NURS 3325 Module 3 Discussion Mental Health
NURS 3325 Module 3 Discussion Mental Health
NURS 3325 Module 3 Discussion Mental Health
This discussion focuses on Mrs. Gomez’s history which is relevant to her insomnia. It includes chief complaint, HPI, social, family, and past medical history that are essential to know.
Patient Initials: MG
Subjective Data: MG presents with an ongoing problem of feeling extremely tired and inability to sleep properly for the past six months. The patient is in grief following the recent death of her husband. She reports fatigue, weight gain, and loss of interest in activities she once enjoyed such as going to church and reading. She says that she has lost focus and can read the same page continuously. She denies suicide ideation or self-injury.
Chief Complaint: A 65-year-old Mrs. Gomez claims to be extremely tired lately and has trouble sleeping
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HPI: The patient presents with complaints of insomnia for the last six months. She says that she only manages to sleep for a few hours every night.
Onset: Six months ago
Location: General
Duration: She reports sleeping a few hours every night
Characteristics: Loss of focus, extremely tired
Aggravating factors: Watching TV at night
Relieving Factors: None
Treatment: MG is on Tylenol PM and Zapote Blanco, a Mexican herbal tea
Severity: Rigorous alteration in sleep pattern, which compromises her routine functioning.
PMH: Type 2 diabetes, Hypertension, Hypercholesterolemia
Social: MG is staying with her daughter and son-in-law following the death of her husband of 30 years. She denies smoking and taking alcohol.
Surgical history: MG has undergone Cholecystectomy, Hysterectomy
Medications: MG has been placed on Glyburide 10 mg daily and Metformin 1,000 mg bid for the management of diabetes, Methyldopa 250 mg bid and Lisinopril 10 mg daily for the management of HTN, Atorvastatin 80 mg daily for the management of hypercholesterolemia, Aspirin 81 mg daily for the management of CHD prophylaxis, and Calcium citrate with vitamin D 600mg/400 IU bid for prevention of osteoarthritis prevention. MG also uses zapote tea and Diphenhydramine.
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Pain: None
Respiration: No apnea, shortness of breath, CTA, snoring
Head, eyes, ears, nose, and throat (HEENT): Denies adenopathy, thyromegaly, or masses
Cardiac: No chest pains, edema, palpitations
Constitutional: No fevers or dizziness
Significant labs: MG’s final hemoglobin A1c has elevated to 8.7%
Endocrinologic: Denies polydipsia or polyuria
Gastrointestinal: No nausea, hematochezia, alterations in bowel habits,
Neurologic: Normal gait, no serious neurologic changes, no confusion, no tremors
Urologic: MG usually urinates once or twice at night without any difficulty
Vital signs: BP 128/78 mm Hg, HT 64 in, WT: 186 pounds, HR 60 beats/minute, and regular
The Physical Exam, Diagnostic Tools, and Recommended Additional Information
MG’s hemoglobin A1c elevated to 8.7%, which is an indication of uncontrolled blood glucose. It is recommended to conduct laboratory tests such as thyroid stimulating hormone (TSH), complete blood count (CBC), and complete metabolic panel (CMP). These tests are crucial in ruling out other potential causes of insomnia, depression, and fatigue. They will assess conditions such as vitamin deficiencies, electrolyte imbalance, anemia, and renal or hepatic problems. The additional information I would seek from this patient is the amount of Zapote tea she consumes daily. This tea contains glucoside which reduces blood pressure. It can also act as an arthritic pain reliever and sedative when consumed in higher doses.
Differential Diagnoses for Mrs. Gomez
The first differential diagnosis is hypothyroidism. The majority of people globally are affected by thyroid problems, which disproportionally affect women compared to men. Hypothyroidism can make a person feel fatigued, alter mood and behavior, and feel apathetic (Wilson et al., 2021). The second differential diagnosis is dementia. However, this diagnosis was ruled out after MG scored normal range in the Mini-Cog exam. The final diagnosis was depression. An episode of depression entails at least five symptoms such as depressed mood, unintended changes in weight, impaired concentration, recurrent suicide ideation, significant changes in sleep pattern, and feeling worthless (Paykel, 2022). MG presents at least five of the symptoms that confirm depression.
Plan of Care for Mrs. Gomez at Visit, Patient Education, and Follow-up
The main treatment plan of choice for MG includes diet, Sertraline, cognitive-behavioral therapy (CBT), and exercise. MG should be placed on sertraline to manage depression. This medication is well-tolerated and accessible in a generic form (Guerrera et al., 2020). The goal of treatment is to optimize the quality of life of MG to enable her to function emotionally and physically to the best of their ability. CBT is crucial for MG to help her cope with the loss of a spouse and move on with life. Exercise is critical in helping to improve mood and other health benefits such as improving diabetes and blood pressure.
Mrs. Gomez should be educated on the possible side effects of sertraline. Education should also cover the need to adhere to the medication’s proper dosage even after starting to feel better (Guerrera et al., 2020). She should be advised to report any problem or side effects she encounters during the treatment process. Mrs. Gomez should also be advised to create a sleep schedule. She should be discouraged from using certain drinks such as alcohol, sugary foods, and caffeine a few hours before going to bed. On the other hand, follow-up is necessary to determine the effectiveness of the medication (Schramm et al., 2019). Follow-up is also crucial in monitoring medication compliance since some patients do not report side effects or missing doses.
