Week 4 Discussion ANP

Discuss the Mrs. Gomez’s history that would be pertinent to her difficulty sleeping. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
Describe the physical exam and diagnostic tools to be used for Mrs. Gomez. Are there any additional you would have liked to be included that were not?
Please list 3 differential diagnoses for Mrs. Gomez and explain why you chose them. What was your final diagnosis and how did you make the determination?
What plan of care will Mrs. Gomez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

On further questioning, Mrs. Gomez denies any discomfort such as pain or breathing problems disturbing her sleep. She denies any snoring, apneic spells (a period of time during which breathing stops or is markedly reduced), or physical restlessness during sleep. Her daughter agrees that she has not seen these problems. She rarely consumes alcohol or caffeine.

Don't use plagiarized sources. Get Your Custom Essay on
Week 4 Discussion ANP
Get an essay WRITTEN FOR YOU, Plagiarism free, and by an EXPERT!
Order Essay

When you ask if anything like noise or an uncomfortable sleeping environment might be bothering her, she replies that this is not a problem – but her daughter interjects: “Yes, in fact Mom’s waking up the rest of us, walking around and turning on the TV. My husband and I both work. So we all need our rest. Mom came to live with us last year after Dad passed away. We’re her only family around here and we thought we should help her.”

She seems to be in slow motion most of the time. She doesn’t even go to church anymore. She used to go three to four times a week. She used to read all the time, and she doesn’t do that anymore either.”

Mrs. Gomez explains, “I haven’t been reading as much as I used to because I can’t seem to focus and I end up reading the same page over and over.” She goes on to say, “And I don’t seem to have any energy to do anything. I’m not even able to help out around the house. I feel bad about that; I should be helping out more. I seem to spend a lot of time just watching TV and eating junk food.”

Problem list:

Type 2 diabetes
Surgical history:

Hysterectomy (due to fibroids)

For diabetes:

Glyburide (10 mg daily)
Metformin (1,000 mg bid)
For blood pressure:

Methyldopa (250 mg bid)
Lisinopril (10 mg daily)
For cholesterol:

Atorvastatin (80 mg daily)
For CHD prophylaxis:

Aspirin 81 mg daily
For osteoporosis prevention:

Calcium citrate with vitamin D (600mg/400 IU bid)
Diphenhydramine is her only over-the-counter medication, and she is taking no traditional or herbal medications beyond the zapote tea.

Social History

She does not smoke, and drinks only small amounts of alcohol on holidays.

Given what you have heard from Mrs. Gomez and her daughter, especially

her inability to focus,
her lack of energy,
the sense that she is in slow motion,
she has stopped doing activities she previously enjoyed,
You are concerned that her insomnia may be due to depression. Depression may stem from environmental stressors such as her husband’s death and her loss of independence along with a primary neurochemical imbalance. Her depression also could be caused by another medical condition.

Keeping in mind the disorders associated with depression, you elicit a review of systems from Mrs. Gomez to help discover what these indicate regarding her underlying illness.

Constitutional: Mrs. Gomez has gained about 10 lbs in the last six months. She denies fevers or dizziness. This makes you less concerned about cancer or other systemic illness.

Respiratory: No shortness of breath, making cardio-respiratory disease less likely.

Cardiac: No chest pains, palpitations or edema, decreasing the likelihood of cardiovascular disease.

Gastrointestinal: No nausea, changes in bowel habits, hematochezia or melena. This makes you less concerned about gastrointestinal cancer or occult blood loss leading to anemia.

Endocrinologic: No polydipsia or polyuria, decreasing the likelihood of poorly controlled diabetes.

Neurologic: No acute neurologic changes or tremors. Her daughter confirms that patient has been alert, oriented and has had no episodes of confusion. So you are now less concerned about cerebral infarction, intracranial tumors, multiple sclerosis, and Parkinson disease.

Urologic: Normally urinates one to two times at night.

Vital signs:

Heart rate: 60 beats/minute and regular
Respiratory rate: 16 breaths/minute
Blood pressure: 128/78 mm Hg
Weight: 186 pounds (up 10 pounds since last year)
Height: 64 in
Head, eyes, ears, nose and throat (HEENT): No thyromegaly, adenopathy, or masses.

Cardiac: Regular rate and rhythm, no murmur or gallops. No edema.

Respiratory: Clear to auscultation.

Abdominal: Soft, nontender, without organomegaly or masses.

Neurologic: Cranial nerves 3-12 intact. Normal strength and light touch sensation in extremities. No tremors. Normal gait.

You locate Dr. Lee and present the case to her, expressing your concern that Mrs. Gomez is depressed. She suggests discussing the evidence you found that Mrs. Gomez may have depression.

You tell Dr. Lee, “Mrs. Gomez has depressed mood and seven of the nine criteria.”
Major Depression Diagnostic Criteria
For a diagnosis of major depression, the patient must have at least five of the following nine criteria for a minimum of two weeks.
A least one of the symptoms must be either (1) depressed mood or (2) loss of interest or pleasure.
Depressed Mood

(The eight remaining criteria can be remembered using the mnemonic SIG E CAPS):

Sleep: Insomnia or hypersomnia nearly every day.

Interest (loss of): Anhedonia (loss of interest or enjoyment) in usual activities.

Guilt: Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

Energy (decreased): Fatigue or loss of energy nearly every day.

Concentration (decreased, or crying): Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

Appetite (increased or decreased): or significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month).

Psychomotor retardation: Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

Suicidal ideation: Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

The Homework Market
Order NOW For A 10% Discount!
Pages (550 words)
Approximate price: -

Why Choose Us

Top quality papers

We always make sure that writers follow all your instructions precisely. You can choose your academic level: high school, college/university or professional, and we will assign a writer who has a respective degree.

Professional academic writers

We have hired a team of professional writers experienced in academic and business writing. Most of them are native speakers and PhD holders able to take care of any assignment you need help with.

Free revisions

If you feel that we missed something, send the order for a free revision. You will have 10 days to send the order for revision after you receive the final paper. You can either do it on your own after signing in to your personal account or by contacting our support.

On-time delivery

All papers are always delivered on time. In case we need more time to master your paper, we may contact you regarding the deadline extension. In case you cannot provide us with more time, a 100% refund is guaranteed.

Original & confidential

We use several checkers to make sure all papers are plagiarism-free and do not share them with third parties.

24/7 Customer Support

Our support agents are available 24 hours a day 7 days a week and committed to providing you with the best customer experience. Get in touch whenever you need any assistance.

Try it now!

Calculate the price of your order

We'll send you the first draft for approval by at
Total price:

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

No need to work on your paper at night. Sleep tight, we will cover your back. We offer all kinds of writing services.


Essay Writing Service

You are welcome to choose your academic level and the type of your paper. Our academic experts will gladly help you with essays, case studies, research papers and other assignments.


Admission help & business writing

You can be positive that we will be here 24/7 to help you get accepted to the Master’s program at the TOP-universities or help you get a well-paid position.


Editing your paper

Our academic writers and editors will help you submit a well-structured and organized paper just on time. We will ensure that your final paper is of the highest quality and absolutely free of mistakes.


Editing your paper

Our academic writers and editors will help you submit a well-structured and organized paper just on time. We will ensure that your final paper is of the highest quality and absolutely free of mistakes.