Chief Complaint: Mrs. Lane is a 42-year-old Korean American female who presents stating, I’m just so. Question
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Chief Complaint: Mrs. Lane is a 42-year-old Korean American female who presents stating, I’m just so sad, I cannot stop crying. My primary care provider sent me because she says I am depressed and she started me on Lexapro.
History of Present Illness
Onset: Past three months worsening of moods, no interest in going out, seeing family, and cooking.
Location: Is distracted at home.
Duration: Depression was diagnosed in primary care two years ago.
Characteristics: Mrs. Lane reports that she has a history of Major Depressive Disorder and Generalized Anxiety Disorder, which is recurrent and was diagnosed by her primary care provider three years ago.
She reports that she was started on Lexapro 10 mg and felt some better, until the last couple of months when, she states, I just feel off. She has a depressed mood and her affect is congruent. She has difficulty falling asleep and staying asleep, as she wakes most nights in the middle of the night.
Her appetite is the same, but she has a great deal of trouble concentrating on tasks and has an increase in poor memory. Her memory issues worry her the most, and she inquires if she should be tested for Alzheimers.
She also states she lacks motivation to cook for her family and has not had them over for a meal for three months. Her favorite day of the week used to be Saturdays, when she cooked for her entire family.
Aggravating: With stress and less sleep.
Relieving: Sometimes reading in bed and talking to family during the daytime helps.
Temporal: Worse in the a.m. at first waking and at bedtime before sleep.
Severity: I feel sad a lot and like everything is in gray shades. I think I’m getting worse.
Questions:
1. Differentials: List the three most likely differential diagnoses based on her objective findings, with cited rationale.
2. What is the etiology/pathophysiology associated with each diagnosis?
3. What is the prevalence of each of these diagnoses?
4. Develop a plan of care for each of the three differential diagnoses, including the following:
5. Diagnostic testing
6. Pharmacologic interventions, including dosage, route, and frequency
7. Nonpharmacologic interventions, including modality and frequency
8. Education, including health promotion, maintenance, and psychosocial needs
9. Safety plan
10. Referrals required
11. Follow-up, including return to clinic (RTC) in what time frame and reason, including any labs needed for next visit
SCIENCE
HEALTH SCIENCE
NURSING
NU 643
Chief Complaint: Mrs. Lane is a 42-year-old Korean American female who presents stating, I’m just so
