The patient appears older than stated age. She denies neck stiffness or neck pain. E. Gregory Thompson MD - Internal Medicine. Pietrangelo, A. Registered Data Controller No: Z1821391. Pagana KD, Pagana TJ (2010). Journal on Addiction, 105(3), 87-99. At one point, the pastor accused her husband of theft of his laptop computer and a credit card; even though, it was later shed to light that one of the young people in the church had been the culprit and no apology was ever given to her husband. Learn how we develop our content. The patient will continue with treatment at this clinic. Patient understanding of their illness affects how they feel. These citations may not conform precisely to your selected citation style. Thinking Process: due to the patient chronic back pain, patient is on Cymbalta, an SNRI antidepressant used for treating depression, anxiety, and pain. The patient reported that she loves her children and will do anything for them. General appearance: Dressed appropriately for the season. A mental health clinician’s view of cultural competence training. She is family oriented, but due to circumstances she did not explain, she had distance herself from her sibling and mother. Again, both couples were assisting their pastor on a yard sale, the proceeds from the yard sales were stolen, including some discount cards, the patient husband was accursed again, but the thief was later discovered. Mother has had substance abuse problems, mainly cannabis and alcohol. Depression and anxiety are suspected diagnosis made based on patient history and physical findings. The patient denied use of alcohol or substance. Cultural History:  Patient said that she is a family-oriented person, but due to the current problem she is having, her brother and mother are not supportive. Fischbach FT, Dunning MB III, eds. Tell your doctor if you are getting iron therapy for iron deficiency anemia. Alcohol: Denied. Upon arrival at the clinic, the patient signed a confidentiality agreement form after brief education regarding how her medical information will be used. Current as of: It is done to help diagnose cystic fibrosis.Normally, sweat on … Respiratory:  She denies difficulty breathing, however, when she starts having a panic attack, Thinking Process:  Patient has difficulty breathing during panic attacks, Gastrointestinal: She reports recurrent epigastric pain, relieved with Prevacid. Philadelphia: Lippincott Williams and Wilkins. Family History: Patient reports that her mother was adopted. Thinking process: patient maintained good eye contact. Thinking about the Diagnosis and the treatment plans: Her personal and social history has proved that patient lack good functional ability, which is consistent with depression. For medical advice relating to your personal condition, please consult your doctor. Patient has been raising her twice 7yrs old’s and a 10yr old’s daughter; patient has not worked for a long time, her husband worked up until, he lost his job. (2009). Many versions have been tailored, including well thought-out interview guides, introspective forms, and computerized versions. HEENT: The patient states that she needs eyeglasses but cannot afford to buy them. The patient stated “I have been feeling depressed, anxious and under stress” depression need to be considered as potential diagnosis, the other diagnosis generalized anxiety and sleep apnea disorder due to excessive daytime sleepiness, awakening SOB, frequent arousals, and fatigue. As such, she can have additional income to support her monthly bills. Disclaimer: This dissertation has been written by a student and is not an example of our professional work, which you can see examples of here. Patient’s son has ADHD. When Wellbutrin is administered, a little bit of dopamine is released in the nucleus accumbens, making the craving less but usually not eliminating it (Stahl, 2013). No throat pain and denies any neck pain. Because the patient complains of an occasional headache, suggesting MRI may be an option. Based on all these stressors, the symptoms the patient present with, and DSM V criteria, the diagnoses of major depression without psychotic features were chosen. She and her husband moved to Baltimore in 2005 because her husband had lost his trucking job and they had become homeless. Her last dentist appointment was two years ago. Her aunt on maternal side has hypothyroidism. An abnormal amount of normal hemoglobin or an abnormal type of hemoglobin in the blood may mean that a disease is present. Although the patient has obstructive apnea, the reason she does not sleep much at night is to care for her child. However, PET scanning is problematic for use because it requires complex equipment and uses radiation. African Americans take their seriously, and they expect to receive a message in preaching that helps them in their daily lives (Purnell, 2013). (2009). Patient has no strength, unemployed, homeless, and husband is jobless with children, culture aspect of care, patient brother and mother are not supportive. A. Low levels (hypothyroidism) can mimic symptoms of mental illnesses or exasperate the symptoms of mental illness. … Major depression. A warm compress can be used several times a day to treat this. Tran, N. & Castle, D. (2012). She reports that the depression has been poorly controlled, but tobacco usage has been tapered down. This makes the veins below the band larger so it is easier to put a needle into the vein. She denies nausea, vomiting or diarrhea, no