Step 1: Review your assigned case and topics associated with this week’s lesson. Your
Case 2 | Alma Garcia
Client Introduction

A 23-year-old Hispanic female presents with ongoing grief following a spontaneous abortion at seven weeks. The client states she had been trying to conceive for several months and is devastated by this loss. She has since broken up with her partner. She expresses concerns about managing her overall well-being.
History and Recent Activities
When addressing the client’s concerns, it is essential for the provider to explore her emotional and physical state comprehensively. Questions should focus on her experiences, the impact on her daily life, and any associated changes in habits, such as sleep, appetite, or energy levels. Additionally, the provider should inquire about her support system and coping mechanisms to better understand her current situation and any existing challenges.
Click each plus (+) sign in the activity below to learn more about appropriate initial follow-up questions for this client.
History and Recent Activities Transcript
Red Flags: Do Not Miss

There are priority concerns based on the client’s presentation that must be thoroughly addressed during the initial information-gathering process. Exploring key areas of her emotional and physical well-being will help identify underlying factors and guide the direction of the examination.
Important topics to explore include:
• Emotional response and mood changes: The client’s emotional response to recent events and any significant changes in mood or behavior.
• Alterations in sleep, appetite, and energy: Changes in sleep patterns, appetite, or energy levels.
• Support system: Presence of a support system and any challenges in accessing it.
• Physical symptoms: Recent physical symptoms, such as fatigue or weight changes, that may indicate additional concerns.
• Coping mechanisms: History of coping mechanisms or strategies used during times of stress.
• Suicidal ideation: Assessment of suicidal ideation to ensure a comprehensive evaluation of her mental health and safety.
Physical Assessment Findings
The provider observes that the client appears visibly distressed and fatigued, with intermittent difficulty maintaining eye contact during the discussion. Her responses are deliberate but occasionally halting, suggesting potential difficulty articulating her experiences.
Examine the table below to learn more about the current vital signs for this client.
Vital Signs Height Weight BMI Blood Pressure
5’4″ (162.6 cm) 220 lbs. (100 kg) 37.8 130/84 mmHg
Heart Rate Respiratory Rate Oxygen Saturation Temperature
80 bpm, regular 18 breaths/min 97% on room air 98.6°F (37°C)
Learn By Applying
Apply what you have learned to the questions below.
Consider the client’s vital signs and information gathered from the history and recent activities. Place the following focused assessments in order of priority.
Learn By Applying Transcript
Red Flags: Do Not Miss

There are critical assessments based on the client’s concerns and setting that should not be overlooked at this stage. These assessments are vital to guide the diagnostic process and promptly address key contributing factors.
Assessments to focus on include:
• Mental health assessment: Mental health evaluation to assess emotional distress and its impact on daily functioning.
• Endocrine assessment: Endocrine assessment to explore any physiological factors influencing the client’s symptoms.
• Psychosocial assessment: Psychosocial evaluation to identify external stressors and support systems.
• Cardiovascular assessment: Cardiovascular assessment to rule out underlying concerns related to circulatory health.
• Gastrointestinal assessment: Gastrointestinal assessment to determine any recent changes in diet or weight that may affect overall health.

At this point, there are critical follow-up questions that must be addressed to ensure all relevant factors influencing the client’s presentation are identified. These questions will guide the diagnostic and management process and should include an assessment of the client’s personal goals to align care with her needs and expectations.
Assessments to focus on include:
• Energy levels: Evaluating the client’s energy levels and physical symptoms to identify potential contributing factors affecting her well-being.
• Emotional triggers: Exploring emotional triggers and coping mechanisms to understand the impact of recent events on her mental health.
• Sleep patterns: Assessing sleep patterns and changes in routine to determine how these may influence her condition.
• Health goals: Clarifying the client’s immediate and long-term goals for managing her health and addressing her concerns.
• Diet and activity: Investigating dietary habits and activity levels to provide a comprehensive view of her physical state and lifestyle.
• Suicidal ideation: Assessing for suicidal ideation to ensure any immediate safety concerns are identified and addressed appropriately.
Diagnosis

The provider notes that the client appears visibly fatigued, emotionally distressed, and hesitant to engage fully in the conversation, with a flat affect and slowed speech. Her reported difficulty sleeping, reduced appetite, and persistent low energy raise concerns about underlying emotional and psychological factors contributing to her presentation. Given the client’s disrupted routine, reluctance to seek support from family, and history of elevated glucose levels, further evaluation is necessary to differentiate between psychological conditions and any contributing medical issues.
What additional questions could the provider ask to better understand the client’s coping mechanisms and support system, and how might addressing cultural factors improve the client’s engagement in her care plan?
Management Plan

