Psychiatric nursing Case Study


Case Study

List of questions to the patient
· What medical conditions do you have or might have been diagnosed?
· Do you have medical conditions such as high blood pressure or diabetes?
· Did you had any childhood illness such as measles or chicken pox?
· Does any member of your family have similar conditions of depression?
· Are you currently on any kind of medication?

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· If yes, what is the name of the medications that you are currently undertaking?
· Have you ever been treated for depression in the past?
· Do you take or have you taken in the past any kind of illicit drugs? Other people in the patient’s life to get the feedback
· The parents
These are the family member that gives good details concerning the childhood history of the patient concerning various illness.
· Teachers
Teachers will be able to give the various conditions that the patient experienced while in school. · Nursing home aides
These are the people who will give the past medical history of the patient. Additional physical exam
The additional diagnostic tests that can be done include cholesterol, the blood pressure, and the blood sugar levels. The need to conduct these tests is because the levels may be high in the patient without showing any signs. The physical examination will help to establish other problems that the patient may be suffering before treating the primary illness.
Differential Diagnoses for the Patient

Condition Differentiating signs Differentiating tests
1. The adjustment of the disorder with some depressed mood. This is kind of syndrome depression that has a clearly identified precipitating event. This does not need medication. DSM-5
2. The medical illness that is associated with depressive disorders. Depressive signs short of the diagnostic criteria for the major depression due to substance use. Use of the medical history, physical examination, hematological tests that will help in ruling out somatic medical illness.
3. Dementia This is characterized by some memory changes, psychiatric signs, changes in the personality, problem behaviors and changes in the body functioning. Mental state exam or conduct the neuropsychiatric testing when there is uncertainty in the diagnosis having a focused laboratory testing for identifying the causes of dementia (Maier et al. 2015).

The most likely differential diagnoses are dementia. It has a wide number of symptoms that are normally associated with the loss of memory. It reduces the ability of the individual to perform their daily activities (Hirschfeld, 2014).
Pharmacologic agents and their dosing
· Amitriptyline HCL
The dosing of this pharmacologic is normally 1 to 4 times daily, and it is taken orally.
· Cymbalta
This dosing of this pharmacologic is normally one to two times every day as directed by the doctor. It is in form of a capsule and should be taken with or without food (Murphy & Peterson, 2015).
Action Perspective
Cymbalta would be the best compared to Amitriptyline HCL in dealing with the ailment due to the following reasons. Cymbalta improves the moods of the patient, improves the sleep, increases appetite, and reduces the nervousness (Murphy & Peterson, 2015). It also helps in restoring serotonin and the norepinephrine in the brain
Lessons Learnt
From the above case study, it is learned that it is necessary to conduct a routine test on the basic physical examinations such as body pressure, heart rate, and the blood sugar levels. This will help to identify the wellness of the patient before commencing further treatment. It is during the physical examination that the basic questions on the health of the patient are asked. From there, the different test can be done regarding the illness.

References


1. Hirschfeld, R. M. (2014). Differential diagnosis of bipolar disorder and major depressive disorder. Journal of affective disorders, 169, S12-S16.
2. Murphy, M. J., and Peterson, M. J. (2015). Sleep disturbances in depression. Sleep medicine clinics, 10(1), 17-23.
3. Maier, R., Moser, G., Chen, G. B., Ripke, S., Coryell, W., Potash, J. B., and Landén, M. (2015). Joint analysis of psychiatric disorders increases the accuracy of risk prediction for schizophrenia, bipolar disorder, and major depressive disorder. The American Journal of Human Genetics, 96(2), 283-294.
4. Frankland, A., Cerrillo, E., Hadzi-Pavlovic, D., Roberts, G., Wright, A., Loo, C. K., and Mitchell, P. B. (2015). Comparing the phenomenology of depressive episodes in bipolar I and II disorder and major depressive disorder within bipolar disorder pedigrees. The Journal of clinical psychiatry, 76(1), 32-8.
5. Goldstein, B. I., Carnethon, M. R., Matthews, K. A., McIntyre, R. S., Miller, G. E., Raghuveer, G., ... and McCrindle, B. W. (2015). Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease. Circulation, 132(10), 965-986.

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