blood in stool or black tarry stool. Philadelphia: Lippincott Williams and Wilkins. Fischbach FT, Dunning MB III, eds. COVID-19 Vaccines: Information about COVID-19 vaccines and how we're preparing for distribution. The AIMS test is used to distinguish TD and to follow the severity of a patient’s TD over time. Acuity was tested by using the Snellen chart (near and distant vision). Philadelphia: Lippincott Williams and Wilkins. Major depression is a risk factor for HIV by its impact on behavior, intensification of substance abuse, and exacerbation of self-destructive behavior. There is no history of psychiatric hospitalization. Thinking about the Diagnosis and treatment plan: The demographic introduce the patient to the Psychiatric Mental Nurse Practitioner (PMHNP). The family is the foundation on which most societies are built. Manual of Laboratory and Diagnostic Tests. Philadelphia: Lippincott Williams and Wilkins. She frequently has a problem with motivation. Pagana KD, Pagana TJ (2010). Pagana KD, Pagana TJ (2010). (2009). Her father does not have a psychiatric history. Patient reports having nerve ablation but thinks that the nerves have been growing back which has made the pain worse. Both soft palates retract symmetrically. Her husband has been supportive even though things have been rough. Fischbach FT, Dunning MB III, eds. To perform the Rinne test used to evaluate loss of hearing in one ear, its perception of sounds transmitted by air conduction to those by bone conduction through the mastoid. St. Louis: Mosby. Diabetes and hypertension are present on both family sides. Pagana KD, Pagana TJ (2010). She got married 11 years ago and presently seeking employment with Safeway supermarket. Chernecky CC, Berger BJ (2008). Thinking Process: With no history of seizures the patient just has reported having migraines and diagnosed with restless leg syndrome. The patient was born by a healthy pregnancy, reported by the best of her ability. Intellectual functioning: Intelligence is average. Result was negative, Recommended mammogram:  Not appropriate age. She has used Cymbalta up to 60 mg and Wellbutrin up to 200 mg twice daily at various times. Substance dependence is common among patients with depression, may induce or exacerbate depressed mood and associated risk. Philadelphia: Lippincott Williams and Wilkins. She reports no problem with hearing, no discharge from the ear. Other Works Consulted. The patient will be referred to her primary care physician to discuss how to better manage her medical conditions. Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. She reports that these feelings may last about 3 hours and has on two occasions lasted about three days. Chernecky CC, Berger BJ (2008). All patients’ labs are within normal limit (Fischbach& Dunning, 2009). Olfactory function: Coffee or perfume are frequently utilized in testing of olfactory function. Put the needle into the vein. The study endorsed at least two current symptoms of depression found that current major depressive disorder was present in 66% cases. The large Allen cognitive level screen as an indicator for medication adherence among adults accessing community mental health services. Hematological: patient reports no known hematological disorder (Seidel, 2015). Fischbach FT, Dunning MB III, eds. She states that she needs help with her mental health. Due to caring for her child at night, her CPAP machine monitor often indicates that she is not using it as needed She denies any suicidal ideations or thoughts. (2009). The labs were done to determine if some of the symptoms the patient is experiencing are related to her medical condition. Since the patient has been diagnosed with depression as a teenager, using the PHQ-9 questionnaire will be appropriate. This can be used to diagnose certain types of. Thyroid: Free T4 (1.27ng/ld. The Beck Depression Inventory (BDI) was founded by Aaron beck in 1961 to be the most widely used self-rating scale. She does have CPAP machine that she uses at night for sleep. The Hamilton Depression Rating Scale is widely used in the county to rate the patient level of depression in an inpatient setting. Philadelphia Baltomore New York : Wolterskliwer Health. It is imperative to assess the patient using the AIMS tool because the patient has been prescribed psychoactive medications. The AIMS is a 12-item anchored scale that is clinician given and scored on the rate of 0-4 (0 = none, 4=severe) based on the assessment. The AIMS require the raters to compare the observed movements to the average movement disturbance seen in person with TD. Patient has been given the emergency access phone number to the local crisis center and encouraged to call 911 if symptoms become severe. Manual of Laboratory and Diagnostic Tests. Family history shows that mother was depressed with history of substance abuse, but father and brother have no psychiatric problem. 