Treatment for a Patient with a Common Condition

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

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

Post a response to each of the following:
1. List three questions you might ask the patient if she were in your office.
Provide a rationale for why you might ask these questions.

2. 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.

3.Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

4. List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

5. 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.

6. 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?

7. 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.