Decision 1
The decision aims at beginning medication for patients with a severe anxiety disorder. In a bid to solve the problem, several drugs have been proposed. The best drug, in this case, will be the Zoloft 50mg PO BID. Also known as Sertraline, the drug is best suited for a host of mental health problems, including panic attacks, depression, and anxiety disorders, among others (Aschenbrenner & Venable, 2009).
Reason for the Decision
Proper treatment requires that the patient is not immediately induced to a higher amount of prescription, especially for the oral dosage. Instead, they should be subjected to drugs that work to enhance progressive medication. The reason for introducing the patient to Zoloft 50 mg PO BID is to ensure that the drug is taken on a daily basis to assist the patient in relieving their anxiety disorder (DiTomasso & Gosch, 2006). In the meantime, the physician will be keen to follow the drug reactions with the patient. After witnessing the outcome, they will be in a position to look for another alternative in case this does not work.
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Anticipated Results
The expected result is a significant improvement or a slight difference in the patient condition compared to what was recorded before the medication was started. An ideal treatment will be characterized by a reduction in either one or two of the major symptoms that characterized their disease after the drug administration. The oral Zoloft 50gm PO BIF dosage is a good option for the patient’s problem. As such, to an extent, the patient will have a percentage of their problem solved.
Difference between the Expected Outcome and the Real Initial Results
First, it was expected that there would be some changes which did not necessarily correspond to the outcome. After the patient visited the physician after a month of medication, notable changes were observed by the PMHNP. Key among the changes included shortness of breath and chest tightness. The patient also experienced lower levels of worries compared to when they had not started their medication. After taking the Zoloft medication, the Hamilton Anxiety Rating Scale (HAM-A) score dropped by 8 from its initial value of 26. The HAM-A scale is used in many clinical settings today as one of the most reliable means of measuring the patient’s anxiety levels (DiTomasso & Gosch, 2006). The patient and the physician, therefore, need to assess the next decision, which primarily depends on the results of the first one.
Decision 2
The second decision is the most effective for a middle-aged man with anxiety. However, it should be noted that the outcomes from the first decision did not necessarily give the need for another intervention to be conducted. The administration of Zoloft at the first juncture proved to be an effective strategy in the management of the disease. The second decision will hinge on increasing the dosage to 75gm, taken orally per day. This is expected to be good therapy for the patient because it will reduce the additional symptoms and in some instances eradicating others for good.
Reason for the Decision
The decision is made based on the initial drug interactions exhibited by the patient. It is critical to appreciate that the drug had a positive impact on the anxiety disorder initially exhibited by the patient. Therefore, the best decision would be to maintain the regimen, albeit at a higher dosage. It is therefore anticipated that an increase in Zoloft dosage to 75mg orally per day will play a significant role in reducing the symptom exhibited. Most fundamentally, a reduction in the HAM-A score is expected to reduce. From the symptoms, the patient is overweight. Part of the expectations with the medication is to trigger a significant weight loss.
Anticipated Results
Based on the previous dosage, the patient improved in certain crucial areas such as shortage of breath and chest problems. With the continued treatment focused on bolstering the dosage, it is expected that the rest of the complications will be adjusted to normal levels. Solving the frequent heart attacks and hypertension means that the body will be slowly moving in the right direction.
Difference between the Expected Outcome and the Real Initial Results
Unexpected changes were witnessed when administering the new Zoloft dosage to the patient. Four weeks later, after visiting the physician, the patient did not exhibit any signs of shortness of breath or chest tightness. Also, it was clear that the patient did not exhibit worries about their state of work as had previously been witnessed. Most of the symptoms had been reduced with other being slowly eradicated. From the initial step, the HAM-A rating scale lowered from 18 to 10. From a general point of view, it was beyond any reasonable doubt that the patient was positively responding to the altered medication, which is a good sign of treatment.
Decision 3
The third decision took a different twist in a bid to solve the medical problem using special techniques. The basis of the decision was informed by the need to solve the problem using health promotion. While maintaining the client on the drug, educating them on matters of diet and weight loss would be an effective way of enhancing their treatment.
Reason for the Decision
Sharma (2016) asserted that health promotion involved the activity of empowering people to manage their own health. It can occur in the form of education and advocacy through public health policies. When prescribed changes cannot positively influence the patient, changes might be required. One of the changes would be to alter the dosage or the prescription. However, in this case, there is no need to qualitatively or quantitatively change the drug because the patient has shown some signs of improvement. Here, the focus will be on health promotion where the patient is provided with the much-needed knowledge on matters relating to diet and weight loss. Important to note is that the patient should not abandon the medication on the grounds that they are adding their weight.
Anticipated Results
Without properly handling the weight issues that the patient exhibits, the side effects would outweigh the benefits that emanate from the drug treatment. Therefore, the patient needs to embrace the health promotion strategies they have received, including the direction on diet and exercise to deal with the weight problems. A normal weight can be achieved if the patient embarks on proper dietary methods.
Difference between the Expected Outcome and the Real Initial Results
The PMHNP asserts that the patient might fail in their treatment if they maintain a constant Zoloft dosage. However, fluctuations in the amount of Zoloft taken might not be the best idea, especially when managing weight issues. It is important for the patient to stick to a constant medication because a slight increase in the dosage could adversely affect the weight of the patient, thus exposing them to additional risks. Therefore, if the diet changes do not help in weight reduction, then it is important to look into other options. In this regard, the best strategy would be to incorporate polypharmacy. Polypharmacy is defined as the concurrent utilizes of a host of medications by the patient (Jacobs, 2016). This will be applicable in case Zoloft, and diet changes do not positively impact all the symptoms that the patient exhibits. However, this must first require a decision-making process between the physician and the patient.
Ethical Considerations
The first ethical consideration that must be considered will deal with the appropriate prescriptions for each and every level of the disorder. In the treatment of a serious mental health issue such as the bipolar disorder, physicians have an ethical obligation to provide appropriate prescriptions at each level including the mild, moderate, and severe stages of the anxiety disorder (Feinstein & Eden, 2011). The second consideration will be on the proper administration of the drugs. Physicians are reminded to treat patients using the correct medication that follows all the guidelines and instructions (English, Sommerville, & Brannan, 2012). For instance, physicians must always remind the patient whether they need drugs with food. Also, they need to inform the patient on time if there is a need to change the drug currently on use.
Ethical behavior must also guide the modification of the dosage. The modification needs to take into account factors such as the condition of the patient and how they are interacting with the drugs. The modification of the dosage should also come after significant deliberations with the patient who must be informed of all the benefits and possible adversities. However, informed consent might not be required in this case. Lastly, the physician ethics must also guide patient education. The patient must know what to expect before and after the medication. Dossey & Keegan (2013) asserted that they get the opportunity to understand and appreciate the possible side-effects that they might encounter in the course of their treatment. Patient education removes anxiety and allows the client to exercise the power of autonomy.
References
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
Dossey, B. M., & Keegan, L. (2013). Holistic nursing: A handbook for practice. Jones & Bartlett Publishers.
English, V., Sommerville, A., & Brannan, S. (2012). Medical ethics today: the BMAs Handbook of Ethics and Law.
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
Jacobs, S. (2016). Traumatic grief: Diagnosis, treatment, and prevention. Routledge.
Sharma, M. (2016). Theoretical foundations of health education and health promotion. Jones & Bartlett Publishers.
