Compare vulnerable populations. Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as “vulnerable.” Include the number of individuals belonging to this group and the specific challenges or issues involved. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.
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List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
When assessing this patient, it's important to ask questions that will help the provider understand the underlying causes and potential treatment options. Given the patient's recent loss and significant life changes, it's crucial to approach the assessment with sensitivity. Here are three questions I'd like to ask, along with their rationales:
1. Have you observed any changes in your sleep pattern, mood, or feelings since your husband passed away?
Rationale: This question allows the patient to provide insight into the nature and duration of her sleep disturbances and changes in her mood or feelings. Understanding the onset and progression of depression symptoms can related to her recent bereavement following her husband's passing.
2. Could you describe your emotions and have you ever experienced thoughts of self-harm or suicide?
Rationale: This question aims to comprehend a person's emotional state and evaluate the presence of suicidal thoughts or self-harm ideation. It's important to ask such questions without delay in treatment. Since the patient has a history of major depressive disorder (MDD), and her depression has worsened, it's crucial to explore her emotional state.
3. How have you been coping with the loss of your husband, and have you sought support or counseling to help you through this difficult time?
Rationale: Inquiring about coping strategies and support systems is essential for assessing the patient's resilience and identifying potential sources of assistance. Grief counseling or therapy can be invaluable in helping individuals navigate the complex emotions associated with loss. Additionally, it's important to assess whether the patient has been utilizing any resources to manage her depression.
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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.
To gain a more comprehensive understanding of the patient's situation and evaluate her social support network, I would identify individuals in the patient's life, such as family members or close friends. Engaging in conversations with these individuals can be beneficial because they may have insights into the patient's emotional well-being and daily functioning. I would ask Questions like: “Could you please share any observations regarding alterations you may have noticed in the patient's behavior, mood, or sleep patterns following her husband's passing?” Family members and close friends are often the first to detect significant shifts in a person's behavior and emotional state. Their observations can offer valuable insights into the patient's emotional condition and the way the loss of her husband has affected her daily life.
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Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
In evaluating a 75-year-old patient with a chief complaint of insomnia and depression, diabetes (DM), and hypertension (HTN), a thorough assessment should include both physical exams and diagnostic tests: A physical examination should include checking blood pressure, heart rate, heart sounds, peripheral pulses, respiratory rate, and temperature. It should also involve assessing the patient's overall appearance and evaluating their general health. In addition, assessing mental status, cognitive function, and neurological signs can help identify any neurological issues that may be contributing to sleep disturbances. Consider arranging a sleep study, also known as polysomnography (PSG). This medical test monitors various physiological functions while a person sleeps.
Diagnostic Tests include the following Blood Tests: Complete Blood Count (CBC) will check for anemia or other blood-related issues that can affect sleep and overall health; a Comprehensive Metabolic Panel (CMP), assess kidney and liver function, electrolytes, and glucose levels; The HbA1c (Glycated Hemoglobin) test can monitor her long-term blood glucose control, can provide valuable insights into her diabetes management. The results of these exams and tests will inform a comprehensive treatment plan tailored to the patient's specific needs.
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List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
When assessing a patient with insomnia, along with chronic medical conditions like diabetes and hypertension, this patient likely has Major Depressive Disorder (MDD). She had no history of MDD before her husband's passing, and the current worsening of her depression may be attributed to his death. Although anxiety can cause insomnia problems, MDD with Bereavement seems most likely. However, we need to ensure there aren't other underlying causes, such as sleep problems or medical issues. To do that, we should conduct thorough assessments and laboratory tests. She needs to seek help from both her regular doctor and a mental health professional to find the right treatment and support.
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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.
When selecting pharmacologic agents for this 75-year-old patient, the choice of antidepressant therapy should consider pharmacokinetics and pharmacodynamics. Reduced kidney and liver function in elderly individuals can potentially affect both pharmacokinetics and pharmacodynamics.
SSRIs, such as sertraline (Zoloft) and escitalopram (Lexapro), are two preferred for elderly patients. They are generally well-tolerated and have a lower risk of certain side effects, such as sedation or anticholinergic effects, which can be problematic for older adults. Sertraline (Zoloft) 150mg once daily or Escitalopram (Lexapro) 20 mg daily would be appropriate for this patient.
