Use this scenario and make it original. SCENARIO #1 The most interesting client

Use this scenario and make it original.
SCENARIO #1
The most interesting client that I encountered this week:
Background: The patient is a male, 42 years of age.
Reason for Visit: Diagnostic Interview.
CC: Recent feelings of significant anxiety.
The patient is a Caucasian, 42-year-old single male with a history of alcohol abuse that is ongoing. The patient presents after being recommended by a friend to see a therapist at this clinic for cognitive behavioral therapy and ongoing addiction treatment. Subsequently, this therapist recommended him to my preceptor for further management.
The patient is 6’ 2” and 279lbs. All vital signs are within normal limits apart from a blood pressure that maintains in the 150’s/100’s after multiple attempts. The patient has a positive cardiac history for hypertension, previously being on amlodipine however developing angioedema and subsequently changed to an ace inhibitor thereafter. It should be noted that the patient’s blood pressure may also be elevated at the time of his appointment due to his anxiety around it per his subjective response.
The patient presents well dressed, no evidence of personal malodor with a stable gait. MMSE WNL. However, when the patient begins discussing his psychiatric history, he often does not take deep breaths and appears to intermittently become tearful. The patient was previously diagnosed with major depressive disorder, single episode, moderate and alcohol dependence with intoxication, uncomplicated. During the interview, the patient describes a multitude of recent deaths within his circle of family and friends. He believes he has always had a history of anxiety; however, both his anxiety and drinking have become much worse after these deaths occurred. He describes having episodes of frequent panic and worry where he becomes diaphoretic and unable to breath. Twice these episodes have sent him to the emergency room. He also describes that he feels a sense of impending doom when these episodes occur. When these episodes are not occurring, he rates his general anxiety and 8/10 most days. He believes he has suffered with some depression however denies feeling depressed on a regular basis and makes emphasis towards his anxiety.
The patient denies suicidal thoughts or ideations as well as any history of trauma or abuse. He does however mention recently finding out about abuse occurring with his siblings that is evidently hard for him to speak about in detail currently. The patient denies a history of manic symptoms, delusions, and/or hallucinations. He is sad because he does not have “very many friends” and has never been” in a relationship”. He believes this is because he lost a relationship with his parents for 10 years after coming out as homosexual 15 years ago but is hopeful because he is now rebuilding that relationship. He finds happiness in his job(s) and being surrounded by “good people at work”.
After this visit the patient is diagnosed with panic disorder [episodic paroxysmal anxiety] and generalized anxiety disorder. My preceptor decided to prescribe Effexor XR for him and recommended he follow up in 2 weeks. The patient is given information about medication side effects as well as when to seek non-emergent vs. emergent intervention including if he were to experience suicidal thoughts. It is recommended he continue cognitive behavioral therapy to help change his thought processes around drinking and was provided information of a local group for individuals diagnosed with anxiety and/or anxiety disorders.
Lab levels are requested prior to starting this medication and it is recommended that he follow up with his primary care provider concerning his blood pressure while being on this medication and/or to follow-up with a cardiologist.

Evidenced Based Discussion
Effexor is an serotonin-norepinephrine reuptake inhibitors (SNRIs). It is approved by the food and drug administration (FDA) to treat and manage symptoms of depression, social anxiety disorder, and cataplexy. It has many off label uses. Some of these uses include anxiety, panic attacks, social phobia, attention-deficit/hyperactivity disorder (ADHD) in adults and children/adolescents, diabetic neuropathy, migraine prevention, hot flashes, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). According toSingh, D., & Saadabadi, A. 2022, “Venlafaxine works by increasing serotonin levels, norepinephrine, and dopamine in the brain by blocking transport proteins and stopping their reuptake at the presynaptic terminal” (p.1).
This medication may be helpful in managing all aspects of the patients anxiety as well as prevent future depressive episodes and assist him with managing his substance abuse along with continued therapy.
Thank you!
-Lydia W.

References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
Singh, D., & Saadabadi, A. (2022). Venlafaxine. In StatPearls. StatPearls Publishing.
SCENARIO #2
In a rural area, one hears stories about how their grandfather had to quit middle school to help his family make it through rough times. It could also be one’s aunt or cousin who dropped out of high school when she became pregnant. The American Medical Association recommends that patient education material should be written at a sixth grade level (Rooney et al., 2021). Literacy of the English language can often be a barrier to care for some ethnic groups, but can be solved with a translator or translation service (Halter, 2018). What does a new practitioner do when your 32-year-old patient is unable to read any of the intake assessment paperwork?
This patient grew up in an impoverished area in a county that had a decent school system, but the patient often missed school due to working on the family farm and exposure to substances at a young age. This patient’s history consists of numerous jail stays because of possession and use of illicit substances. Patient reports that he has been to five different rehabilitation programs and none seem to take the time to help him with his issues. Patient stated that he faithfully attended an alcohol detoxification program, and he had great success with maintaining his sobriety until his cousins showed up with methamphetamines. He was told that these would make him feel great and would not complicate his parole. This landed him back in jail right at the time that the COVID-19 pandemic started. Being in the isolated environment of confinement can be challenging enough on one’s mental health, but quarantined in a facility that is overpopulated and understaffed scarred this patient with some of the horrors he had seen. With his recent release of prison in the last month, he decided to seek suboxone treatment at the recommendation of his parole officer to clean up his life and start anew.
Patients who typically suffer with substance use disorder often are forthright with which substances they prefer and have abused in the past. While talking about the agreement that the patient would have to sign for consent of treatment, the patient admitted that he was unable to read. He was quite embarrassed about this fact. He stated that the other facilities just had him sign consent forms for treatment without him knowing what he agreed to or explaining what to expect as the weeks continue. Whether this was completely true or a fabrication to explain noncompliance with treatment has yet to be seen. At his request, each line was read to him and any questions he asked was answered. He was quite surprised that the RN conducting the assessment would take the time to ensure that he knew what to expect. The patient seemed to be very open to treatment possibilities and what the future could hold for him.
Coordination of care management will be one of the most important things for this patient. Even though a nurse practitioner can balance all aspects of his care, other members of the care team can provide support and resources as he enters treatment. Social workers can give the patient access to community resources, such as adult education programs or living quarters (Halter, 2018). This patient may require more dedication to his recovery because of his illiteracy, but taking the time to educate and treat him like a person will make all the difference.
References
Halter, M. J. (2018). Varcarolis’ foundations of psychiatric-mental health nursing: A clinical approach (8th ed.). Saunders.
Rooney, M. K., Santiago, G., Perni, S., Horowitz, D. P., McCall, A. R., Einstein, A. J., Jagsi, R., & Golden, D. W. (2021). Readability of patient education materials from high-impact medical journals: A 20-year analysis. Journal of Patient Experience, 8, 237437352199884. https://doi.org/10.1177/2374373521998847Links to an external site.