Ms. JN is a 24-year-old law student who presents to an outpatient psychiatry clinic accompanied by her husband. She feels “worried about everything!” She is “stressed out” about her academic workload and upcoming exams. She feels fatigued and has difficulty concentrating on her assignments. She also complains of frequent headaches and associated neck muscle spasms, as well as difficulty falling asleep.
The patient’s husband describes her as “a worrier. She’ll worry about me getting into an accident, losing my job, not making enough money—the list goes on and on.”
Ms. JN reports that she has always had some degree of anxiety, but previously found that it motivated her. Over the last year, her symptoms have become debilitating and beyond her control.
Questions: Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.
1. Summarize the clinical case
2. Formulate
3. Create a list of the patient’s problems and prioritize them.
4. Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
5. Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
6. Include an assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.
Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
The Baker Act
Rafael E Segura Herrera
ST Thomas University
Professor Dr. Adma Wilson-Romans
NUR-620-AP1
05/16/2023
The Baker Act
The Baker Act, also called the Florida Mental Health Act, provides a framework for involuntary detention and examination of people who need psychiatric or medical care and appear incapable or unwilling to provide it themselves. This law grants grounds for setting up an emergency hospitalization and examining a patient who is unable to seek out appropriate care for their psychiatric needs. It mostly applies to individuals who are mentally unstable, making bad decisions due to repeated episodes of mental illness, need protection from themselves and others, or are in a state of significant distress (Lemieux, 2020). In this paper, I will summarize the details of K.W.’s case and discuss why the Baker Act law is relevant to her case. Also, I will discuss some of the legal implications that the PMHNP must take into account when unlawfully restraining a patient.
In K.W.’s case, the Baker Act would be the most relevant law for a PMHNP to consider. In her case, K.W., appears to have a mental illness since she wants to live off the “fat of the land” and is eating from dumpsters and drinking from a water hose. K.W. has refused to live in an apartment and appears unable to determine whether a voluntary examination is necessary. Furthermore, K.W. prone to experience neglect or unwilling to take care of herself without treatment. Her neglect is already presenting a real and present threat to her well-being. Therefore, an examination of the relevant law, the Baker’s Act, concerning the issue of unlawful restraint must be undertaken. This Act allows for the facilitation o those who could be a harm to themselves for up to 72 hours, after which they are released with documented approval from physicians or psychologists (Dailey, 2022). However, before a PMHNP carries out the Assessment, it would be important to consider the legal implications of doing so. The PMHNP must be aware of the potential legal pitfalls that come with restraining and examining a patient without their consent.
The PMHNP must consider the importance of informed consent in relation to the Baker Act. This is because this consent can only be provided by a legally competent patient who has the power to make decisions regarding his mental health care. Therefore, if K.W. is deemed competent, the PMHNP must seek informed consent prior to initiating an involuntary Assessment. Failure to do so may violate a patient’s constitutional rights and potential legal responsibility for any injuries sustained during the process. Furthermore, the PMHNP must understand the potential costs associated with the involuntary examination, both financial and clinical. In some cases, the Assessment may not be necessary, and the PMHNP must be mindful of the potential financial costs of starting the procedure unnecessarily. Moreover, he needs to think of the clinical implications of an unconsented Assessment, as it can significantly affect the patient-provider relationship. In order to maintain the relationship, it is crucial to ensure the patient understands why the procedure is being initiated.
In conclusion, the PMHNP should be aware of the potential legal risks involved with restraint and examination of a patient without the patient’s informed consent. Before beginning an involuntary examination, it is critical to consider the value of informed consent, potential financial costs, and the process’s therapeutic ramifications. The PMHNP must carefully weigh these legal ramifications in the case of K.W. before deciding whether to pursue involuntary examination under the Baker Act.
References
Dailey, R. (2022). Thousands of Florida students were committed under the Baker Act last year. WFSU Public Media. https://wusfnews.wusf.usf.edu/health-news-florida/2022-11-17/thousands-florida-students-committed-baker-act-last-year
Lemieux, A. E. (2020). The Baker Act: Time for Florida to get its Act together. Child & Fam. L.J., 8, 117. https://lawpublications.barry.edu/cgi/viewcontent.cgi?article=1045&context=cflj
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Summary of the clinical case:
Ms. JN is a 24-year-old law student who is experiencing excessive worry, stress, fatigue, difficulty concentrating, headaches, muscle spasms, and difficulty falling asleep. She has a history of anxiety, but her symptoms have become debilitating and beyond her control. Her husband describes her as a chronic worrier, and her anxiety is significantly impacting her academic and personal life.
Formulation:
Based on the clinical case, it appears that Ms. JN is experiencing generalized anxiety disorder (GAD). GAD is characterized by excessive and uncontrollable worry and anxiety that lasts for at least six months and affects various areas of life.
List of the patient’s problems and prioritization:
a) Excessive worry and stress: This is the primary concern as it affects Ms. JN’s daily functioning and well-being.
b) Fatigue and difficulty concentrating: These symptoms are likely secondary to anxiety and need to be addressed to improve her academic performance.
c) Headaches and muscle spasms: These symptoms may be related to anxiety-induced tension and should be addressed to alleviate discomfort.
d) Difficulty falling asleep: Sleep disturbances can worsen anxiety symptoms and overall functioning and should be addressed.
Pharmacological treatment:
Selective serotonin reuptake inhibitors (SSRIs) are commonly used as first-line pharmacotherapy for generalized anxiety disorder. Medications such as escitalopram, sertraline, or paroxetine can be considered. SSRIs have been shown to reduce anxiety symptoms and improve overall functioning in patients with GAD. The choice of medication should be individualized based on factors such as side effect profile, patient preferences, and comorbidities. Regular monitoring and adjustment of medication dosage may be necessary to achieve optimal treatment outcomes.
Non-pharmacological treatment:
Cognitive-behavioral therapy (CBT) is a recommended non-pharmacological treatment for generalized anxiety disorder. CBT focuses on identifying and modifying negative thought patterns and behaviors associated with anxiety. It helps individuals develop coping skills and strategies to manage anxiety more effectively. CBT can be delivered through individual therapy sessions or group therapy. It is important to involve Ms. JN in therapy to address her excessive worry, stress, and coping mechanisms.
Assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence:
a) Appropriateness: Both pharmacological and non-pharmacological treatments are appropriate for generalized anxiety disorder, and their combination can provide optimal outcomes.
b) Cost: The cost of treatment can vary depending on factors such as insurance coverage, specific medications, and therapy sessions. It is essential to discuss the financial aspects with the patient and explore available resources.
c) Effectiveness: Both pharmacological and non-pharmacological treatments have shown effectiveness in managing generalized anxiety disorder. However, the response to treatment may vary among individuals, and it may take time to achieve significant improvements.
d) Safety: SSRIs are generally safe and well-tolerated, but they can have side effects such as gastrointestinal symptoms, headaches, and sexual dysfunction. The benefits and risks should be discussed with the patient.
e) Potential for patient adherence: Adherence to treatment can be influenced by various factors, including patient education, support, and regular follow-up. It is important
