Rle Module Rle Unit Week: Bachelor of Science in Nursing: Rle NCM 105 - Psychiatric Nursing

BACHELOR OF SCIENCE IN NURSING:
RLE NCM 105 – PSYCHIATRIC NURSING

RLE MODULE RLE UNIT WEEK
4 4 7
Generalized Anxiety Disorder
✔ Read course and laboratory unit objectives

✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to course unit terminologies for jargons
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks
This case scenario aims to broaden the students’ knowledge and develop their skills and
attitude in the care of clients with Generalized Anxiety Disorder.
It is therefore expected that at the end of this course unit (CU), students will:
● Understand the disease process of GAD.
● Discuss the anatomy and pathophysiology of GAD.
● Provide measurable and reliable short and long term goals.
● Formulate appropriate nursing diagnosis based on the assessment data gathered.
● Determine and provide nursing priorities, interventions and management to meet
the client’s needs.
● Distinguish and present psychopharmacological actions of the drugs involved in the
treatment of the disease, and identify the nursing considerations that must be employed,
● Develop an effective care planning which the client may benefit.
● Formulate relevant health teachings to patient with GAD.
CLINICAL SCENARIO:
A. Patient’s Profile
Name: Patient Mrs, Xenia
Birthday: Sept. 2,1972
Age: 45 y/o
Sex: Female
Nationality: Filipino
Religion: Catholic
Address: Makati City
Date of admission: June 12, 2018
Chief Complaint: Constant worrying, insomnia and fatigue.

Admitting Diagnosis: General Anxiety Disorder
Medication; Diazepam, Fluoxetine
Management: Cognitive Behavioral Therapy
History of Present Illness

Two months prior to admission Mrs Zenia 45 year old a university professor, continued to be
tortured by persistent feelings of anxiety and worry associated with insomnia, irritability, tension,
and fatigue. Over the years, her friends and family chided her for "worrying too much," and she
reported difficulty controlling her anxiety over her financial situation, job security, and her
children's safety, despite evidence that none of these were problematic. Her husband reported
that he found her persistent anxiety and ongoing need for reassurance "exhausting" and that he
noticed himself withdrawing from her, which led to significant tension between them. The high
quality of her work at the university was recognized and she was well-compensated financially, yet
she continued to worry about her performance and was, in fact, passed over for promotion to team
leader because, as one of her annual reviews stated, her "constant anxiety makes everyone else
too nervous."
Other relevant aspects of her medical and psychiatric history include the fact that her overall
health had been generally good, although she had presented numerous times to her primary care
physician with a variety of somatic complaints, including headaches, gastrointestinal disturbance,
and muscular aches and pains with no clear etiology. She had repeated thyroid testing with
normal results. Her mother had had a history of menopause in her early 40s and the patient noted
that her menstrual cycles had become more irregular over the last couple of years, and her
anxiety and irritability become notably worse premenstrually.
Her doctor treated her intermittently with benzodiazepines at low doses (eg, Diazepam 5-10 mg),
which she took on an as-needed rather than daily basis when the anxiety worsened because of
her concerns about addiction, she was started on fluoxetine 20 mg/day by her primary care
doctor. She had been in supportive therapy on and off since college to help her deal with
situational stressors.
Past Medical History
Mrs. Xenia was presented with exacerbation of her chronic generalized anxiety and recurrent
depressive symptoms in March 2010.
Mrs. Xenia had a history of anxiety dating back "as far as I can remember." She was an anxious
young girl with separation anxiety and shyness that manifested in elementary school. As she grew
up, she experienced ongoing anxieties about the health of her parents (worrying that her parents
would die, even though they were in good health) and her school performance (though she was a
good student). She remembers marked fears, including fears of the dark and lightning, most of
which she "outgrew" except for a persistent fear of insects, particularly cockroaches.
Her anxiety became more prominent and persistent after she left home at age 19 and entered
college. She sought care at the university health service and received a prescription for
Lamotrigine that she used over the next 5 years on an as-needed basis during periods of
increased anxiety such as examinations; she also met episodically with a therapist at the
counseling center. In her freshman year, she experienced her first major depressive episode
following a break-up with a boyfriend. She was prescribed Buspirone, which she took for a couple
of months but then discontinued because of intolerable side effects (nausea and
lightheadedness). The depression gradually resolved over the next 6 months.
Social and Family History
After finishing college, Mrs, Zenia work to a university, where she met her husband. She
reported being attracted to his sense of calm and stability. He reported that part of what drew
him to her was the sense of how much she seemed to need and depend on him. They were
married shortly after graduation and had 2 children over the next 5 years. After the birth of her
second child, she developed a postpartum depression that lasted almost a year and for which
she didn't seek treatment. She said that her youngest child "is just like I was -- she's afraid of her
own shadow."
She grew up in a middle-class home, the second of 3 children. She reported that childhood was
"generally happy," although she was troubled by anxiety starting early in life. There was no
history of physical or sexual abuse. Both parents were still alive in January 2005, although they
had significant medical conditions and she was worried about their health. She noted that her
mother and father were both "nervous" people, and though never formally diagnosed and
treated, her maternal grandmother had a history of depression.
GROUP TASK:
1. The class will be divided into groups depending upon the number of students.
2. Each group will discuss among themselves the case scenario provided.
3. Each group should make their PowerPoint for presentation.
4. Each group should present their case in a synchronous session via zoom class for 30
minutes.
4. Each group should submit their manuscript and PowerPoint through email or
Canvas upload.
5. Students presentation will be graded with the use of a Rubric.
GUIDELINES FOR THE CASE PRESENTATION

1. Discuss the disease process stating the definition, epidemiology, signs and symptoms
treatment and management.
2. Describe the importance of assessing the mental health status of patient with anxiety
disorder.
3. Trace the psychopathology of disease process.
4. Make a drug study with 6 columns.
4.1. Generic name, brand name if any, classification, dosage, frequency, route of
administration
4.2. Mechanism of action
4.3. Indications and drug rationale
4.4. Contraindication
4.5. Common side effects
4.6. Nursing considerations and responsibility while taking the drug.
5. Make at least two nursing care plan based on your assessment that needs to prioritize.
6. Discuss your discharge plan or recommendation using the mnemonic METHODS
6.1. M-Medication
6.2. E-Environment/Exercise/Economy
6.3. T-Treatment
6.4. H-Health Teaching
6.5. O-Observation/Out-patient
6.6. D-Diet
6.7. Spiritual/Sexual
Boyd (2017), Essentials of Psychiatric Nursing, Wolters/Kluwer

Keltner (2019), Psychiatric Nursing 8th edition, St. Louis, Mo.: Elsevier/Mosby.
Kozier, Barbara, (2017) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice 10th edition Upper Saddle River, N.J.: Pearson Prentice Hall
Videbeck, Sheila L. (2017) Psychiatric-Mental Health Nursing 7th edition. Wolters

Kluwer/Lippincott Williams and Wilkins
Can access to YouTube, Google and other electronic communicable disease nursing books
available

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BACHELOR OF SCIENCE IN NURSING:

RLE NCM 105 – PSYCHIATRIC NURSING

✔ Read course and laboratory unit objectives

Chief Complaint: Constant worrying, insomnia and fatigue.

History of Present Illness

Past Medical History

Social and Family History

GUIDELINES FOR THE CASE PRESENTATION

Boyd (2017), Essentials of Psychiatric Nursing, Wolters/Kluwer

Videbeck, Sheila L. (2017) Psychiatric-Mental Health Nursing 7th edition. Wolters

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