HPI (History of Present Illness):   Miss R is an 18-year-old whitefemale college student who was rec

HPI (History of Present Illness):   Miss R is an 18-year-old whitefemale college student who was recently hospitalized for major depression. Her mother calls the primary care office where the nurse is employed and shares concerns about her daughter’s agitation and hostility telling the nurse that her daughter is “pacing the halls at night and doesn’t sleep much. She isn’t eating. The mother says, “When I ask her what’s wrong, she shuts her door, telling me she doesn’t want to talk now. The few people she’ll talk to are suspicious characters, not her usual group of friends. I think they’re using drugs.”Miss R’s mother then tells you that her daughter’s condition has deteriorated since the brief hospitalization 4 days ago when she was started on her medications.The nurse has seen Miss R in the past and has a good relationship with her. The nurse convinces her to come to the clinic to be evaluated. Miss R arrives at the clinic appearing agitated. She admits that she has been “nerved up” and “full of energy,” but she can’t understand why her mom is so concerned. She tells the nurse: “My depression is starting to lift. I’m actually starting to see the world in vivid color. Yeah, I have new friends, because I’m starting to live again. No, I’m not using drugs. I drink once in a while, sometimes more than I should.”When questioned further about her mood, Miss R. admits that “Sometimes at night, I get nervous and start to get those dark thoughts that made me miserable this past year, but I no longer want to hurt myself. I want to live.”Past Medical History:Anorexia/BulimiaPossible ADHD (poor school performance, never fully worked up)Depression (several episodes since age 14, most serious 2 weeks ago, when she considered suicide following the break-up with boyfriend)Seasonal allergic rhinitisMedications:Imipramine (Tofranil), 150 mg, PO, qhsCimetidine (Tagamet), 800 mg, PO, bid, for indigestion/heartburn, obtained OTC, started 1 week agoLoratadine, 10 mg, PO, dailyLoestrin 21 (1.5/30), tablet PO, dailyAllergies:Sulfa drugs cause hivesPhysical Exam:Vital signs: BP: 125/78, HR: 108, RR: 20, T: 37.5Hypervigilant, anxious, thin female, pacing the roomDressed casually, appropriate for the settingSpeech: somewhat pressured, loudNeuro: Attention poor- starts out the window instead of answering some questions             Thought content is logical and relevant              Oriented x3, no focal neurological signsQ1: Should the nurse be concerned about this patient’s behavioral changes? What might be going on with this patient?Q2: Are insomnia and increased energy likely side effects of this patient’s antidepressant medication?Q3: Are there drug interactions between this patient’s medications that are concerning? If so, list them. Hint: cimetidine is a CYP450 inhibitorQ4: Is there anything that should get the nurse’s attention on the physical exam?Q5: Given her history and the findings on today’s examination, are there safer medications for this patient? Health Science Science Nursing CON|NUR MISC Share QuestionEmailCopy link Comments (0)

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