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discussion

Peer Response

Instructions:

Review the plans posted by your peers from your advanced practice nursing role perspective (educator, leader or nurse practitioner).  From this mindset, reflect upon a discussion you would like to have with your colleagues about their plan.

· For example – if you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the plan, or do you want to comment on or add to the education provided?  

· If you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the plan.?

· If you are a nurse practitioner did your peer develop a plan that aligns with evidence-based practice and current clinical guidelines? Etc.

Please be sure to validate your opinions and ideas with citations and references in APA format. 


Kathrina Pioquinto

Ms. Johnson presents with
 Generalized Anxiety Disorder (F41.1). Her “racing mind” and visible distress during the visit immediately caught my attention. The constant fidgeting and avoidance of eye contact painted a clear picture of someone genuinely struggling with anxiety. Her symptom profile aligns perfectly with DSM-5-TR criteria: excessive worry worsening over twelve months, inability to control worrying thoughts, and classic physical manifestations including restlessness, fatigue despite 7-8 hours of sleep, concentration difficulties, and neck/shoulder tension (American Psychiatric Association, 2022). The sleep-fatigue paradox is particularly telling – adequate duration but poor quality suggests anxiety disrupting restorative sleep cycles.

Treatment:

Pharmacological Management: I recommend sertraline 25mg daily, increasing to 50mg after one week if tolerated. SSRIs represent first-line treatment for GAD with superior efficacy compared to older antidepressants. Sertraline offers excellent anxiety disorder outcomes with minimal drug interactions – crucial given her cetirizine use for allergies. Clinical trials demonstrate 60-75% response rates versus 40-60% for placebo, with improvement typically beginning within 4-6 weeks (Strawn et al., 2020).

Prescription:

· Sertraline 25mg PO daily

· Quantity: 30 tablets, 2 refills

· Instructions: Take with food, may increase to 50mg after one week

Referral:

Psychotherapy: Immediate CBT referral is essential. Research consistently shows combined medication and therapy provide superior long-term outcomes compared to either treatment alone (Carpenter et al., 2018). CBT will help her develop practical worry management techniques and interrupt catastrophic thinking patterns.

Patient Education:

Lifestyle Modifications: Regular exercise proves as effective as medication for some anxiety patients (Aylett et al., 2018). Given her muscle tension, yoga or swimming might provide dual benefits. Caffeine reduction deserves attention – that morning coffee could exacerbate racing thoughts.

Medication Instruction: Sertraline requires 4-6 weeks for full therapeutic effect. Initial side effects like nausea typically resolve within two weeks. She must never discontinue abruptly and should contact us immediately if anxiety worsens significantly during the first month.

Follow-up Plan

· 2 weeks: Phone assessment for tolerance

· 4-6 weeks: Comprehensive response evaluation

· 3 months: Complete treatment review

References:

American Psychiatric Association. (2022). 
Diagnostic and statistical manual of mental disorders (DSM-5-TR). Psychiatry.org; American Psychiatric Association. 
to an external site. 

Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. 
BMC Health Services Research, 
18(1). 
to an external site.

Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. 
Depression and Anxiety, 
35(6), 502–514. 
to an external site. 

Gale, C., & Davidson, O. (2007). Generalised anxiety disorder. 
BMJ, 
334(7593), 579–581. 
to an external site. 

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2020). Pharmacotherapy for Generalized Anxiety Disorder in Adult and Pediatric patients: an evidence-based Treatment Review. 
Expert Opinion on Pharmacotherapy, 
19(10), 1057–1070. 
to an external site. 


Hailey Votino

Diagnosis
The most appropriate diagnosis for Ms. Clara Johnson is Generalized Anxiety Disorder (GAD), as defined by DSM-5 criteria. She presents with excessive, uncontrollable worry for over six months, accompanied by restlessness (fidgeting), muscle tension (neck and shoulder pain), fatigue, and impaired concentration, all without psychosis or other primary mood disorder features (First et al., 2022).

Management and Rationale
First-line pharmacologic therapy for GAD is a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) due to their efficacy and tolerability (Arcangelo & Peterson, 2021; DeGeorge et al., 2022). Escitalopram is an evidence-based option with a favorable side-effect profile and once-daily dosing, which may improve adherence.

Non-pharmacologic treatment should be integrated, including referral for cognitive behavioral therapy (CBT), which is equally effective as pharmacotherapy and offers longer-lasting benefits (Borza., 2017).

Rationale: SSRIs address the dysregulation of serotonergic pathways implicated in GAD, reducing somatic and cognitive symptoms over 4–6 weeks. Combining medication with CBT increases remission rates compared to either alone (DeGeorge et al., 2022).

Prescription

·
Escitalopram (Lexapro) 10 mg tablet

· Instructions: Take one tablet (10 mg) by mouth once daily in the morning.

· Dispense: 30 tablets

· Refills: 1

· Special Instructions: May start with 5 mg daily for the first week if patient is sensitive to medications, then increase to 10 mg daily. Advise taking at the same time each day.

Patient Education

1.
Expected Effects: Symptom improvement may take 4–6 weeks; initial effects may be subtle.

2.
Side Effects: Possible nausea, headache, or sleep changes, often transient. Report worsening anxiety, agitation, or suicidal thoughts immediately.

3.
Adherence: Take daily as prescribed; do not abruptly stop medication to avoid withdrawal symptoms.

4.
Lifestyle Support: Incorporate relaxation techniques, regular physical activity, and good sleep hygiene to support recovery.

5.
Interaction Precautions: Avoid alcohol excess; inform provider before starting new medications or supplements.

Follow-Up and Referral

·
Follow-up: Schedule follow-up in 4 weeks to assess symptom response, side effects, and adherence.

·
Referral: Refer to a licensed mental health provider for CBT.

·
Long-Term Monitoring: If well tolerated and effective, continue for at least 12 months to reduce relapse risk, with periodic reassessment (Arcangelo & Peterson, 2021).

References

Arcangelo, V. P., & Peterson, A. M. (2021). 
Pharmacotherapeutics for advanced practice: A practical approach (5th ed.). Wolters Kluwer.

Borza, L. (2017). Cognitive-behavioral therapy for generalized anxiety. 
Dialogues in Clinical Neuroscience, 
19(2), 203–208. 
to an external site. 

DeGeorge, K. C., Grover, M., & Streeter, G. S. (2022, August 15). 
Generalized anxiety disorder and panic disorder in adults. AAFP. 
to an external site. 

First, M. B., Yousif, L. H., Clarke, D. E., Wang, P. S., Gogtay, N., & Appelbaum, P. S. (2022). DSM‐5‐TR: overview of what’s new and what’s changed. 
World Psychiatry, 
21(2), 218–219. 
to an external site. 

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