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
By Day 3 of Week 7
Post a response to each of the following:
- List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
- Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
- Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
- List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
- List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
- For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
- Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
An Elderly Widow Who Just Lost Her Spouse
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An Elderly Widow Who Just Lost Her Spouse
Introduction
Grief or bereavement is different among people and may lead to detrimental effects on individuals. Grief entails a range of feelings from deep sadness, anger, and even depression. The process of adapting to a significant loss varies from one person to another (Willis, 2020). The patient in the case study is an old woman who just lost her husband. She seems to be experiencing symptoms of depression. This paper answers all the questions asked to complete the assignment.
Possible questions include when did you begin experiencing the symptoms? What do you believe is the cause of your husband’s death? what is your belief about death?. Asking the patient about the onset of the symptoms can help verify possible illnesses (Pierce, 2018). The other two questions assess the patient’s belief about death and her coping mechanism. This will help devise an appropriate treatment plan.
People who would be involved in the patient’s treatment include close facility members such as her children. Relatives such as brother/sister-in-law as well as friends are important people. Some of the questions to ask them include the patient’s social background including people she stays with and whether she has someone to keep her accompany (Pierce, 2018). They may be asked about the patient taker her medicine property and even whether the patient has some chronic illnesses.
A diagnostic procedure may involve physical examination long side lab tests. Physical examination may include observing the patient’s level of concentration, assessing body weight, temperature, and pulse rate. It may also include movement and speech patterns (Pierce, 2018). A mental examination is also recommended using the DSM-5 or any other appropriate tool. Thyroid tests and complete blood count rests may help.
There could be so many differential diagnoses related to the patient’s condition. They include depression, post-traumatic stress disorder, panic disorder. However, the most likely differential diagnosis is major depressive disorder (depression). It patient acknowledged that her depression has worsened since the death of her spouse (Willis, 2020). Symptoms such as insomnia are related to depression. Therefore, she is more likely to suffer from depression than any other differential diagnosis.
The two medications include Zoloft and phenelzine. Although the two medications are effective in treating medications, Zoloft is preferred. Zoloft is a selective serotonin reuptake inhibitor (SSRIs) and first-line medication for depression (Chesebro et al., 2019). It has very few unserious side effects. On the other hand, phenelzine is a monoamine oxidase inhibitor (MAOIs). It should be used when other drugs have not worked.
Zoloft is contraindicated in a few circumstances, which is why it is important to talk to a physician before taking the medication. It is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or who used it within 14 days (Chesebro et al., 2019). It is also contraindicated in patients being treated with methylene blue injections as well as in those who are allergic to the medication.
The patient should report back to the hospital every four weeks. For instance, she will return on weeks 4, 8, 12, and 15. Follow-ups will help the patient recover properly from the illness (Pierce, 2018). The physician will note all changes experienced by the patient and apply necessary adjustments.
Conclusion
Grief is both good and bad depending on its effects on the individual. It affects people differently. The patient in the case study is an old woman who just lost her husband. Grief may lead to depression if not handled well. The most likely illness of the patient is depression. This paper answered all questions regarding the case study.
References
Chesebro, J., Armes, K., & Peterson, K. (2019). Focus on pharmacotherapy for depression. Nursing2020, 49(12), 32-39. https://journals.lww.com/nursing/Fulltext/2019/12000/Focus_on_pharmacotherapy_for_depression.10.aspx
Pierce, S. (2018). Major depressive disorder. Lucent Press.
Willis. (2020). RESTORED: A self-paced grief workbook for your journey from loss to life by Marilyn Willis LPCC. ZAMIZ Press.