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NR 601 Week 3 TD 2 latest
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NR 601 Week 3 TD 2 NR 601 Week 3 TD 2 NR 601 Week 3 TD 2
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1NR 601 Week 3 TD 2
Anxiety and depression are the most common psychiatric problems you will
encounter in your primary care practice.
Review this case study
HPI: KB, 55 year old Caucasian female who presents to office with
complaints of fatigue. The fatigue has been present for 6 months and seems
worse in the morning, improving slightly through the day. KB reports a lack
of energy and "loss of joy". States" I really don't feel like going anywhere or
doing anything" Reports she often has difficulty staying on task and
completing projects for work. She reports not feeling hungry and does not
feel rested when she wakes up in the morning. KB is a widow for 2 years,
social events that are couples only can make her symptoms worse. She tries
to do at least one social activity a week but it can be really exhausting. Her
husband died in their car while she was driving him to the hospital and
sometimes driving in that car makes all the memories come back. She
recently got a puppy, which she thought would help with the loneliness but
the care of the puppy seems overwhelming at times. Rest and exercise,
specifically yoga and meditation seem to make her feel better. At this time
she does not want to do either. She has not tried any medications, prescribed
or otherwise. She reports drinking a lot of coffee, but that does not seem to
help.
Current medications: Excedrin PM about once a week when she can't sleep,
seems to help a bit. NKDA.
PMH: no major illnesses. Immunizations up to date.
SH: widowed, employed full time as a manager. Drinks wine, 1 glass every
night. No tobacco, no illicit drugs. Previously married while living in
France, reports an abusive relationship. The French government gave
custody of her son to the ex-husband. She returned to US without her son 10
years ago. She sees her son two times a year, they skype and text "all the
time" but she misses him.
FH: Parents are alive and well. Has one son, age 21, he is healthy but lives
in France with his father.
ROS
, 2
CONSTITUTIONAL: reports weight loss of 2-3 pounds, no fever, chills, or
weakness reported
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera.
Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or
sore throat.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort.
No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: Reports decreased appetite for about 3 months. No
nausea, vomiting or diarrhea. No abdominal pain or blood.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia,
numbness or tingling in the extremities. No change in bowel or bladder
control.
GENITOURINARY: no burning on urination. Last menstrual period 4 years
ago.
PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports
great anxiety due to verbal and concern for physical abuse, reports feeling
very sad and anxious when divorcing and leaving her son in France. Did not
seek treatment. She started to feel better after about 4 months.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No
polyuria or polydipsia
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
Discussion Questions: (55 yo Caucasian)
1. Research screening tools for depression and anxiety.
Choose one screening tool for depression and one screening tool for anxiety
that you feel are appropriate to screen KB. PHQ-9 anf GAD-7
Explain why you chose that particular tool for KB. If you can, attempt to
score KB based on the information provided (not all data may be provided).
Include what questions could be scored, and your chosen sore.
2. Identify your next step for evaluation and treatment for KB.
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