Anxiety Disorder: Diagnosis, Legal Status, Risk, Treatment Plan, and Discharge

This report discusses the diagnosis, legal status, associated risks, treatment plan, and discharge process for a patient with anxiety disorder. It covers the symptoms, legal status according to NSW Mental Health Act, risks associated with the diagnosis, treatment plan, and evidence for discharge readiness. The report also suggests services for discharge into a community setting.

Nursing
1

CONTENTS
Contents...........................................................................................................................................2
INTRODUCTION...........................................................................................................................3
Presenting symptoms of Diagnosis..............................................................................................3
Legal status according to NSW Mental Health Act (2007).........................................................3
Risk associated with diagnosis....................................................................................................4
Treatment plan for individual care..............................................................................................5
Evidence about ready for discharge.............................................................................................5
Suggestion services for discharge into community setting..........................................................6
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................8
2

INTRODUCTION
Mental health can be stated as a emotional, behavioural and cognitive wellbeing of an
individual. It is about the way individuals behave, feel and think (Gibby, Casline and Ginsburg,
2017). In every stage of life, mental health is very important as it influence the emotions
thoughts and behaviours of an individual. This report is based on the case study of Julie who is
48 years old women, previously diagnosed with anxiety and find a doctor or psychologist. This
report covers the sentence of diagnosis as per DSM-5 and the legal status Julie according to
NSW mental health act. Additionally, it also details about the risk in diagnosis, treatment plan of
Julie and evidence that ensure that she is ready to get discharge.
Presenting symptoms of Diagnosis
When Julie started remain more worried and disturbed like she uses to stay alone, cry
several times a day and also pacing in kitchen. These al are the symptoms of getting uneasy and
uncomfortable with the situation or something that is going within her mind. So, getting a normal
check up by a local general practitioner she is diagnosed with anxiety. As according to the
criteria specified with in DSM-5, an individual experiencing symptom like,
 Feeling restlessness or keyed up or on edge.
 Experiencing sleeping disturbance
 Get fatigued easily
 Person find it difficult to control worries or emotions
These are the symptoms when an individual is experiencing from some days but not more
than six months is consider under the condition of anxiety disorder which is usually occurs either
due to worries, embarrassed in public, become contaminated, gaining weight, away from home
etc. (Substance and Mental, 2016) In case of Julie, she is living alone, found issue in getting
social interaction due to her incident of argument with old man in Aldi and after that she found
difficult to asleep, get emotional too often and remain disturb always. So, these all symptoms are
according to criteria decided by DSM-5 for anxiety disorder.
Legal status according to NSW Mental Health Act (2007)
As per the scenario Julie is facing certain kind of mental disturbance due to way of their
living as she use to lives alone and after her argument with old man in Aldi this issue get more
increased. She is experiencing anxiety and also remain disturbed as that situation of
embarrassment recall again and again which make her hurt as well as emotionally instable. So,
3

the general practitioner suggested her to get admitted within private mental hospital. As per this
case of Julie it was a voluntary admission within mental hospital. So the legal status is voluntary
when it is compare as per the NSW Mental Health Act 2007. This is so because according to this
NSW Mental Heath Act 2007 a person who is suffering from nay kind of mental illness or
disorder must get admitted to the public private mental hospital in get appropriate mental
treatment as per their condition either voluntarily or involuntary basis. Other than that, this law
also creates a system where public mental health care related services are provide and also
provide licences for the public mental health facilities within NSW.
Risk associated with diagnosis
Anxiety disorder is considered as a mental condition of a person which make it difficult for
them to handle their responsibilities, do daily tasks, maintain their health condition etc. There are
several types of risk or behaviour that may be found within Julie due to anxiety disorder that may
be riskier for health (Keeton and et. al., 2019). This mainly includes depression which is usually
occur with anxiety disorder that may cause insomnia, agitation etc. that affect the health
condition of Julie. Another major risk can be found as suicide attempt, as around 90 percent
people died with suicide are found to have mental illness. Despite of this, Julie can also
experience a substance abuse of her anxiety get increased as people usually intake alcohol or
drugs to reduce their anxiety and get relaxed which in turn may further bring biological illness
and may also increased anxiety issue which creates illness by weakening the immune system.
This create more issue to get infected with flu, viral or other bacterial disease for Julie.
The behavioural issues among the patients dealing with anxiety disorder is usually varied
which make it difficult to manage them. But there are certain actions that can be taken by a nurse
for managing patients with anxiety disorder in ward. This includes breathing exercise, by
controlling the breath a nurse can mange the anxiety of patients. Deep breath allows the mind,
heart and body to countering the side effect of stress and get back into normal condition. Another
is guided imagery where a nurse can verbally allow a patient to imagine themselves either at
calm environment like beach or garden which are less stressful and give instant relaxation to
them (Leichsenring and Leweke 2017). Cognitive therapy is another method that can be used by
a nurse to treat patient with anxiety disorder in ward as it help in changing the thinking pattern
and belief of patient which is creating mental disturbance.
4

