Question

A 72-year-old woman, Jane, is being seen by her nurse practitioner for her yearly physical exam. She explains that she has multiple physical symptoms that have suddenly developed over the last year. For example, she complains of increased arthritis pain in all of her joints and notes that it is diffuse and not responsive to medication. As the NP continues to do the assessment, she learns that Jane’s oldest daughter and closest relative has moved to Utah for her husband’s business. She only speaks with her on a weekly basis. When the NP explores the patient’s increase in pain, she brings up the daughter’s move. The patient replies: “I don’t know if that has anything to do with it. I am just always nervous and anxious”.

1.      Which anxiety disorder(s) would the nurse consider in assessing the patient?

2.      What other parts of a psychosocial assessment would be important to consider?

3.      Identify the nursing diagnosis that would best fit with Jane's identified symptoms?

4.      What would the NP's nursing care plan include?

Answer 1

1)anxiety disorders are different, though they are group of mental illness, and the distress they cause can keep you from carrying on with your life normally. here in this case Jane having Generalized anxiety disorder, in generalized anxiety disorder it's normal to feel anxious from time to time, especially if life is stressfull. however, exessive , ongoing anxiety and worry that are difficult to control and interfere with day to day activities may be a sign of GAD. living with generalized anxiety disorder can be a long term challenge. in many cases, it occurs along with other anxiety or mood disorders.

in this case Jane having multiple physical symptoms it is developed suddenly developed over the last year, increased arthritis pain all over the joints, not response to medication,and also she is telling , she is always nervous and anxious. she is more thing about her family.

2) Psychosocial problems that these patients may have in the long run include anxiety, uneasiness, mourning, helplessness, fatigue, impairment of concentration,sleep disorders, mental and cognitive reservation, psychological distress, and psychiatric disordes etc...psychosocial assessment is an evaluation of person's mental health, social status, and functional capacity within the community. it considers the client's perception of self and his or her ability to function in the community. in this case not having more psychosocial problem, the problem is Jane is only speak with her daughter on a weekly basis. she is not talking with others also.

3) here the nursing diagnosis is generalized anxiety and it may be the pain due to other physchiatric disorder like Pain disorder- the pain disorder is the essential feature of pain disorder is severe and prolonged pain that causes clinically significant distress or impairment in social , occupational, ot other important areas of funtioning . this diagnosis is made when psychological factors have major role in the onset, severity, exacerbation, or maintenance of pain, even when the physical examination reveals pathology that is associated with the pain.

4)In this case nursing care first sholud be symptomatically treat the patient.    then Jane having physical problem and anxiety problem also. first should give to Jane medication for her physical problem, with that should understand her problem, and tell to her she is not having more physical problems, it manifest due to her mental illness, so when she will get mental fitness then only reduce her pain and other problems, otherwise she is taking long time medication also it won't work.

initially meet client's dependancy needs as required,Encourage independence and give positive reinforcement for independent behaviors. explore client 's perception of treat to physical integrity or threat to self-concept. and give small dosage medication for stress reliaf and reduce nevous and anxiety.

if it possible inform her relatives about her situation, especially her daughter.