Drug transcription

Josie Bellings, a 34-year-old nurse, presents to your office. Her boyfriend, Robs, is with her.
“Hi,” Josie sighs deeply. “Remember your first months as a new nurse? I just finished orientation and I’m
struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands
are clean before I start my shift.”
Robs breaks in. “She’s told me she sometimes washes her hands six times in a row. Maybe even seven or
eight to be sure. She does this at home, too.”
Josie nods. “Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes
just as many times before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I
just have to do it. And it’s not just cleanliness. At home, I’m the last to bed because I have to check the doors
at night five to six times at night.”
“Even if I’ve already locked up and she saw me do it,” puts in Robs.
“Well, I feel like I have to have some control over my world. And, um, Robs doesn’t know this, sometimes I get
up after he falls asleep because I worry to the point that I will have to get up and go check one or two more
times before I can go to sleep.”
Robs adds, “Actually, I did know about that, Josie. I’m also concerned because Josie will get focused on
something and then not be able to shut her mind down. She perseverates and I cannot distract her for
anything.”
Josie reports that she has always had these symptoms but that they are worse recently. She reports feeling
depressed, mainly because of the OCD symptoms that are causing her trouble. She denies any SI, HI, or A/V
hallucinations.
Questions
Based on the initial letter of your first name, from your perspective as Josie’s psychiatric nurse practitioner,
address the following in your initial post.

  1. What screening or diagnostic tool(s) would you use for Josie? Include a link or copy of the screening or
    diagnostic tool(s). Identify additional questions you need to ask that will help you know what the best treatment
    option(s) are for Josie.
    It has been six weeks since you first saw Josie. She is in the office for a follow-up visit by herself.
    Josie reports, “I think my symptoms are 80% better on medication. But I do still worry and obsess, particularly
    at work. I am also getting horrible anxiety attacks, where I freeze and am not able to move. It has happened
    about once a week since my last visit.
    “…. Ah…. I hate to admit this. Ummmm…. This is confidential, right? The last one at work was during a code
    blue.
    “…. But yes, overall, I feel much better. The medication is working in general. It’s just, occasionally that I feel
    like that. I’m tolerating the medication well but I have noticed dry mouth and a decreased sexual drive. And,
    um, yeah, you can imagine the friction that is causing in my relationship with Robs.
    “So, what I’m thinking is, could I have Xanax? Or maybe Ativan? I know those are really good for anxiety like
    this. I think they’d really help me.”
    Questions
    Compare and contrast at least four medications that Josie could take “as needed.” Include generic/brand name, pros, and cons for each medication.
    Are there any additional questions that you would want to know and/or labs that you would order before prescribing an “as needed” medication?
    Which pharmacological treatment would you choose? Please include rationale, starting dose, tapering schedule (if any), how the medication works, major drug/drug interactions, and patient education.
    What community and support resources would you provide to Josie?
    Would you refer Josie to therapy? If so, what type? Please provide evidence for your decision

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