NR 601 Week 3 Assignment -Psychiatric Disorders

The Patient Health Questionnaire (PHQ – 9) depression screening tool is widely used in screening patients for depression in nonpsychiatric settings (Manea, Gilbody, & McMillan, 2015). It integrates DSM-IV depression diagnostic criteria with other leading major depressive symptoms into a short self-report tool. The screening rates the frequency of the symptoms, whole factoring the scoring severity index. One of the most important questions is question 9 that screens for presence and duration of suicidal ideation. I chose his as my depression screening tool to use in the primary care setting. Because it is brief and very useful in preventing patient harm …

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NR 601 Week 3 Case Study Assignment

Discussion Part One

• Background:
  • Although Mrs. Smith is scheduled for an annual physical exam and reports no particular chief complaint, you will need to complete a detailed geriatric assessment. Katie reports a lack of appetite. She tells you that she nibbles most of the time rather than eating full meals. She also reports having insomnia on a regular basis.
• PMH:
  • Katie reports a recent bout of pneumonia approximately 3 months ago, but did not require hospitalization.  She also has a history of HTN and high cholesterol.
• Current medications:
  • HCTZ 25mg daily
  • Evista 60mg daily
  • Multivitamin daily
• Surgeries:
  • Appendectomy as a child in Ireland (date unknown)
  • 1968- Cesarean section
  • Allergies: Denies food, drug, or environmental allergies
• Vaccination History:
  • Cannot remember when she had her last influenza vaccine
  • Does not recall having received a Pneumovax
  • Her last TD was greater than 10 years ago
  • Has not had the herpes zoster vaccine
  • Screening History:
  • Last Colonoscopy was 12 years ago
  • Last mammogram was 4 years ago
  • Has never had a DEXA/Bone Density Test
• Social history:
  • Emigrated with her husband from Ireland in her 20s and has always lived in the same house until recently. She retired a year and a half ago from 30 years of teaching elementary school; has never smoked but drinks alcohol socially. She states that she does not have an advanced directive, but her daughter Mary keeps asking her about setting one up.
• Family history:
  • Both parents are deceased but lived disease-free up into their late 90s.  She has one daughter who is 44 years old with no chronic illness and two sons, ages 42 and 40, both in good health.

Discussion Day 1:

• Differential Diagnoses with rationale
• Further ROS questions needed to develop DD
• Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

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Discussion Part Two (graded)

• Physical examination:
• Vital Signs:
• Height:  5’0”   Weight: 150 pounds BMI: 29.3   BP: 120/64    T: 98.0 oral  P: 68 regular    R: 16, non-labored
• HEENT: Normocephalic, symmetric. Evidence of prior cataract surgery in both eyes. PERRLA, EOMI, cerumen impaction bilateral ears.
• NECK: Neck supple; non-palpable lymph nodes; no carotid bruits.
• LUNGS: Clear to auscultation
• HEART: RRR with regular without S3, S4, murmurs or rubs.
• ABDOMEN: Normal contour; active bowel sounds, LLQ tenderness.
• PV: Pulses are 2+ BL in upper and lower extremities; no edema. No evidence of peripheral neuropathy.
• NEUROLOGIC: Negative
• GENITOURINARY: No CVA tenderness
• MUSCULOSKELETAL: Gait fluid and steady. No muscle atrophy or asymmetry. Full ROM all joints. Strength 5/5 and equal bilaterally. Joint swelling in fingers both hands.
• PSYCH: Flat affect; patient declined to answer PHQ-9 and GDS
• SKIN: Grossly intact without rashes or ecchymosis.

Discussion Part Two:

Others, also available upon request:

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NR 508 Advanced Pharmacology,

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NR 510 Leadership and Role of the Advanced Practice Nurse,

NR 511 Differential Diagnosis and Primary Care Practicum,

NR 512 Fundamentals of Nursing Informatics,

NR 531 Nursing Leadership in Healthcare Organizations,

NR 534 Healthcare Systems Management, NR 601 Week 3 Assignment -Psychiatric Disorders.