Reference no: EM133920002

Question

A patient's daughter brings her mother in to see her primary care provider because she is concerned about her mother's health since the patient's husband passed away. In gathering the patient's history, she tells you that she is 63 years old and currently unemployed because she and her husband were preparing for his upcoming retirement this month with plans to travel and visit relatives in Ireland, fulfilling a lifelong dream of theirs. She tearfully tells you that this won't be happening now because her husband died from a massive myocardial infarction, which occurred at home during the night 7 weeks ago. When asked about her current symptoms, she reports feeling "depressed and stressed with all that has happened," she has lost weight, and she has problems sleeping since her husband passed away. At this point in the interview, the patient's daughter interrupts and states that she is extremely concerned about her mother's lack of sleep. She tells you that her mother began taking melatonin 1 week ago because both the patient and her daughter are not "big on taking medicine, and we feel more comfortable using natural interventions, like the melatonin." When performing the sleep assessment, the patient provides the following data: she reports she feels depressed and "lost" without her husband; she is stressed with handling the legal and financial affairs; she reports she has no energy, and concentrating has been extremely difficult; and she feels exhausted all the time, yet when she attempts to lie down to sleep, she is unable to fall asleep in bed because that is where her husband died. She also tells you that since beginning the melatonin, she does fall into a light sleep, usually on the couch, but she tends to wake up with a "start" or jerk, feeling scared and overwhelmed with a profound feeling of dread upon awakening. She also admits to now drinking one to two glasses of wine in the evening in an attempt to soothe her nerves and fall asleep; however, it has not seemed to help and leaves her with a "heavy, dull" feeling in the morning. At this point, she tells you she is keeping herself going on strong black coffee and drinks two 12-cup pots of coffee a day. She and her daughter are both concerned about the patient's health and believe she would be better off in the hospital.

1. What therapeutic interventions would you suggest for this patient?

2. Which additional disorders is this individual at risk of developing?

3. What class of medications do you expect the provider to prescribe for the patient, if any?