The patient has been taking Sertraline (Zoloft), her start dose was 100mg daily; increase slowly, no more than a maximum Dose of 200 mg once daily; sertraline increases serotonin levels and can be effective in treating depression. Escitalopram is considered perhaps the best-tolerated SSRI, with the fewest cytochrome P450 (CYP450)-mediated drug interactions. (Stahl, 2021). Escitalopram (Lexapro) 20 mg daily is also the appropriate choice.
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For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
When prescribing antidepressant therapy, it's important to consider drug contraindications and alterations. For the selected antidepressant, escitalopram (Lexapro), don't use it with MAOIs or within 14 days after stopping an MAOI to prevent serotonin syndrome. This is a contraindication due to the risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, and other symptoms. Escitalopram is primarily metabolized in the liver; it should be used with caution in patients with severe hepatic impairment or elderly with decreased liver function. In such cases, a lower initial dose and slower titration may be considered, as drug clearance may be reduced.
In all cases, ethical prescribing involves a thorough assessment of the patient's medical history, medication history, and potential contraindications. Dosing adjustments, when necessary, should be made to maximize therapeutic benefits while minimizing risks and adverse effects.
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Include any “checkpoints” (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.
In depression treatment, scheduled follow-up appointments are vital for assessing progress, managing side effects, and adjusting treatment. Common intervals are every 4 weeks. At the checkpoint, like follow-up data at weeks 4, 8, 12, etc., make treatment decisions based on the patient's response, side effects, and goals. If there's significant improvement with few side effects, stick with the current dose. If there's limited improvement or major side effects, consider increasing the dose (if not already at the maximum) or trying a different antidepressant. In cases of long-term remission with a low risk of recurrence, think about tapering or discontinuing the medication.
At Week 4 (four weeks after initiating treatment), it's the time to evaluate the patient's initial response to medication. Inquire about changes in mood, sleep patterns, energy levels, and any side effects.
At Week 8 (eight weeks after starting treatment), it's time to reassess the patient's mood and overall well-being. Keep an eye on side effects, whether they're taking the medication as prescribed, any changes in their medical conditions, and any suicidal ideation.
At Week 12 (12 weeks after starting treatment), continue monitoring the patient's mood and how they're responding to treatment. Check for any signs that their depression might be coming back or getting worse.
Ongoing Follow-up (Regularly, every 3-6 months): Continue to monitor the patient's mental health, medication adherence, and any emerging side effects. Evaluate the need for ongoing treatment.
Reference:
Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015 Apr;147(4):1179-1192. doi: 10.1378/chest.14-1617. PMID: 25846534; PMCID: PMC4388122.
Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
Lexapro Labeling-508; Reference ID: 4036381 https://www.fda.gov/media/135185/download
Student Name________________
Write your topic and final PICO(T) question below:
My topic:__Health and wellbeing of nurses___________
My PICO(T) question: ____”In nurses working in specialized care units, how does the implementation of stress reduction and focused mental care techniques compared to everyday self-care practices affect their overall health and wellbeing outcomes over a period of one year?”____
My article:
1. Published within the last five years? Yes___ No___
2. Has a nurse author OR published in a nursing journal? Yes___ No___
3. Is it a single report of a quantitative research study? Yes___ No___
4. Is it a prospective study? Yes___ No___
5. Give an APA style reference of the article here:
______Diehl, E., Rieger, S., Letzel, S., Schablon, A., Nienhaus, A., & Dietz, P. (2021). Burdens, resources, health and wellbeing of nurses working in general and specialized palliative care in Germany – results of a nationwide cross-sectional survey study.
BMC Nursing,
20(162), 1-15.
https://doi.org/10.1186/s12912-021-00687-z
_________________________________
In order to be acceptable, you must be able to say yes to the four questions above. Remember, your article cannot be a retrospective study, a mixed methods study, a qualitative study, a systematic review, a quality improvement article, or an evidence based practice article.
