Case study analysis

Students,

Here is some essential information about the patient case assignments. For the patient case assignments, please read these very important key points before submitting your assignment. I hope this will help guide you with the cases. Some weeks you will be doing an analysis of a provided case and some weeks you will be doing a critique of a provided case, so please read the assignment instructions carefully.

Please review the provided patient case examples posted for analysis and critique, the separate grading rubrics for each, and the provided case studies. Use these examples as a guide for your assignments. However, note the examples do not use the current APA format, so please use the 7th ed Professional (not student) formatting for yours. You must use the case information provided and do not add to the case information or change the provided case information in any way. The case information you are provided is the information you will use to do your analysis or critique depending on the week’s assignment. 

 For your analysis on weeks where you will be completing an analysis of the provided case:

Your analysis needs to be exactly the same case template as the provided depression case in week 2 and the example analysis with all sections on the example completed in that order (presenting the problem, risk factors, assessment, appropriateness of all medications, additional information needed, desired therapeutic outcomes, non-pharmacologic therapy recommendations, pharmacologic therapy recommendations, and monitoring). Please do not vary from this example in terms of how you write your AP note and do not add any additional information to the case itself.  In other words, do not write this case with different sections, different categories, different headings, etc. Include the provided case information in your analysis exactly as provided without changing any case information. Rubric grading is based on including the content required (shown on the grading rubric) for each section of this assignment, so if required sections are not included, credit cannot be given for these sections. Please heed my directions because not follow these instructions will result in grade point deductions.

For example, if the monitoring grid charts in the Plan section’s Pharmacologic Therapy are omitted or incomplete, then up to 15 points will be deducted per grading rubric. Why? Any medication that is given, must be monitored for efficacy (E=Efficacy on the chart) and adverse effects (AE=Adverse Effects on the chart). This is essential in clinical practice because all medications have side effects and “come at a cost”. It’s crucial to assess risk versus benefit before using a medication and to monitor medications (so we need to know what we are looking for with these medications). Every medication on your treatment plan for this patient must have a monitoring grid. If the current medication is not working (not efficacious/effective), then we need to appropriately modify or discontinue this medication.

For the Determine Appropriateness of Current Medications section, please address every current medication, for all PMH conditions, with all the categories listed in the example case, for each medication patient is currently taking. Each medication needs to include: indication, interactions (drug-drug interactions; drug-disease interactions-renal, hepatic, etc.; drug-food interactions; contraindications; warnings, etc.), dosing, compliance, and outcome (are changes necessary, is it appropriate to continue patient on this medication, should this medication be discontinued?- give the reasons for your outcome) just as done on the example. Is this medication causing adverse effects or exacerbating/causing another medical condition? Is this medication appropriate for this patient for this condition based on the categories mentioned above and on the example? Is the dosing appropriate for this patient and indication? 

The Plan will include 2 separate sections: a Non-pharmacologic Recommendations section and a Pharmacologic Therapy Recommendations section of the Plan.  This is your treatment plan for the patient starting now and going forward. Here, please address treatment and monitoring for all the medications patient will be taking based on your recommendation. Note whether it is a new medication or a continuing medication in the Pharmacologic Therapy section. This is the treatment for your patient and this is the section where you will implement your plan based on your determination of the  appropriateness of patient’s medications and your assessment. You will not refer patient to another health care professional for treatment. You are the PMHNP who is treating this patient!

For the Pharmacologic Therapy Recommendation section,  in the introductory paragraph, state your plan for all medications-what you will discontinue, what you will continue, what you will add, what you will change in terms of medications-this paragraph is required. Please see the provided depression case for week 2. Then, proceed to address every medication that patient will be taking now based on your treatment plan for all patient’s PMH conditions, and be very specific, including indications and dosing. This is not just the depression medication for the depression case but all medications the patient needs to take for all their medical conditions.  We treat the whole patient! Then under each medication, there needs to be a monitoring grid for E (efficacy) and AE (adverse effects) for every medication patient will be taking on your treatment plan. Do not include grids for medications you have discontinued. It is not necessary to list every side effect of each medication.  Address the most significant and most common side effects.  Review the example analysis/depression case and follow the formatting and information included in this section on the example.  

