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
The paper: 12 font times new roman APA, 3 references within past five years:
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 the client’s ethnicity. Discuss why the contraindication/alteration you identify exists.
That is, what would be problematic with the use of this drug in individuals of other ethnicities?
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.