MY NUMBER ASSIGNED WAS 7 WHICH IS: Tension hemo/pneumothorax – when does this occur, s/s, treatment, and complication
Each student will be assigned a number randomly. Whatever your number is, select the corresponding topic below, then post a minimum of 5 bullet points about the topic.
Your bullet points should address key components of the topic, such as what, how, who, & why. This information should not be basic things you learned in Med/Surg, but rather advanced critical care based.
Think about this as a group effort to create a study guide. Use ONLY your textbook, but do not cut & paste from the book.
Then create, find, or borrow a test style question about your topic & post at the bottom of your bullet points. The format needs to be multiple choice or select all that apply. Think NCLEX style.
PART 2:
Take a few minutes and ask 2 people about their personal coping mechanisms for dealing with the stress of working in healthcare during this unique time of Covid. Stress can be physical, emotional, spiritual, or any combination of triggers. Ask a diverse variety of people, don’t forget those in other departs at different points of hierarchy. For example, ask your unit manager, environmental services, volunteers, patients, fellow nurses, etc. Write 2-3 paragraphs on your findings and impressions while respecting the person’s identity.
Discussion: PICOT Question
Over the course of the next eight weeks, we will be examining concepts related to nursing research and the translation of evidence to practice. To help you better understand the process, you will be identifying a practice issue for nurse practitioners.
You will develop a PICOT question associated with the issue, find evidence to support a change in practice, and present your recommendations for change to your peers. This week, we will work on helping you refine your area of interest so that you will be able to develop a concise question for next week’s assignment. You are encouraged to use the area of interest you chose for the project in NR500NP and/or NR501NP; however, you may choose a different area if you wish.
Select an issue in nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic. In 1-2 paragraphs, describe the scope and relevance of the issue and your recommended change. Provide reference support from at least two outside scholarly sources to support your ideas.
Please pick something you can do as a NP in your practice that is patient focused. Your intervention needs to relate to a measurable patient health outcome. Please avoid anything that would require a policy or law change, such as full-practice authority. Burnout and satisfaction surveys also are not appropriate topics as they are not patient centered.
Review this 4-minute video to gain a better understanding of the requirements of a PICOT question. The PICOT question is not a research question, but a quality improvement issue that requires a practice change.
Hello, my name is Dr. Lynch. Hey, I'm an assistant professor a Chamberlain University College of Nursing. Today we're gonna talk about pico questions and best practices in formulating these questions. There are five parts to a pico question. Patient intervention, comparison, outcome in time. The slides subsequently we will discuss each part of this question. The first ingredient for cooking up a pico question is population. Pick a broad topic, drill down, focus down so that then your population is very specific. Type two diabetic female patients age 30 to 40 who consume over 400 g of carbohydrates per day. A bunch more specific population then patients with diabetes intervention. What intervention do you think will make a difference? Is that supported by the scholarly literature? What is being done in clinical practice today? Are there better alternatives? You must use an intervention based on scholarly literature? Remember the definition of scholarly literature is a US based peer reviewed journal article geared for clinicians published in the past five years, or the latest clinical practice guideline. Comparison. So what is the standard of care currently? Patients without the intervention, patients without a condition, patients without risk factor. This part defines another population who will be used as a comparison against the group receiving the intervention. What is your desired outcome? The outcome should relate directly to the intervention and outcomes should be measurable. Time. This is a specific timeframe to demonstrate the outcome. In quality improvement efforts, the timeframe has to be realistic and manageable. Not over years, may not be even over months, but it could be. But it is usually a short timeframe to make an improvement effort. Many students ask what the differences between pico research and quality improvement questions. This chart will help you understand the difference. The pico question used here is in postoperative kidney transplant adults aged 65 to 75, how does a health coach compared with no health coaching affect hospital readmission rates within 90 days of discharge? This is a perfect pico question compared to the research question or QI question that also could be asked about this matter. Here's an example. In real life, you're a nurse practitioner working in a skilled nursing facility, the rate of false as unacceptable. And your care team has come together to discuss what should be done about this. Your pico question is, in elderly patients between age 65.75 residing in a sniff, how do fall prevention programs with risk assessment compared to fall prevention programs without risk assessment effect fall rates within 90 days after the intervention. So you can see how this question will guide how you view the literature on this topic. You will be looking for fall prevention with risk assessment in the scholarly literature to see what has worked in other places. What are the crucial ingredients in an outpatient fall prevention program? The literature holds the key, holds the answer to these questions. If you need further assistance, please contact your instructor directly. You can also contact the librarians at the Chamberlain library who can be accessed through many means, email, chat on real time. This material comes from Malbec and find out overhauled book evidence-based practice in nursing and health care, a guide to best practice, which is a great addition to your library.
