1400: The client was referred by her primary health care provider. The client reports, "no matter what, I cannot relax." "My friends talked to me a few times about how nervous I am all the time." Symptoms started 13 months ago and are daily. She states that "something bad is going to happen." She reports "poor" sleep and that she sleeps approximately six hours a night and wakes up frequently with worry about the next day. At work, she was told that her performance had decreased because she could not concentrate. About a month ago, she noticed back and neck pains that improved with hot showers and compresses. "I was awake until 2 am worrying about how things were going to go today." She denies any thoughts of self-harm. She denies any previous hospitalizations. She reports that she is still grieving the loss of her mother, who died traumatically 3 months ago. On assessment, the client is alert and oriented. She was restless and frequently wringing her hands. Skin was normal for ethnicity, warm and dry. She had excessive facial hair and acne. Peripheral pulses 2+. Bowel sounds normoactive in all quadrants. No peripheral edema. Lung sounds clear bilaterally. The client has a medical history of polycystic ovary syndrome. She has a BMI of 26.4 kg/m2. The client became overwhelmed and could not recall her current medications.

1515:

• hydroxyzine 25 mg p.o. daily PRN anxiety symptoms
• fluvoxamine 100 mg CR p.o. daily
• psychotherapy – cognitive behavioral therapy
• home blood pressure monitoring