Introduction
As observed by Leichsenring and Leweke (2017), anxiety disorders comprise recurrent incidents that cause an abrupt feeling of sudden fear that reaches a peak within an unspecified time. The incidences in most cases trigger panic attacks in an individual. Furthermore, according to Crocq (2017), anxiety is a collection of connected illnesses where each disease has a unique symptom. Constant and excessive worry, especially in non-threatening situations, is one symptom anxiety disorder frequently exhibits. Symptoms for patients typically suffering from anxiety include both physical and emotional ones.
The most common forms of anxiety include but are not limited to agoraphobia, social anxiety disorder, and panic disorder. The subject in discussion in this project is a 46-year-old middle-aged Caucasian male who suffers from anxiety. The patient exhibits signs of an anxiety condition, such as chest tightness, shortness of breath, and muscle stiffness. ECK and ER findings assessment are standard therefore excluding any myocardial infarction. A score of 26 points was obtained after conducting a test using the Hamilton anxiety rating scale. Moreover, the study looked at generalized anxiety disorder (GAD). Three choices for treatment plans were made, proving to be suitable for treating the patient’s conditions. Treatment approaches are based on pharmacokinetics and pharmacodynamics. Ethical considerations and suggestions that will influence the treatment approaches of the patient will also be discussed in this paper for research and how the approach can help in the future treatment of similar cases. The patient has exhibited factors, such as intake of 4-5 bottles of beer a night and being overweight, which has prompted the decision to administer a Paxil dosage of 10mg, as discussed in the decision section.
Reasons for Decision 1
As a Psychiatric Mental Health Nurse Practitioner I must make the first choice to start with in this case. This decision is designed to be a start-up medication for the patient who is suffering from anxiety disorders. In this case, I can choose from: Paxil 10mg po daily, imipramine 25mg, or Buspirone 10mg. I chose to administer Paxil 10mg which is done orally daily. One of the reasons why Buspirone is not selected in this case is because it is only effective in short-term medical interventions. At the same time, the Food and Drug Administration (FDA) has not endorsed Imipramine in treating anxiety as it can result in unexpected mortality. Clinical studies have found a correlation between the use of the drug and reduced survival rates in mice (Alhowail et al., 2020). In order to make sure that the health and well-being of individuals are protected, it is best to avoid using Imipramine.
The anticipated outcome in this case on the patient’s symptoms is projected to lessen due to treatment. Another expectation is a sharp decline in the HAM-A score. The reason behind the expectation of the HAM-A score to drop is that generalized anxiety disorder (GAD) symptoms are effectively treated with Paxil (Slee et al., 2019). The likelihood of side effects is very low as few adverse effects occur when SSRIs are tolerated by the patient using the medication. On reporting back to the clinic, the patient positively reported that most of the worrying symptoms he was previously experiencing were slowly fading away. For instance, the patient’s chest tightness and shortness of breath had gone. The HAM-A score has also drastically dropped, meaning the patient is positively responding to treatment. Having positive results, in this case, means that communicating with the patient on the increase of Paxil dosage has produced the desired outcomes.
Decision 2
As the patient has shown significant improvement in his medical response, increasing the availability of Paxil from 10mg to 20mg can commence. As stated by Wichniak et al., (2017) the increase in SSRI dosage, more so in patients suffering from anxiety, leads to a suitable response by patients. The outcomes indicate that the patient is making outstanding positive progress. The option is to increase Paxil to 40mg, but this decision is not undertaken because it can lead to severe side effects such as vomiting. Another option is to let the patient continue with the exact dosage, but it is challenging to provide the expected results.