During the course, you have done a thorough analysis of a company and the health care subsector in which the company operates now is the time to look at all your findings and insights and frame the situation of the company in terms of cost, access, and quality. Specifically:
After identifying the articles to be used in your literature review, conduct a critical analysis of each article and summarize the findings. The literature you choose should support your proposed
intervention.
It is no secret that phones, computers, and technology in general have started to take over the world. It is safe to say that every one of our co-workers owns a cellphone of their own and has probably used it in the workplace at one point or another. “Information technology opens our windows and doors upon the world, allowing us to quickly communicate and exchange data and information within facilities, within healthcare delivery systems, and even across the globe” (Chamberlain College of Nursing, 2020). This can become tricky when put into legal terms in relation to patient safety and privacy. “Communication within the medical field is critical to ensure safe, timely delivery of healthcare” (Chandra, et al., 2023). Considering this patient scenario, it is both unethical and unlawful to take photos and send and receive patient photos on your personal cellphone. This can very easily violate the HIPAA policy because the patient photos are not sent under a secure network and can be breached through the firewall of your own personal cellphone by hackers. It is also possible that someone is using your phone and sees it mistakingly, or you decide to show friends or family the photos of another patients wound. With that being said, technology is very important in healthcare as it allows for more efficient healthcare when used appropriately. “Technology in healthcare today allows for global healthcare information systems (HISs), more specialized clinical information systems (CIS), and the electronic health record” (EHR) (Hebda et al., 2019). Many facilities have started to incorporate secure messaging devices in order to taking pictures, and send messages relating to patient data/care. This makes it so that the healthcare personnel are not taking any healthcare data home as they are to return the device at the end of their shift and the messages delete are a certain amount of time if not deleted previously by the employee. My facility has specific guidelines regarding the use of personal communication devices in patient care settings. This policy states that we are not allowed to take phones within the health care setting that could breech patient information. This includes taking pictures at the desk that could possibly include patient care charts and patient boards in the background of the photo. We do have access to our hospital email, and secure messaging services within applications on our personal cellphones but we have to download and encrypt our phone with certain secure firewalls in order to keep these apps so that the messages remain secure. This allows for us to use our personal phones, almost like in the scenario, but we would be messaging the PCP with a secure application that could not be hacked or shared.
Resources
Chamberlain College of Nursing. (2020).
NR-361 RN Information Systems in Healthcare: Week 7 Lesson. Downers Grove, IL: Online Publication.
Chandra, S., Oberg, M., Hilburn, G., Wu, D. T., & Adhyaru, B. (2023). Improving Communication in a Large Urban Academic Safety Net Hospital System: Implementation of Secure Messaging.
Journal of medical systems,
47(1), 56. https://doi.org/10.1007/s10916-023-01956-x
Hebda, T., Hunter, K., & Czar, P. (2019).
Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.
Discussion Topic
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DISCUSSION QUESTIONS
Choose one of the following case studies and answer the following questions. The information provided may not be sufficient but it is what is available for you to analyze and conceptualize how you might proceed with the following patients, Case Example A and Case Example B. After reviewing each vignette discuss with colleagues the following questions. There are no single correct answers to the questions, just different approaches to take.
1.In reviewing this chapter, which factors are important to consider for this patient?
2.What additional information would you like to have to be more comfortable in working with this patient?
3.How will you explain your diagnosis and treatment plan in relation to the patient presentation? What treatment options will you recommend and why?
4.What is your initial approach in negotiating treatment for this patient?
5.What medication changes would you want to discuss with the patient and how will you negotiate that with her or him?
6.What time frame do you propose for this plan, and how will you transition with the patient?
7.How will you coordinate care with the other providers working with this patient?
