Treatment for a Patient With a Common Condition

CASE STUDY: An Elderly Widow who just Lost her spouse.
SUBJECTIVE: A patient presents to your primary care office today with the chief complaint of insomnia. The patient is 75 years old with PRIMARY MEDICAL HISTORY of:
DIABETES, Hypertension, and Major Depressive Disorder ( 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. She has no history of depression prior to her husband’s death. She is awake and alert, and oriented x 3. The patient normally sees PCP once or twice a year. Pt denies any suicidal ideations. The patient arrived at the office by private vehicle. She currently takes the following medications: (a) Metformin 500mg BID, (b) Januvia 100mg daily, (c) Losartan 100mg daily, (d) HCTZ 25MG DAILY, (e) sertraline 100mg daily, Current weight: 88 kg, Current Ht: 64inches, Temp: 98.6f, BP: 132/86.
ASSIGNMENT INSTRUCTIONS ARE (1) List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
(2) Identify people in the patient’s life you need to speak to or get feedback from to assess the patient’s situation further. Include specific questions you might ask these people and why.
(3) Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results will be used.
(4) List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
(5) List two pharmacologic agent and their dosing that would be appropriate for the patients’ antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
(6) For the drug therapy you select, Identify any contraindication to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/ alteration you identified exists. That is, What would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
(7) Include any checkpoint, and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
(8) Provide at least four scholarly references in APA writing style. Write clearly and answer all parts of the discussion questions clearly without any spelling or grammar errors.
(8) Respond to TWO of your classmates in one of the following ways:
(a) If your classmates’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insight you gained.
(b) If you think your classmate might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.
WRITER, PLEASE NOTE: I WILL UPLOAD THE CLASSMATE’S POSTS TO YOU FOR YOUR RESPONSE AS SOON AS THEY BECOME AVAILABLE. Please provide TWO references each for the two classmates’ responses. I will need the responses back after your response ASAP.

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