Case Study of Molly
Instructions: Read the following case, and follow the instructions in u02a1 in the courseroom to complete the assignment.

Molly, a 29-year-old unmarried woman, comes to the clinic complaining of a depressed mood, sleep problems, lack of concentration, loss of interest and pleasure in things, irritability, nervousness, lack of sex drive, no appetite, and undesired loss of 15 pounds in two months. She looks tired, sad, and gaunt. She moves slowly and occasionally tears up during the interview. She reports feeling this way for about two and a half years, since losing a job in a high-pressure computer start-up company. She had been a “shooting star,” rising fast in the dot-com world.

Prior to her collapse, she had never experienced failure of any kind. The collapse on the job seemed to be precipitated by a sexual affair she initiated with a coworker. As soon as this affair became known, she was criticized by coworkers and threatened by her supervisors with termination unless she ended the affair. Her lover was fired, and in his anger he refused to see her anymore. Thus, she lost her lover and the respect of her coworkers at the same time, and within six weeks was so depressed she could not function. She was then fired.

Since that time, she has taken a number of similar jobs, but has been unable to overcome her doubts that her “luck” would hold. She was afraid that her depression would impair her ability to concentrate and that she would either quit or be fired. She has moved back home with her parents, who are very supportive. Molly’s mother brought her to the interview.

During her love affair, Molly says, she began using cocaine with her boyfriend. After losing her job, she did not give up drugs, but switched to marijuana because it was much cheaper. Although she says that she preferred the rush of cocaine, she could not afford it, and now relishes the calm and numbness that marijuana brings. She smokes at least two marijuana cigarettes per day, often more. She had had one smoke earlier on the day of the interview. Her parents disapprove, though they give her the money for it, since “it helps me relax.” Molly also says that she drinks ” two to five” glasses of white wine each evening. “Wine helps me sleep,” she reports.

Molly has no medical problems to speak of. Difficult ovulation has always been a problem, but “nothing I can’t live with.” During ovulation, she tends to become more irritable than normal, and often snaps at people. But after 48 hours, she says, this dissipates. “It’s predictable as the trains,” she says. Her menstrual periods are uneventful.

Molly has had no accidents or illnesses besides the normal ones of life. No surgeries and no medications complicated her health picture. She has never needed or been to a therapist or psychiatrist prior to this visit. She feels ashamed of coming now.Use this outline to structure your case assignments.

1. Case Summary
Provide a brief summary of what you have learned about the individual reviewed in the case. Include information about the individual in terms of demographics and general history, and the sources of that information, and the reason that the individual was referred, and by whom.
Summarize any information you may have about evaluations that have been conducted, including the results.
2. Clinical Impression (Diagnosis)
Write the clinical impression in the DSM-5 format:

XXX.xx (Yyy.yy) Primary Diagnoses (list in order of salience).

(DSM-5 Code is first, as in XXX.xx, and ICD-10 codes next, in parentheses.)

OTHER FACTORS:

Use the V and Z codes, or simply appropriate descriptors to psychosocial and contextual factors of importance to the diagnostic case. These replace the DSM-IV-TR Axis IV & V used to address these concerns.

3. Recommendations
Explain any recommendations for interventions, treatment, and/or disposition.

4. Questions
Address the specific questions that were asked in the instructions for this assignment.

Here is a sample assignment question and an appropriate brief response:

Question: Describe what further information you would need to accurately diagnose this case.
Response: To diagnose this case accurately, I would also need to review any pertinent medical records. I would want to interview this client’s mother, with whom he lives, to corroborate the clinical interview data supplied by the client, and to learn more about his developmental history. I would also want to

2 scenario’s: Patient A (Acute Renal Failure) and Patient B (Chronic Renal Failure)

Each Scenario has 4- Questions (Total 8 q’s)

Each question require 25-50 word response

(1) source and reference for each Patient A and B. (2 total sources)

Format: APA style

Microsoft Word

(see attachment)

Urinary tract infections (UTIs) occur when bacteria invade the normally sterile urinary system, causing inflammation to the epithelium. If the infection is found in the urethra and bladder, it is considered a lower urinary tract infection. When the infection goes above the level of the bladder and into the ureters and kidney, it is considered an upper urinary tract infection or pyelonephritis (Huether & McCance, 2017). Risk factors for UTIs include female gender, diabetes, sexual intercourse, urinary incontinence and/or retention, and immobility (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).

Lower urinary tract infections are most commonly caused by intestinal microbes like E. Coli. These pathogens bind to the urinary epithelium and create an inflammatory response. This response created edema and stretching of the bladder wall, which signals the stretch receptors to relay the feeling of fullness. This created the urgency, frequency, dysuria, and low back pain that are commonly felt. If left untreated, the epithelial wall will become more and more damaged, eventually leading to bleeding, ulcerations, and even gangrene (Huether & McCance, 2017).

Upper urinary tract infections, or pyelonephritis, can be caused by the pathogen climbing and spreading into the upper part of the urinary system. Unlike lower urinary infections, upper urinary infections can also be caused by contaminated blood flowing through the kidneys. If left untreated, abscesses can form in the adrenal medulla and cortex. Back or flank pain and costovertebral tenderness are symptoms that are more unique to the upper urinary infection and can help differentiate along with diagnostic testing. Fibrosis formation in the tubules can form after the initial infection (Huether & McCance, 2017).

Females are far more likely to suffer from urinary tract infections because of the shorter urethra and closer proximity to the rectum (Huether & McCance, 2017). Age is also a factor, as immobility, dehydration, and urinary incontinence increase the risk of developing UTIs. A UTI in an older adult can have different symptoms and manifestations, such as delirium, hallucinations, sudden decrease in mobility, and subsequent falls. These symptoms can be dangerous and may cause significant injury (Armstrong, 2015).

Along with antibiotics, urinary analgesics can help with the discomfort associated with urinary tract infections. Urised is a common urinary analgesic that is prescribed which often has anticholinergic side effects. Patients should be educated on the chance for urinary and/or bowel retention and when to seek treatment (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Encouraging fluid and fiber intake may help offset these side effects.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Armstrong, K. (2015). Diagnosing and treating urinary tract infections in older people. British Journal of Community Nursing, 20(5), 226-230. doi:10.12968/bjcn.2015.20.5.226

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Much of the ongoing debate over scope-of-practice (SoP) laws that govern the practice of nurse practitioners (NPs) across the country focuses on the cost of and access to health care and on whether these laws legitimately promote patient safety or are simply anticompetitive restrictions on NPs’ ability to compete with physicians. After completing the following CE activity at Medscape https://www.medscape.org/viewarticle/506277_1 ( sign for the free account), please answer the following questions:

Should an NP who is educationally prepared as an acute care NP work in an adult primary care setting?

Is it within the scope for an FNP to diagnose and treat uncomplicated mental health conditions like depression, anxiety, and ADHD?

Are there any restrictions for the FNP to treat patients with mood disorders and to prescribe them antipsychotics or SSRIs ?

Use APA Style and appropriated references.