NR 603 Week 6 Mental Health Clinical Presentation Part 1 Bipolar Disorder

NR 603 Week 6 Mental Health Clinical Presentation Part 1 Bipolar Disorder/NR 603 Week 6 Mental Health Clinical Presentation Part 1 Bipolar Disorder/NR 603 Week 6 Mental Health Clinical Presentation Part 1 Bipolar Disorder A

Week 6: Mental Health Clinical Presentation Part 1

Dr. Julian and Classmates,

Please see the following for my case study for this week which was based off a patient I had

seen in the clinic in one of my first clinical rotations. I would normally have done some routine lab work

for the patient to rule out other possible physical causes that could contribute to the patient’s

symptoms; however, in this particular situation my preceptor felt confident on not doing them at the

initial visit and opt to do it at one of the follow up appointments in the next six months if the patient

was to return back to the clinic.

Setting: Primary Care Office

Patient Information: A.B., 22-year-old Caucasian Male

Subjective

CC: “Unable to leave my house.”

HPI: A.B. is a 22-year-old Caucasian male that presents to the clinic today with complaints of anxietylike symptoms and fearfulness of interacting with people in social gatherings and at work. He states he

feels nervous and fearful and can feel his heart racing when he has to leave his house to attend work

meetings. Onset of symptoms was 7 months ago after he graduated from online college and started his

first job post-college using his degree in business. Prior to this, the patient states he was never really

social and usually kept to himself growing up. He states he had one to two close friends growing up but

he never partake in usual friendly gatherings at school or in the community, but also never had anxiety

like this before. At his current job he has to attend required meetings with his boss and coworkers that

usually have 20 to 30 people present for hours at a time. Sometimes he has to speak in these meetings

which increases his anxiety of the whole situation. A.B. states he only feels anxious and fearful when he

goes to work every day and once he is home, he feels like himself again and is able to finally “breathe

and relax”. A.B. states that he begins to feel anxious and fearful anytime he has to initiate a

conversation with others at work and that is when he starts to excessively sweat all over, his heart feels

as though it is racing fast and he has trouble collecting his thoughts. He has missed work and meetings

due to his symptoms and he now fears he might lose his job because of this. He states he has tried yoga,

meditation, positive reflection and thinking but none have worked or lessened his symptoms. He has not

tried any medications but is willing to do whatever it takes to ‘feel normal again’ and to not lose his job.

Current Medications: No current medications.

Allergies: NKDA

PMHx and PSHx: No chronic illnesses, no recent hospitalizations or surgeries, all vaccines and

immunizations are up-to-date. Patient has had the chicken pox as a child.

Health Screening: Patient has a routine physical annually with last one being one year ago in November

2018.

Social Hx: A.B. is single, never married, a recent college graduate with a bachelor’s degree in business,

lives alone, non-smoker, denies alcohol or illicit drug abuse or intake, denies caffeine intake, denies

exercising regularly and states he enjoys video games in his free time. Patient is an only child.

Family Hx: Maternal family has a history of general anxiety and depression. Paternal side has a history of

hypertension, diabetes, arthritis, and general anxiety.

Risk Factors: Patient has a family history of anxiety on both sides of his family. Patient has been

experiencing high stress levels related to a new job he has just started and has tried various coping

measures with no relief.

ROS:

CONSTITUTIONAL: Denies fatigue, weakness, dizziness, weight loss, fever, chills, bleeding, headache, or

vision changes.

HEENT: Denies any headache, head injury, syncope involuntary movements, blurred vision, difficulty

focusing, visual disturbances or changes in vision. Denies earaches or ear pain, tinnitus, vertigo, changes

in hearing. Denies any sinus problems, nose bleeds, nasal congestion, allergies, or change in smell.

Denies difficulty swallowing, hoarseness, throat pain, or change in voice or taste.

CARDIOVASCULAR: Denies fatigue, chest pain, chest pressure, shortness of breath, cyanosis, pallor,

edema or activity intolerance. Denies palpitations on a regular basis, but does state he has occasional

chest discomfort when he feels severely anxious.

RESPIRATORY: Denies lung disease, difficulty breathing, shortness of breath, wheezing, cough, smoking

history or environmental exposures.

GASTROINTESTINIAL: Denies any change in diet, appetite, foot intolerance, dysphagia, heartburn,

indigestion, abdominal pain, nausea, vomiting, change in bowel pattern, or history of rectal or

abdominal conditions.

GENITOURINARY: Denies any change in bladder such as frequency, urgency, nocturia, dysuria, polyuria,

oliguria, straining or incontinence. Also denies any pelvic pain, sores, lesions or tenderness.

NEUROLOGICAL: Denies any headaches, weakness, numbness, tingling, memory issues, paralysis,

syncope, tremors, vertigo, head injury or seizures. Complaints of muscle twitching while at work around

coworkers.

MUSCULOSKELETAL: Denies any muscle pain, joint pain, back pain, hip pain, knee pain or ankle pain.

Denies any changes in ROM of extremities.

HEMATOLOGIC/LYMPHATICS: Denies any anemia, bruising, bleeding, lymph node swelling, delayed

healing or history of blood disorders.

INTEGUMENTARY: Denies rash, swelling, nail deformity, or changes in skin color. Reports excessive

sweating during episodes of anxiety.

PSYCHIATRIC: Denies any history of depression, anxiety, mood disorders/changes in mood,

hallucinations, or suicidal ideations. Reports being an introvert and reports being shy and anxious

around multiple people at one time.

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