NURS 6630- An elderly widow who just lost her spouse

1 Case: An elderly widow who just lost her spouse Subjective: A patient presents to your primary care office today with a 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. The patient normally sees PCP once or twice a year. The patient denies any suicidal ideations. The 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 Questions to ask the patient 1.How many hours of sleep do you typically get each night? Understanding the pattern of sleep a patent gets each night is fundamental in determining whether they are getting enough sleep or they are disrupted. Sleep duration that is less than 6 hours per night is insufficient for an elderly person, and this may indicate insomnia or depression. Sleep disruptions may be caused by a plague of negative thoughts or concerns that involve emotions. 2.Have you noticed any changes in your mood, such as sadness, hopelessness, depression, anxiety, or changes in the ability to concentrate during the day? People experiencing the loss of their loved one are at high risk of developing depression, and insomnia is common for depressed individuals. Patients reporting insomnia tend to feel not refreshed in the morning and thus have difficulties concentrating throughout their day.

2 3.Are you currently taking drinks rich in caffeine? If yes, how frequently do you take them in a day, and at what time? Caffeine is a stimulating substance, and its consumption during the day leads to a reduction in 6- sulfatoxymelatonin (the main metabolite of melatonin) on the ensuing night leading to disruption in sleep. Further assessment of the patient's situation Further assessment is fundamental, especially when dealing with elderly patients, to avoid misdiagnosis. For instance, in the case presented above, the people who are in the life of the patient that one can obtain more information are the family and the caregiver. If possible, the husband would have given solid information about the patient, but he is deceased. Some of the questions that can be asked for screening include the following; Have you noticed changes in her interest in pleasure in doing activities she used to enjoy a month ago? Does she have the usual energy she had before the death of her husband, or she feels fatigued mostly? Is she complaining of any physical symptoms such as headache, stomachache, or other pain without any clear physical cause? If yes, how often does she complain? Does she have difficulty concentrating, making decisions, and remembering things, unlike in the previous month? Do you know whether she is adhering to her medication schedule? Appropriate Physical Tests and Diagnostic Exams Physical tests and diagnostic exams are carried out by healthcare professionals to rule out underlying medical conditions and identify the most likely health issue in a patient. Based on the above case study, it is possible to diagnose the patient through screening; one way to detect depression in the patient is by utilizing the Hamilton Rating Scale for Depression (HAM-D), through which the rating scale is clinically administered to assess the severity of the depression

3 symptoms. The scale consists of 17 items that are clustered to measure cognitive, mood, and physical symptoms of depression. Below 7, the patient is said to be normal, with scores between 7-17, mild depression, 18-24, moderate depression, and above 25, severe depression (Carrozino et al., 2020). The Montgomery-Asberg Depression Rating scale (MADRS) is also a clinically administered rating scale that is used to assess the severity of depression symptoms. If the patient scores a rate of 0-6, is said to be normal, 7-12 borderline mentally ill, 13-18 mildly ill, 19-23 moderately ill, 24-36 markedly ill, and 37-39 severely ill (Herniman et al., 2021). While there are no physical tests that are linked to detecting depression, the healthcare professional may conduct blood tests to identify and rule out any underlying medical condition, such as anemia or thyroid disease, that may be causing depression. Differential Diagnosis for the Patient Some of the differential diagnoses for the patient include; post-traumatic stress disorder (PSTD), premenstrual dysphoric disorder (PMDD), hyperkalemia, Hypothyroidism, bipolar disorder, personality disorder, and anxiety disorder. However, among the differential diagnoses, I think Hypothyroidism is most likely to be misdiagno