When it comes to facilitating spiritual care for patients with worldviews different from your own, what are your strengths and weaknesses? If you were the patient, who would have the final say in terms of ethical decision-making and intervention in the event of a difficult situation? 

2

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

Using the theory of unpleasant symptoms as a guide, what would you look for in an assessment tool for patient symptoms?

Three references please 

 Week Four APA Assignment: Evaluating the socioeconomic impact of healthcare across our diverse communities: Educating our clients regarding accessibility and affordability.

• Sections of the assignment must include:
  Introduction
  Focus points covered in the discussion posts
  Any arguments and rationales for your stance
  Conclusion or Summary
• The components of your APA Assignment includes the following:
  The assignment must be completed on a word document.
  Your APA  Assignment must include a title page (Refer to Purdue OWL).
  All in-text citations must be used when paraphrasing or quoting a previous author.
  All references must reflect the in-text citations used.
  All reference sources must be within the past 5 years unless it is the works of a nurse theorist or a significant reference material.
  The length of the assignment must be 750-1000 words. Please pay attention to spelling and grammar. Points are deducted for repeat offenders.
  Upon completion of the assignment, you must submit it via Turnitin.com and please note that your plagiarism score should be no more than 20%. If you score higher, please make adjustments