Which anxiety disorder(s) would the nurse practitioner consider in assessing the patient? Justify your reasoning using DSM-5 criteria for mental health disorder? 2) What other parts of a psychosocial assessment would be important to consider? 3) Mention 3 differential diagnosis that could be consider for this case 4)What would the NP’s nursing care plan include? please include non pharmacological, pharmacological and referall options
1) In assessing the patient, the nurse practitioner would consider several anxiety disorders based on the symptoms and their impact on the patient’s daily functioning. As described, the patient experiences persistent worry, restlessness, difficulty concentrating, irritability, and sleep disturbances, which are indicative of generalized anxiety disorder (GAD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). According to the DSM-5 criteria, GAD involves excessive anxiety and worry about various domains of life, such as work, health, and family, occurring more days than not for at least six months, and leading to significant distress or impairment in functioning.
Furthermore, the patient’s symptoms also meet the criteria for panic disorder, which is characterized by recurrent panic attacks. Panic attacks are sudden, intense episodes of fear or discomfort, accompanied by physical symptoms such as a racing heart, chest pain, shortness of breath, dizziness, and a fear of dying or losing control. These panic attacks are associated with an intense fear of having another attack and a significant change in behavior, such as avoiding places or situations where panic attacks have occurred.
Additionally, the patient’s avoidance behaviors, fear of being judged, and reluctance to engage in social situations suggest the possibility of social anxiety disorder (SAD). The criteria for SAD in the DSM-5 include excessive fear or anxiety about social situations where the individual may be scrutinized or embarrassed, leading to avoidance or intense distress.
2) In addition to assessing for anxiety disorders, the nurse practitioner would consider several important psychosocial factors during the assessment. These factors include the patient’s support system, such as family and friends, as well as any significant life events or stressors that could be contributing to the development or exacerbation of anxiety symptoms. Understanding the patient’s coping mechanisms and previous experiences with mental health treatment is essential for tailoring an appropriate care plan.
Furthermore, it is important to assess for any co-occurring mental health conditions, such as depression or substance use disorders, as anxiety disorders often coexist with other psychiatric disorders. The nurse practitioner should also explore the patient’s functional impairment in various areas of life, such as work, relationships, and daily activities, to gain a comprehensive understanding of the impact of anxiety on the patient’s overall well-being.
3) Three differential diagnoses that could be considered for this case include:
a) Adjustment disorder with anxiety: This diagnosis would be considered if the patient’s anxiety symptoms are directly related to a specific stressor or life event and the symptoms exceed what would be expected given the circumstances. It is characterized by significant distress and impairment within three months of the stressor.
b) Obsessive-compulsive disorder (OCD): OCD involves recurrent obsessions (intrusive and unwanted thoughts) and compulsions (repetitive behaviors or mental acts) that the individual feels driven to perform to alleviate distress. If the patient’s symptoms involve specific obsessions and compulsions that significantly interfere with daily functioning, an OCD diagnosis could be considered.
c) Posttraumatic stress disorder (PTSD): If the patient has experienced a traumatic event in the past, such as a personal assault or a natural disaster, and is experiencing symptoms such as intrusive memories, nightmares, hypervigilance, and avoidance of reminders, a PTSD diagnosis could be considered.
4) The nurse practitioner’s nursing care plan for this patient would include both non-pharmacological and pharmacological interventions, as well as a referral for additional support. Non-pharmacological interventions would focus on psychoeducation, counseling approaches such as cognitive-behavioral therapy (CBT), and stress-management techniques. Psychoeducation would involve providing the patient with information about anxiety disorders, their symptoms, and treatment options, helping them develop insight into their condition.
CBT, a evidence-based therapy for anxiety disorders, would involve identifying and challenging negative thought patterns and teaching the patient coping mechanisms for managing anxiety symptoms. Stress-management techniques, such as relaxation exercises, deep breathing, and mindfulness practices, would also be taught to the patient to help them better manage their anxiety.
In terms of pharmacological options, the nurse practitioner may consider prescribing selective serotonin reuptake inhibitors (SSRIs), which are commonly used for the treatment of anxiety disorders. SSRIs have been shown to be effective in reducing anxiety symptoms and improving overall functioning. Other medication options, such as benzodiazepines, may be considered for short-term relief of severe symptoms, but are generally avoided as long-term treatment options due to their potential for dependence and abuse.
Finally, the nurse practitioner would refer the patient to appropriate support services, such as a mental health counselor or support group, to provide ongoing emotional support and to help the patient develop coping skills. Referral to a psychiatrist may also be necessary if the patient’s symptoms do not adequately respond to initial treatment or if there are concerns about complex medication management.
In conclusion, the nurse practitioner would consider generalized anxiety disorder, panic disorder, and social anxiety disorder when assessing the patient based on the DSM-5 criteria. Other important aspects of the psychosocial assessment would include evaluating the patient’s support system, identifying any co-occurring mental health conditions, and understanding the functional impairment caused by anxiety symptoms. The differential diagnosis would involve considering adjustment disorder with anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder. The nursing care plan would include non-pharmacological interventions, such as psychoeducation, counseling, and stress-management techniques, as well as pharmacological options, such as SSRIs, and appropriate referrals for continued support.