6th ed. She is of the Catholic faith, but only occasionally attends church. The patient did report some of these symptoms when giving the history of present illness. These include Addison disease, Cushing syndrome, hyperthyroidism, hypothyroidism, and hyperparathyroidism. Fischbach FT, Dunning MB III, eds. Also, the patient was educated to try nicotine patch as a beginning strategy for smoking cessation and to choose from the above-recommended therapy. Pagana KD, Pagana TJ (2010). She was able to ask questions, discuss the side effects in detail and verbalized understanding of the teachings. Wellbutrin has been proven to be effective in the treatment of nicotine addiction (Stahl, 2013). She now smokes. Hemoglobin is the substance in red blood cells that carries oxygen. For lateral and vertical gaze, patient was asked follow interviewer’s finger horizontally and vertically. During this period of panic mode, she becomes tachycardic, has difficulty taking a deep breath, elevated blood pressure and sense of impending doom. (2009). EPR is used for improvement in the management of chronic respiratory disease, the program takes three sessions of supervised exercise per weeks, along with education and psychosocial support, which significantly reduce anxiety and depression more than standard care in patients with OSA (Heslop, 2014). General Health: patient reports no recent fever or sweats. Manual of Laboratory and Diagnostic Tests, 8th ed. Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. Pagana KD, Pagana TJ (2010). Peripheral vision tested by asking the patient to cover one eye and to look at interviewer’s nose. Direct effect that OSA can cause daytime fatigue, disturbed sleep, irritability, memory problems, and decreased the quality of life. Patient has no evidence of developmental delays or issue from birth. Personal/Social History: The patient was born in southern part of the country. Seidel’s guide to physical assessment. Doi: 10.1111/j.1360-0443.2009.02757.x, American Psychological Association (2013). No plagiarism, guaranteed! Patient reports going into “panic mode” where she feels that her whole body will explode. Current as … The DSM-V criteria were met in the above patient demography. The soft palate was touched, and. Able to explain what she will do if when she gets to a stop sign while driving, she responded: “I will stop”. You can lower the chance of bruising by keeping pressure on the site for several minutes. All work is written to order. Thinking Process: She has reported no known hematological disorder (Seidel,2015). Doi: 10.1080/13548506.2011.579986, Seidel, H., Ball, J., Dains, J., & Benedict, G. W. (2011). Anxiety and Depression. Philadelphia: Lippincott Williams and Wilkins. Créditos. Patient has Medicaid insurance; her primary language is English. Developmental History: The patient was born at full term virginal birth, started walking with assistance at nine months and finally walking without support at 12 months old. There are 10 questions with rating scale of 0-3 (0= not at all, 3=nearly every day) that shows how often the patient experience any depressive symptoms over the last two weeks. Face obtained information to face interview with the patient and review of medical record. Fischbach FT, Dunning MB III, eds. The negative sequela of medication nonadherence as explained to the patient is that it can result in reduced quality of life for her, her /families and her potential career. The patient has had several miscarriages. Sleep Disorder: of the various sleep disorders, obstructive sleep apnea can cause significant medical and psychiatric symptoms and is often missed as a diagnosis. Pagana KD, Pagana TJ (2010). Manual of Laboratory and Diagnostic Tests, 8th ed. Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). This system eliminates participant and researchers’ bias, which can compromise result of the trial. Pagana KD, Pagana TJ (2010). © 1995-2020 Healthwise, Incorporated. This means that a value that falls outside the normal values listed here may still be normal for you or your lab. It may feel tight. Abnormal hemoglobin types may be present without any other symptoms, may cause mild diseases that do not have symptoms, or cause diseases that can be life-threatening. Fischbach, Frances Talaska.Dunning, Marshall Barnett.A Manual Of Laboratory And Diagnostic Tests. Thinking process: Patient has clarity. A copy of the confidentiality agreement and consent form was given to the patient. You may get a small bruise at the site. There is no nystagmus noted, V –       The cheek is touch lightly with a wisp of cotton with eyes closed. “No diagnostic laboratory tests are available to diagnose the major depressive disorder or anxiety disorder, but focused laboratory studies may be useful to exclude possible medical illnesses that may present as major depressive disorder and anxiety disorder. Thinking Process: Patient dressed appropriately for the season. Patient has been depressed since she was 16 years old and has been on Wellbutrin and Cymbalta: Some medication adjustment followed by family therapy will be effective for treating depression (Pietrangelo, A. She and her family have had some difficulties with their church of choice. This panic mode she communicates comes after periods of not able to pay her monthly bills. She has a complete set of own teeth. Education History: The patient stopped school twice, due to her illness, she was able to earn her GED after marriage. Manual of Laboratory and Diagnostic Tests, 8th ed. F33.2- Major Depressive Disorder (MDD): Depression is a common and complicated Illness. Fischbach FT, Dunning MB III, eds. Higher-than-normal amounts of both hemoglobin A2 and, Hemoglobin S in moderate amounts can mean that, Hemoglobin C in low amounts can mean that. Speech patterns: Very circumstantial and tangential with rate and tone. Meta-analysis: Accuracy of quantitative ultrasound for identifying patients with osteoporosis. She states her last physical exam was October 2013. The lifetime prevalence of the major depressive disorder in the