Your next session is with Armella Ottinger, (Links to an external site.) a 77-year-old African American woman. Her primary care provider referred her to you, a psychiatric mental health nurse practitioner, for an evaluation and medication management.
- Iâ€“O: What screening tools or measurement tools are available for anxiety disorder? Include the tool with your discussion and describe what anxiety disorder(s) the tool is useful for identifying/measuring and what limitations the tool has (such as age, language, time it takes to complete, whether it costs money to use or is free for use, and so on).
Background information for Case Study.
Armella Intro Transcript
Hello, my name is Armella. I know itâ€™s old fashioned, but Iâ€™m an old-fashioned kind of lady. [pause] You know, it was real difficult coming in to see you.
My husband, Bud, died not quite a year ago. He isâ€¦wasâ€¦the love of my life and Iâ€™m not sure how to live without him. Iâ€™m not sure I want to live without him.
We were married for 58 years. I bet you arenâ€™t even that old. Our 59th anniversary would have been last month. I still live in the four-bedroom house where we raised our five children, took walks with our dogs, had friends overâ€¦.
The children all live far away now. They donâ€™t come home much. They send me pictures, but itâ€™s not the same. And I donâ€™t feel like traveling. My sister lives about 20 minutes away and she and her husband come over every few weeks. Eugene helps out around the house. Itâ€™s not the same as Bud of course.
A couple months ago, Breannaâ€™s family came back for a week. Mary and some of her children and grandchildren came over for a cookout. That was nice. But most of the time? Iâ€™m feeling, well, Iâ€™m not sure exactly how to put it. Iâ€™m constantly uneasy and nervous, restless, I feel â€¦ on edge. Iâ€™ve felt this way ever since Bud died.
Armella Medication Transcript
Well, thatâ€™s what Iâ€™m supposed to be taking. I forget them some days. When I take the pills consistently, I don’t seem to have the distressing physical symptoms.
Q: What medications do you take?
- Diazepam 10 mg twice daily for anxiety, for the last two months, prescribed by primary care provider
- Metformin 1000 mg daily with meals
- Paroxetine 20 mg at night, for two months, prescribed by primary care provider
- Propranolol 120 mg daily
- Rituxan infusions every 4 to 6 months for rheumatoid arthritis
- Tramadol 100 mg every 6 to 8 hours as needed for back pain
- OTC multivitamins
Armella Work Transcript
I have a masterâ€™s degree in education. I taught elementary school for 40 years. I finally retired as a schoolteacher 10 years ago, so that Bud and I would have time for just us. I really loved it, but I donâ€™t think I miss it.
About a month ago, my pastor finally got me to go to a grief support group at church. Itâ€™s all ladies like me, which I think is good.
Armella Symptoms Transcript
Over the last month, Iâ€™ve had some particularly distressing physical symptoms including nausea, pins and needles, dizziness, headache, fatigue, agitation, and panic attacks. Itâ€™s not all the time, more like episodes of them now and then.
Iâ€™ve also had some short-term memory loss. Sometimes I wake up at night feeling confused.
About six weeks ago, I fell. I didnâ€™t hurt anything bad enough to go to the doctor though.