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

Answer the following questions:

1. What is a suffix? Write an example of its use.

2. What is a prefix? Write an example of its use.

3. What is the definition of word root? Write an example of its use.

3. What is an eponymous? Write three examples.

4. What is an acronym? Write an example.

5. What is an initialism in Nursing? Write an example.

6. What is a combining form? Write an example.

7. When do you use a combining vowel? Write an example.

8. What is a number prefix? Write three examples of its use in medical terminology.

9. What are the other four levels of body organization that follow after the cellular level? 

10. Make a list of the systems that form the human body.

Preparing the Assignment

1. Review the elements included in PICOT questions to guide evidence-based nursing practice. 

2. Respond to the questions below using the 

PICOT Question Worksheet TemplateLinks to an external site.


 Download PICOT Question Worksheet Template
.

3. Using a minimum of 3 scholarly nursing sources, current within 5 years:  

· Identify and describe one practice-related issue or concern.  You may choose to build on the practice issue you identified in NR500NP/NR501NP. 

· Explain why the issue/concern is important to nurse practitioner practice and its impact on health outcomes. 

· Describe each element of your PICOT question in one or two sentences, being sure to address all of the following: 

·
P-Population and problem– What is the nursing practice concern or problem and whom does it affect? 

·
I–Intervention– What evidence-based solution for the problem would you like to apply? 

·
C–Comparison– What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or alternative solutions.  

·
O–Outcome– Very specifically, how will you know that the intervention worked? Think about how you will measure the outcome. 

·
T–Time frame– What is the Timeframe involved for the EBP initiative or the target date of completion?

· Construct your PICOT question in the standard PICOT question format (narrative) and define each letter separately, such as:  

· P =  

· I =  

· C =  

· O =  

· T =  

· PICOT question written in full =

1. Abide by the Chamberlain College of Nursing Academic Integrity Policy.  

2. At the graduate level, we like to see you synthesizing your ideas into your own words. No direct quotes may be used in this worksheet. 

3. Use APA formatting guidelines for references and citations.

· Using the area of interest identified in the Week 1 discussion, address the following:

· Draft a PICOT question using the standard quantitative PICOT format. 

· Identify your practice question, being sure to include the following information and describe each part of the PICOT question in detail:

· Population 

· Intervention 

· Comparison 

· Outcome 

· Time 

In ________(Population) what is the effect of ___________(Intervention) in comparison to ___________ (Comparison) on _____________ (Outcome) to be completed over __________ (Time). 

Read pages 460-461 of your textbook to learn more about the challenges of long-term care. Based on what you have learned so far (1) Why is important and challenging to offer insurance for long-term care? (2) What kind of solution you can think of to increase value and/or reduce costs in long-term care? (3) Are there any type of organizations (think ACOs, etc) be able to offer these services at a low cost that would allow insurers to participate in this market?