Grief and Bereavement in Nursing - Case Study Example

Symptoms: 31-year-old Caucasian female biology graduate student presents with "I'm overtired and can't sleep or eat."
A. Identify (list) appropriate history questions to be asked of your client to discriminate critical characteristics or attributes about the above-presenting complaint.

Do you feel like hurting yourself or others?
Have you tried hurting yourself in the past year?
Do you feel safe at home?
Are you depressed, worried, or stressed about something?
Has something traumatic happened?
When did the symptoms start?
Do you have difficulty falling asleep or staying asleep?
Are you taking any new medication?
Do you have little pleasure or interest in accomplishing things?
B. Delineate 5 competing hy¬potheses that could support the above symptoms in relation to pertinent answers given in the history. Note: you should include the diagnosis from the Final Assessment Findings section in the case study as part of the 5 hypotheses.
1. Major depressive disorder
2. Insomnia
3. Grieving
4. Anemia
5. Thyroiditis

C. Explain the physical findings or reported symptoms you would expect during the visit. Using the inspection, palpation, percussion, and auscultation (IPPA) format define hypothesized objective and subjective data you would expect to obtain during the patient exam.
Hypothesis 1: Major Depressive Disorder – Observation of thin, tired-looking, fatigued, weight loss, poor appetite, muscle weakness, skin warm, dry, flat affect, provides little detail in answers, indecisive, has difficulty concentrating depressed mood or anhedonia (absence or pleasure) for at least 2 weeks. (Pg 53) sleep disturbance, weight loss, loss of appetite, and loss of sexual interest (Pg 59-60), Patients with depression may display poor or lapsed hygiene. Pg 61 May cause a patient to be withdrawn (Pg 61), negative, slow, and low-self-esteem

Hypothesis 2: Insomnia – problems falling asleep, staying asleep, and waking up frequently or early in the sleep cycle. (Pg 54)
Hypothesis 3: Grieving-a feeling of guilt, denial, shock, loss of appetite, fatigue, isolation or detachment from others
Hypothesis 4: Anemia-fatigue, lethargy or lack of energy, signs of cognitive problems, lack of sleep (insomnia)
Hypothesis 5: Thyroiditis- fatigue, depression, decreased concentration.

D. Describe the physiology or pathophysiology associated with each hypothesis.
Hypothesis 1: Major depressive disorder – genetics plays a vital role, resulting from abnormalities between brain hormones and neurotransmitters i.e. hypothalamus-pituitary-adrenal (HPA) axis; serotonergic, dopaminergic and noradrenergic systems. Depression might be caused by relational issues.

Hypothesis 4: anemia-a condition where there is a deficit of erythrocytes (red blood cells). Therefore, the blood’s capacity of carrying oxygen is reduced.
Hypothesis 5: thyroiditis- is caused by a combination of environmental and genetic factors. Evidence implies that a partial specific antigen defect in T lymphocytes is the primary cause.

E. Describe the diagnostic tests that would be appropriate for each diagnosis.
Hypothesis 1: Major depressive disorder – Serum electrolytes, CBC, Thyroid function test, Refer for psychological evaluation (Pg 44)
Hypothesis 2: Insomnia – sleep diary (Pg 355), mental exam, actigraphy test, polysomnography test
Hypothesis 3Grieving-physical exam tests, query if someone close to the patient has died
Hypothesis 4: Anemia-CBC test, reticulocyte count and urine test
Hypothesis 5: Thyroiditis- hormone test, antibody test.

Analysis:
Bereavement is among the most traumatizing, painful and gut-wrenching experiences a person will ever face. Grieving people often undergo various states during this period (regret, loneliness, withdrawal, intrusive images, depression, unhappiness, a feeling of being overwhelmed and depersonalization. Read More