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 faced 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.
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 faced 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...
…in need.Full 5-Point Plan
A full five-point plan for this patient is suggested as follows:
Based on the techniques used in cognitive behavioral therapy, the patient could be provided a goal or agenda-setting for the behavioral changes and elimination of negative thoughts (Stiles-Shields, Ho & Mohr, 2016).
Being familiar with her emotions and being aware whenever her attitudes change towards people should be stopped immediately, for which increased engagement in pleasant activities could be advised.
Exposing her steadily to one or two social interactions at a time, for example, asking her to invite one friend over at her home and then next time, inviting two colleagues from the office, or meeting three friends next time out at a rstaurant, etc.
Homework assignments could be given so that she can focus her thoughts in a specific direction rather than thinking of her surroundings and people.
Psycho-education involving coping strategies, rewards, and relapse avoidance could be modeled for this patient.
Quality
The changes that should be made while seeing similar patients could include asking the patients about certain social situations and reviewing to see whether the patients reactions change upon a certain circumstance. The list of situations could be given to the patient to ensure her anxiousness occurs at each of them, for certifying the exact condition of the disorder. In addition to that, the use of self-reported questionnaires could be helpful 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, making 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…
References
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Higuera, V. (2018, September 3). Social anxiety disorder. Health Line. https://www.healthline.com/health/anxiety/social-phobia
Jefferson J. W. (2001). Social anxiety disorder: More than just a little shyness. Primary Care Companion to the Journal of Clinical Psychiatry, 3(1), 4–9. https://doi.org/10.4088/pcc.v03n0102
Mayo Clinic. (2021, June 19). Social anxiety disorder (social phobia). https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
National HIV Curriculum. (n.a.). Generalized anxiety disorder 7-item (GAD 7). https://www.hiv.uw.edu/page/mental-health-screening/gad-7
National Institute for Health and Care Excellence. (2013, May 22). Guidance. https://www.nice.org.uk/guidance/cg159/chapter/1-Recommendations#interventions-for-adults-with-social-anxiety-disorder-2
Porter, D. (n.a.). Social anxiety disorder (social phobia) DSM 5 300.23 (F40.10). Theravive. https://www.theravive.com/therapedia/social-anxiety-disorder-(social-phobia)-dsm--5-300.23-(f40.10)#:~:text=Social%20Anxiety%20Disorder%20(Social%20Phobia,10)%20%2D%20Therapedia
Rose, G.M. & Tadi, P. (2021). Social anxiety disorder. In: StatPearls [Internet]. Treasure Island (F.L.): StatPearls Publishing. Available at NCBI. https://www.ncbi.nlm.nih.gov/books/NBK555890/
Williams, T., Hattingh, C. J., Kariuki, C. M., Tromp, S. A., van Balkom, A. J., Ipser, J. C., & Stein, D. J. (2017). Pharmacotherapy for social anxiety disorder (SAnD). The Cochrane Database of Systematic Reviews, 10(10), CD001206. https://doi.org/10.1002/14651858.CD001206.pub3
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