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Anxiety, OCD, Somatic Discussion

 

 

A 21-year-old woman is brought to the emergency department (ED) by the university ambulance complaining of difficulty breathing, chest pain, profuse sweating, and racing pulse. BP = 130/88, P = 108, R = 20. The patient reports the symptoms developed suddenly without warning while she was taking her final exam. Additionally, she reports severe trembling, difficulty organizing her thoughts, restlessness, poor concentration, feeling as if she is disconnected from her body, and trouble communicating her distress to the exam proctor. She was removed from the exam, and the ambulance was called to transport the patient to the ED for further assessment. The patient repeatedly asks if she has suffered a heart attack. There is a family history of obstructive airway disease (COPD) in her paternal grandparents, breast cancer in her mother, and social phobia in a cousin, and her brother has a substance use disorder history. The patient had been treated for anorexia nervosa in her early teens. She denies any current eating problems or change in her appetite. Her weight is 112 lb, and her height is 5 ft 3 in. She does state that she has been under a great deal of stress this semester because her course load has been quite heavy, and she has struggled to maintain her GPA of 3.4.  

 

 

1. Anxiety is an unavoidable, human condition that takes many forms. Differentiate normal anxiety from that of an anxiety disorder.​

 

2. Based on the patient’s presentation, what (psychiatric) condition is the patient most likely experiencing? Which symptoms suggest this?

 

3. What biopsychosocial interventions should be implemented in the ED for this patient’s psychiatric condition? What interventions might be recommended after discharge? Assume medical etiology has been ruled out.

 

4. The patient is started on paroxetine 20 mg daily. Explain why a benzodiazepine might be used initially in conjunction with the SSRI paroxetine. Include patient education that should be provided to the patient regarding both of these medications before discharge from the ED.

 

 

 

 

 

 

 

A 21-year-old woman is brought to the clinic by her fiancé. He states he has been worried about her. She will not leave their apartment because she feels that things are out of place and she must fix them. Her fiancé says that she counts everything: she counts her steps and how many times she touches the light switch and she also arranges everything in alphabetical order, even his clothes. He is getting frustrated with her and now because she won’t go to work as she feels things at home are not in proper order. He says she stays up all hours of the night rearranging and reordering things. They constantly argue and he has become distant. He wants to leave her but is afraid she will not be able to exist without him there.  Her vitals are BP = 110/88, P = 84, R = 20.

 

1. Based on the patient’s presentation, what (psychiatric) condition is the patient most likely experiencing? Which symptoms suggest this?

 

2. What biopsychosocial interventions may be implemented for this patient?

 

3. Develop a teaching plan for the fiancé.

 

4. Explain the behaviors associated with trichotillomania, excoriation disorder, BDD, and hoarding disorder. What are the similarities and differences?

 

A female patient, age 64 years and unemployed, comes in to see a new primary care provider with complaints of “acute gallbladder attacks” consisting of severe pain in her right upper quadrant, which worsens with food intake. As the RN reviewing the patient’s medical history, the patient states she had a serious kidney infection at the age of 10 years, severe anemia, dysmenorrhea, fibromyalgia, and multiple medication and food allergies. Most recently, she underwent surgical repair for carpal tunnel syndrome, and was also seen by her last primary care physician for workup of a possible gastric ulcer. She is one of six siblings, and the patient’s mother died suddenly from unknown causes when the patient was 7 years old. She lives home with her husband. Today she tells you she is so very sick from her gallbladder that she believes there is no recourse but to have it removed, hence her visit to this medical provider, who she hears is “very good about getting to the bottom of things.” She goes on to tell you that although she doesn’t really want more surgery, she can’t see how it can be avoided; moreover, she’d like to have her gallbladder removed in the next week or two because she’s scheduled for a hysterectomy in 1 month, and she believes it’s important for her to deal with the gallbladder first so she will have less pain, better nutrition, and hence improved healing after her hysterectomy. There are no lab values or computed tomography results that support the patient’s assertion of an “acute gallbladder attack.” The patient also states that medication is not a viable option in treatment because she does not tolerate medications well.

1. Based on the patient’s presentation, what (psychiatric) condition is the patient most likely experiencing? Which symptoms suggest this?

 

2. What biopsychosocial interventions are important to use with this patient?

 

3. What is your approach to this patient and why

 

1. Describe “somatization” and its importance in mental health care. How does cultural humility/cultural competency play a role in the nurse’s understanding and assessment of somatization?

 

2. A 39-year-old patient diagnosed with factitious disorder has had recurrent hospitalizations for the disorder. How is this disorder differentiated from a somatic disorder?

 

3. A patient being seen in the mental health clinic has been diagnosed with illness anxiety disorder. Compare and contrast symptoms of illness anxiety disorder with conversion disorder (functional neurologic symptom disorder).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCIENCE
HEALTH SCIENCE
NURSING
MENTAL HEA NRG2008

 

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