Week 7 responses 6630 | NURS 6630 - Psychopharmacologic Approaches to Treatment of Psychopathology | Walden University - Minneapolis, MN

week 7 responses 6630 Ifeoma12Victoria Abolarin Week 7- Initial postCOLLAPSE

Questions to ask

• How would you describe the way you are feeling today- Open-ended questions allow for further conversation which leads to in-depth knowledge of the situation. This patient will be able to explain her condition more with a question like this
• How would you describe your typical day and bedtime routine- This patient is in the clinic with complaints of insomnia, since Environmental factors can affect sleep pattern, It is important to rule out any of that before focusing on physiological causes. Daily activities can expose information that can affect the patient’s sleep pattern
• When did you start having problems sleeping- This question will help understand whether this is an acute or chronic problem? The length of time will also help understand the level of other system involvement.

People to interview I would like to speak with the neighbors, children, other close family members and caregivers, friends, or anyone that works inside the home. It will also be beneficial to know how this patient spends most of her time. Some people volunteer or have religious involvement. Physical exam and diagnostic test sleep study- A sleep study will assess the patient’s sleep pattern; this patient already has comorbidities that can further worsen her health. Hollsen et al., (2020) explain that patients with a sleep disorder also have an increased risk of depression and cardiovascular disease. urine culture to test urinary tract infection- Elderly patients do not have the typical symptoms seen in patients, so healthcare providers need to look for other signs. Dexter and Mortimore (2021) state that older people are more vulnerable due to low immunity and should be assessed for possible infection Comprehensive metabolic panel- To assess for any underlying conditions. Due to the medications, this patient is already taking, I will like to know her kidney and liver function. Sleep diary- Since this is her first complaint, I will suggest the patient keep a sleep diary which will be further discussed at the next visit. Pharmacological agent Paxil- This is a selective serotonin reuptake inhibitor (SSRI). Ostuzzi et al.,(2020) state that SSRI is the first drug of choice in the elderly due to increasing tolerability in side effects and less interference with cardiovascular health. This will be a good drug of choice because this patient is already on medications for hypertensive so the least amount of medication interference will be beneficial Quetiapine 50mg daily by mouth HS- This medication can play two roles. First as an antidepressant then as a sedative from its side effect. Differential Diagnosis Anxiety disorder Depressive disorder-I think this is the possible diagnosis for this patient, based on her history. loneliness is a major risk factor for depression among the elderly (Pan & Liu, 2021). The patient may be having worsening symptoms which is manifecting as insomnia. Insomnia Check points I will request a follow up in 4 weeks to assess medication adherence, monitor effectiveness and side effects.

References

Dexter, J., & Mortimore, G. (2021). The management of urinary tract infections in older patients within an urgent care out-of-hours setting. British Journal of Nursing, 30(6), 334–342. https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2021.30.6.334 Hollsten, I., Foldbo, B. M., Kousgaard Andersen, M. K., & Nexøe, J. (2020). Insomnia in the elderly: reported reasons and their associations with medication in general practice in Denmark. Scandinavian Journal of Primary Health Care, 38(2), 210–218. https://doi-org.ezp.waldenulibrary.org/10.1080/02813432.2020.1753382 Pan, H., & Liu, Q. (2021). Difference of depression between widowed and non-widowed older people in China: A network analysis approach. Journal of Affective Disorders, 280, 68–76. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2020.11.058 Ostuzzi, G., Gastaldon, C., Barbato, A., D’Avanzo, B., Tettamanti, M., Monti, I., Aguglia, A., Aguglia, E., Alessi, M. C., Amore, M., Bartoli, F., Biondi, M., Bortolaso, P., Callegari, C., Carrà, G., Caruso, R., Cavallotti, S., Crocamo, C., D’Agostino, A., & De Fazio, P. (2020). Tolerability and efficacy of vortioxetine versus SSRIs in elderly with major depression. Study protocol of the VESPA study: a pragmatic, multicentre, open-label, parallel-group, superiority, randomized trial. Trials, 21(1), 1–14. https://doi-org.ezp.waldenulibrary.org/10.1186/s13063-020-04460-6 Ifeanuli Ona week 7/ ifeanuliCOLLAPSE Week 7: Discussion Case: An elderly widow who just lost her spouse. Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle.

Patient currently takes the following medications:

Metformin 500mg BID Januvia 100mg daily Losartan 100mg daily HCTZ 25mg daily Sertraline 100mg daily Current weight: 88 kg Current height: 64 inches Temp: 98.6 degrees F

BP: 132/86

Everybody grieves differently and the symptoms are very similar to depression, such as withdrawal from social settings and intense feelings of sadness. But there are very significant differences between depression and grief. The patient of taking sertraline, so there is a mood problem. Individual with depression feel depressed virtually all the time but people grieving have symptoms that fluctuates. Grief can be defined as a natural response to any loss, including physical, cognitive, emotional, behavioral and spiritual responses. According to American psychiatric association, Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home. Grief can be a trigger for depression, but not everyone who grieves will experience depression. Three are questions for patient and rationale.