Questions 1.
2. In addition to being flat and animated, Mrs. J’s affect may also be described as anxious. Because her affect seems to be fluctuating, there may be an incongruence between her affect and behavior. 3. Word salad is a common finding and learners should be familiar with the term. Mrs. J’s nonsensical and disorganized speech gives some indication of her thought processes. Her thought process appears to be confused. She exhibits word salad and her thought processes are disjointed and incoherent. Mrs. J’s thought content is not clear as she does not respond coherently to the questions being asked. 4. It would be helpful for the psychiatric nurse to obtain information from the patient’s daughter. What has Mrs. J been exhibiting at home? What is Mrs. J’s baseline level of functioning? Were there any past episodes of self-harm or dangerous behavior? Over what period has this change in behavior occurred? Were there any triggers? 3. Which recommendations regarding his relationship status with his wife could the nurse practitioner discuss with Donald? Responses 1. Panic attacks and panic disorder are treatable and respond well to medications and therapy. Cognitive-behavioral therapy is indicated to help this patient learn to identify anxiety-provoking triggers and reframe how he thinks about these events. Relaxation training, such as guided imagery and mindfulness, could be helpful in teaching Donald a means of reducing the anxiety once it occurs. 2. Another recommendation for Donald would be to include regular daily exercise in his routine (aerobic or weightlifting) because exercise can have a significantly positive effect on panic disorder treatment. 3. Donald may wish to consider the need for marital therapy sessions to work on improving communication with his wife. If she is willing to participate in Donald’s treatment plan, they may also want to join a National Alliance on Mental Illness (NAMI) support group to learn more about psychiatric disorders and the rights of individuals who have such disorders. Finally, mental and behavioral health problems are considered medical problems and are protected under the federal Family and Medical Leave Act of 1993. If Donald’s symptoms increase and become more debilitating, the psychiatric nurse practitioner treating Donald can provide him with a work statement and absence excuse that should help to protect his employment status and prevent him from losing his job while he is receiving treatment. excitatory and inhibitory amino acids that assist in regulating these brain functions. The nurse describes that a person’s emotions and behaviors are the result of the functioning of these chemicals carrying messages between the neurons and amino acids. When there is an imbalance among neurotransmitters, the messenger system receives too many or too few messages, impairing regulation. 2. The nurse should explain that, in a person with panic disorder, the function of GABA may be altered. Normally, GABA slows down other chemicals that are more excitatory. If GABA is not working correctly or at the correct level, there is no way to slow down the other chemicals. The result may be panic attacks. There are anti-anxiety medications, such as benzodiazepines, that aim to increase levels of GABA to help slow down brain activity; they decrease anxiety by changing how the chemicals in the brain communicate and work.
Which components of the mental status examination can the nurse document from this interaction with Mrs. Jones? 2. How might you describe Mrs. Jones’ affect? 3. How would you summarize the nurse’s observation and evaluation of Mrs. Jones’ thought processes? 4. What other health status information is helpful for the nurse to assess? Responses 1. The psychiatric nurse can document Mrs. J’s appearance, her behavior, and her affect, but not her mood. Documentation can also include thought processes and thought content. The psychiatric nurse is unable to assess Mrs. J’s memory, cognition, insight, motivation, and judgment as well as her safety. Case study 2 Donald is a 45-year-old male patient employed as a financial manager by a large bank. Because of economic downturns, there have not been as many opportunities to gain new business, which has led to fierce competition between financial managers. Donald presents to his primary care provider’s office reporting recent episodes of shortness of breath, sweating, anxiety, and the strong feeling that he is about to die. These symptoms started 3 months ago, occurring once or twice a week. Within the past few weeks, Donald reports he has experienced symptoms daily and he has begun to fear leaving his home because he is afraid that he will have another attack. His attendance at work has suffered and he reports that his supervisor told him that he might lose his job as a result. This has caused problems between him and his wife and she has started talking about leaving him to move back in with her parents. An electrocardiogram, stress test, and laboratory testing are performed, all of which show normal results. Donald is prescribed alprazolam (Xanax) by his primary care provider and referred to the local mental health center for treatment. Once there, he meets with a therapist for a comprehensive assessment. Donald is diagnosed with panic disorder and agoraphobia. He is referred to the psychiatric nurse practitioner for a medication evaluation and treatment. The nurse practitioner recommends that Donald start taking sertraline (Zoloft), 50 mg daily, and that he uses the Xanax only as needed to avoid tolerance and dependency. Questions 1. What are other therapies that are most likely to be beneficial for Donald? 2. Are there any ancillary services that could also be helpful to Donald? Case study 3 Mr. Fisher is a young adult male patient who has been newly diagnosed with panic attacks. The psychiatric mental-health nurse working in the outpatient clinic meets with Mr. Fisher, who was recently prescribed benzodiazepine by the psychiatrist for his panic attacks. Mr. Fisher asks the nurse what it means to have “a chemical imbalance” in the brain. He also asks how the new medication will “fix” his panic attacks. Questions 1. How should the nurse explain “a chemical imbalance” in the brain to Mr. Fisher? 2. How should the nurse describe how benzodiazepine medications work? Responses 1. The psychiatric-mental health nurse should explain to Mr. Fisher that neurotransmitters are chemicals in the brain that form messenger systems between neurons to help the brain and body regulate functions (e.g., thinking, feeling) and react or behave. The nurse also explains that there are
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Book Code: ANCCUS3023
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