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Case study

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Case study

Subjective: the patient is anxious about performing everyday tasks without her

husband present. She gained 25 pounds after starting Abilify and required an increased

dose of atorvastatin and Ozempic. She has been unable to lose weight and closely

monitors dietary intake but still craves carbohydrates. Type 2 diabetic on 1mg Ozempic

and depression and generalized anxiety from the loss of husband 7 years ago.

Objective: 70-year-old female patient, no visible distress, Ht: 5’2”, Wt:176 lb, BP:

146/83, Fasting blood glucose – 115, HbgA1c – 6.9, LDL 100, HDL 37, and Total

cholesterol -200.

Assessment :

● General anxiety disorder,

● Major depression disorder

● Type 2 diabetes

What would be your approach to managing this patient's weight concern?

( discuss at least two aspects of your approach). Please support your answer with

research-based evidence.

Patsalo et al., (2021) state that depression and obesity can occur at the same time

and are linked by mechanisms of the immune system, endocrine system, psychological

and social mechanisms. The study findings show that a calorie-restricted diet is efficient

for the management of weight and depression. I would recommend a calorie-restricted

diet to eliminate the carbohydrate cravings to manage the weight of the patient.

Additionally, exercise and physical and cognitive behavioral therapy would be

recommended besides stopping Abilify medication to help the patient lose weight.
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Exercise and diet have been found to have greater effects on depression (Patsalo et al.,

2021). Recommending physical exercise is a cost-effective yet effective approach to

weight management that would significantly improve depression conditions.

What would be our approach to the sexual side effects she is experiencing

The prolonged use of serotoninergic drugs is associated with decreased sexual

desire among depressed patients (Montejo et al., 2019). I would approach these sexual

side effects by switching to non-serotoninergic drugs or lowering their dose. Preferably,

switching to medication like aripiprazole would improve patient conditions

If you suggested additional medications, look up your state's prescribing laws.

are PMHNPs able to prescribe the medication you recommended?

Illinois State has Illinois Nurse Practitioner Supervision laws that deny the nurses

the freedom to practice independently hence cannot prescribe recommended medication

unless when they are working under a collaborative practice agreement with the

physician. The collaborative agreement entails the nurse practitioner-physician

relationships; categories of care, treatment, and procedures that the nurse practitioner is

expected to perform.
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Reference

Patsalos O., Keeler J., Schmidt U., & Himmerich H., (2021).Diet obesity and depression.

A systematic Review. Journal of Personalized Medicine, 11(3), 176

https://doi.org/10.3390/jpm11030176

Montejo A., Prieto N., Espada N., & Montejo L., (2019). Management Strategies for

Anti-depressant related sexual dysfunction. A Clinical Approach. Journal of

Clinical Medicine, 8(10), 1640. https://doi.org/10.3390/jcm8101640.