NR 601 Week 3 Discussion 2 Solution

NR 601 Week 3 Discussion 2 Solution

NR 601 Week 3 Discussion 2 Solution Sample

Total Points Possible: 70

Requirements:

Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.

Review this case study

HPI: BT, 50-year-old Caucasian male presents to office with complaints of “no energy and staying in bed all day.” These symptoms have been present for about 4?months and seem worse in the morning. It is hard to get out of bed and get the day started because he does not feel rested when he gets up in the morning.? BT reports “deep sadness & heartache over the loss of his wife”. States” I really don’t feel like making plans or going out”.

He tries to make plans with family or friends once a week, but it can be really exhausting because everyone asks about how he is handling the loss. Reports he also has difficulty completing projects for work, he cannot stay focused anymore. He reports not eating regularly and has lost some weight.?BT has been a widower for 10 months. His wife died unexpectedly, she had an MI. His oldest daughter has a 2-year-old daughter, she asked him to babysit a couple of times, which he thought would help with the loneliness, but the care of his granddaughter seems overwhelming at times. NR 601 Week 3 Discussion 2 Solution

Rest, evening walks, & lifting weights 2 days a week help him feel better. At this time, he does not want to do any activities or exercise, it seems like too much effort to get up and go. He has not tried any medications, prescribed or otherwise. He reports drinking a lot of coffee, but that does not seem to help with his energy levels.? NR 601 Week 3 Discussion 2 Solution
Current medications: Tylenol PM about once a week when he can’t sleep, does not help.
NKDA.

PMH: no major illnesses. Immunizations up to date.? COVID Vaccinated.

SH: widowed, employed part time as a computer programmer. Drinks 1 beer almost every night. No tobacco use, no illicit drug use. Previously married 25 years ago, reports a passive aggressive, abusive relationship that ended in divorce. The judge gave full custody of his children to his ex-wife.

The last time he saw his son was10 years ago. He lives in another stated. He sees his daughter 1-2 times a month. He would like to talk to his son but he is concerned the relationship cannot be repaired because he moved out during the divorce.

FH: Parents are alive and well. Has a daughter 20 and a son 18. NR 601 Week 3 Discussion 2 Solution

ROS

CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough or sputum.

GASTROINTESTINAL: Reports decreased appetite for about 4 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

GENITOURINARY: no burning on urination.

PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history feeling very sad and anxious about loss of wife. Sad about not speaking to his son. Did not seek treatment. He started to feel better about the loss of his wife after 6 months but the grief and depression has returned.

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia

ALLERGIES: No history of asthma, hives, eczema or rhinitis. NR 601 Week 3 Discussion 2 Solution

Discussion Questions: NR 601 Week 3 Discussion 2 Solution

1. Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen BT.
2. Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
3. Score BT using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.? In your response include what questions could be scored, and your chosen score.
4. Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.
5. Identify your next step for evaluation and treatment for BT. Remember to consider both physical and mental health differential diagnoses when answering this question.?(2-3 sentences).
6. What medication or treatment is appropriate for BT based on his screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for BT. Include initial prescribing information.
7. If the medication works as expected, when should BT expect to start feeling better?

Direct Quotes

Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

Dr. Burks and Class,

The tools that I would use would be the PHQ-9 for depression and the GAD-7 for anxiety. The initial reasoning for the use of these tools are ease of use and both tools can be quickly applied. Despite our desires to spend hours with each patient, we all understand and know that time is of the essence in a primary care setting. NR 601 Week 3 Discussion 2 Solution

Nonetheless, the PHQ-9 is one of the most validated tools in mental health and can help clinicians with diagnosing depression and monitoring if the chosen treatment was effective. According to Williams (2014), the PHQ-9 assist with the diagnosis of major depression and with symptom severity, furthermore, it has been proven to be useful for the geriatric population. The GAD-7 is utilized to screen for anxiety. It is 70-90% sensitive and 80-90% specific across disorders / cutoffs.

“The GAD-7 is useful for initial screening and measuring symptom severity. While a score of 10 or greater indicates GAD, scores of 5, 10, and 15 indicate mild, moderate, and severe GAD, respectively” (Posmontier & Breiter, p. 271, 2012).  Whereas, the PHQ-9 scores 9 items 0-3, it is been stated by some research that certain scores on the PHQ-9 correlate with a major depression diagnosis. However, not everyone with an elevated PHQ-9 is certain to have major depression. The PHQ-9 is intended as a tool and is not a substitute for diagnosis by a trained clinician. NR 601 Week 3 Discussion 2 Solution

Using the information already obtained the score for KB on the PHQ-9 would be: moderate to moderately severe depression. The GAD-7 score would be: inconclusive regarding anxiety or a score not exhibiting GAD.

The first thing I think would be important would be to ask additional questions in order to clarify that depression is a concern to her. The first line of treatment for depression would be a SSRI according to Gautam, Jain, et al., (2017). My choice would be Celexa 20 mg PO QD along with follow up with a mental health specialist.

Celexa is an SSRI, the reason is according to Gautam, Jain et al., (p. S38, 2017) “is that in general all the antidepressants have been shown to have nearly equal efficacy in the management of depression”. As the name states, Celexa, selectively inhibits serotonin reuptake. I need to let the patient know it may take up to 4 weeks before she starts to feel better. NR 601 Week 3 Discussion 2 Solution

Celexa 20 mg

Disp # 30

Sig: 1 tablet daily

RF: 5

References for NR 601 Week 3 Discussion 2 Solution

Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical Practice

Guidelines for the management of Depression. Indian Journal of Psychiatry, 59(Suppl 1), S34–S50. http://doi.org/10.4103/0019-5545.196973

Posmontier, B., & Breiter, D. (2012). Continuing Education: Managing Generalized Anxiety

Disorder in Primary Care. The Journal for Nurse Practitioners, 8, 268–274. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.nurpra.2011.09.018

Williams, N. (2014). PHQ-9. Occupational Medicine (Oxford, England), 64(2), 139–140.

https://doi-org.chamberlainuniversity.idm.oclc.org/10.1093/occmed/kqt154

NR 601 Week 3 Assignment -Psychiatric Disorders (LINK)

Patient Health Questionnaire (PHQ – 9) – Depression Screening