Reflect on the case study excerpt below and consider the therapy approaches to assess, diagnose, and treat the patient’s 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’s death. She is awake, alert, and oriented x3. Patient normally sees 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:

Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

Assignment
Post a response to each of the following:

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s 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.
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?
Include any “check points” (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.

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  Here’s the be

Decision Tree for Neurological and Musculoskeletal

Case study: http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html

• Review the interactive case Study
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide an example

The principal objective of utilization management is the reduction of practice variations by establishing parameters for the cost-effective use of healthcare resources. There are four main techniques or tools used in utilization management: demand management, utilization review, case management, and disease management. Utilization management helps MCOs control costs and improve quality.

Refer to the readings of this week and the Internet on the above information, and answer the following questions:

What are the challenges faced by MCOs regarding practice variations? What do you think can be done to meet these challenges?
Differentiate between the three main processes of institutional utilization management.
Determine the main purposes of each process of institutional utilization management. Which process do you think is the most important, and why?
Research the role of the utilization management nurse.
Explain the functions of the utilization management nurse, and compare and contrast the information from that organization.
Explain your understanding of disease management and case management. What is your opinion are one major similarity and one major difference between the two types of management?
Now, access information on disease and case management by searching the Internet by using the following keywords:

Care Continuum Alliance
Commission of Case Manager Certification
Based on your research, answer the following questions:

What is the purpose or mission of these professional organizations?
What standards do these organizations set for certification or membership?
How do these organizations define disease or case management and do they differ from the text definitions?

Talk about the nurse-client relationship and the use of therapeutic communication as an important part of that relationship. Please answer the following questions:

What are your concerns or fears about mental health nursing in general? Are you interested in mental health nursing, or do you approach the topic with some anxiety?
What do you feel are essential aspects of a good nurse-client relationship?
Please include an example of how you established good rapport and a good professional relationship with a patient in the work or clinical setting. What nonverbal and verbal techniques did you use in this relationship?