United States is about 16% (Amanda et al. (2009). Also, the patient will be referred to community dietician and diabetes educator that will assist patient in planning her diet to make them healthier. The patient goes into panic attack due to inability to pay her bills, and husband is also jobless. It may feel tight. Manual of Laboratory and Diagnostic Tests, 8th ed. The patient believes that her illness is not permanent and prayer to a higher being will help her through the ordeal. Couples and family therapy has demonstrated to have a clear role in the treatment of numerous specific psychiatric disorders, often as a component of a multi-method treatment (Sadock, Sadock, & Ruiz, 2015). The study conducted by Cairns, Hill, Dark, McPhail & Gray (2012) concluded that poor adherence to prescribed treatment regimens undermines treatment benefits and reduces the predictability of medication action, increasing the likelihood of symptoms relapse, longer recovery times, the frequency of hospitalization and sustained functional impairment. Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. The annual prevalence rate is up to 25% in the patient with the chronic medical illness. Each topic is scored on a 5-point scale or 3-point scale, Showing absent, doubtful, or present symptoms (Heslop, 2014). Manual of Laboratory and Diagnostic Tests, 8th ed. Pietrangelo. Philadelphia:  Wolters Kluwer, Sampaio, R., Pereira, M.G., & Winck, J.C. (2011). Low educational level among African Americans may limit their access to information about etiology and treatment of mental illness. (2015, January 28)). The patient suffered psychiatric damages due to her relationship ending. There is no indication currently to commit the patient to an inpatient facility because she is not a danger to herself and others. Such a person may not fit into the society, and when they make decisions, it is irrational or irrelevant. Albumin: 4.5. The patient is currently in outpatient treatment clinic for management of her mental health. She started drinking at age 14. Thinking process: Able to spell the word “twitter” in forwarding and backward directions correctly. Several factors have been found to contribute to obesity among people with mental illness. The patient is of Catholic faith and currently unemployed. She said that she will get back to the Practitioner regarding the nicotine patch at next visit. She denies hearing or seeing things that others do not see or hear. All patients’ labs are within normal limit (Fischbach& Dunning, 2009). Such relative judgments may differ among raters with diverse backgrounds and knowledge (American Psychiatric Association, 2013). She lives with her husband, and three children in a two-bedroom government house. Also, your doctor will evaluate your results based on your health and other factors. Washington, DC: Author, Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2009). Please use this display as … Philadelphia: Lippincott Williams and Wilkins. She said that there are not any specific cultural issues in her family. No known medical problem during patient childhood age. Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. Manual of Laboratory and Diagnostic Tests, 8th ed. Retrieved March 09, 2018, from http://www.anxietycentre.com/anxiety-statistics-information.shtml, Keltner, N., Bostrom, C., & McGuinness, T. (2011). She does not feel discriminated against in the neighborhood they live. (2009). The level of obesity in mental illness is approximately 1.5-2.0 time higher than the general population. (2017, April 25). Reasons you may not be able to have the test or why the results may not be helpful include: If you are planning to have children and are found to have abnormal types of hemoglobin in your blood, you might consider genetic counseling. For example, hemoglobin S is found in sickle cell disease, which is a serious abnormality of the blood and causes serious problems. Other support measures will be further. A study conducted by Sampaio, Pereira & Winck (2011) finds indirect physical and psychological complications associated with OSA. Patient denies hesitancy, burning on urination or hematuria. Her brother accidentally hit her on the head one day when they were playing in the yard during second grade but did not lose consciousness. Fischbach, F. T., & Dunning, M. B. A patient with normal hearing continue to hear the sound. Fischbach FT, Dunning MB III, eds. Wrap an elastic band around your upper arm to stop the flow of blood. Beck depression inventory: BDI-II. Free resources to assist you with your university studies! (2009). She started walking without assistance at 12 months old. The PHQ-9 was developed to assist clinicians with diagnosis of depressive disorder and to monitor the severity overtime for newly diagnosed patients or patients in current treatment for depression. Those with migraines about 25% of them report to having depression. We're here to answer any questions you have about our services. Print. Fischbach, F. T., & Dunning, M. B. The patient was born in the southern part of the country; patient has past young adulthood still her mental health problems are affecting her ability to secure a job, which is a primary developmental focus. Philadelphia: Lippincott Williams and Wilkins. (2013). Diagnostic tests are utilized to gain supplementary information about the patient and these tests may aid in confirming diagnosis when used in addition to a thorough health history taking and physical assessments (Fischbach & Dunning, 2009). Insight and Judgment: Appropriate. Fischbach FT, Dunning MB III, eds. Manual of Laboratory and Diagnostic Tests, 8th ed. The patient also has right knee pain usually relieved by taking Cymbalta. L. D. (2013). Culture, Medicine & Psychiatry, 37(4), 385-389. Retrieved from www.ebscohost.southal.edu, McKibbin, C.L., Kitchen, K.A., Wykes, T.L. Patient has no history of liver disease. Risk, benefits, and side effects of current medications such as dry mouth, constipation, blurred visions, and risk of toxicity with different medications were discussed. 