NURS 3325 Module 3 Discussion Mental Health References
Guerrera, C. S., Furneri, G., Grasso, M., Caruso, G., Castellano, S., Drago, F., … & Caraci, F. (2020). Antidepressant drugs and physical activity: a possible synergism in the treatment of major depression? Frontiers in Psychology, 11, 857. https://doi.org/10.3389/fpsyg.2020.00857
Paykel, E. S. (2022). Basic concepts of depression. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/espaykel
Schramm, E., Kriston, L., Elsaesser, M., Fangmeier, T., Meister, R., Bausch, P., … & Härter, M. (2019). Two-year follow-up after treatment with the cognitive behavioral analysis system of psychotherapy versus supportive psychotherapy for early-onset chronic depression. Psychotherapy and psychosomatics, 88(3), 154-164. https://doi.org/10.1159/000500189
Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: diagnosis and treatment. American family physician, 103(10), 605-613. https://pubmed.ncbi.nlm.nih.gov/33983002/
When I Was Growing Up…How were older adults in my family treated?
What did I observe about the treatment of older adults in society?
How were people with mental or emotional disorders viewed?
What language was used to describe aging, old age, and older adults with altered mental function?
What words did my family use, and what was the connotative meaning of the words used, to describe older adults? Was it positive, negative, or mixed?
Be sure to use reference to support statements, what was the culture of the time regarding mental health for example,
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Far more than any other type of illness, mental disorders are subject to negative judgements and stigmatization. Many patients not only have to cope with the often devastating effects of their illness, but also suffer from social exclusion and prejudices. Stigmatization of the mentally ill has a long tradition, and the word “stigmatization” itself indicates the negative connotations: in ancient Greece, a “stigma” was a brand to mark slaves or criminals. For millennia, society did not treat persons suffering from depression, autism, schizophrenia and other mental illnesses much better than slaves or criminals: they were imprisoned, tortured or killed. During the Middle Ages, mental illness was regarded as a punishment from God: sufferers were thought to be possessed by the devil and were burned at the stake, or thrown in penitentiaries and madhouses where they were chained to the walls or their beds. During the Enlightenment, the mentally ill were finally freed from their chains and institutions were established to help sufferers of mental illness. However, stigmatization and discrimination reached an unfortunate peak during the Nazi reign in Germany when hundreds of thousands of mentally ill people were murdered or sterilized.
Structural discrimination of the mentally ill is still pervasive, whether in legislation or in rehabilitation efforts.
The stigmatization of mental illness is still an important societal problem. The general population is largely ignorant about this problem, and fear of the mentally ill remains prevalent. Although we no longer imprison, burn or kill the mentally ill as in the Middle Ages or in Nazi Germany, our social standards and attitudes are nonetheless unworthy of modern welfare states. Structural discrimination of the mentally ill is still pervasive, whether in legislation or in rehabilitation efforts.
A comprehensive concept of stigma
Stigma can be described on three conceptual levels: cognitive, emotional and behavioural, which allows us to separate mere stereotypes from prejudice and discrimination. Stereotypes refer to prefabricated opinions and attitudes towards members of certain groups, such as ethnic or religious groups, whites and blacks, Europeans and Latin Americans, Jews and Muslims, and the mentally ill. The most prominent stereotypes surrounding the mentally ill presume dangerousness, unpredictability and unreliability; patients with schizophrenia are most affected by such views.
Stereotypes are not necessarily wrong or negative, as they can help us make quick judgements about persons who share specific characteristics. Stereotypes thereby allow us to deal with or adapt to a specific situation without needing more information about the persons involved. If we asked for directions, we would approach a police officer in a different way than an old lady; our stereotypes of police officers and old ladies would help us to adopt the appropriate behaviour.
To make a fair and rational judgement about individuals, however, would require more information than simply calling up stereotypes. In cases of mental illness, stereotypes can therefore become dysfunctional because they typically activate generalized rather than customized response patterns; contradictory information can even reinforce stereotypes as “exceptions prove the rule”. In the case of the mentally ill, we can only determine whether a person is indeed dangerous, unpredictable or unreliable, if we make an effort to know him or her better.
In cases of mental illness, stereotypes can therefore become dysfunctional because they typically activate generalized rather than customized response patterns…
This scenario becomes even more complicated with prejudices that are consenting emotional reactions to a stereotype or a stereotyped person. A prejudice about the mentally ill might comprise the reaction or attitude “I am afraid of schizophrenics because they are dangerous and unpredictable”. This changes the context from “a person who suffers from schizophrenia” to “a schizophrenic”, as if this illness characterizes the whole person. Stereotypes and prejudice can subsequently lead to discrimination of individuals or a whole group as a behavioural response: “Mentally ill should be locked away because they are dangerous and unpredictable” or “We can’t employ a mentally ill person because they are unreliable”.
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