The Best Nursing Case Study Help

The Pharmacologic Therapy Recommendations and Monitoring is a huge portion of the grade for this assignment. Each is worth 15 points so 30 points total.  The point value is related to the value of these sections in the case assignment.  They are important and need to be complete! This is Clinical Psychopharmacology after all.

Beginning with this coming week’s assignment, you will be completing weekly patient case assignments.  

Patient Case Assignment reminders: 

o   All analyses and critiques must be completed and submitted as a Word document using APA 7th ed Professional formatting.

o   All work is to be done independently, 

o   Submit your assignment through that week’s assignment.

o   Your assignment will be checked for originality via the Turnitin plagiarism tool.

o   Citations are required throughout your analyses and critiques anytime a source is used in order to give credit to the author. See the provided depression case analysis for how to include citations within your case analyses and the provided critique example for citations in your critiques.

o   Be sure to meet the minimum 5 page requirement for each analysis and critique. 

o   Be sure to meet the minimum reference requirement listed on the rubric. Because we treat patients using POEM (Patient Oriented Evidenced Medicine) guidelines, the appropriate guidelines should be included in your references such as APA guidelines on depression, etc.

Case Study Anxiety

CC:

“I’m really stressed and feel like I’m losing it.  I’m so tense that I am having trouble sleeping and fell like I’m a time bomb about to explode.”

HPI:

JA is a 24-year-old female who presents to the primary clinic with complaints of nausea, restlessness, fatigue, poor sleep, and headaches.  She states that since starting her graduate school program approximately 6 months ago, she has been on edge and worries about everything.  She worries about her school performance, paying for her tuition, her father’s health, and even her younger brother, who is a freshman undergraduate at Colorado State University.  She states her mother reassures her that everything is “OK” with her dad and brother but she worries about them anyway.  She was offered a summer internship program with a pharmaceutical company and is considering not taking it as she feels overwhelmed and is not sure she can manage moving to the east coast for the summer.  She reports having a couple of “episodes” while at home studying, where her heart races, she feels shaky, and had difficulty concentrating on her work.  This prompted her to seek treatment at an urgent care clinic last month and she was provided a prescription for quetiapine.  “They said it would help me sleep and feel less anxious.”  She also describes being easily startled when someone taps her on the shoulder.  This happened in class and she was embarrassed by her response.  JA states she has taken a friend’s medication for anxiety a couple of times and that it “calms her immediately.”  She also reports seeing a therapist for several sessions a couple of months ago with little improvement, so she stopped.

PMH:

Knee surgery (age 16, ACL tear while playing soccer)

Mild traumatic brain injury (TBI) (age 16 from motor vehicle accident.  Treated with levetiracetam for 1 year)

Mild depression (age 21, resolved with counseling)

FH:

Father has CAD and had MI 3 months ago at age 52.  Mother with depression, treated with venlafaxine.  Paternal grandfather with alcoholism and a maternal aunt who died at age 60 of suicide.

SH:

JA is a graduate student in biomedical engineering at the University of Colorado.  She lives alone in a condominium and works part-time as a research assistant in the College of Medicine.  Nonsmoker.  ETOH 2-3 drinks daily.

Allergies/Intolerances/Adverse Drug Events:

NKDA

Medication History:

Levetiracetam 500 mg bid x 12 months for seizure prophylaxis 8 years ago

Quetiapine 25 mg po twice daily as needed – received 30 days supply from urgent care physician last week

Ibuprofen 400 mg po prn

Review of Systems:

Frequent tension headaches relieved by ibuprofen; muscle ache in shoulders; nausea and intermittent loose stools

PE:

• General: Anxious-appearing 24-year-old woman in no acute distress
• Vital signs
  • BP 130/76 mm Hg, P 88, RR 18, T 37.3oC
  • Weight 169 lb.
  • Height 65 in.
  • Denies pain

Mental Status Examination:

A 24-year-old cooperative, casually dressed, well-groomed female.  Appears dysphoric and moderately anxious.  Speech is normal in rate and volume.  Mood is “irritable” and “sometimes down,” affect congruent to mood.  No apparent delusions or hallucinations.  Denies suicidal or homicidal ideation.  She appears to have good attention and concentration.

Labs:

All WNL

Urine pregnancy test (-)

Urine drug screen (+) benzodiazepine

ECG: QTc 442 ms