NSG 4055- Week 4 discussion

NSG 4055- Week 4 discussion

NSG 4055- Week 4 discussion

The Mrs. Gomez’s History

This discussion focuses on Mrs. Gomez’s history which is relevant to her insomnia. It includes chief complaint, HPI, social, family, and past medical history that are essential to know.

Patient Initials: MG

Subjective Data: MG presents with an ongoing problem of feeling extremely tired and inability to sleep properly for the past six months. The patient is in grief following the recent death of her husband. She reports fatigue, weight gain, and loss of interest in activities she once enjoyed such as going to church and reading. She says that she has lost focus and can read the same page continuously. She denies suicide ideation or self-injury.

Chief Complaint: A 65-year-old Mrs. Gomez claims to be extremely tired lately and has trouble sleeping

HPI: The patient presents with complaints of insomnia for the last six months. She says that she only manages to sleep for a few hours every night.

            Onset: Six months ago

            Location: General

            Duration: She reports sleeping a few hours every night

            Characteristics: Loss of focus, extremely tired

            Aggravating factors: Watching TV at night

            Relieving Factors: None

            Treatment: MG is on Tylenol PM and Zapote Blanco, a Mexican herbal tea

            Severity: Rigorous alteration in sleep pattern, which compromises her routine functioning.

PMH: Type 2 diabetes, Hypertension, Hypercholesterolemia

Social: MG is staying with her daughter and son-in-law following the death of her husband of 30 years. She denies smoking and taking alcohol.

Surgical history: MG has undergone Cholecystectomy, Hysterectomy

Medications: MG has been placed on Glyburide 10 mg daily and Metformin 1,000 mg bid for the management of diabetes, Methyldopa 250 mg bid and Lisinopril 10 mg daily for the management of HTN, Atorvastatin 80 mg daily for the management of hypercholesterolemia, Aspirin 81 mg daily for the management of CHD prophylaxis, and Calcium citrate with vitamin D 600mg/400 IU bid for prevention of osteoarthritis prevention. MG also uses zapote tea and Diphenhydramine.

Pain: None

Respiration: No apnea, shortness of breath, CTA, snoring

Head, eyes, ears, nose, and throat (HEENT): Denies adenopathy, thyromegaly, or masses

Cardiac: No chest pains, edema, palpitations

Constitutional: No fevers or dizziness

Significant labs: MG’s final hemoglobin A1c has elevated to 8.7%

Endocrinologic: Denies polydipsia or polyuria

Gastrointestinal: No nausea, hematochezia, alterations in bowel habits,

Neurologic: Normal gait, no serious neurologic changes, no confusion, no tremors

Urologic: MG usually urinates once or twice at night without any difficulty

Vital signs: BP 128/78 mm Hg, HT 64 in, WT: 186 pounds, HR 60 beats/minute, and regular

The Physical Exam, Diagnostic Tools, and Recommended Additional Information

MG’s hemoglobin A1c elevated to 8.7%, which is an indication of uncontrolled blood glucose. It is recommended to conduct laboratory tests such as thyroid stimulating hormone (TSH), complete blood count (CBC), and complete metabolic panel (CMP). These tests are crucial in ruling out other potential causes of insomnia, depression, and fatigue. They will assess conditions such as vitamin deficiencies, electrolyte imbalance, anemia, and renal or hepatic problems. The additional information I would seek from this patient is the amount of Zapote tea she consumes daily. This tea contains glucoside which reduces blood pressure. It can also act as an arthritic pain reliever and sedative when consumed in higher doses.

Differential Diagnoses for Mrs. Gomez

The first differential diagnosis is hypothyroidism. The majority of people globally are affected by thyroid problems, which disproportionally affect women compared to men. Hypothyroidism can make a person feel fatigued, alter mood and behavior, and feel apathetic (Wilson et al., 2021). The second differential diagnosis is dementia. However, this diagnosis was ruled out after MG scored normal range in the Mini-Cog exam. The final diagnosis was depression. An episode of depression entails at least five symptoms such as depressed mood, unintended changes in weight, impaired concentration, recurrent suicide ideation, significant changes in sleep pattern, and feeling worthless (Paykel, 2022).  MG presents at least five of the symptoms that confirm depression.

