ScenarioAs a nurse on a general medical floor, the RN has received a new admit. Review the client data provided.Richard Henderson58 years oldMaleAdmit diagnosis: GI bleedHistory: no surgical historyMedical history: Gastritis & GERDMedications: Prilosec 40 mg PO daily, Atenolol 25 mg PO BID, Fiber daily, Alka Seltzer PO – states he takes this at least daily.Report from physician’s office: Mr. Henderson arrived to the physician’s office today for a complaint of increasing abdominal pain. He states that he is now throwing up coffee-ground emesis. He states that he didn’t take his BP medication this morning because he was dizzy. The physician is admitting him with a diagnosis of GI bleed with an EGD scheduled for tomorrow. He is NPO, and has a 22G IV lock in the left forearm. Last set of vital signs BP 106/60 mm Hg, HR 98 beats/min, RR 20 breaths/min, Temp. 98.8 degrees F, P.O. 90% on room air. He last vomited about 45 minutes ago with a small amount of dark coffee-ground emesis. His pain is 4/10 at present. No pain medication is ordered at this time.Lab assessments ordered: CBC and chemistry panelCT of the abdomen shows no signs of free air (no perforation)When he arrives to the floor, he is pale, nauseous, and his skin is cool and clammy. When he is transferred to the bed from the stretcher, he vomits a large amount of coffee-ground emesis and loses consciousness.InstructionsIn the discussion post, address the following:While receiving report, what concerns do you have regarding the client report?What type of shock is occurring?What stage of shock is the client experiencing?What is your next intervention and why?What additional lab assessments would you anticipate?Provide additional thoughts and insights.

Question 1- Individuals with severe anxiety disorders may find many aspects of their lives adversely impacted. Adele experiences panic disorder that affects her career. Howie Mandel's obsessive compulsive disorder has affected his personal life and professional life. Both pharmacological and psychological treatments are helpful in treating anxiety disorders such as these, but research indicates that they may sometimes interact. Which do you think is more effective – combining drug and therapeutic treatments, or therapeutic treatment alone? Provide examples of specific treatments based on your text. Question 2- In the video, Renee reports a number of symptoms that are consistent with anxiety disorders but may also be seen in other disorders, such as feeling guilty, ruminating, and having difficulty sleeping. What is the most common comorbid diagnosis for all anxiety disorders? How do you think this comorbidity affects recovery? VIDEO SCRIPT: - What types of things do you worry about?  - I worry about tons of things. Um, well, I mean I worry about the general things that I think people worry about… like… you know… like… well, maybe that’s not true. Um, I guess the future… I’m big in the future – I’m not a really “present” person much… something I try to work on. Um, I always worry about the future – how I’m doing, how far I’m getting in life - if I’m succeeding. Um, and then there’s worrying about... you know, like, um, well not worry, but I have a lot of work, or am I going to get my school work done on time, or maybe financial, like that kind of thing. But then I have the worrying about the worrying, which is not good. And I try not to, but that’s my constant worry about when I’m going to… have an anxiety attack, or when I’m going to, um… get really tired or feel like crap, or not be able to get things done. Um, and then I worry about, like, death. I worry about other people dying… a lot. It depends on the time period in my life, but I’ll be really concerned that a family member is going to get hurt, just randomly. Um, and then there’ll be the really irrational fears that are like, kind of spontaneous that I might get, like… you know, I’ll be straightening my hair and then I’ll think about the house burning down or, not that I left the hair straightener on..., but that, you know like, I’ll quickly go through a whole situation, a blown out situation in my mind that… shouldn’t even be there – I don’t even know what it started from. I don’t know why.  - What does it feel like when your anxiety takes over? - Yes, sometimes I just feel like I get foggy… like really foggy. Uh, like today I was working at the clinic, or shadowing for the first time, and then there hit a point when I’m like… you know, for me, I like to think biologically, like, maybe I’m low blood sugar. I didn’t feel like eating this morning, probably because I was nervous, you know, maybe it’s kicking in. But now, um, now I can’t concentrate. And then, I kind of freeze for a second, and I’m thinking “If I have to fill out this form – and there’s like, so many forms – I don’t know if I can fill it out”. And then all of a sudden… I’ll… it’s like I can’t see as well. I’m going to zone out. At the wall! I’m going to like, not look into space per se, but it’s like I literally can’t even focus in with my eyes almost, you know. My vision is fine – I mean I wear contacts, but it’s not an actual vision problem. And then, to follow it, I guess I get a tiredness… you know? Like… yeah, tired? But then, trying to figure out how to rev it up, try to clear up. It’s like if you were waking up from anesthesia I guess or something… and then… you… um … yeah, like you’ve been drugged I guess! I guess! I don’t know! And then I can’t … I want to be clear - I want to be clear minded. And there’s times when I’m, like foggy, or I could just say I’m tired or whatever, where… I could just drink coffee. I could just drink shots of espresso and I wouldn’t wake up, it just wouldn’t happen. And maybe my body would start pounding and my heart would start doing something, but my brain, like, won’t go. Yeah. - When did you first know that anxiety was a major problem for you? - And then, it hit, like, you know puberty. And I think that’s when anxiety came on even stronger. Um, I would say like, up until 6th grade, I… you know, I would still say that I think worried a lot more than most kids, but I wouldn’t say that I felt like that true, like, you know, impacting anxiety attack. Um, and I would think that came right when puberty really hit. And… I think that’s when I started to feel like this kind of fear. Also guilt, guilt comes up in it a lot ... which is weird… you know, I don’t really know what I’m feeling guilty about… but it’s like guilt mixed with fear. - Do you separate anxiety and panic?  - I, well, I separate anxiety and panic. Um, I think of anxiety as kind of bold. I think of panic as mostly physical... which is like tightening up of the chest, sweating, my arms feel limp. Like, it’s scary. It just gets scary. I mean that’s when people go in to the hospital because they think they are having a heart attack. It probably feels like what a heart attack feels like. But then anxiety is different because anxiety is… if it’s an anxiety attack, like a full blown one, then I’m confused. I’m not… I’ve got negative things running through my head constantly and I can’t put things together and I can’t focus on anything. It’s like I really just want to get out of my skin and I can’t. I’m stuck. - What types of medication have you tried to manage the problem?  - I took Lexapro … and it didn’t do anything. And I took Prozac and it wired me… and I felt happy and I don’t think I felt anxiety and I felt good. But I couldn’t sleep. And so then came the next drug. And I also couldn’t concentrate – it’s like it made my concentration worse. So it was harder for me to read, which I guess I thought was weird and I don’t know if they connected it to it. And then I found out that it is common for it to actually hurt your… concentration. So they gave me Vyvanse which my brother had been on. You know, it’s scary, he’s a meth addict… so… not that I wanted to become one! Yeah, so it’s a substance that’s pretty controlled and I felt great. I loved it. I barely took any. My reading speed increased so much, like I felt, normal. I felt like I could do everything, but I also probably felt a little too up, mixed with the Prozac and stuff. I got Prozac from the psychiatrist… and I didn’t take it. As soon as I started taking it, I just… I have TMJ and it busts up my jaw if I take it because I’m wound pretty tight. I did start to feel a little better, but my concentration just went. It’s harder for me to… At this point I guess it wouldn’t matter as my focus is already pretty bad. I mean there are a few times when I can wake up and have caffeine and it will work, you know, I’ll be able to study and I can focus, whether it be from anxiety or whatever, or me, myself. - When did the issue of anxiety begin for you?  - My parents said I was always worried – since birth! So, I always ... I was ... yeah, I was always curious about what was going on near me. I had a real desire to learn how to read because I wanted to be able to read notes that people wrote people. And I wanted to know what was going on. I was really afraid to not know what was going on. And around that time, I think was when my parents got divorced, so I had a lot of anxiety then and I tried … you know I’m the oldest, so I tried to … watch out for my brothers, you know? My dad was really depressed about it and I had to see him go through that and so, I was constantly trying to keep tabs on everything, you know? Make sure everyone was feeling fine all the time. That kind of thing.