Video Case Study - Caring for Patients With Generalized Anxiety Disorder
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, go 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 Aziza recognizes important cues, including Clarence’s vital signs which are temperature 98 F or 36.6 C, heart rate 88 beats per minute, respirations 18 breaths per minute, blood pressure 115/70 mmHg, and oxygen saturation 96 percent on room air.
She notes that Clarence is biting his nails and appears restless. Nurse Aziza gathers more information from Clarence about his symptoms.Nurse Aziz: Hi Clarence, tell me how you’re feeling.Clarence: I'm having trouble sleeping lately.
I’m worrying about everything, and I can’t seem to relax.Nurse Aziza: That sounds stressful. Have you had any major changes in your life recently?Clarence: Yeah, I lost my job two weeks ago.Nurse Aziz: I’m sorry to hear that, but you’re in the right place and we’re here to support you.Next Nurse Aziza analyzes these clues.
She reviews the electronic health record, or EHR, and notes that RN Michael administered the Generalized Anxiety Disorder 7-item screening tool, known as GAD-7, and Clarence had a score of ten out of 21, indicating moderate anxiety.Nurse Aziza 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 nonpharmacologic interventions; and they establish the expected outcome that after intervening, Clarence will report feeling less worried and have improved sleep by his 2-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 re-enters Clarence’s room to review the plan of care.Nurse Aziza: Clarence, your health care 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.Clarence: 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?Nurse Aziza: This type of antidepressant can take up to six weeks for you to feel the full effects.
RN Michael told me about some strategies I can use to sleep better, but I’m not sure I remember them all.Nurse Aziza: Let’s 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 takes Clarence’s vital signs which are temperature 98.2 F, or 36.7 C, heart rate 72 beats per minute, respirations 16 breaths per minute, blood pressure 118/68 mmHg, and oxygen saturation 97 percent 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.Alright, 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 nonpharmacologic 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
No notes for this video yet
Try adding a note below