Case study - Generalized anxiety disorder (GAD): Nursing

Nurse, Aziza works in a primary care office and is caring for Clarence. A 25 year old who presents with anxiety.

Nurse Aziza in collaboration with the registered nurse, RN Michael goes through the steps of the clinical judgment measurement model to make clinical decisions about Clarence's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse Izo recognizes important cues including Clarence's vital signs which are temperature, 98 °F or 36.6 °C, heart rate, 88 BPM, respirations, 18 breaths per minute BP, 115/70 millimeters of mercury and oxygen saturation 96% on room air.

She notes that Clarence is biting his nails and appears restless. Nurse Aziza gathers more information from Clarence about his symptoms.

Hi, Clarence, tell me how you're feeling. I'm having trouble sleeping lately.

I'm worrying about everything and I can't seem to relax. That sounds stressful.

Have you had any major changes in your life recently? Yeah, I lost my job two weeks ago.

I am sorry to hear that but youre in the right place and were here to support you next nurse Aziza analyzes these cues. She reviews the electronic health record or EHR and notes that RN Michael administered the generalized Anxiety disorder seven item screening tool known as Gad seven and Clarence had a score of 10 out of 21 indicating moderate anxiety nurses.

Iza knows that one of the major findings associated with Gad is excessive worry. Although the exact cause of Gad isn't known, it's thought to be caused by an imbalance of the neurotransmitters where serotonin system activity is low and noradrenergic system activity is elevated.

This imbalance can cause symptoms of restlessness, difficulty concentrating and impaired sleep. She also knows Gad can be brought on by stressful events or life changes like losing a job.

Nurse, Aziza recognizes that Clarence needs help managing his anxiety. Next.

Using the information she has gathered along with Clarence's medical history. Nurse, Aziza discusses her findings with RN Michael and they choose a priority hypothesis of ineffective coping.

Then they generate solutions to address Clarence's anxiety that will include pharmacologic and non pharmacologic interventions.

And they establish the expected outcome that after intervening Clarence will report feeling less worried and have improved sleep by his two week follow up appointment.

Nurse Aziza takes action to implement these solutions. While the health care provider and RN Michael speak with Clarence about his diagnosis.

Nurse Aziza reviews the EHR and Notes, Clarence has been prescribed escitalopram and cognitive behavioral therapy or CBT.

Nurse Aziza then reenters Clarence's room to review the plan of care, Clarence. Your healthcare provider ordered a new medication called Escitalopram, which is an antidepressant to help you with anxiety.

They also recommended that you start attending outpatient therapy. Yeah, they told me that RN Michael also told me that the medication will take some time to work.

How long until I feel better? This type of antidepressant can take up to six weeks for you to feel the full effects.

In the meantime, the therapist will help you develop techniques to manage your anxiety. Ok?

I'm hoping the therapist can help me relax so I can sleep better. R and Michael told me about some strategies I can use to sleep better, but I'm not sure I remember them all.

Lets go over them together. Nurse Aziza then reviews strategies with Clarence to promote sleep, like limiting screen time and avoiding caffeinated beverages and alcohol before bed.

Since these can interfere with falling and staying asleep. She also assists Clarence to download a meditation app on his cell phone to help him relax before bedtime.

At the two week. Follow up, nurse Aziza evaluates the outcomes of her actions.

She takes clearances vital signs which are temperature 98.2 °F or 36.7 °C, heart rate, 72 BPM, respirations, 16 breaths per minute BP, 118/68 millimeters of mercury and oxygen saturation.

97% on room air Clarence reports that he's been taking his escitalopram as prescribed and tells nurse Aziza that he's learned some stress management techniques during his CBT sessions.

He reports that he's feeling less worried and that his sleep has improved. All right.

As a quick recap, nurse Aziza recognized and analyzed cues related to Clarence's ineffective coping and in collaboration with RN Michael.

She prioritized hypotheses and generated solutions to address this problem. Nurse Aziza and RN Michael then implemented pharmacologic and non pharmacologic interventions and evaluated Clarence's outcomes and compared them to the expected outcomes.

Since Clarence reported that he's less worried and has been able to sleep. They determined that the plan of care was successful.