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PLEASE READ INSTRUCTIONS
Assignment Instructions
Create a patient scenario for the behavioral health issue assigned to you (Panic Disorder) – I WILL CREATE THE SCENARI, I PASTED AN SCENARIO PROVIDED BY CHATGPT BECAUSE I HAVEN’T DONE IT YET BUT I WILL, BUT IT WAS GOING TO BE DIFFICULT FOR YOU TO ANSWER THE QUESTIONS WITHOUT ANYTHING TO GUIDE YOU. BUT KEY POINTS ARE, MY PATIENT WILL COME WITH SYMPTOMS OF PANIC DISORDER, AND SHE WILL NEED MEDICATION, WHICH I HAVE NOT READ THE REGULATIONS BUT I DON’T KNOW IF I CAN PRESCRIBE OR NOT SINCE IM A PRIMARY CARE NURSE PRACTITIONER NOT IN THE PSYCH FIELD.
I LIVE IN ORLANDO FLORIDA SINCE IT ASKS FOR RESOURCES AROUND MY AREA.
I DON’T HAVE TIME TO DO RESEARCH. I NEED TO FOCUS ON MY WEEKLY READINGS AND EXAM AND QUIZZES
PLEASE DO A GOOD JOB AND BORDERLINE FAILING THE CLASS, I HAVE A NEW BABY AND TOO MANY THINGS ON MY PLATE
1. Include the following sections (DONT DO THIS – I WILL)
1. Patient chief complaint
2. History of present illness
3. Social history
4. Family medical history
5. Past medical history
6. Medications
7. Treatment plan
1. State and Federal Regulations
1. Identify the state where you live (Florida)
2. Identify what your state laws say about prescribing behavioral health drugs without being certified and/or credentialed as a psych-mental health NP.
3. How does the Affordable Care Act affect behavioral health care?
4. How do these factors impact the patient in the scenario you provided?
2. Community Resources
1. Provide information on how you would know if the patient you created needs support beyond what you can provide as a primary care NP.
2. Identify community resources available in your area to refer patients in need of assistance before they can establish care with a primary mental health provider.
3. Identify the facilities in your area (Orlando, FL) where you would send a patient in need of urgent assessment and intervention.
4. Identify resources in your area that are available to patients who may not be able to afford behavioral health care.
3. Legal & Ethical Considerations
1. Identify potential legal issues that could arise from how you do or do not choose to treat this patient.
2. Identify potential ethical issues that could arise from how you do or do not choose to treat this patient.
3. What follow-up is needed for your patient?
4. What do you need to do as a primary care provider to mitigate potential risks in providing care for behavioral health concerns?
Patient Chief Complaint
“I’ve been having these episodes where my heart races, I feel like I can’t breathe, and I’m going to lose control. It’s happening more often, and I’m scared something is wrong with my heart.”
History of Present Illness
The patient is a 34-year-old female who presents to the clinic with complaints of recurrent panic attacks. She reports these episodes started approximately six months ago, occurring about once every two weeks initially. Recently, the frequency has increased to twice a week, with episodes typically lasting 10-20 minutes. During these episodes, she experiences heart palpitations, shortness of breath, chest tightness, dizziness, trembling, and an intense fear that she might die or lose control. She denies any triggers but notes they often occur when she’s at work or driving. She has been avoiding driving due to fear of experiencing another episode.
The patient denies any history of heart conditions and has previously seen her primary care physician, who performed an EKG and some blood work, all of which came back normal. She has not had a full psychological evaluation and has been hesitant to seek mental health support due to stigma but admits these episodes are negatively affecting her life.
Social History
* Occupation: High school teacher, feels increasingly stressed with work due to recent changes in curriculum and classroom sizes.
* Marital Status: Married, two children ages 8 and 10.
* Substance Use: No tobacco or recreational drug use. Drinks 2-3 glasses of wine weekly. Reports drinking more coffee recently (about 3 cups/day).
* Exercise: Inconsistent, does light walking but finds herself too tired after work.
* Sleep: Reports poor sleep, averaging 4-5 hours a night, often waking up early with racing thoughts.
Family Medical History
* Father: History of hypertension, died of a heart attack at age 58.
* Mother: Diagnosed with generalized anxiety disorder, treated with medications.
* Brother: Has been treated for panic disorder.
* No family history of other significant psychiatric or cardiac issues.
Past Medical History
* History of mild asthma, well-controlled with an inhaler as needed.
* No history of major surgeries or hospitalizations.
* No psychiatric history prior to this presentation.
Medications
* Albuterol inhaler as needed for asthma.
* No current medications for anxiety or depression.
Treatment Plan
1. Pharmacological Management:
* SSRIs: Start sertraline (Zoloft) 25 mg daily to be titrated up as needed for anxiety management.
* Benzodiazepines: Prescribe a low dose of lorazepam (Ativan) 0.5 mg as needed for acute panic attacks (limited to short-term use due to dependence risk).
2. Psychotherapy:
* Refer the patient for Cognitive Behavioral Therapy (CBT) to help address anxiety, panic attacks, and avoidance behaviors.
3. Lifestyle Modifications:
* Recommend reducing caffeine intake, limiting to one cup of coffee a day.
* Encourage regular physical activity, such as a 20-minute walk daily, to help reduce stress levels.
* Practice relaxation techniques (deep breathing exercises, progressive muscle relaxation) to manage acute anxiety.
4. Follow-Up:
* Schedule follow-up in 4 weeks to assess response to medication and therapy.
* Recommend follow-up with a therapist or counselor within the next two weeks.
* Monitor for side effects of medications, particularly with SSRIs (nausea, sleep disturbances, etc.).
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