Your top three (3) differentials based on the information provided, the primary diagnosis you are leaning toward, and first line treatment for how you would treat that diagnosis. Use references to support your response.
Insurance: no information provided
chief complaint: tired all the time and I think I’m unfit to care for my baby
HPI: Hanna is a 33 years old female who came to the clinic 3 months post-partum for a checkup. Hanna told me that for the past 2 weeks she is not able to care for her baby girl and that she thinks she wants to give her for adoption. She reports insomnia even when the baby is asleep. Hanna reports that she was eager when the baby was still in the uterus and that now she thinks it was a mistake to keep the pregnancy. She stated that she loves the baby just that she is unfit to be a mom.” I don’t even know how to bathe or feed her” she complained about not having enough energy morning to provide for her child. And she is thinking about killing herself but that it is selfish to do so. During the interview, Hanna burst into tear and refused to continue answering questions.
PSHX: Laminectomy L3-L5 mg PRN for pain.
Medication: Nexium, Ibuprofen PRN for pain.
Social History: Hanna is single, live alone in a one-bedroom apartment, barely have a close friend, her father’s baby is married and wanted her to abort the baby. Like to watch TV shows and works as a waitress in a big restaurant. she denies smoking alcohol use and illicit drugs
Family History: mother 59 years old, father 63 years old, Maternal Grandfather: deceases at 70years old complication of heart failure, Maternal Grandmother: deceased 68 years from a complication of dementia, Paternal Grandfather: deceased at 73 years old from Alzheimer’s disease, Paternal Grandmother 70 years old osteoarthritis
Review of Systems (ROS).
constitutional symptoms: Alert, oriented and cooperative, fever, chills, weakness or fatigue. Weight loss of 7 pounds in 2 months. Unable to speak without crying; does not appear short of breath, skin is intact warm and dry.
HEENT: denies headache, no visual loss, vision change and blurred vision,
Cardiovascular: denies chest pain, chest pain. Denies palpitation and edema
Respiratory: denies cough, DOE, SOB. Difficulty breathing when anxious
GI: denies nausea, vomiting, diarrhea, denies constipation, abdominal pain.
GU: denies burning on urination, denies vaginal discharge, denies hematuria, periods is irregular ,
Musculoskeletal: denies back pain, joint pain and stiffness
Skin: denies rash and itchiness.
Neuro: denies, dizziness, numbness or tingling in the extremities. reports light headache in the morning
Psych: reports being +stressed, +anxious, unable to sleep or to stay asleep even when the baby is sleeping +unable to take care of her baby, crying all the time
Endocrine: denies sweating, polyphagia polyuria, polydipsia
PE: Height 5’6″, Weight 156 pounds
Vital signs: BP 118/80, Temp 98.6, HR: 90, RR 20 Spo2 100% on Room Air
Gravida and Parity: G1P1001
General: 33-year-old African-American female in no apparent distress. Alert, oriented, and cooperative. unable to speak in full sentences without crying and does not appear short of breath. Skin is intact, warm, and dry to touch, Skin color is normal for her ethnicity
HEENT: Head normocephalic. Hair thick, and distribution even throughout the scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses are non-tender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudates. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, dry no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses.
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing does not clear with a forced cough.
CV: Heart S1 and S2 noted, no murmurs noted, no displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema noted
Abdomen: Abdomen round, soft, non-tender; bowel sounds present in all four quadrants. No organomegaly noted.
TSH: 2.1 mIU/L.
PHQ- 9 score 10
Nr603 Part 2 Response
From the subjective and objective data obtained, the three differential diagnoses include Post-partum depression, post-partum psychosis, and post-partum blues with Post-partum depression being the main diagnosis. The parts below describes the these diagnosis in details of the primary diagnosis as well as differential diagnosis.
Primary Diagnosis: Post-partum depression
As defined by Brummelte and Galea (2016), post-partum depression is a complex mix of behavioral, emotional, and physical changes that materialize in a woman after child delivery. The DSM-5 manual used for diagnosing mental disorders describes post-partum depression as a form of depression that commences within 4 weeks after child delivery whose diagnosis based on the length of time between child delivery and its onset as well as the severity of the presenting depression (Stewart & Vigod, 2016). Brummelte and Galea (2016) link post-partum depression to chemical, psychological, and social changes related to having a newborn baby that a plethora of new mothers experience. Chemical changes entail the rapid increase of estrogen and progesterone levels during pregnancy followed by a sharp decrease after delivery.
According to Stewart and Vigod (2016), some of the post-partum depression symptoms such as difficulty sleeping, excessive fatigue, appetite changes, frequent mood changes, and decreased libido are similar to typical experiences of many women experience following childbirth. However, post-partum depression involves other symptoms of depressed mood, loss of pleasure, feelings of worthlessness, helplessness, and hopelessness, and suicidal ideations or thoughts of hurting others (Stewart & Vigod, 2016)……Please click the icon below to purchase full solution at $10