Insomnia

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient鈥檚 health needs.

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and 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. The patient has no previous history of depression prior to her husband鈥檚 death. She is awake, alert, and oriented x3. Patients normally see PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:

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路聽Metformin 500mg BID

路聽Januvia 100mg daily

路聽Losartan 100mg daily

路聽HCTZ 25mg daily

路聽Sertraline 100mg daily

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

Post聽a response to each of the following:

路 List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

路 Identify people in the patient鈥檚 life you would need to speak to or get feedback from to further assess the patient鈥檚 situation. Include specific questions you might ask these people and why.

路 Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

路 List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

路 List two pharmacologic agents and their dosing that would be appropriate for the patient鈥檚 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.

路 For the drug therapy you select, identify any contraindications 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 identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

路 Include any 鈥渃heck points鈥 (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.