In this Assignment, you will create a case study in which you will use to present and participate in clinical discussions called grand rounds.
To prepare:
- Review the below Learning Resources and consider the insights they provide.
Assignment:
- Select an older adult patient from your clinical experience that presents with a significant concern. Create a Focused SOAP Note for this patient using the template provided. (Note to writer: Patient provided below… However, please add on to patient details as needed to complete assignment )
- Your note should include objectives for your readers/audience, ADD at least 3 possible discussion questions/prompts for your classmates to respond to, and at least 4-5 scholarly resources to support your diagnostic reasoning and treatment plan.
- State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
- Pose 3 questions or discussion prompts, based on your presentation that your colleagues can respond to after viewing your presentation.
Patient:
68yo Male, presents for a follow-up visit.
Diagnosis:
– F20.0: Paranoid schizophrenia
– F41.9: Anxiety disorder, unspecified
– F51.01: Primary insomnia
Medications:
– Prozac 20 mg
– Propranolol 10 mg HS
Patient reports he had some palpitations after an increase to his propranolol to 20 mg, so self-discontinued the increased dose to propranolol 10 mg daily. Pt. currently stable on Prozac 20 mg daily for anxiety and depression, with manageable depression symptoms. Had been prescribed Seroquel 25 mg for mood and sleep issues but experienced severe priapism, so discontinued Seroquel due to this side effect; priapism resolved, but pain persists around the penis shaft, pt. expressed anxiety about resuming sexual activity for fear of priapism recurrence.
Plan:
– Decrease propranolol to 10 mg daily.
– Discontinue propranolol 20 mg.
– Monitor for further side effects.
Prozac for Depression and Anxiety Plan:
– Maintain Prozac 20 mg daily.
– Monitor effectiveness and side effects.
Seroquel for Mood and Sleep Plan:
– Discontinue Seroquel 25 mg immediately.
– Consult primary care for potential penile damage.
– Resume sexual activity as appropriate.
Mood Swings and Psychiatric Follow-up Plan:
– Maintain only propranolol 10 mg and Prozac 20 mg.
– Continue therapy sessions.
Sleep and Psychiatric Symptoms Plan:
– Continue management for primary insomnia.
– Monitor psychiatric symptoms.
Priapism Management
– Status: Patient reports that the priapism has resolved.
Follow up in 4 weeks
Resources to consider:
- Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.
- Chapter 26, “Assessing Alcohol Use Disorder”
- Office of Disease Prevention and Health Promotion. (n.d.). Social Determinates of Health. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/priority-areas/social-determinants-health
NOTE: Please use Resources/References not older than 5-years. (2019 – 2024)
