SUBJECTIVE (S):  A 32-year-old white female is in the office today with a complaint “I have to force myself to go to work and other than that I don’t want to leave my house.” She reports that last week she tried to go to a Pampered Chef party one of her coworkers was having and she only got about three blocks from her house and had to turn around and go back home. She admits to being anxious and that those feelings are now negatively impacting her life. She is married and is the mother of a 4-year-old son. Her medical history is inclusive for a diagnosis of psoriasis. She is currently on no prescription medications. Her OTC medications include vitamin B-50 which she takes to manage stress. LMP 10/2/23.

OBJECTIVE (O): 

Vital Signs – BP 100/58, P 66, R 18

HEENT – Large raised silvery-white scaly patch noted posterior occipital region of scalp. No thyroid enlargement or tenderness with palpation

Cardiovascular – Regular rate and rhythm

Respiratory – Lungs are clear to auscultation

ASSESSMENT (A):  Generalized Anxiety Disorder

PLAN (P): Stress and coping theory argue that when faced with a stressor, perceiving and evaluating stress is key to the stress response (Ozdemir and Kuru, 2023). A person who is not able to respond to stress successfully causes themselves increased distress and uneasiness which is labeled as anxiety. Anxiety disorders are a general term for a group of psychiatric disorders in which pathological anxiety symptoms are the main clinical stage and are one of the most common clinical psychiatric disorders that are a major cause of disability (Cao et al., 2023). The first thing that the nurse practitioner should do is acknowledge the patient’s feeling of anxiousness. There is nothing worse than someone telling the one who is experiencing anxiety to just calm down or that it is all in their head.

Therapeutics: Successful treatment of anxiety disorders also implies a longer-term commitment from the patient and the clinician, as GAD and the other anxiety disorders are chronic illnesses (Arcangelo et al., 2021). This patient should start on first line therapy that includes SSRI’s such as Lexapro or SNRI’s such as Effexor. Benzodiazepines such as Xanax may be prescribed for a faster relief if the patient’s anxiety turns into more of a panic episode. There are nonpharmacologic things that the patient can be encouraged to do such as counseling, behavior therapy, and meditation. Lifestyle changes include adding in or increasing an exercise routine.

Educational: The patient education from the outset should include not only explanations of the illness itself but also what the patient should expect during treatment in terms of duration of therapy, when to follow-up, expected length of time before pharmacotherapy will be optimized, and how to respond to potential adverse drug effects (Arcangelo et al., 2021). She will have to be educated that the dose of medication may need to be increased or decreased based on symptoms or may have to switch to a different medication all together. Also, inform the patient that she will need a 4-8 week follow-up visit after initiating prescription medication.

Consultation/Collaboration: May need a referral to a psychologist for counseling and medication management.

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