The correct diagnosis for this client is depression, as indicated by her persistent fatigue, sleep disturbances, reduced appetite, emotional distress, and a PHQ-9 score of 12, reflecting moderate depressive symptoms. Students should have deduced this diagnosis by integrating her clinical presentation with validated screening tools. The setting plays a crucial role in influencing the diagnosis, as delays in access to mental health services or limited availability of appropriate providers can impede timely care. The management plan for depression should emphasize three key areas: psychotherapy, pharmacologic treatment, and self-management strategies. Psychotherapy, such as cognitive behavioral therapy (CBT) or interpersonal therapy (IPT) is recommended for moderate depression, particularly given the client’s reluctance to share her emotional concerns with her family due to cultural stigma. Pharmacologic options should focus on medications with minimal metabolic side effects, aligning with her health profile. Additionally, self-management strategies, including sleep hygiene, physical activity, and stress reduction techniques, support the client’s goals of improving daily functioning and overall well-being (American Psychological Association [APA], 2019). Fiscal considerations involve ensuring access to cost-effective therapy and medications, while cultural considerations require providers to address stigma through culturally sensitive communication and education, fostering trust and engagement in her care.
Case Summary

This client’s case highlights the importance of a comprehensive approach to diagnosing and managing moderate depression, as indicated by her PHQ-9 score, reported emotional distress, and physical symptoms such as fatigue and reduced appetite. The management plan includes both non-pharmacologic interventions, such as CBT or IPT and stress reduction techniques, and pharmacologic options that prioritize medications with a low metabolic profile, such as bupropion or SSRIs, to minimize the risk of exacerbating her elevated glucose levels and BMI. Regular follow-up with her PCP and a mental health specialist, combined with monitoring PHQ-9 and GAD-7 scores, ensures proper symptom tracking and early detection of any worsening conditions. Additionally, referrals for nutritional counseling and potential future endocrinology evaluation address her metabolic health risks. It is essential to continue evaluating the client’s progress while being mindful of potential co-occurring conditions, such as anxiety or adjustment disorder, which may require additional interventions. Maintaining a culturally sensitive approach, addressing stigma, and setting realistic goals are critical to ensuring the client remains engaged in her care and achieves optimal outcomes.
Self-Assessment of Learning

The assessment, diagnosis, and management of this client involve key topics such as mental health evaluation using tools like PHQ-9 and GAD-7, pharmacologic and non-pharmacologic treatment options for depression, and the importance of ongoing monitoring to ensure treatment effectiveness and safety. Additionally, considerations around metabolic health, such as elevated glucose levels and BMI, highlight the need for interdisciplinary care, including dietary counseling. This case emphasizes the importance of students pausing to reflect on their strengths in identifying and managing complex conditions while recognizing opportunities to improve in areas such as culturally sensitive communication, medication selection, and comprehensive follow-up care. Understanding these components is essential for effective clinical decision-making and preparation for board exams.

Last Name Topics from this Week’s Cases
K – O Case #2 Depression and generalized anxiety disorder
Step 2: Consider your client’s clinical presentation in this week’s lesson and thoughtfully discuss your responses to the discussion prompts. Answer the discussion prompts below with explanation and detail, providing complete references for all citations.
Step 3: Reply to a peer with a different assigned client and topics.
Include the following sections:
1. Application of Course Knowledge: Compare and contrast the assigned diagnoses in your initial discussion post. Answer all questions/criteria with explanations and detail.
a. Compare and contrast your assigned client’s presentation for each assigned diagnosis. Consider factors such as demographics, onset of symptoms, history of present illness, and associated risk factors.
b. Compare and contrast the diagnostic criteria (assessment findings and diagnostic tests) for your assigned client and diagnoses. Support your response with the most current clinical practice guidelines (CPG) for each diagnosis.
c. Compare and contrast the evidence-based management of each assigned diagnosis, including similarities and differences in pharmacologic and non-pharmacologic treatment, client education, referral, and follow-up care. Consider how the client’s unique past medical history and social history impact care decisions.
d. Consider how this week’s care setting (a clinic with access to resources) impacts the assessment, diagnosis, and management of these diagnoses. Explain your rationale.
2. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectationsLinks to an external site.:
a. Cite a scholarly source in the initial post.
b. Cite a scholarly source in one faculty response post.
c. Cite a scholarly source in one peer post.
d. Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
e. Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
3. Engagement in Meaningful Dialogue: Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.
a. Peer Response: Respond to at least one peer on a topic other than the initially assigned topic.
b. Faculty Response: Respond to at least one faculty post.
c. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
4. Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation. 
5. Reference Citation: Use current APA format to format citations and references and is free of errors. 
6. Wednesday Participation Requirement: Provide a substantive response to the graded discussion topic (not a response to a peer or faculty), by Wednesday, 11:59 p.m. MT of each week. 
7. Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.  
**To view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.