8.After stabilization, which psychotherapeutic approach would you take?
Post your initial response and on a different day respond to one student in your class. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text).
CASE EXAMPLE A
Campus security was called to the dormitory to assess a 19-year-old man who barricaded himself in his room and covered the windows with aluminum foil. His roommate reported that this man hasn’t been attending classes for the past week, hasn’t bathed or eaten, and has been mumbling that the FBI is monitoring all his communications. Security removed the door and took the man into custody and to the community mental health center for evaluation.
History of current episode: Information obtained by interview with the patient and with collateral telephone interviews with each of his parents, his college roommate, and his English professors. This is the first year away from home for this young man, who has been described as an “odd and reserved” person since teen years. Academically he did well his first semester at college, although he has made few friends and does not participate in any social or extracurricular events. His teachers describe him as a bright and quiet student. His parents, who live in a small town over 70 miles away from the college, expressed sadness but not surprise at his behavioral deterioration because they didn’t expect him to be able to cope with the discrepancy of the large college campus compared to his small-town previous experience.
Psychiatric history: Although he has never been hospitalized or had outpatient psychiatric treatment, this young man has been showing signs of emotional and cognitive disorganization since his early teens. During his high school years the patient became more and more aloof, and strange with both his family and friends. At times he would be mute for days at a time, remained in his room and refused to bathe. He said he did not have control over his thoughts and he believed he was possessed. In his junior year of high school his counselor recommended he attend a breakout group to help him learn interpersonal skills and make friends, but he never attended. The summer before going to college his parents asked if he wanted to see a therapist or counselor to talk about transitions but he said he didn’t want to do that and that he wasn’t concerned about living away from his family for the first time.
Medical history: Has had regular preventive care and immunizations through local family practice. In good health, weight proportion to height, denies smoking or alcohol or drug consumption. Broke his left wrist at age 7 years when he fell off his bike. Moderate acne in late teens treated with oral doxycycline for several months. No drug or food allergies. Allergic reaction to bee sting when 10 years old with swelling, shortness of breath, now carries EpiPen.
Family history: Has an older brother, 23 years old, who graduated from college and is now attending graduate school in business administration. Younger sister is 15 years old and in good health. Father is a business executive, has chronic obstructive pulmonary disease (COPD) related to long-standing cigarette smoking. Mother is an Episcopal priest and is in good health. Maternal uncle died at age 49, diagnosed with schizophrenia.
Personal history: Normal pregnancy and uncomplicated childbirth. Was an active and creative child who enjoyed reading, art, and cooking with his mother and grandmother. Parents said he started to become reserved and shy in middle school for no apparent reason. By early teens he seemed socially inept, had few friends, and preferred solitary play. Never interested in romantic relationships or dating in high school and spent most of his time studying or reading fantasy novels. Seemed to be withdrawn and serious, although denied feeling sad, or depressed.
Trauma/abuse history: Mild bullying in middle school, otherwise no apparent trauma.
Mental status examination: Well groomed, neatly attired, cooperative. Polite without motor abnormalities or gait. Moderate eye contact when directly addressed. Alert, mildly sedated, oriented to time, place, person. Attentive during interview and provided accurate albeit minimal history that was corroborated by family members. Based on fund of knowledge seemed of average intelligence. Speech is normal rate and soft spoken and at times mumbled responses to questions. Stated that he hears a soft voice in his head that tells him to “be careful” but offered no other explanation of voices. Denied visual or other perceptual hallucinations. Thought processes are linear and coherent. Reports that he believes people talk about him behind his back and that he is being controlled by unseen forces. Refused to elaborate on these thoughts. Stated that he has never thought of killing himself or anyone else. Described his mood as “fine” and refused to elaborate. Affect is flat. Demonstrates impulse control and alludes to feeling like an automaton. Judgment is reasonable in terms of recognizing consequences of actions.
Current medications: No regularly prescribed medications. Given lorazepam 1.0 mg orally in urgent care when brought in by campus security because of his extreme agitation. Slept for an hour after administration while waiting to be interviewed.
