Anxiety and Grief Peter Allen is a 60-year-old man. He

Anxiety and Grief Peter Allen is a 60-year-old man. He has worked as a clerk for the past 40 years. About four ago, his supervisor suggested that he consider retirement rather than being laid off, as his department cutting back. He is a private person who has always his lived with his mother, a woman who just one month ago diagnosed with Parkinson’s disease. He has just two friends both of whom are from work, and avoids social He describes himself as “always sensitive others think of me.” He presents today with feelings of anxiety, restlessness, and irritability which has been increasing over the last four months. Peter makes poor eye contact during the visit and is restless. He looks scared and is timid when asked questions. The nurse reviews Peter’s statements to identify potential stressor(s) that are currently impacting Peter’s life and emotional state. Which factors should the nurse consider? Select all that apply. Forced retirement. Lack of friends. Mother’s recent diagnosis. Worked as a government clerk for 40 years. Lives with his mother. Considering Peter’s situation and presentation, what should be the nurse’s next action? Assess the anxiety and restlessness that Peter mentioned. Refer to a mental health clinician. Admit to the mental health unit. Nothing, this appears to be normal behavior for him. What would be the appropriate way for the nurse to chart congruent affect and mood for Peter? Labile and sad. Irritable and anxious. Flat and angry. Constricted and euphoric. Peter says that his anxiety and restlessness began when his boss told him he needed to retire to avoid being laid off from work. Along with these symptoms, he also reports difficulty falling asleep with mild insomnia and early morning awakening. He has been having feelings of guilt about his problems in performing at work and always worries about his future. He reports a loss of energy and difficulty concentrating. His appetite is decreased, and he has lost 5 pounds over the past three months on his already small body frame. 4. Evaluate the behaviors that Mr. Allen is exhibiting and determine the Top 3 Priority cues. 1. 2. 3. 5. The nurse is assessing Peter’s level of anxiety. Which statement provides the best indication? 1. “l feel so tired all the time. I don’t know what to do or where to go for help.” 2. “l have never felt this way before; I would rate my anxiety as an 8 on a 10-point scale.” 3. “My anxiety is so bad right now, that I can’t sleep or eat, and I am just not doing well at work.” 4. “l have so many stressors in my life right now that I can’t just concentrate on anything.” For each of the nurse’s comments to Peter listed in the box, mark if it is therapeutic or non-therapeutic to the conversation. “Have you considered looking for another job?” “What does your mother think about you retiring?” “It sounds like you are going through a lot right now.” “Do you enjoy your job?” “What are your greatest fears about the future?” “Who do you feel is most supportive in your life?” “Do you go to church?” Upon further assessment, Peter’s medical history reveals arthritis and hypertension. He is worried about both of these conditions worsening as he gets older. He also voices concern that he will not be able to care for his mother as she progresses with her Parkinson’s disease. The nurse is concerned that Peter is experiencing an acute stress reaction related to grief and brought on by anticipatory grief. List the five stages of grief. Determine which stage you feel Peter is currently experiencing. 1. 2. 3. 4. 5. Peter agrees to see a healthcare provider, and the nurse makes a referral to the mental health clinic for further follow-up and treatment. Image transcription text Nursing Flow Sheets Provider Labs & Diagnostics MAR Collaborative Care Other Nurse Name: Peter Allen Age: 60 years Think Health Care Provider: … Show more INTAKE ASSESSMENT Feb. 16 Background and Assessment: 60-year-old man presents to the outpatient clinic for an initial assessment 1300 with the mental health provider. The client was seen at his primary care provider’s office and was referred to this clinic for follow-up. History includes work-related issues, decreased support system, chronic medical conditions, and a recent diagnosis of his mother with Parkinson’s Disease. He presents with symptoms of anxiety and restlessness, problems with sleep and appetite, feelings of guilt, decreased energy, and problems with concentration. Client states, “l have never felt this way before, I would rate my anxiety as an 8 on a IQ-point scale.” The client has a history of arthritis and hypertension. 7. Evaluate the Intake Note and determine the Top 3 Priority findings or cues that require a followup by the nurse. 1. 2. 3. 10. What priority nursing assessment is missing from the above intake note? Select all that apply. Suicidality. Depression. Psychosis. Panic Attacks. Hyperactivity. 