Week 7 Discussion
Select one of the following case studies and corresponding Differentials Table to complete. In the subject line of your post, please identify which case study you are responding to. Select one of the following case studies.Complete the corresponding “Differentials Table” to align your clinical reasoning – include 5 differentials (excluding the example provided).In SOAP format, discuss what questions you would ask the patient (Review of Systems), what physical exam elements you would include, what further testing you would want to have performed (if any), differential and working diagnosis, treatment plan, including the addition of complementary and OTC therapy, referrals and other team members needed to complete patient care.Upload your Differentials Table and SOAP note to the Discussion BoardNote: Document at least one scholarly source to connect your response to national guidelines and evidence-based research in support of your ideas.In your peer replies, please reply to at least one peer who chose a different case study.***Important Considerations – As you dive deeper into your clinical practice, challenge yourself to formulate well-thought-out differentials prior to arriving at your final diagnosis. Diseases, despite their common features, can become unique and dynamic. This means that symptomatology can easily be affected by different modifying factors such as age, co-morbid conditions, environmental factors, and the like.Case StudiesMildred is a 45-year-old married female with three children. She presents to the clinic with complaints of fatigue and difficulty sleeping. She states she wants to get a good night’s sleep and is requesting a prescription to help her sleep. Mildred tells you she is awake off and on during the night, frequently thinking about her husband’s recent layoff from construction work and the effect this is having on the family. She lies down often during the day and has been so fatigued that she took some time off from work during the last two weeks. She is tearful at times during the visit and looks sad and anxious. On further discussion, she says she feels overwhelmed, helpless, and anxious. She tells you about an episode where she felt her heart beating rapidly, had difficulty catching her breath, felt she was going to have a heart attack, and became frightened until her husband was able to help calm her down. She is not eating as much as usual, and when she reads the newspaper, she does not remember what she has read.Kylie, a 24-year-old female patient, comes to your office for a refill of her allergy medication. Before going into the room, you note that her Patient Health Questionnaire – Depression (PHQ-9) score is 20, and that she is not currently on any medication for depression. When you enter the room, you notice that Kylie is easily startled, and she is sitting in the corner of the room very close to the wall.Dale, a 40-year-old construction worker, lost his 4-year-old daughter in a car accident six months ago, in which his sister was driving and he was a passenger. He is at this visit for a follow-up of a shoulder injury sustained last month. You notice that he has lost about eight pounds since his last visit, and he is somewhat disheveled in his appearance. Dale has not been back to work, and has not been able to get into a car since the accident. Before going into the room, your nurse pulled you aside to let you know that the patient was very rude to the front office staff, and was also rude to her while he was being processed for his visit. This is not Dale’s usual behavior.If you chose case study 1, 2, or 3 complete the below Differentials Table DifferentialSigns/SymptomsGold Standard DiagnosticsGold Standard TreatmentEx: PTSDFlashbacks, nightmares, intrusive thoughts, avoidance of reminders of trauma, agoraphobia, sleep disturbance and hypervigilance, feelings of detachment.Clinician-Administered PTSD Scale (CAPS-5)First-line treatment with a trauma-focused psychotherapy such as eye movement desensitization and reprocessing (EMDR). In individuals with comorbid disorders (ex., depression, psychosis) that affect the person’s ability to work in trauma-focused therapy (ex., concentration, motivation), treat with pharmacologic management; SSRI first line such as sertraline or paroxetine. 1. 2. 3. 4. 5.