Mildred is a 45-y.o. married female with three children. She presents to you with complaints of fatigue and difficulties sleeping. She states she wants to get a good night’s sleep and is requesting a prescription to help her sleep. Mildred tells you she is awake off and on during the night, frequently thinking about her husband’s recent layoff from construction work and the effect this is having on the family. She lies down often during the day and has been so fatigued that she took some time off from work during the last 2 weeks. She is tearful at times during the visit and looks sad and anxious. On further discussion, she says she feels overwhelmed, helpless, and anxious. She tells you about an episode where she felt her heart beating rapidly, had difficulty catching her breath, felt she was going to have a heart attack, and became frightened until her husband was able to help calm her down. She is not eating as much as usual, and when she reads the newspaper, she doesn’t remember what she has read.There are a multitude of questions to answer. I ask that if you give a treatment plan in your discussion that you also include why you chose it, and why you didn’t chose a different plan.
- What would your focused clinical assessment include?
- What are your initial differential diagnoses?
- What major psychological question needs to be addressed?
- What testing would you order to rule out any medical problems?
- What is your plan of care?
- What are the mainstays of treatment?What is your initial follow up plan?
- What education would you provide to your patient?
- Post an initial substantive response of to each questions as an FNP. Use Diagnostic Reasoning to answer each question.
- Please be sure to validate your opinions and ideas with in text citations and references in APA format. 250 words minimum.
- References and citations should conform to the APA 6th edition.
Expert Solution Preview
Introduction:
Mildred presents with complaints of fatigue, difficulties sleeping, anxiety, and feelings of overwhelming helplessness. She has a recent history of heart palpitations and shortness of breath, which suggests possible underlying medical issues. In this case, comprehensive clinical assessment is vital to evaluate Mildred’s overall health and identify an appropriate course of treatment.
1. What would your focused clinical assessment include?
My focused clinical assessment would include a thorough physical examination, assessment of the patient’s vital signs, and medical history. Additionally, I would evaluate Mildred’s sleep pattern and dietary habits. It is important to determine if Mildred is experiencing depression or anxiety symptoms. Mental status examination and a review of the patient’s current medications and supplements may also be necessary.
2. What are your initial differential diagnoses?
The initial differential diagnoses for Mildred may include anxiety disorder, depression, insomnia, and possibly pulmonary or cardiac diseases. The shortness of breath and heart palpitations experienced by the patient suggest a possible cardiac condition that needs further evaluation.
3. What major psychological question needs to be addressed?
One major psychological question that needs to be addressed is why Mildred is experiencing feelings of overwhelming helplessness. Psychological evaluation of the patient’s emotional state, coping mechanisms, and support systems can provide valuable information.
4. What testing would you order to rule out any medical problems?
To rule out medical problems, I would order blood tests to evaluate Mildred’s thyroid function, CBC, electrolytes, and liver and kidney function. An electrocardiogram would also be necessary to rule out any underlying cardiac conditions. If needed, testing for sleep apnea may also be considered.
5. What is your plan of care?
The plan of care for Mildred would involve a combination of medication and therapy. Initially, I would prescribe short-term medication for insomnia and anxiety. Mildred would also be referred for cognitive-behavioral therapy to help her address her emotional issues. A follow-up appointment would be necessary to evaluate the effectiveness of the treatment.
6. What are the mainstays of treatment? What is your initial follow-up plan?
The mainstays of treatment for Mildred would be medication management and psychotherapy. The initial follow-up plan would involve monitoring the effectiveness of the prescribed medication and therapy. Adjustments would be made as necessary.
7. What education would you provide to your patient?
I would educate Mildred on the importance of regular sleep hygiene practices and the potential side effects of her prescribed medication and supplements. Additionally, I would provide her with information on stress management techniques and resources for ongoing counseling and support.