11 . When planning care for the client, the nurse works with Peter to identify actions to help decrease his anxiety. Which statement made by Peter shows that he understands how to manage his anxiety? “When I feel anxious, I’ll just take lorazepam.” “l should avoid all situations that make me anxious.” “Once my meds start working, I won’t be anxious anymore.” “l need to make sure to take time for myself, at least 30 minutes every day.” 12. The nurse is concerned about Peter’s lack of social support with his mother’s recent diagnosis. Which action should the nurse take first when creating the plan of care to meet his social support needs best? Encourage him to attend support groups for caregivers. Suggest he finds a support group for family caregivers. Guide him in recognizing his personal preferences for social support. Give him the pamphlet with local support groups in his area. After meeting with the mental health provider, Peter is given the following prescriptions and follow-up plan. Image transcription text e e e e 7 — e » —_— —_ Nursing 5 Flow Sheets | Provider J Labs & Diagnostics | @ MAR | Collaborative Care @, Nurse N I ) PR ¥ T… Show more HEALTH CARE PROVIDER PRESCRIPTIONS Feb. 16 1. Lorazepam 0.25 mg by mouth as needed every 4 hours. 1300 Escitalopram 10 mg by mouth once per day. Follow-up in 4 weeks with a mental health provider. If there are concerns with the medications or side effects, please call the clinic immediately. 13, As the nurse plans for discharge instructions, what teaching is priority regarding lorazepam? It should not be taken with antidepressant medications as this could cause excessive sedation. It is used as the temporary bridge when initiating treatment with an antidepressant being used for anxiety. It does not require tapering upon discontinuation, and there is no concern for tolerance or withdrawal symptoms. It can be used safely in all clients and works well in the treatment of generalized anxiety disorder. 14. Evaluate the new prescriptions and determine the Top 3 Priority teaching needs for the prescription for lorazepam. 1. 2. 3. Evaluate the new prescriptions and determine the Top 3 Priority teaching needs for the prescription for escitalopram. The nurse is reviewing the medications with Peter. Which of his statement(s) require further follow-up? Select all that apply. “l can’t wait to feel better next week when these meds start working.” “I am fine with taking lorazepam because I know I won’t become addicted.” “l will take these medications only when I am feeling anxious.” “l know that this will take time, and I need to wait for the escitalopram to start working.” “My aunt took escitalopram when she had her anxiety issues, and it worked for her.” Peter returns to the mental health provider for his four-week follow-up. He states that he has been taking the medication as prescribed without any significant side effects. However, he is still having “a lot” of anxiety about his mother’s diagnosis. He does not know how to move forward knowing that her condition will worsen and he’ll lose her. The nurse decides to use some motivational interviewing techniques to help Peter see the importance of caregiver resources for him to take care of his mother. Select the statements that the nurse could use to assess Peter’s readiness for change when using motivational interviewing techniques. Select all that apply. “Let me suggest some things that might be helpful for you.” “Why do you think you’re feeling this way now?” “Could I have your permission to discuss the behavior and elicits pros and cons?” “I’d like to ask your perception of the importance of change on a scale of 1-10.” “I’d like to ask your perception of the confidence to change on a scale of 1-10.” Peter asks to discuss nonpharmacological measures to help with his anxiety. Which teaching would be most helpful to him regarding anxiety reduction? Explain how Peter should avoid anxiety in his life. Teach Peter how to eliminate anxiety from his life. Demonstrate alternative methods of anxiety reduction that he might try. Suggest to Peter what herbal remedies may be taken that will reduce anxiety. Mindfulness is an effective nonpharmacologic treatment method for anxiety. What are the basic principles of mindfulness related to anxiety? Select all that apply. . Self-intention. Focused attention. Virtue Physical health. Judgement. Attitude. Peter asks what cognitive behavioral therapy is. How should the nurse respond? This type of therapy highlights the role of risk and protective factors in anxiety. This type of therapy works on identifying and changing automatic thoughts surrounding the anxiety. This type of therapy links the dual roles of nature and nurture in the development of anxiety. This type of therapy identifies the family as a whole contributing to the client’s anxiety.

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