L.P., age 23, is a white woman who graduated from college last year. She began working as an accountant 1 month after graduating. Approximately 2 months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she see a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past 9 months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. She reports that all her life she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” L.P. reports that she has a good relationship with her boyfriend, but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past 4 years without any adverse effects.Diagnosis: Generalized Anxiety Disorder Questions:1. List specific treatment goals for L.P.2. What drug therapy would you prescribe? Why?3. What are the parameters for monitoring the success of the therapy?4. Describe specific patient monitoring based on the prescribed therapy.5. List one or two adverse reactions for the selected agent that would cause you to change therapy.6. What would be the choice for second-line therapy?7. What dietary and lifestyle changes should be recommended for this patient?

Pre class assignment for Week 7 Ch 28 Aggression ATI pg 293Ch 38 Abuse/ Violence ATI pg 300 and 309Ch 40 Life Threatening- ATI pg.253Ch 21 Personality Disorders ATI p 128 Ch 28 Aggressive 1. List some of the possible co morbid disorders that go along with aggressive behavior. 2. Does the use of seclusion and restraints lead to a positive behavior change in the client? why or why not and explain your answer? 3. When does the nursing staff remove the client from seclusion and or restraints? why? 4. What are some behaviors that nurses need to be aware of in clients when suspected of becoming aggressive? list several. 5. list some interventions that the nurses use to help de escalate a client who might be coming aggressive/ angry? Look in the ATI book. 6. When would it be appropriate to administer an IM medication to an aggressive patient? and what type of IM medications might be used for an aggressive client? 7. ATI pg 294-5- review the nursing care and medications and care after discharge and be ready to discuss. No answer required.8. Review BOX 28-2 in the Stuart about background information associated with violent behavior. Do any of these surprise you? What is the best single predictor of violence? 9. What does debriefing mean and why is it used? Family and Community Violence ATI p 300 and Stuart- pg 7351. Review table 38-1 and list one or two of these myths that you did not know or surprised you. How would you use this information to educate survivors? 2. Explain some of the issues that makes it difficult for a woman to leave an abusive relationship. If you were working with an abused woman who wanted to return to her husband, would you try to talk her out of leaving? list some nursing interventions that you would use to help her in discharge planning. 3. Review the cycle of violence - how can a person stop this cycle? what would you as a nurse need to teach both the abuser and the victim? Does this cycle sound familiar to you- have you used it or seen others in this cycle? 4. List several areas or injuries that the nurse would suspect abuse when assessing the patient Infants: Preschoolers and adolescents: Older persons: 5. A nurse is a mandated reporter for what type of abuse? and what agency does the nurse report the abuse to? 6. List two goals that you would have in your care plan for a survivor of abuse and 2 interventions for each goal. 7. List one information source for abuse or violence in your own neighborhood. Ch 21 Personality Disorders stuart and ATI ch 15 p 128. Review my ppt on Moodle for Personality disorders. 1. Describe personality disorder in your own words. Compare it to psychosis and DID. 2. Review the common pathological personality characteristics listed in ATI pg 128. Describe two of these and explain how they can be pathological. 3. Manipulation is one of the major behaviors that is seen in personality disorders. Explain why manipulation is used as a coping mechanism so frequently with these people. 4. What are some issues that nurses need to be aware of when someone with a personality disorder uses manipulation on a psychiatric unit? 5. Review all three clusters of Personality Disorders. Describe some of the nursing interventions to use with the following personality disorders. - Borderline - Antisocial - Narcissism6. List two of the other mental illness or co morbidities that are linked to personality disorders. 7. List some of the communication strategies that a nurse might use with a client with a personality disorder. Would it be easy or difficult to develop a therapeutic relationship with this patient? 8. Describe briefly: Projection Splitting Projective identification. 9. Review the medications used for personality disorders. Are they used to treat the personality or the symptoms manifested? Ch 40 Life Threatening Illness- in Stuart pg 762 and ATI p 253 Ch 251. Imagine that you are working with a client who has a life threatening illness like those listed on pg 763 or Box 40-1. Describe a conversation that you might have with that patient regarding end of life issues. What type of questions might the patient ask? what would your response be? Use the term therapeutic presence and intensive proactive communication in your description. 2. Describe or define: advanced directives living will Durable power of attorney of health care3. Give an example of each type of loss stated in ATI pg 253. 4. Grief: List the 5 stages of grief from Kubler- Ross. ATI pg 254How would you explain or teach to a patient or family these stages of grief? 5. In Stuart- under critical reasoning- answer the question on pg 765. 6. Define palliative care and some of the medical issues that need to be managed during this time. How would you as a nurse feel about your patient being on palliative care? 7. Define hospice care. When is hospice used? what are the services? Can anyone be discharged from hospice ie get better? Have you had any experience with hospice? briefly describe. 8. Review the end of life nursing interventions on pg 257 in ATI- and identify several that you have used when working with dying patients. Are there any that you might find difficult to do? 9. Nurses sometimes have difficulty dealing with a dying patient and maintaining professional boundaries. Put yourself into the position of working with a dying patient and describe some of the boundary issues that you might face.