Running head: MIDDLE AGED CAUCASIAN MAN WITH ANXIETY1

MIDDLE AGED CAUCASIAN MAN WITH ANXIETY4

Decision #1

This decision is basically designed for start up medication for patients with anxiety disorder. Several drugs have been advanced towards solving the medical condition. However, the best decision(Ressler, K. 2015) is to start Zoloft 50 mg PO BID.

Reasons for choosing the decision

Normally the patient will not be immediately introduced to a higher amount of prescriptions of the oral dosages or rather, be subjected to other drugs meant for progressive medication. Therefore, the reason for this decision is to introduce the patient to Zoloft 50 mg PO BID that is taken orally on a daily basis (Gosch, 2006) to relieve anxiety. This is where physicians can determine the drug reactions and the outcome to pick on another decision to work in case this does not materialize.

Anticipated results of the decision

The results I expected were an improvement or rather a slight difference in what was recorded before the patient started the medication. At least one or two symptoms of the disorder will under reduction after the administration of the drug. The oral dosage of Zoloft 50gm PO BID is a good recommendation for the problem and no doubt I hoped the problem will be solved to some level of percentage.

Difference in expected results and the real initial results of the decision

The expectations that there would be some changes did not correspond to the outcome. When the patient made a visit to the physician after the four weeks of medication, the PNHNP noted that there were notable changes. There was reported reduction in chest tightness and short breath. Additionally, the patient had less worries compared to when he had not been introduced to the medication. At the first attempt of Zoloft medication the HAM-A score had decreased by 8 from the initial recorded value 26. This refers the patient and the physician to next decision, which greatly depends on the results of, decision one.

Decision #2

Decision #2 is the most effective and appropriate for the middle aged Caucasian man with anxiety (Venable, 2009). Results from the first decision do not really necessitate for another intervention to be carried out. Since the first administration of Zoloft drug at the amount of 50gm turned to affect the client positively, decision two aimed at increasing the dosage to 75gm to be taken orally daily. This definitely could be the most effective therapeutic approach towards the patient because additional symptoms will be reduced while other being eradicated for good.

Reason for choosing the decision

Since the drug had a positive impact on the client’s anxiety disorder, it is thinkable to maintain the dosage though at an increased rate. Increasing Zoloft 50gm PO BID to 75mg orally daily will work to relief of most of the client’s symptomsincluding reduction in the HAM-A score and overweight.

Anticipated results of the decision

The previous dosage had seen the patient improve in some of the symptoms such as chest problems and breathe shortage. Other more complications would definitely be adjusted to normal levels something closest to proper functioning of the body system including hypertensive conditions and frequent heart attacks.

Difference in expected results and the real initial results of the decision

The changes that were expected from administering the new dosage of Zoloft drug to the patient turned out to be unexpected. After four weeks when the client visited the physician, it was recorded there was not chest tightness and shortage of breathe. Worries about his work had also reduced from the previous state. Most, if not all of the symptoms had been reduced with others purely eradicated (Gosch, 2006). The most tremendous outcome of the medication was the HAM-A scale rating that had reduced from 18 in the previous record to ten.

Decision #3

The third decision is a very different approach that applies to special cases in for this category of medical problem. Choosing to educate the client on diet/weight loss while maintaining the client on the same drug would work better.

Reasons for choosing the decision

Whenever the prescribed dosage does not influence a patient in any positive manner, there must be changes. Sometimes alteration of the dosage form the previous prescription applies. However, in this case there is no need to have the quantitative changes in the drug administration because the condition in address is quite different especially when other conditions are not being cured by the current medication. This decision has been advanced to help the client have knowledge about diet and weight loss to understand that she does not have to abandon the medication just because he is gaining weight.

Anticipated results of the decision

This is a very crucial condition where if there might be any other intervening medical processes to deal with overweight issues, side effects would turn out to be multiple than even before. The patient is expected to adhere to the directions given on her diets to ensure the desirable normal weight is naturally achieved through his eating habits.

Difference in expected results and the real initial results of the decision

The suggestion from PMHNP that the patient may not cop the situation with a constant quantity of the dosage of Zoloft is not effective in reducing weight. The patient needs to stickto the same medication because an increase in the dosage will definitely alter the weight of the client and put him at high risk of adverse side effects. Therefore, if diet would not help reduce weight, there is another medication that is basically a solution to overweight problem. Polypharmacy can be advisable in this case because the drug used cannot manage all symptoms related to anxiety disorder. The physician and the client must have engaged in a decision making process to come up with the best remedy

Ethical considerations in treatment plan and communication with clients

· Appropriate prescriptions for each level of disorder

In treatment of bipolar disorder, this ethical consideration helps physicians to administer the most appropriate prescriptions to each case as whether (Venable, 2009)mild, moderate of severe conditions of anxiety disorder.

· Proper administration

This reminds physicians that patients should take the right course of drug administration ensuring they follow all instructions given (Eden, D. 2011). For example, patients may need to take the drug with food or be subjected to taper dosage in cases of discontinuation of the drug. Sometimes it could be a change in the type of medication being offered where there should be a shift from the previous drug.

· Modifications of dosage

Just like for prescriptions as discussed above, modifying the correct dosage for a given disorder is an ethical consideration. This may help nursing team to reduce the dosage as appropriate depending on the condition of the patient.

· Provision of Patient-education

This is mostly knowledge about what to expect during the medication and after. This helps nurses to highlight potential side effects (Eden, D. 2011) of the prescribed treatment for patients to get to know what might happen in the end. It also helps clients understand that they need to stick to a certain drug even when they do not want use it.

Reference

Aschenbrenner, D. S., & Venable, S. J. (2009). Drug therapy in nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

DiTomasso, R. A., & Gosch, E. A. (2006). Anxiety disorders: A practitioner's guide to comparative treatments. New York: Springer Pub.

Feinstein, D., & Eden, D. (2011). Ethics handbook for energy healing practitioners: A guide for the professional practice of energy medicine and energy psychology. Fulton, CA: Energy Psychology Press.In Pine, D., In Rothbaum, B. O., & In Ressler, K. (2015). Anxiety disorders: Translational perspectives on diagnosis and treatment.

Wurtzel, E. (1994). Prozac nation: Young and depressed in America. Boston: Houghton Mifflin.