Question Answered step-by-step CC (chief complaint): “I have been struggling with my focus and… CC (chief complaint): “I have been struggling with my focus and have no energy.”HPI: The patient is a 37-year-old male of Hispanic origin who presents for an established visit to the clinic after six weeks and an increase in his duloxetine to 60 mg.  The patient believes that he has had some benefits from the duloxetine but does not feel like he has any increased motivation. He does report feeling less depressed and less anhedonia since the increase. The patient reports that he continues to oversleep and has a difficult time with his energy. The patient reports that he has been sleeping about 10-11 hours a night as he is not currently working due to still recovering from his car accident from last year. The patient reports that he has struggled to be compliant with his insulin, cardiac medications, and diet. The patient reports that he has always felt depressed in his life, and he states, “I never get a break from feeling down”. He states most days, he just rolls over in bed and takes his medications but then goes back to sleep. He reports no motivation to get out of bed and eat a healthy diet, attempt to work out or check his blood pressure and blood sugar. He reports that he has had WNL blood sugar levels and hemoglobin A1c levels at his last endocrinologist appointment. He reports difficulty keeping track of what he plans to start doing, and he has issues focusing. The patient reports a previous Hx of ADHD and has a sister who has ADHD as well. Patient scores 6/6 on the ADHD self-report scale part A, indicative of having ADHD combined type. The patient meets 16/18 criteria for ADHD and has experienced these symptoms for “as long as I can remember”. Currently, on the PHQ 9, he scores a 16, which is better than his previous PHQ 9 score of 23. Patient reports being interested in starting stimulant therapy for ADHD symptoms but reports that he has difficulty keeping his blood pressure under control. The patient will follow up with his cardiologist soon to discuss the doses of his lisinopril and metoprolol. Past Psychiatric History: Patient: Denies previous psychiatric care with psychiatrist. The patient does report a history of two suicide attempts around the ages of 20 through 22. States he tried to overdose once and then tried to drive his car into other parked vehicles. The patient states that he has been inpatient two times early in his 20s surrounding his suicide attempt. The patient has difficulties remembering what medications he has trialed but has reported using clonazepam and Trazodone in the past. The patient’s primary care provider was the current medication prescriber. The patient denies a history of self-harm. The patient does have current diagnoses of unspecified mood disorder, generalized anxiety disorder, ADHD combined presentation, and insomnia unspecified. He was previously diagnosed with major depressive disorder, recurrent episode, moderate. Family: The patient reports that mental health has not been discussed in the family because of his Hispanic background, and he does not know the extent of his family’s mental health history. The patient reports that he does believe his mother has had mood swings and depression. The patient also reports that his sister is currently experiencing   How would you address collaboration concerns with patient’s providers? Above2. What ADHD treatment would you most be willing to use with this case? For this patient   Health Science Science Nursing NURS MISC Share QuestionEmailCopy link Comments (0)

Question Answered step-by-step CC (chief complaint): “I have been struggling with my focus and… CC (chief complaint): “I have been struggling with my focus and have no energy.”HPI: The patient is a 37-year-old male of Hispanic origin who presents for an established visit to the clinic after six weeks and an increase in his duloxetine to 60 mg.  The patient believes that he has had some benefits from the duloxetine but does not feel like he has any increased motivation. He does report feeling less depressed and less anhedonia since the increase. The patient reports that he continues to oversleep and has a difficult time with his energy. The patient reports that he has been sleeping about 10-11 hours a night as he is not currently working due to still recovering from his car accident from last year. The patient reports that he has struggled to be compliant with his insulin, cardiac medications, and diet. The patient reports that he has always felt depressed in his life, and he states, “I never get a break from feeling down”. He states most days, he just rolls over in bed and takes his medications but then goes back to sleep. He reports no motivation to get out of bed and eat a healthy diet, attempt to work out or check his blood pressure and blood sugar. He reports that he has had WNL blood sugar levels and hemoglobin A1c levels at his last endocrinologist appointment. He reports difficulty keeping track of what he plans to start doing, and he has issues focusing. The patient reports a previous Hx of ADHD and has a sister who has ADHD as well. Patient scores 6/6 on the ADHD self-report scale part A, indicative of having ADHD combined type. The patient meets 16/18 criteria for ADHD and has experienced these symptoms for “as long as I can remember”. Currently, on the PHQ 9, he scores a 16, which is better than his previous PHQ 9 score of 23. Patient reports being interested in starting stimulant therapy for ADHD symptoms but reports that he has difficulty keeping his blood pressure under control. The patient will follow up with his cardiologist soon to discuss the doses of his lisinopril and metoprolol. Past Psychiatric History: Patient: Denies previous psychiatric care with psychiatrist. The patient does report a history of two suicide attempts around the ages of 20 through 22. States he tried to overdose once and then tried to drive his car into other parked vehicles. The patient states that he has been inpatient two times early in his 20s surrounding his suicide attempt. The patient has difficulties remembering what medications he has trialed but has reported using clonazepam and Trazodone in the past. The patient’s primary care provider was the current medication prescriber. The patient denies a history of self-harm. The patient does have current diagnoses of unspecified mood disorder, generalized anxiety disorder, ADHD combined presentation, and insomnia unspecified. He was previously diagnosed with major depressive disorder, recurrent episode, moderate. Family: The patient reports that mental health has not been discussed in the family because of his Hispanic background, and he does not know the extent of his family’s mental health history. The patient reports that he does believe his mother has had mood swings and depression. The patient also reports that his sister is currently experiencing   How would you address collaboration concerns with patient’s providers? Above2. What ADHD treatment would you most be willing to use with this case? For this patient   Health Science Science Nursing NURS MISC Share QuestionEmailCopy link Comments (0)