Treatment plan for individual care
With the diagnosis it has been found that Julie is suffering from an anxiety disorder and
also refer to private mental hospital to get back her into normal position. For this several
intervention will be consider with them which are explained below,
 Trying to identify the main reason behind the anxiety of Julie. A nurse can use presence,
verbalization, touch and demeanor in order to assure the patients that they are not alone
to encourage their expressions. Additionally, they also make comfortable and familiarise
with the environment and regularly interact with patients in peaceful manner.
 Reinforce patients to present their personal reaction or expression regarding their
discomfort, pain or threat of well being in form of crying, talking, nonverbal or physical
expression. Then the nurse will try to talk with Julie about the anxious feeling for
determining the anxiety provoking situation (Anxiety Nursing Care Plan. 2019).
 Then Julie will be encouraged to deal with anxiety by taking it normal and adopting
actions like deep breath, positive visualisation, reassuring self-statement, so that sources
of anxiety can be eliminate.
 Give antianxiety medication treatment such as Benzodiazepines, Buspirone HCl
(BuSpar), Selective serotonin reuptake inhibitors (SSRIs) and Nonselective beta-
blockers and alpha-2-receptor agonists.
 Other than this in case of emergency patients will be provided with massage, backrubs to
reduce anxiety, provide mean to listen music, educate husband of Julie regarding
symptom of anxiety and teach the way of visualization to reduce anxiety situation.
 Other than this medication treatment, Julie will also get some treatment like talking
therapy, cognitive therapy and assertive training for teaching patient to negotiate over
interpersonal conflict (Yonkers, Gilstad-Hayden, Forray and Lipkind, 2017).
Evidence about ready for discharge
After getting into the observation of the skilled nurses and doctors who are expertise in
treating the anxiety disorder issues, Julie would be able to get into a condition of discharge when
certain kind of symptoms found in her behaviour. This mainly includes her calming behaviour,
an understanding about the ways to reduce the anxiety level, when she be able to intake
medication on their own, she become fit in term of getting sleepy nights, elimination of
5

uneasiness etc. Other than this, she also found to manage things by their own and the impact of
her fear of getting socialise reduced. After evaluating all these symptom Julie will be consider
for discharging from the private mental hospital (Zisman-Ilani and et. al., 2019). But the decision
of discharge would eb taken after considering her home care situation that whether her husband
would be able to deal with her or require a carer who remain with her and deal with the anxiety
issues she faces. After them all when each thing found to be correct then only Julie get discharge
from the hospital.
Suggestion services for discharge into community setting
For ensuring the better care and support to the patient suffering from any kind of mental
disorder the engagement with eth community setting services is increasing. While discharging
the patients from inpatient services several interventions are adopted by the hospitals. This
mainly includes the registered nurse liaising with the community service for arranging the follow
up care. Once the Julie gone through discharging plan a RN is assigned to her who take care of
her when she shifted to the community or home-based care (Guerin, Grimmer and Kumar, 2013).
This is mainly done to increases the knowledge of service users and families about taking better
care of themselves. The community carer assess the in hospital condition of Julie and according
to requirement arrange the supporting following discharge from hospital. After that the hospital
staff undertake the home visit while coordinating with the community service provider.
According to NMBA, the RN remains responsible for planning as well as communicating about
the nursing practice. Th plane for the transfer of inpatient to the community services a care plan
must be developed with the agreed partnership (Tyler, Wright and Waring, 2019). The RN
remain responsible to deliver care services as per the agreed plan and liable to bring changes as
per the condition of patient but having approval over it. These instructions are provided within
the standard 5 of NMBA.
CONCLUSION
From the above performed report it can be said that there are several form of mental
health issues which an individual may face and anxiety is one among them which is usually
happen due to a phobia to something, having social distance etc. which in turn make a people get
uneasy, remain disturbed and lack of sleep. As per the mental health act 2007, such patients
required immediate attention for the mental health care by getting admitted to the private or
public hospital as per the admission permission offered by GP. The basic treatment which is
6

granted to patient suffering from anxiety disorder is usually medication that can ease their level
of anxiety and normal the pulse rate, blood pressure etc. On the other hand, non-pharmaceutical
treatments involve cognitive behavioural therapy, talking therapy etc.
7

REFERENCES
Books & Journals
Gibby, B. A., Casline, E. P., & Ginsburg, G. S. (2017). Long-term outcomes of youth treated for
an anxiety disorder: A critical review. Clinical child and family psychology
review, 20(2), 201-225.
Guerin, M., Grimmer, K., & Kumar, S. (2013). Community services' involvement in the
discharge of older adults from hospital into the community. International Journal of
Integrated Care, 13.
Keeton, C. P. & et. al., (2019). Mood and suicidality outcomes 3–11 years following pediatric
anxiety disorder treatment. Depression and anxiety, 36(10), 930-940.
Leichsenring, F., & Leweke, F. (2017). Social anxiety disorder. New England Journal of
Medicine, 376(23), 2255-2264.
Substance, A., & Mental, H. S. A. (2016). Impact of the DSM-IV to DSM-5 Changes on the
National Survey on Drug Use and Health.
Tyler, N., Wright, N., & Waring, J. (2019). Interventions to improve discharge from acute adult
mental health inpatient care to the community: systematic review and narrative
synthesis. BMC health services research, 19(1), 883.
Yonkers, K. A., Gilstad-Hayden, K., Forray, A., & Lipkind, H. S. (2017). Association of panic
disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy
with risk of adverse birth outcomes. JAMA psychiatry, 74(11), 1145-1152.
Zisman-Ilani, Y. & et. al., (2019). Shared decision making for psychiatric rehabilitation services
before discharge from psychiatric hospitals. Health communication, 34(6), 631-637.
Online
Anxiety Nursing Care Plan. 2019. [Online] Available through: <
https://nurseslabs.com/anxiety/>.
8