Brittany is a 17 year old female diagnosed with social anxiety disorder 6 months ago. She lives with her mother and step-father and one younger brother, 15 year old. She has one sister who attends college in another state. As per Brittany’s mother, Brittany met all of her developmental milestones. However, from the ages of 4 to 6, her father developed an alcohol addiction and would emotionally abuse her by yelling at her for “no reason” and call her derogatory names. Her parents divorced and her mother remarried when Brittany was 10. Her step-father is supportive and Brittany refers to him as “Dad”. Two years ago, the family moved to a different city in the same state. Brittany is a junior at a public high school. She gets good grades and likes her creative writing class. She has one friend who lives on the same street. She attends Baptist church with her family but is not involved in the youth group. She says, “Sometimes I think God is always critical of me.”

You are the school nurse at the school where Brittany attends and you notice that she comes to your office just about every day during her lunch period. She often describes feeling tires or having a headache. Her pediatrician has prescribed fluoxetine 15 mg each day.

1. Develop a short teaching plan about Cognitive Reframing (sometimes called cognitive restructuring).  Complete the Development of Patient Teaching Plan form
2. Create a handout about fluoxetine that you could give to Brittany. Include generic and trade names, how it is to be taken, dosage, why it was prescribed, how it works (use layman’s terminology), side effects, and important instructions.

ANSWER

Patient Teaching Plan for Cognitive Reframing and Fluoxetine

Introduction

Brittany is a 17-year-old student diagnosed with social anxiety disorder, who frequently visits the school nurse’s office with complaints of tiredness and headaches. She has been prescribed fluoxetine (Prozac) 15 mg daily by her pediatrician. In addition to providing information on fluoxetine, it is essential to offer Brittany coping strategies for managing her social anxiety. One such technique is cognitive reframing, which can help her change her negative thought patterns. This teaching plan aims to provide guidance on cognitive reframing and fluoxetine.

Teaching Plan: Cognitive Reframing

Step 1: Introduction to Cognitive Reframing
Begin by explaining to Brittany what cognitive reframing is. Use simple language to convey that it’s a technique that helps individuals change negative or unhelpful thoughts into more positive and constructive ones.

Step 2: Identifying Negative Thoughts
Encourage Brittany to identify her negative thoughts. Ask her to think about specific situations or events that trigger her anxiety and the thoughts associated with them. She can write these thoughts down.

Step 3: Challenge Negative Thoughts
Teach Brittany to challenge her negative thoughts. Explain that she should question the accuracy and validity of these thoughts. Are they based on facts or assumptions? Are there alternative ways to interpret the situation?

Step 4: Replace with Positive Thoughts
Guide Brittany in replacing negative thoughts with positive ones. Encourage her to reframe her thoughts by considering more optimistic and balanced perspectives. Help her develop positive affirmations or statements to counteract negative beliefs.

Step 5: Practice and Patience
Emphasize that cognitive reframing takes practice and patience. Brittany should not expect instant results. Encourage her to keep a journal of her thoughts and reframed versions to track progress.

Step 6: Seek Support
Remind Brittany that she can seek support from her school counselor, a trusted teacher, or a mental health professional if she struggles with cognitive reframing or her anxiety.

Handout for Fluoxetine (Prozac)

Generic Name: Fluoxetine
Trade Name: Prozac

How to Take It
Take one 15 mg capsule by mouth daily, preferably at the same time each day.
– It can be taken with or without food.

Dosage
The prescribed dosage is 15 mg daily.

Why It Was Prescribed
Fluoxetine is prescribed to help manage social anxiety disorder and improve mood by increasing the levels of serotonin, a neurotransmitter, in the brain.

How It Works(Layman’s Terminology)

Serotonin is like a “feel-good” messenger in the brain. Fluoxetine helps make sure there’s enough serotonin to improve mood and reduce anxiety.

Side Effects

Common side effects may include nausea, headache, and trouble sleeping. These usually go away as your body adjusts.
Rare but serious side effects may include allergic reactions, unusual bleeding or bruising, and changes in sexual desire or ability.

Important Instructions

Take fluoxetine exactly as prescribed by your doctor.
Keep track of how you feel and any side effects, and share this information with your healthcare provider.
Do not stop taking fluoxetine suddenly. If you want to stop, consult your doctor to taper off gradually.
If you experience severe mood changes or suicidal thoughts, seek immediate help.

Conclusion

This teaching plan aims to empower Brittany with cognitive reframing techniques to manage her social anxiety effectively. Additionally, the handout on fluoxetine provides crucial information on its usage, purpose, potential side effects, and important instructions to ensure her safe and informed medication management.