Differential diagnosis: Brief Psychotic Disorder versus First Episode of Schizophrenia. The duration of the episode is greater than 1 day but uncertain if longer than 1 month, and no previous psychiatric hospitalization. Teen years are suggestive of prodromal period of schizophrenia that may be precipitated by stress of independence from family and college experience.
CASE EXAMPLE B
John B. is a 15-year-old man of Sudanese descent who resides with his mother, grandmother, 23-year-old brother, and his brother’s wife. They are all asylum seekers to the United States, having arrived from South Sudan 2 years prior to this. He is seen in this mental health clinic after discharge from an inpatient stay following a suicide attempt by hanging.
Brother found patient hanging by a rope tied to the clothes rod in the closet. Patient was cyanotic with slow pulse and taken to the hospital by ambulance. He was treated in the inpatient adolescent unit for 1 week and discharged to this clinic for an assessment and follow-up treatment. He reported that he has been feeling depressed “for as long as I can remember” with low self-esteem, feelings of hopelessness and being a burden to his family, guilt, and self-hatred. He said he had been thinking about killing himself for several months and has been cutting on his arms in practicing for this. His brother came home from work unexpectedly to find him. He described not fitting in at school and not feeling comfortable in his new home. His brother arranged to bring his mother and grandmother to the United States to flee from the war. His brother was brought to the United States when he was 14 years old under the UNICEF program for rehabilitation of child soldiers, and believes the patient was being recruited to be a soldier before coming here. Patient sleeps less than 4 hours/night with frequent nightmares and refuses to sleep in bed, prefers to sleep under the bed. Has poor appetite. Teachers report he has difficulty concentrating in school and has to take frequent breaks to sit in quiet room with soft music. He has made few friends and gets into fights, both physical and verbal, with other boys. Easily upset by loud noises or changes in routine at school or at home.
Medical history: Patient has no known drug or food allergies. He was treated for malnutrition upon arrival to the United States and remains underweight. He was diagnosed with mild intermittent asthma, triggered by exercise and seasonal allergies. Physical exam also revealed several horizontal scars on the inner surfaces of his left forearm.
Substance use history: Denies alcohol or drug use.
Family history: Father died in war in South Sudan when patient was 4 years old. Raised by mother and maternal grandmother with older brother. Older sister killed in village raid when patient was 5 years old. Unknown paternal history. Mother is 42 years old with unknown health history.
Personal history: Full-term birth without known complications. Attended school intermittently in South Sudan due to civil war. Currently attending special school and mostly fluent in English. Has had behavioral problems in school due to inattentiveness, anger, poor impulse control, and low frustration tolerance. Mother and grandmother do not speak English and are unable to provide description of patient’s behavior at home. Brother works two jobs, as does brother’s wife.
Trauma history: Witnessed his sister and mother being raped and sister’s death. Possible torture prior to coming to United States.
Mental status examination: Thin, lanky young man with multiple scars on arms and back. Clean, casually attired with close-cropped hair. Cooperative and sullen during the assessment. Sits in chair with legs pulled up on the chair and gripping his knees with his arms. Makes moderate eye contact. Alert, oriented to time, place, and person. Memory not formally assessed but appears to be intact based on his ability to accurately relate details from his recent experience. Hypervigilant to the environment and interviewer’s behavior. Linear thinking with abstract reasoning and seems to be of average to above average intelligence based on fund of knowledge. Speech is soft with pronounced accent, regular rate and rhythm. Comprehends English sufficiently to not need interpreter. Thinking process is coherent and goal directed. Thought content is focused on distress of hospitalization. Acknowledges wanting to die but without current plan to kill self and feeling remorseful that he upset his family with his recent attempt. Described his current mood as scared and depressed. Affect is fearful, tearful, and angry. Impulsive previous behavior with poor judgment and belief in limited future. Insight is reasonable in terms of understanding why he is referred to treatment.
Current medications prescribed at last hospitalization:
1. Prazosin 5 mg bid for nightmares and daytime stress
2. Vortioxetine 10 mg daily for depression and anxiety
3. Fluticasone-salmeterol inhaler qd for asthma
4. Theophylline 300 mg qd for asthma
Differential diagnosis: Major depressive disorder with suicidal thinking. Posttraumatic stress disorder.
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