Plan of Care for Mrs. Gomez at Visit, Patient Education, and Follow-up

The main treatment plan of choice for MG includes diet, Sertraline, cognitive-behavioral therapy (CBT), and exercise.  MG should be placed on sertraline to manage depression. This medication is well-tolerated and accessible in a generic form (Guerrera et al., 2020).  The goal of treatment is to optimize the quality of life of MG to enable her to function emotionally and physically to the best of their ability. CBT is crucial for MG to help her cope with the loss of a spouse and move on with life. Exercise is critical in helping to improve mood and other health benefits such as improving diabetes and blood pressure.

Mrs. Gomez should be educated on the possible side effects of sertraline. Education should also cover the need to adhere to the medication’s proper dosage even after starting to feel better (Guerrera et al., 2020). She should be advised to report any problem or side effects she encounters during the treatment process. Mrs. Gomez should also be advised to create a sleep schedule. She should be discouraged from using certain drinks such as alcohol, sugary foods, and caffeine a few hours before going to bed. On the other hand, follow-up is necessary to determine the effectiveness of the medication (Schramm et al., 2019). Follow-up is also crucial in monitoring medication compliance since some patients do not report side effects or missing doses.

NSG 4055- Week 4 discussion References

Guerrera, C. S., Furneri, G., Grasso, M., Caruso, G., Castellano, S., Drago, F., … & Caraci, F. (2020). Antidepressant drugs and physical activity: a possible synergism in the treatment of major depression? Frontiers in Psychology, 11, 857. https://doi.org/10.3389/fpsyg.2020.00857

Paykel, E. S. (2022). Basic concepts of depression. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/espaykel

Schramm, E., Kriston, L., Elsaesser, M., Fangmeier, T., Meister, R., Bausch, P., … & Härter, M. (2019). Two-year follow-up after treatment with the cognitive behavioral analysis system of psychotherapy versus supportive psychotherapy for early-onset chronic depression. Psychotherapy and psychosomatics, 88(3), 154-164. https://doi.org/10.1159/000500189

Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: diagnosis and treatment. American family physician, 103(10), 605-613. https://pubmed.ncbi.nlm.nih.gov/33983002/

Respond to one of the following questions:

Review the Healthy People 2020 objectives for the older
adult. Of the objectives listed for the older adult, which do you feel is most
important? Be sure to include examples and references to support your response.

There are several vulnerable populations that have a chronic
illness (older; homeless; and lesbian, gay, bisexual, and transgender
populations) that face challenges when it comes to care. Choose one vulnerable
population and discuss what can be done to help alleviate these challenges.

Citations should conform to APA guidelines. You may use this
APA Citation Helper as a convenient reference for properly citing resources or
connect to the APA Style website through the APA icon below.

NSG 4055 Week 4 Project

Locating Resources

Locate a minimum of three community or national resources for your illness group chosen in Week 1, preferably in your community. Study these resources and write a report about them in a 4- to 5-page Microsoft Word document. Include in your response all the information the patient should know about them (the specific services they offer, fee schedules, if and when appropriate, criteria for eligibility, and any other important information).Discuss potential advantages and disadvantages for vulnerable populations in seeking these resources.

Support your responses with examples.

On a separate references page, cite all sources using APA format.

Use this APA Citation Helper as a convenient reference for properly citing resources.

This handout will provide you the details of formatting your essay using APA style.

You may create your essay in this APA-formatted template.

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APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate

program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

☐ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.

☐  The title page is present. APA format is applied correctly. There are no errors.

☐ The introduction is present. APA format is applied correctly. There are no errors.

☐ Topic is well defined.

☐ Strong thesis statement is included in the introduction of the paper.

☐ The thesis statement is consistently threaded throughout the paper and included in the conclusion.

☐ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.

☐ All sources are cited. APA style and format are correctly applied and are free from error.

☐ Sources are completely and correctly documented on a References page, as appropriate to assignment and APA style, and format is free of error.

Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.

Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.

Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.

☐ The writer is clearly in command of standard, written, academic English. Utilize writing resources such as Grammarly, LopesWrite report, and ThinkingStorm to check your writing.

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