significant distress and functional impairment (O’Donnell et al., 2019). The patient's presentation with acute anxiety and panic symptoms following a clear traumatic event makes panic disorder the most probable primary diagnosis.
Treatment Approach and Clinical Insights
The management of anxiety disorders, particularly panic disorder in this context, necessitates an integrated approach involving psychotherapy and pharmacotherapy. Cognitive-behavioral therapy (CBT), especially exposure therapy and cognitive restructuring, is well-documented in reducing panic symptoms and modifying maladaptive thought patterns (Bandelow et al., 2022). During CBT, the patient can learn to identify their physiological and cognitive triggers, develop coping mechanisms, and gradually confront avoided situations, thus diminishing paranoia and anxiety related to trauma recall.
Pharmacologically, benzodiazepines such as Vistaril provide rapid relief of acute anxiety symptoms, but their long-term use should be cautious due to dependency risks. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line pharmacotherapy for panic disorder; they are effective in reducing the frequency and intensity of panic attacks and also have beneficial effects on comorbid depression (Gensichen & Domschke, 2018). A combined treatment regimen, including SSRIs and CBT, offers a comprehensive approach to managing symptoms and preventing relapse.
Addressing her weight loss and uncontrolled blood sugar levels is also critical, as these could be stress-induced or indicative of underlying metabolic conditions. Collaborating with her primary care provider for a metabolic workup and nutritional support can improve her overall health and facilitate her recovery from anxiety symptoms.
Regular follow-up sessions should assess her response to therapy, medication adherence, and any emerging side effects. Psychoeducation about her condition, stress management techniques, and social support systems are essential components of holistic care. Engaging family members or significant others in her therapy, if possible, can also enhance her coping capacity and reduce paranoia-driven behavior.
Reflections and Future Considerations
Despite a thorough initial assessment, collecting additional subjective data, particularly regarding her mental health history and family psychiatric history, could improve diagnostic accuracy and treatment planning. Understanding if she has experienced prior anxiety or depression episodes, or if there is a familial predisposition to mental health issues, would inform the nuanced approach required for her care.
Furthermore, exploring her reproductive history and social determinants could shed light on other contributing factors to her mental health. These considerations emphasize the importance of comprehensive biopsychosocial assessment principles in mental health nursing practice.
Conclusion
In summary, B. L.’s clinical presentation strongly indicates a diagnosis of panic disorder, precipitated by traumatic carjacking incidents. A treatment plan integrating psychotherapy, pharmacotherapy, and health management should be implemented, with ongoing monitoring for effectiveness and side effects. Recognizing and addressing comorbid conditions and psychosocial factors will enhance her chances of recovery and improve her quality of life.
References
- Bandelow, B., Michaelis, S., & Wedekind, D. (2022). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 24(1), 49–58.
- Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt International, 115(11), 179–187.
- O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International Journal of Environmental Research and Public Health, 16(14), 2537.
- Riva, G., & Serino, S. (2020). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Journal of Clinical Medicine, 9(11), 3434.
- Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt International, 115(4), 611–622.
- Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological Services, 16(4), 621–632.