Anxiety Case Study PDF

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Read the following case study, answer the questions and then submit your answers.
A 72 year old woman, Jane, is being seen by her nurse practitioner for her yearly physical exam. She explains that she has multiple physical symptoms that have suddenly developed over the last year. For example, ...

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Assignment on NRSG 3400 Anxiety Disorder Case Study

A 72-year-old woman, Jane, is being seen by her nurse practitioner for her yearly physical exam. She explains that she has multiple physical symptoms that have suddenly developed over the last year. For example, she complains of increased arthritis pain in all of her joints and notes that it is diffuse and not responsive to medication. As the NP continues to do the assessment, she learns that Jane’s oldest daughter and closest relative has moved to Utah for her husband’s business. She only speaks with her on a weekly basis. When the NP explores the patient’s increase in pain, she brings up the daughter’s move. The patient replies: “I don’t know if that has anything to do with it. I am just always nervous and anxious”. 1. Which anxiety disorder(s) would the nurse consider in assessing the patient? The nurse would consider Generalized Anxiety Disorder (GAD) when assessing this patient focusing on physiological and psychological aspects. The nurse would consider GAD based on the client’s description of being “always nervous and anxious” and sudden development of physical symptoms over the past year. The nurse would also consider the patient anxiety as a result of the separation from her daughter based on the clients report of her daughters move and unsure if it is contributing to her physical symptoms of anxiety (Halter, 2018). 2. What other parts of a psychosocial assessment would be important to consider? It would be important for the nurse to consider the effect of the anxiety on her coping abilities and how the family relationship or communication have affected her daily life such as sleep and ADLs. It would also be important for the nurse to include assessments and collection of information on previous hospitalizations, mental status, occupational background, current social patterns, stress level during the past year, interests and abilities, substance use or abuse (if any),

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and a spiritual assessment. The nurse would need to use Maslow’s hierarchy of needs to guide her considerations and prioritization of potential and actual problems for the patient (Halter, 2018). 3. Identify the nursing diagnosis that would best fit with Jane’s identified symptoms? The nursing diagnosis that best fits Janes identified symptoms is Anxiety (moderate) related to situational event or psychological stress, as evidenced by increase in pain and decrease in ability to manage pain, moderate discomfort, separation from significant other, and patient report of persistent and excessive feelings of anxiety. Jane meets the minimum requirements in the DSM5 Criteria for GAD which includes excessive anxiety and worry occurring more days than not for at least six months, about a number of events; the individual finds it difficult to control the worry; the anxiety or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Carpenito-Moyet, 2006). Additionally, epidemiological studies also show that most anxiety disorders in the elderly are chronic and usually occur earlier in life, except for generalized anxiety disorder (GAD) and agoraphobia, which often may have onset later in life. Principal predictors of late-onset GAD identified in these studies were gender (female), recent adverse life events, chronic medical illness (respiratory disorders, cardiac illness, cognitive impairment), and chronic mental illness, many of which Jane has and or are implicated in Janes description of her symptoms (Andreescu & Varon, 2015). 4. What would the NP’s nursing care plan include? The NP’s nursing care plan would focus on anxiety management and reduction, as well as consideration of other patient needs and concerns. The plan of care would use interventions that include and or incorporate counseling options, milieu therapy, promote of self-care activities, include psychological and health teaching interventions when appropriate, guide

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patients through slow, deep breathing exercises along with progressive muscle relaxation, evaluate resources and support systems available to the patient. The NP will observe for strengths such as the ability to relate the facts and to acknowledge the source of stressors, analyze past use of coping mechanisms including decision-making and problem-solving. The nursing care plan would use Maslow’s hierarchy to determine priority of interventions and identify areas of need for the patient and would use therapeutic communication strategies (Halter, 2018). Interventions would primarily center around encouraging and instilling coping enhancement, hope inspiration, self-esteem enhancement, and relaxation therapies (Andreescu & Varon, 2015). Some examples of specific interventions for this patient may include use presence, touch (with permission), verbalization and demeanor to remind patients that they are not alone and to encourage the patient to express her feelings, clarify needs and concerns, avoiding closing off avenues of communication that are important to the patient. Asking clarifying questions about the patients report of anxiety, help the patient to identify thoughts and feelings during moments of anxiety, assist in developing alternative solutions to anxiety, and providing outlets to work off excess energy (Wayne, 2019) . The care plan may also include pharmacological interventions such as antidepressants (SSRI) or antianxiety drugs. Due to the clients age, the care plan may emphasize relaxation and pharmacotherapy, as studies have shown that late-life anxiety disorders found medications more effective than cognitive behavioral therapy (CBT) in the acute phase of treatment, and in elderly persons, the most effective ingredient of CBT may be relaxation as cognitive restructuring may be more difficult given potential decrease in cognitive abilities in late life (Correa & Brown, 2019). Additionally, the care plan would include achievable goals for the client and evaluation of the progress to meeting those goals.

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REFERENCE Andreescu, C., & Varon, D. (2015). New research on anxiety disorders in the elderly and an update on evidence-based treatments. Current Psychiatry Reports, 17(7), 595. https://doiorg.ezproxy.neu.edu/10.1007/s11920-015-0595-8 Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins. Correa, J. K., & Brown, T. A. (2019). Expression of Generalized Anxiety Disorder Across the Lifespan. Journal of Psychopathology & Behavioral Assessment, 41(1), 53–59. https://doiorg.ezproxy.neu.edu/10.1007/s10862-018-9697 Halter, M.J. (2018) Foundations of Psychiatric-Mental Health Nursing (8th Ed). Chapter 17. New York: Saunder-Elsevier. Wayne Gil, (2019). Anxiety – Nursing Diagnosis & Care Plan. Retrieved June 19, 2020, from https://nurseslabs.com/anxiety/

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