Question

A. Martha is a 44 year old married woman with three children who presents with a 2 month history of initial and terminal insomnia and a 12 pound weight loss over that same period. She admits to feeling sad almost every day for the past 2 months that occured after she lost her job. She denies feeling enjoyment, has not engaged in any previously enjoyable activities, and wonders if life is worth living. Her physical examination is negative, vital signs and blood work including a thyroid profile are all within normal limits, and her body mass index is 22. Her mother and one of her sisters both had episodes of depression and were treated successfully with sertraline. 1. Which medication would you start Martha on and why? Describe the benefits you expect to see for her 2. What is critical education to share with her? 3. Does the fact that she is of childbearing age impact your decision making? 4. Describe the ongoing care and management needed for Martha (as appropriate for the medication you suggest for her).

Answer 1

1.Martha has to be started with an antidepressant to get rid of her symptoms and get a sleep.(loss of job,feeling sad,lack of activities )

An hypnotic can also help her to induce sleep and prescribed and monitored for 2 to 3 weeks.

The benefits which can be observed are

• Increase in the quality of sleep
• Maintaining a sleep cycle or a sleep hygiene
• Feeling loneliness is decreased
• Engaging in activities which gives her happiness or enjoyment

2.The critical education to be shared with her are

• Educating on the necessity of taking medication daily ,and not stopping if symptoms subsides without order
• Not to drive when on medication
• No alcohol and smoking
• Can do exercise because this improves the function in overall and enhance sleep
• Can follow relaxation therapy

3.The healthy childbearing age is from 20s to 30s .She is in her 40s nearing the menopause. Hence the patient can be given a selective serotonin reuptake inhibitor (Sertraline) to manage her symptoms.

4.The following care is necessary

• Health education to be given on the action ,effects of the medication
• General precautionary steps like no smoking ,alcohol,driving to be informed
• Weight management in accordance with her anthropometric measurements.
• Having well balance nutritional diet.