NSG 6001 Week 4 Discussion Essay
NSG 6001 Week 4 Discussion Essay
NSG 6001 Week 4 Discussion Essay
Week 4 Discussion
The Mrs. Gomez’s History
This discussion focuses on Mrs. Gomez’s history which is relevant to her insomnia. It includes chief complaint, HPI, social, family, and past medical history that are essential to know.
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Patient Initials: MG
Subjective Data: MG presents with an ongoing problem of feeling extremely tired and inability to sleep properly for the past six months. The patient is in grief following the recent death of her husband. She reports fatigue, weight gain, and loss of interest in activities she once enjoyed such as going to church and reading. She says that she has lost focus and can read the same page continuously. She denies suicide ideation or self-injury.
Chief Complaint: A 65-year-old Mrs. Gomez claims to be extremely tired lately and has trouble sleeping
HPI: The patient presents with complaints of insomnia for the last six months. She says that she only manages to sleep for a few hours every night.
Onset: Six months ago
Location: General
Duration: She reports sleeping a few hours every night
Characteristics: Loss of focus, extremely tired
Aggravating factors: Watching TV at night
Relieving Factors: None
Treatment: MG is on Tylenol PM and Zapote Blanco, a Mexican herbal tea
Severity: Rigorous alteration in sleep pattern, which compromises her routine functioning.
PMH: Type 2 diabetes, Hypertension, Hypercholesterolemia
Social: MG is staying with her daughter and son-in-law following the death of her husband of 30 years. She denies smoking and taking alcohol.
Surgical history: MG has undergone Cholecystectomy, Hysterectomy
Medications: MG has been placed on Glyburide 10 mg daily and Metformin 1,000 mg bid for the management of diabetes, Methyldopa 250 mg bid and Lisinopril 10 mg daily for the management of HTN, Atorvastatin 80 mg daily for the management of hypercholesterolemia, Aspirin 81 mg daily for the management of CHD prophylaxis, and Calcium citrate with vitamin D 600mg/400 IU bid for prevention of osteoarthritis prevention. MG also uses zapote tea and Diphenhydramine.
Pain: None
Respiration: No apnea, shortness of breath, CTA, snoring
Head, eyes, ears, nose, and throat (HEENT): Denies adenopathy, thyromegaly, or masses
Cardiac: No chest pains, edema, palpitations
Constitutional: No fevers or dizziness
Significant labs: MG’s final hemoglobin A1c has elevated to 8.7%
Endocrinologic: Denies polydipsia or polyuria
Gastrointestinal: No nausea, hematochezia, alterations in bowel habits,
Neurologic: Normal gait, no serious neurologic changes, no confusion, no tremors
Urologic: MG usually urinates once or twice at night without any difficulty
Vital signs: BP 128/78 mm Hg, HT 64 in, WT: 186 pounds, HR 60 beats/minute, and regular
The Physical Exam, Diagnostic Tools, and Recommended Additional Information
MG’s hemoglobin A1c elevated to 8.7%, which is an indication of uncontrolled blood glucose. It is recommended to conduct laboratory tests such as thyroid stimulating hormone (TSH), complete blood count (CBC), and complete metabolic panel (CMP). These tests are crucial in ruling out other potential causes of insomnia, depression, and fatigue. They will assess conditions such as vitamin deficiencies, electrolyte imbalance, anemia, and renal or hepatic problems. The additional information I would seek from this patient is the amount of Zapote tea she consumes daily. This tea contains glucoside which reduces blood pressure. It can also act as an arthritic pain reliever and sedative when consumed in higher doses.
Differential Diagnoses for Mrs. Gomez
The first differential diagnosis is hypothyroidism. The majority of people globally are affected by thyroid problems, which disproportionally affect women compared to men. Hypothyroidism can make a person feel fatigued, alter mood and behavior, and feel apathetic (Wilson et al., 2021). The second differential diagnosis is dementia. However, this diagnosis was ruled out after MG scored normal range in the Mini-Cog exam. The final diagnosis was depression. An episode of depression entails at least five symptoms such as depressed mood, unintended changes in weight, impaired concentration, recurrent suicide ideation, significant changes in sleep pattern, and feeling worthless (Paykel, 2022). MG presents at least five of the symptoms that confirm depression.
Plan of Care for Mrs. Gomez at Visit, Patient Education, and Follow-up
The main treatment plan of choice for MG includes diet, Sertraline, cognitive-behavioral therapy (CBT), and exercise. MG should be placed on sertraline to manage depression. This medication is well-tolerated and accessible in a generic form (Guerrera et al., 2020). The goal of treatment is to optimize the quality of life of MG to enable her to function emotionally and physically to the best of their ability. CBT is crucial for MG to help her cope with the loss of a spouse and move on with life. Exercise is critical in helping to improve mood and other health benefits such as improving diabetes and blood pressure.
Mrs. Gomez should be educated on the possible side effects of sertraline. Education should also cover the need to adhere to the medication’s proper dosage even after starting to feel better (Guerrera et al., 2020). She should be advised to report any problem or side effects she encounters during the treatment process. Mrs. Gomez should also be advised to create a sleep schedule. She should be discouraged from using certain drinks such as alcohol, sugary foods, and caffeine a few hours before going to bed. On the other hand, follow-up is necessary to determine the effectiveness of the medication (Schramm et al., 2019). Follow-up is also crucial in monitoring medication compliance since some patients do not report side effects or missing doses.
References
Guerrera, C. S., Furneri, G., Grasso, M., Caruso, G., Castellano, S., Drago, F., … & Caraci, F. (2020). Antidepressant drugs and physical activity: a possible synergism in the treatment of major depression? Frontiers in Psychology, 11, 857. https://doi.org/10.3389/fpsyg.2020.00857
Paykel, E. S. (2022). Basic concepts of depression. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/espaykel
Schramm, E., Kriston, L., Elsaesser, M., Fangmeier, T., Meister, R., Bausch, P., … & Härter, M. (2019). Two-year follow-up after treatment with the cognitive behavioral analysis system of psychotherapy versus supportive psychotherapy for early-onset chronic depression. Psychotherapy and psychosomatics, 88(3), 154-164. https://doi.org/10.1159/000500189
Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: diagnosis and treatment. American family physician, 103(10), 605-613. https://pubmed.ncbi.nlm.nih.gov/33983002/
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Discussion Mental Health
This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.
To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by the end of the week.
For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.
The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases may be present in the quizzes, the midterm exam, and the final exam.
Learn how to access and navigate Aquifer.
This week, complete the Aquifer case titled “Family Medicine 03: 65-year-old woman with insomnia”
Apply information from the Aquifer Case Study to answer the following discussion questions:
Discuss the Mrs. Gomez’s history that would be pertinent to her difficulty sleeping. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
Describe the physical exam and diagnostic tools to be used for Mrs. Gomez. Are there any additional you would have liked to be included that were not?
Please list 3 differential diagnoses for Mrs. Gomez and explain why you chose them. What was your final diagnosis and how did you make the determination?
What plan of care will Mrs. Gomez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?