Significant improvements are established after the dosage increase to 20mg. Although there is still substantial improvement in the previous dosage, the 20mg increase has shown the expected reduction of anxiety symptoms and a significant drop in the HAM-A score compared to the first patient assessment. The reduction in the HAM-A score is evident after four weeks as the patient records a score of 10 on the HAM-A scale, equivalent to a 61% reduction in the symptoms. In this case, increasing the dosage by 40mg is possible. However, the option to decline the dosage, in this case, is because it could have significant side effects. Compared to when the dosage is 20mg. By increasing the dosage by 20mg, the expected results hoped to be achieved in response to the patient’s medication is the reduction of the mild symptoms in the following clinic assessment. In the process of treatment, I will attempt to follow ethical and moral guidelines befitting the medical profession. Application of specific ethical principles allows one to respect the needs of the patient, their autonomy, and choices, while also fulfilling their professional responsibilities. In particular, this includes establishing a clear channel of communication with the clients and explaining any procedures in detail.
Furthermore, there is an option to use the other two medication approaches provided for the patient i.e. the use of imipramine and buspirone. However, I opted to sideline the options because the medication effects displayed through the optional medication mentioned are not suitable for this case due to high levels of side effects as observed by Wichniak et al (2017). I think this decision will not negatively impact the treatment plan.
Decision 3
At this point, it is more logical to let the patient continue with the current dosage as it is proving to have a positive response. The reason for choosing this decision is that increasing the dosage will further reduce the anxiety symptoms but pose a greater risk to the patient of having side effects. As the results are observed, the patient decides to take the existing prescription. Therefore, no indication from the client’s case that augmentation should continue. As the patient has shown significant improvement, the expected result is to assess the patient and confirm his full recovery. The actual outcomes reveal that the patient has responded positively to medication. Wichniak et al. (2017) observe that there is no need for further tests on the patient as he has portrayed a positive response to treatment. In the case of increasing the dosage, certain precautions, such as having the patient’s consent, should be prioritized to avoid polypharmacy.
One of the most crucial parts of the patient’s healing process is information and guidance on how to overcome anxiety disorders. I believe in an ethical consideration plan. my treatment plan will not only render a platform for use but also will help my patient recover. One of the considerations I intend to use is patient education- patient education is vital as it educates patients on possible side effects. According to Koehler et al. (2018), patient education guides patients on the results, therefore enabling patients to choose wisely on prescriptions. Secondly, I believe proper medication administration can help my patient’s treatment plan. Proper administration as a tool for a better recovery means that the patient will be fully informed on how the prescription will be appropriately administered. Perhaps I consider the dosage adjustment the most crucial aspect of my patient’s recovery. Educating the patient on the proper dosage at every stage of the anxiety disorder helps maintain the stress level. It acts as a catalyst in speeding up the healing process.
Based on the patient, ethical consideration encompasses independence, help in informed consent, and confidentiality. Moreover, this part is crucial as it ensures that the patient has all the significant evidence before choosing the correct nature of the treatment. Information on patient medication should not be disclosed to anyone. Furthermore, Intimidation is not allowed as the patient has the right to choose the type of treatment they consider fit. I will use these principles to help me guide the treatment process with proper respect for the patient. In drug administration, evidence-based practice and continuous communication will ensure the best possible outcome.
Conclusion
The choice to use Paxil 20 mg for the treatment was right because it produced excellent outcomes, such as a reduction in breath shortness by the patient, as observed in the 12 weeks of clinic. In decision 1, Paxil 10 mg is to be taken orally daily. The reason for choosing this drug is that Paxil is a Selective serotonin reuptake inhibitor, generally suggested for managing anxiety disorders (Bandelow et al., 2017). Arguably, substantial improvement can be seen after decision 1, which prompts decision 2, where there is a notable increase in Paxil from 10mg to 20 mg. The increase in Paxil dosage conclusion is arrived at because the patient had displayed limited progress, which is evident through the HAM-A score. It was expected that choosing this decision would give the patient a complete response. The HAM-A score after Decision 2 was 10, which is a reasonable response from 18 in the previous record in Decision 1. Maintaining the current dose will ensure that the patient is fully recovered. Lastly, decision 3 shows a reduced HAM-A score, which proves the elimination of anxiety symptoms where personal data is very optimistic.
References
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