Assessing And Treating Clients With Anxiety Disorders

Case Study:
Middle-Aged White Male With Anxiety
BACKGROUND INFORMATION:
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these anxiety attacks. He will also report occasional feelings of impending doom, and the need to run or escape from wherever he is at.
In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.
Client has never been on any type of psychotropic medication.
MENTAL STATUS EXAM:
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal directed. Clients self-reported mood is bleh and he does endorse feeling nervous. Affect is somewhat blunted but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
The PMHNP administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
To prepare for this Assignment:
Review this weeks Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment:
Examine Case Study: A Middle-Aged Caucasian Man With Anxiety.You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the clients pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision