Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
SUBJECTIVE
Sophie is a 62‐year‐old female who presents today with her son, Taylor, for a chief complaint of “forgetfulness.” Sophie is somewhat withdrawn during the appointment and offers very little information. She gives her son permission to share her history. Her son Taylor tells you that for the past 2 months he has noticed that his mother is becoming increasingly forgetful and more withdrawn. She has forgotten appointments and to pick up her grandson at school 4 times over the past 2 months. She previously was able to take her medications independently but now her son notes he has to remind her daily and has started to organize her medications for her. Taylor also notes that his mother is not sleeping well and is up at 4 a.m. most mornings and then will nap for about 4 hours during the day. She has also stopped going to her weekly knitting group and is not participating in weekly meetings at her church anymore.
Sophie does admit today to feeling “down” and simply states, “I don’t feel like doing anything.” She attributes her forgetfulness to being “stressed out” about her daughter and her father’s medical condition. She reports she has frequent nighttime wakening because “I worry about my family and my legs hurt.” When asked how often she is taking her prescribed Alprazolam, she states, “I have to take it 2–3 times a day for my nerves.”
Sophie has not had any trouble getting dressed, making meals, or showering independently.
She has not gotten lost with driving.
Sophie does not have a mental health counselor or a psychiatrist at the present time. Her former psychiatrist retired 2 years ago and her PCP has been prescribing her psychiatric medications.
Past medical history: Type 2 diabetes mellitus, diabetic peripheral neuropathy (DPN), hyperten-sion, hyperlipidemia, depression, anxiety, post‐traumatic stress disorder, chronic insomnia
Family history:
• Mother age 82: Coronary artery disease (CAD), Type 2 diabetes mellitus, hypertension, hyperlipidemia
• Father, age 88: Hypertension, hyperlipidemia, prostate cancer, diagnosed with Alzheimer’s dis-ease at age 80
• Brother, age 66: Hypertension, myocardial infarction (MI) at age 65, Type 2 diabetes mellitus
• Son, age 40: Hypercholesterolemia
• Grandson, age 10: Asthma
Social history:
• Lives with her son, Taylor, and her 10‐year‐old grandson, Joseph, in a suburban house.
• Taylor assists Sophie with her medications and appointments. Taylor is 40 years old and works full‐time as a math teacher at the local high school. He is divorced and has full custody of his son, as his ex‐wife has a substance use disorder and is currently incarcerated.• Retired (worked as a receptionist for a dental office for over 40 years).
• Highest education completed: high school.
• Divorced for over 10 years and ex‐husband physically and emotionally abused her for over 20 years; ex‐husband now deceased due to lung cancer.
• Her daughter, Cynthia, has a substance‐use disorder and a history of homelessness and incarceration.
• No history of smoking or illicit drug use, and she does not drink alcohol.
Medications:
• Metformin 1000 mg po twice daily
• Gabapentin 1200 mg po three times daily
• Lisinopril 20 mg po daily
• Rosuvastatin 20 mg po daily
• Citalopram 20 mg po daily
• Buproprion XR 150 mg po bid
• Alprazolam 0.5 mg three times daily PRN
• Trazodone 400 mg po at night
Allergies: Sulfa: rash
OBJECTIVE
General: 62‐year‐old female, well‐dressed, well‐nourished, in no apparent distress.
Vital signs: Blood pressure: 136/82; HR: 72; RR 20.
Cardiac: AP RRR, no murmurs, rubs, gallops, no JVD, no carotid bruits bilaterally.
Pulmonary: Lung sounds clear to auscultation bilaterally, no use of accessory muscles
Neurological: Patient is alert/oriented to person, time, and place; flat affect and depressed mood; has difficulty maintaining eye contact during exam; poor effort during physical exam and screen-ing questionnaires; normal insight and judgment, speech clear. CN II–XII grossly intact. Normal tone to all 4 extremities; no cogwheel rigidity noted. Reflexes: 2+ bilaterally to biceps, triceps, and brachioradialis, hypoactive bilateral knee and Achilles reflexes; no clonus, toes downgoing bilat. Coordination: F‐N‐F testing WNL, RAM WNL, Romberg negative. Sensory exam: Decreased pin-prick, light touch, and vibratory sense to lower extremities in a stocking‐like distribution; propri-oception intact. Gait: Slightly wide‐based, normal speed, stride, and arm swing intact, no ataxia observed.
Montreal Cognitive Assessment (MoCA) Screening = 22 Patient Health Questionnaire‐9 (PHQ‐9) = 15
CRITICAL THINKING
What are the top three differential diagnoses in this case and why?
Which diagnostic tests are required in this case and why?
__CBC
__TSH
__Vitamin B12
__CMP
__RPR or FTA testing
__HgA1C
__Lipids
__ESR
What are the concerns at this point?
What are 3–5 case‐specific questions to ask the patient?
What is the plan of treatment?
What are the plans for referral and follow‐up care?
What health education should be provided to this patient?
What demographic characteristics might affect this case?
Does the patient’s psychosocial history impact how you might treat her?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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