NR 603 / NR603 WEEK 2 CASE STUDY MANAGEMENT OF MAJOR DEPRESSION IN A PATIENT COMPLETE STUDY GUIDE GRADED A+ 2025/2026 .

Week 2 Case Study Patient - M.M. 42-year-old Caucasian female Chief Complaint Overwhelming waves of emotion, feelings of utter aloneness, nightmares, feelings of being” stuck” in grief. HPI MM 42-year-old female accompanied by adult daughter and live in boyfriend of 4 years in the office today with complaints of overwhelming waves of emotion, feelings of utter aloneness, nightmares, and feelings of being” stuck” in grief. The patient lost a newborn in her early 20’s and 8 months ago lost her adult son to an automobile accident. Her grief is so overwhelming she has lost her job and her relationships with her daughter and boyfriend are suffering because she feels like they are asking her not to grieve and although they don’t say it their attitudes make her think they feel like she should” just get over it”. Per her daughter, the only reason her mother came today was because they held an intervention of sorts because they are concerned for her well-being. The patient reports that she has been numbing her pain with marijuana use, as it is the only thing that keeps her from crying all day. She states that she doesn’t want to leave her home, has lost interest in most activities, and the only joy she feels is when she spends time with her granddaughter. She denies suicidal ideations, stating her son would not have wanted that. The patient firmly disputes the existence of any manic symptoms, including racing thoughts, grandiose beliefs, irritability, changes in or inappropriate social behaviors, euphoria, elation, difficulty focusing, hypersexual acts, hyperverbal speech patterns, and an increase in energy accompanied by a decrease in sleep patterns. Current Medications None Allergies NDKA Allergic to peanuts Past Medical History Downloaded by kelvin githinji () Immunizations up to date Surgical history- C-section in 1999 and 2003, tubal ligation 2003 Social history- Lives with boyfriend, Smoker, Occasional alcohol use 1-2 times per month, typically a drink with dinner, Marijuana use 2x day QD, used to enjoy going out with friends, riding ATV’s, and traveling with boyfriend Family history- Maternal side: COPD, mother living Paternal side-CHF and HTN father living, has 1 older biological sibling with no PMH Downloaded by kelvin githinji () Review of Systems General - Deniesfever, reports extreme fatigue and 10lb unintentional weight loss Cardio- Denies chest pain, endorses palpitations when she is awakened by a nightmare. HEENTDenies changes in vision, hearing loss or ear pain, sore throat Respiratory- Shortness of breath only when anxious, denies cough orsputum production. Skindenies rash or pruritis, reports increased sweating with nightmares GI- denies nausea, vomiting, or abdominal pain, reports regular bowel movements. GUDenies frequency, urgency, or incontinence Mus- Denies myalgia or joint pain Endo- denies cold or heat intolerance, polyuria, or polydipsia, denies any issues with hair loss Neuro- denies headache or syncope. Psych- see HPI Vitals - SpO2 99%, RR-16, HR: 82, BP: 132/76; T: 98.7; Weight: 170lbs; Height: 5'6 Physical exam findings General - Alert and oriented, responds appropriately, weight loss of 5% HEENT- head normocephalic, eyessymmetrical, pupils are PERRLA, dark circles noted under eyes, ears are symmetrical, no lesions, swelling or erythema noted, tympanic membrane visible, no bulging, redness or fluid noted, mucous membranes moist and pink, no lesions or masses noted. Cardio- Regular rate and rhyth