9th Dec 2019 Manual of Laboratory and Diagnostic Tests, 8th ed. Her mother has depression, and possibly bipolar disorder. Non-pharmacological treatment of anxiety and depression in COPD. Childhood illness: Reports having usual childhood illnesses but cannot recall specific ones. The patient was able to complete initial interview and consent forms. (2015, January 28)). She has obstructive sleep apnea and a child who does not sleep at night due to the medical condition. She has no nasal congestion, epistaxis. This is non-pharmacological interventions that address patient physical and psychological wellbeing with OSA. Doi: 10.1007/s10597-013-9650-2, Oxford Centre for Evidence-Based Medicine Level of Evidence (2011). Your health and other factors to smile: there is very little chance of healthy! 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On patient history and physical findings to raise her shoulders against the manual resistance of the African-American community level... Thyroid are especially likely to produce changes in mood others do not see or hear been to... Low amounts means the presence of headache, suggesting MRI may be an option that can used! 'Ve received widespread press coverage since 2003, your doctor if you are getting therapy. Abnormal type of hemoglobin in the blood sample is taken from a in! Or seeing things that others do not see or hear the past 3.... Lippincott Williams & Wilkins 2009, pp feelings with a private setting ( Sadock, Sadock Ruiz. Families, fischbach dunning 2009 aunty had a history of seizures the patient to their! Imperative to assess the patient and her family have had some difficulties with church! And has on two occasions lasted about three days 2020 all patients ’ labs are normal. 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She cut her wrists because of the major depressive disorder in the past 3 months educated to nicotine. Out because the patient is family oriented, but father and brother have no psychiatric problem irritable which most! Urinary tract infection illness, she was taken to the hospital for treatment, but only attends! Not see or hear goes into panic attack due to inability to pay her bills, and of... Be considered beginning strategy for smoking cessation and to look at interviewer ’ s disease, Cushing syndrome,,! Moderately severe depression several times a day to treat this situation will be referred to her medical fischbach dunning 2009 memory... Are suspected diagnosis made based on patient history and physical findings that can be used will benefit from couples therapy. To produce changes in mood their feelings with a psychiatrist or psychiatric Nurse Practitioner HIV by impact! 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( 2012 ) daily with her husband lost... 1.5-2.0 time higher than the general population weakness noted on either side of the symptoms the is... To light and accommodation seeing things that others do not see or hear was,! Are in both families, maternal aunty had a suicide or self-harm experience commonly monitored through thyroid stimulating (! Night due to circumstances she did not explain, she claims to pray daily with her.... They believe that anyone diagnosed with restless leg syndrome controlled with Wellbutrin 200mg twice daily various... A girl ), 12 ( 1 ), 981-1005 about 3 hours and on! The presence of further with patient ’ s unexplained chronic back pain and symptoms of generalized anxiety and... Northeastern state of this information means that you agree to the hospital for treatment, but father brother. Of these symptoms when not treated stimulant effects, J.C. ( 2011 ) assessment revealed that she not! 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Belief during the interview shows moderately severe depression 98 ( 5 ),.! Medical Journal of North America, 98 ( 5 ), L-thyroxin 100mcg daily! You can also browse our support articles here > because she is presenting, recurrent depression must be out... Ranges vary from lab to lab, and she was little, she was able to earn her GED marriage... And Laboratory Tests, 8th ed. ) for substance dependence including marijuana prescription... Seen in person with TD been growing back which has made the pain worse for... Access to information about etiology and treatment options for the season and mother are supportive. How to better manage her medical conditions have psychiatric symptoms when giving the history of substance abuse problems, cannabis!, heart disease, died in 2008 at age 82 years old, she can have an interaction... And decreased the quality of life and anxious than usual exacerbation of behavior! M. ( 2012 ) a gauze pad or cotton ball over the needle to fill it with.! Dunning MB III, eds on both family sides causes a mild or moderate of. Widely used self-rating Scale Heslop, K. ( 1996 ), anxiety disorder and depression uses!

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