NURS 6630 Discussion: Treatment for a Patient With a Common Condition

NURS 6630 Discussion: Treatment for a Patient With a Common Condition

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 

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
  1. Has she begun grief counseling? “In a population study among the elderly, those between the ages of 75 and 84 years have a higher risk of developing complicated grief compared w

     NURS 6630 Discussion Treatment for a Patient With a Common Condition

     ith a younger age group.” (PubMed Central, 2013)

  2. Does she dream? “Fragmented REM sleep may promote the perception of increased wakefulness and nonrestorative sleep in insomnia, which may contribute to subjective-objective sleep discrepancies insomnia.” (PubMed Central, 2015)
  3. How many hours of sleep is she getting and if she has trouble falling asleep, staying asleep, or waking up early? “ Greater understanding of the pathophysiology of insomnia may provide important information regarding how, and under what conditions, the disorder develops and is maintained as well as potential targets for prevention and treatment.” .” (PubMed Central, 2015)

• 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.

With her approval, I would ask to speak with:

• 1. Anyone living with her: to gain insight on sleeping patterns, mood, appetite, ability to provide self-care and perform IADLs, medication compliance, weight gain or loss, presence of hallucinations or delusions, etc.
  2. Any children: they would be able to speak to who their mother “used to be” to help determine a baseline. They can also discuss how she has handled grief in the past. Also, they could be involved in grief counseling so she feels supported.
  3. Friends: They would be able to provide insight on her social life. Has she been going out as normal? Has she been as talkative?

• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
  1. I would request the following from her provider as the results of these could indicate a physical cause of her symptoms, such as infections, endocrine disease, anemia, etc: CBC, CMP, Thyroid Function, A1C. and Urine drug screen
  2. I would also want the client to be evaluated by neurology to rule out the following:

1. “Central nervous system diseases such as Sleep apnea, Parkinson disease, dementia, multiple sclerosis, neoplastic lesions” ((Jerry L Halverson, 2021)

*While I realize I may not be able to order all of the above tests, if I work in collaboration with her other providers, I can hopefully gather the information needed to rule out other causes.

• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
  1. Major Depression
  2. Insomnia
  3. Prolonged Grief Disorder (PGD)-I believe this is her primary diagnosis.

She meets 2 of the 4 criteria for this diagnosis. Only one is required. The two criteria are:

• 1. 1. “Time and impairment Persisted for an abnormally long period of time (
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