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1. What behaviors does this client have that match the criteria for a diagnosis of Generalized Anxiety Disorder? In order to meet the criteria for a diagnosis of Generalized Anxiety Disorder (GAD), a person must have “excessive anxiety and worry” and “apprehensive expectation” occurring on more days than it does not occur for at least six months and involving a variety of worries about various events or activities. The person has to find it difficult to control the anxiety and worry. In addition, the person must have at least three other symptoms from a list including restlessness, fatiguing easily, concentration difficulties, irritability, muscle tension, and sleep problems, which include difficulty getting asleep, difficulty staying asleep, or feeling as if the sleep has not satisfied their needs (APA, 2000). Betty has had excessive worry most days for over six months. The nurse observed this client’s restless behavior and heard her complaints of fatigue. The client’s husband described her failure to sleep at night.

In addition to the criteria already mentioned, the person diagnosed as having GAD must experience significant distress or impairment in some area of functioning, such as social or occupational, as a result of the anxiety, worry, or physical symptoms. Betty has experienced impairment in both social and occupational areas of her life as a result of her anxiety and worry.

2. How common is the diagnosis of Generalized Anxiety Disorder? Is it common for clients with GAD to have comorbidity, and should this client be assessed for any particular condition? According to Mason and Jacobson (1999), Generalized Anxiety will affect one in twenty adults sometime during their lives and most of those affected will be women. This is congruent with the DSM IV-TR statement that the lifetime prevalence rate of GAD was 5 percent based on a community sample. A large percentage of people with GAD are believed to have a comorbid diagnosis. Wells (1999) describes one national comorbid survey that found more than 90 percent of those with a diagnosis of GAD had a comorbid diagnosis, with 22 percent experiencing dysthymis and 39–69 percent experiencing depression. This client needs to be screened for symptoms of mood disorders. 3. What explanation do you have for the number of family members coming to the community mental health center with this client? If you were the nurse, how would you deal with Betty’s request for her whole family to accompany her to see you? Hispanic and Hispanic Americans are often part of a large extended family system. It is not unusual for extended family members to accompany a Hispanic or Hispanic American person to the office of health care providers or to a health care facility. You need to build some rapport with the family, and this involves respecting the family and their culture, acknowledging each family member, and accepting any input given voluntarily from family members. When the client has medical problems, the nurse can perform most if not all procedures with family members present. When the client has mental health problems, it is important to observe interactions with others, but it is also exceedingly important to talk with the client alone so the client’s issues can be explored in a therapeutic environment with a professional and without the distraction of family members. 4. Before the nurse, or any other staff at the community mental health center, can talk with Betty’s family health care provider, what do they need to do? Before talking with the family health care provider about Betty’s case, the nurse needs to get a release of information form signed by Betty. 5. What does the nurse need to know about buspirone? What teaching needs to be done with the client in regard to buspirone? What medications other than buspirone are being used in the treatment of GAD, and how effective are they? The nurse needs to know the...
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