Nursing homework help| Nursing homework help
Date of the Visit: March 7th, 2021
Principal Complaint: Reports of suicidal ideastion and anxiety are being made by the patient.
Subjective data: Feels overwhelmed and anxious about the job loss due COVID-19. Although he has been thinking about his death, he hasn’t made any plans or intentions to end his own life. During our current session, the patient does not seem to be in distress.
The objective data/assessment revealed that the patient has both psychomotor retardation as well as agitation with labile emotion throughout today’s session. This confirms a diagnosis for Depression with Anxiety Disorder NOS Mild Severity. The PHQ-9 score is 15/27 indicating Moderate Depressive Symptoms while GAD7 score was 13/21, indicating moderate Anxiety symptoms Plan & Recommendations: Prescribed medication Sertraline 25mg qhs and initiated Dialectical Behavior Therapy (DBT) as outpatient therapy in order to reduce severity of symptoms associated with recent depression & anxiety Diagnosis :Depression with Anxiety Disorder NOS Mild Severity
2. Patient:: Mrs A Age 58
Date of the Visit: March 10th, 2021
Chief Complaint:: Patient presents complaining difficulty sleeping as well as social withdrawal Subjective data:: Experiencing significantly impaired sleep onset averaging 2 hours per night for last 4 weeks alongwith significant decrease activity levels including anhedonia avoidance behaviours previously enjoyed activities Objectives Data/ Assessment :PHQ 9 Score 20 ,GAD7 14 suggesting moderate level depression ,positive findings noted from vital signs confirm physiological distress .Mini Mental Status Exam MMSE 28 demonstrates mild cognitive impairment possible existence underlying dementia diagnoses- Clinician administered Drug Abuse Screening Test DAST 10 provides insight into drug used opinions patient involved illicit use drugs indicates result negative no involvement recreational drugs prescribed medications for hypotension rule out possible coexisting physical conditions exacerbating mental illness prescription Amitriptyline 25 mg qHS initiate Cognitive Behavioral Therapy CBT address issues primary care doctor recommendations MRI study performed assess etiology insomnia plan & recommendation ::prescribe amitriptyline 25mg PO HS initiation CBT program addressing concerns lack self confidence perceived worthlessness increased risk suicide thought management Diagnosis -Major Depressive Disorder Severe without psychotic Features
3. Patient –Mr B age 64 Date visit – march 12th 2021 Overall complaint – presenting complaints regarding memory difficulty Subjective data –Reports occasional forgetfulness confusion making daily decisions reports difficulty focusing attention difficulties forming sentences long duration conversations Objective DATA /ASSESSMENT Mini-Mental Status Examination MMSE 24 points suggestive possibility Alzheimer’s Disease AD confirmed diagnosis made after obtaining results Neuropsychological Testing NP testing specifically Montreal Cognitive Assessment MoCA 16 points indicate higher likelihood frontotemporal disorder FTD also finding suggests presence Lewy Body Disease LBD noting fluctuations cognition planning & recommendation Adequate hydration vitamin dietary supplementation monitoring Alprazolam 0 5mg QHS treat MOTO agitated state administration Rivastigmine 1 6mg Bid assist SLGT executive functioning impairments providing explanation strategies cope common forgetfulness enhance awareness promote healthy lifestyle habits supplements recommended organize environment improve focus concentration Diagnosis ; Probable FrontoTemporal Disease 4. Patient–Mrs C age 72 Date visit–March 14th2021 Chief complaint–The patient’s daughter brought her mother in because she felt something was wrong; patient denied any specific complaints Subjects data—The patient apologized constantly for being confused saying that she cannot remember things that should easily come to mind She states that she feels like her mind just went blank at times Objective data assessment––MMSE 17 suggested development dementia short term memory deficits observed reduced ability recall names dates events evidence apraxia especially speech language comprehension limited visual hallucinations detected FAB battery 3 suggestive behavioural variant frontotemporal dementia FTD diagnose phenobarbital 30 mg tid control sundowning behaviour Lorazepam 0 5MG continued PRN help manage restlessness accompanying Agitation offer recommendations ensure proper nutrition hydrate himself Abilify 2 mg QPM increase appetite combating malnutrition related cognitive decline provided counseling family member caretakers educate impact progress disease available services resources home health aides hospice providers assisted living facilities investigate other therapeutic option distraction techniques sensory deprivation breaks alleviate frustration meaningful activities keep busy maintain independence autonomy functionally socially curently diagnosed—-Lewy body disease suspected comorbidities —-Vascular Dementia.