69-year-old Caucasian female presents with a report of depression, insomnia and some memory problems that are not too troubling.
Depression began after husband fell out of an airplane 11 years ago causing his death- reports having had a good supportive relationship with him and just could not believe he had died (with tears); sleep problems since youth worsened after husband’s death- sleeps 4-5 hours nightly without Xanax- wakes after about 1-2 hours of sleep without xanax; referred by primary care provider who has been prescribing Prozac and Xanax; no romantic relationship since husband’s death though she may consider entering a relationship with the right man.
Depression helped with Prozac and sleep helped with Xanax taken for several years (over 5 years)
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Agrees to taper Xanax and begin other sleep medication e.g. trazodone not previously prescribed- denies overuse of Xanax saying she only takes as needed for addiction concern she heard of from friends
Denies any psychiatric hospitalization
MSE: well appearing; well groomed; normal weight for height; pleasant and cooperative; overall WNL with mood generally appearing not depressed; fair insight and judgment; no history of SI, HI, AH, VH
Denies street drug use or alcohol use
Medical hx: DM & htn treated with medications
Medications prescribed at visit:
Xanax 1mg po hs prn (was prescribed 1mg bid; has been taking half of one mg bid as needed)
Prozac 40mg one po am
Family & Social hx: lives in owned condo alone; husband died suddenly after falling out of an airplane after 35 years of marriage; two adult children one (son) who has ‘emotional’ issues does not talk about them, and other child (daughter) seeing a psychiatrist since father’s death; practicing Christian; high school education; last worked 3 years ago in sales; has friends with whom she has fun; attends the gym 3 days of the week; 6-year-old grandson hit by a truck in her presence however she does not clearly remember what happened- fractured ribs suffered by grandson; parents of grandson not allowing her to see grandchildren causing tears and sadness (that clear) at visit and a few times weekly; does not attend psychotherapy and this intervention has not been previously suggested to her- agrees to psychotherapy and wants to know what kind of therapy she will receive e.g. CBT she heard of from friends
Note that the content of your paper dictates the number of pages hence no page limit.
Please address each of the following areas-
- Management of health status
- Maintenance of NP-client relationship
- Professional role i.e. advocacy, ethics, policy, collaboration and consultation, leadership, referrals, research
- Negotiating health care delivery e.g. cost, access, efficacy
- Monitoring quality of care
- Providing culturally sensitive care
- Health promotion and prevention, health protection & treatment
- Management of health status (overall plan of care)- 1 point
- Maintenance of NP-client relationship- 1 point
- Teaching- 1 point
- Professional role i.e. advocacy, ethics, policy, collaboration and consultation, leadership, referrals, research- 4 points
- Negotiating health care delivery i.e. cost, access, efficacy- 3 points
- Monitoring quality of care- 1 point
- Providing culturally sensitive care- 1 point
Health promotion and prevention, health protection & related treatment issues- 3 points