Nursing Social Anxiety Disorder&nbspCase Study

PARAGRAPH FROM Case Study :

NURSING

Nursing: Social Anxiety Disorder

Initials: M.I.

Age: 45 years

Race: African American

Gender: Female

Chief Complaint (CC)

The patient came to the clinic and reported that she fears any strangers or even acquaintances that she has met at her workplace and has been experiencing it for the past year. It is the exact time when she moved here in the country, and belonging to a social minority; she has f some racial discrimination. She could not stop crying and told her that it was routine whenever she felt low, even at home. Also, she felt racial discrimination could be why she has developed a fear of people and avoids mingling with them, other than her family at home and her two to three close friends at the workplace.

Demographic Data

Some of the patients demographic data features have been given above age, race, ethnicity, and gender. Further, the patient is married and has three children. She has completed her Masters in Nursing Studies and works as FT Nurse. She does not drink but smokes 20 packs per year (PPY).

Medications and Allergies

The patient has no allergies specified (NKDA), but she is on Lisinopril (10 mg) daily.

Risk Factors

Some of the risk factors of her condition are the temperament changing when exposed to people who are especially stranger to her and even some of those who are acquaintances at the office. There is always a presence of fear that she is being looked at or people are talking about her and fear of being ridiculed, which causes sudden changes in her mood. Though her boss is familiar with some of her symptoms, when she has to give presentations at the office, her symptoms are triggered just from its thought.

History of Present Illness (HPI)

As she belonged to an African American family, some of her family members had stress and mild depression symptoms. Since she had moved to the present area within the U.S., racism here is serious and has affected her gravely. It had started to affect her work and family life, too, as she is afraid of going out in the neighborhood. When she was a child, her sister narrated that once in school, when she was ten years old, her teacher scolded her badly for not performing well in a test. She started feeling fearful of all of her teachers and showed lesser participation. She was even frightened when some of her school assignments included giving presentations in front of the class and was uncomfortable standing before several children. She had a small group of friends from the beginning of her school days and did not get along well with boys.

Past Medical History (PMHX)

Surgeries: None

Hospitalization: None

Family History: None specified

Vaccination: Had been regular in keeping up with the vaccination schedule.

Social history: The patient has her own house with her husband and three children. Her mother passed from coronary artery disease (CAD), but the father is still alive. Grandmother had no such signs, but grandfather had stress since they f financial difficulties after 50 years.

Developmental history: Sister had not told developmental difficulties other than some symptoms of fearfulness during her second and third pregnancy.

Objective Data

General appearance: The patient looked healthy; she mentioned she gained 20 lbs in the past year. Recently, she felt determined to lose her weight as being overnight increased her worries. She was wearing clean clothes, and the first two buttons were not done since the second button of the shirt was absent. She looked weary and tired, and her eyes looked puffed up due to persistent crying.

LOC: She seemed in some distant state of mind, for example, when a person looks at something and appears to be deep thoughts.

Vital Signs:

Temperature: 98.6 HR: 65 RR: 18 BP: 110/68 HT/WT: 66″/220 BMI:X

HEENT: The patient frequently complained about headaches and Post Natal Depression (PND), particularly after her third pregnancy.

Eyes showed a little redness due to constant crying

Ears, nose, and throat appeared fine.

PULM: Clear to all bases, A/P symmetrical

CV: RRR, S1 S2 no click, rub, gallop

GI/GU: The patients abdomen was soft, non-tender, and no masses were observed. G.U. was deferred as well.

EXT: There was no clubbing, cyanosis or edema, palp DP/PT bilat 2+/2+

Psych: Orientation/consciousness: X4

Attention, memory, and intellect: They showed healthy signs of fulfilling the requirement of a sound conversation.

Speech/thought: The patient did not…for better identifying how the patient feels and if she has emotions like humiliation, embarrassment, or being judged negatively by others, etc.

Analysis

Social anxiety disorder is the dread of facing people for fear of being embarrassed or being ridiculed. After assessing through various verbal tests and physical observations, the patient under discussion was diagnosed with this social disorder. Most people experience it during the early years of their life; some carry it forward to their adult years, makng it difficult to overcome since the behaviors and attitudes of fear and anxiety in social situations have strengthened over time. It is recommended that Zoloft be prescribed as medication, considering that she is already taking anti-depressant medicines. Cognitive-behavioral therapy (CBT) is another beneficial intervention that has been proven in evidence-based practices and earlier clinical studies to produce positive results for such patients. It is a framework that helps the patients suffering from anxiety disorder deal with their interpretive problems as they tend to think negatively of the social situations and people around them. The core beliefs, dysfunctional expectations, automatically occurring negative thoughts are influenced through this therapy successfully. The therapy and medication are expected to provide positive results in patients diminished fear in social gatherings and improved communication with patient education and prevention tactics. After making initial assessments for the patient, such as physical examination and some self-reported questionnaires along with GAD 7, the treatment should be started immediately for quick improvement in her condition as it regularly affects her work and family life. It is preferred that after two months of therapy sessions, a QoL questionnaire should be run to see the efficacy, and if the further need arises, then sessions and follow-ups would be continued.

References

Celestine, N. (2021, January 30). 5 quality of life questionnaires and assessments. Positive Psychology. https://positivepsychology.com/quality-of-life-questionnaires-assessments/

Cuncic, A. (2021, March 15). Social anxiety disorder thought patterns to avoid. Very Well Mind. https://www.verywellmind.com/unhelpful-thinking-styles-3024978

Felman, A. (2020, October 7). What to know about social anxiety disorder. Medical News Today. https://www.medicalnewstoday.com/articles/176891

Higuera, V. (2018, September 3). Social anxiety disorder. Health Line. https://www.healthline.com/health/anxiety/social-phobia

ICD10 Data.com. (2021, October 1). 2022 ICD 10 CM diagnosis code F40.10, social phobia, unspecified. https://www.icd10data.com/ICD10CM/Codes/F01-F99/F40-F48/F40-/F40.10

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