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Posted: August 24th, 2022

Kel is a 42-year-old certified public accountant (CPA)

Nursing homework help


Kel is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhere, anywhere, except Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea.” In fact, she does not even have the energy to dream; getting out of bed and preparing to go to work is simply too labor intensive.

Each evening Kel retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the evening; consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last 2 months. She does not attend to her makeup or clothes; Kel goes to bed every night feeling too tired to do normal things like get her clothes ready for work and make a lunch. She is too tired to go shopping in the evening, so she mostly eats crackers and soup from a can. The number on the scale shows that she is not hungry. In the last two months, she has lost 15 pounds. She doesn’t care about her clothes or make-up; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her co-workers and does not initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete them. Telephone calls and e-mail messages from friends are ignored. Attendance at work is spotty.

Sue, her sister, becomes alarmed with Kel’s unanswered telephone calls and e-mails. Worried, she decides to visit her sister at home. She finds the apartment unclean and in disarray. Kel is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Kel tells Sue that she feels “sad and hopeless. Nothing is ever going to change. I am a bad person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time.” Sue is alarmed at the changes in her sister and arranges for Kel to visit a health care worker at the medical clinic.

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.

Describe the presenting problems.
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
Formulate and prioritize a treatment plan.
Identify and discuss appropriate screening instruments for a patient who has suicidal ideation.
Submission Instructions:

at least 500 words ( 2 complete pages of content) formatted and cited in current APA style 7 ed with support from at least 3 academic sources which need to be journal articles or books from 2018 up to now. NO WEBSITES allowed for reference entry. Include doi, page numbers, etc. Plagiarism must be less than 10%.

Major Depressive Disorder: Kel’s Declining Mental Health
Kel, a 42-year-old certified public accountant, has been experiencing a steady decline in her mental health and daily functioning over the past two months. According to her sister Sue, who is concerned about Kel’s lack of response to phone calls and emails, Kel has become disheveled, sad, and hopeless. She sleeps for many hours yet still feels constantly tired. Kel has lost 15 pounds and shows little interest in self-care or hygiene. At work, she lacks motivation and feels too disorganized to complete tasks she once enjoyed, like filing taxes and writing reports.
Kel’s symptoms meet the diagnostic criteria for a major depressive episode as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013). The DSM-5 criteria for a major depressive episode include at least five of the following symptoms present nearly every day for at least two weeks: depressed mood; diminished interest or pleasure in activities; significant weight loss or weight gain; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive guilt; diminished ability to think or concentrate; and recurrent thoughts of death or suicidal ideation.
Kel clearly experiences a depressed mood, diminished interest, significant weight loss, fatigue, feelings of worthlessness, and diminished concentration. The onset of these symptoms represents a change from her previous level of functioning. Her symptoms cause clinically significant distress and impairment in social and occupational functioning. Based on this evidence, the primary diagnosis is major depressive disorder, single episode, moderate (F32.1).
Other potential diagnoses in the differential include:
Persistent depressive disorder (dysthymia) (F34.1). However, Kel’s symptoms have a clear onset and change in functioning rather than a chronic low-grade depressive mood.
Adjustment disorder with depressed mood (F43.21). But the duration and severity of Kel’s symptoms exceed what would be expected from a stress-related disorder.
Bipolar II disorder, most recent episode depressed (F31.81). Hypomanic episodes would need to be ruled out with further assessment.
Medical conditions like hypothyroidism. A physical exam could evaluate for potential medical causes of depression.
To prioritize treatment, Kel’s safety and level of impairment should be the top concern. She reports feeling hopeless, which with her other symptoms, indicates she is at risk for suicide (NIMH, 2022). The Patient Health Questionnaire-9 (PHQ-9) is a brief, valid, and reliable screening tool that assesses severity of depression symptoms (Kroenke et al., 2001). It could help evaluate Kel’s current state.
The Beck Scale for Suicide Ideation (BSS; Beck et al., 1979) specifically assesses active suicidal thoughts and plans. Given Kel’s reported hopelessness, the BSS would be prudent to administer. If she scores high, immediate intervention and hospitalization may be needed to ensure her safety.
Cognitive-behavioral therapy (CBT) has strong evidence for effectively treating depression (Butler et al., 2006). It teaches clients to challenge negative thought patterns and behaviors linked to their depression. Medication could also help, as antidepressants have demonstrated efficacy for major depressive disorder (Fournier et al., 2010). Selective serotonin reuptake inhibitors (SSRIs) like sertraline are generally well-tolerated first-line options.
Close monitoring of Kel’s symptoms, safety, and functioning would be critical in the initial treatment phase. Regular therapy sessions and medication management with a psychiatrist could help lift her mood and restore her ability to care for herself and work productively. With proper treatment and self-care strategies, her prognosis for recovery from this major depressive episode is good.

Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343–352. https://doi.org/10.1037/0022-006X.47.2.343
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical psychology review, 26(1), 17–31. https://doi.org/10.1016/j.cpr.2005.07.003
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA, 303(1), 47–53. https://doi.org/10.1001/jama.2009.1943 research essay writing service.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
NIMH. (2022, February). Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression

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