Medical and Health Services Managers

1. Create a case study of an older adult and his or her family presenting for therapy and an overview of treatment. a. This will include a description of the case study and presenting issues, a description of assessment procedures, diagnosis, treatment goals, a thorough explanation of the interventions with the client and his/her family, ethical considerations, and cultural considerations

Running head: HEALTHCARE
Healthcare
Name of the Student
Name of the University
Author Note

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a. Case study presentation
Mrs. X is a 65 years old older adult female. Her birth nation is Spain. She arrived at USA with
her husband when she was 24 years old. Since then she has been residing at Florida. Mr and Mrs.
X have 2 daughters and 1 son. In the age of 51, Mrs. X lost her husband in a car accident. After
the death of her husband, the financial condition of the family deteriorated. Both of her sons left
home just 1 year after the death of their father in the search of job. Both of them currently live in
Texas and California respectively for job purpose. As they themselves find it difficult to make
both the end meet, no financial support is sent by them to Mrs. X. Initially they used to pay
frequent visit to her. However with time, their frequency of visit is decreased. 5 years after the
dismiss of Mr. X, Mrs X daughter has got married. Her daughter, being a house wife also does
not provide her with any financial support. Considering the fact that the Social Security income
of Mrs X is too low to pay for an apartment, currently she lives alone in a rented room. For 7
long years, Mrs X is living alone. Being an introvert person, she lacks social interaction.
Additionally, over the past 6 months, she is suffering from widespread pain in on both sides of
her body, back of her head, neck, shoulders, elbows, knees, hips and above and below her
waistline. Initially, she ignored the pain, however, with time the pain became chronic and started
escalating. The pain got accompanied with fatigue and cognitive difficulties. She is often tired
and is suffering from sleeping disorder. She has visited a local physician who is suspecting that
Mrs X may be suffering from Fibromyalgia. However a detained diagnosis is required to confirm
that.
The excessive pain and fatigue makes it very difficult for her to conduct daily household
chores al alone. Not only this, the constant headache along with trouble sleeping is making the
situation worse. As a result of her current physical condition, she is found to be suffering from

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acute depression. Her physical inability along with depression is enhancing the risk of stroke or
coronary heart disease. MRs X is now opting for effective treatment so that she can get rid of
her current physical as well as psychological issues.
b. Assessment procedures in the initial sessions
Considering the fact that the chief issue faced by Mrs X is fibromyalgia which in turn is
resulting in depression, it is highly crucial for the healthcare professional to assess the
following.
1. The past history of health issues faced by Mrs. X: the chief reason behind this is to
identify the relationship of the current heath issue with any previous health issues. For
instance, Fibromyalgia chiefly involves a variety of factors that includes genetic.
Infections and physical or emotional trauma (Taymur et al., 2015). Often fibromyalgia is
a disease that tends to run in family, certain genetic mutations often result in development
of this disorder. Not only have this some infections often triggered or aggravate
fibromyalgia. Additional, he mentioned disease is also triggered physical trauma or
psychological stress. This is the first step for assessment that needs to be taken by the
doctor is to assess the issues faced by Mrs X.
2. The major symptoms faced by Mrs. X: considering the fact that the major symptoms of
Fibromyalgia includes fatigue, sleep, memory and mood issues. The physician needs to
check 18 specific points on Mrs. X body for understanding how many of them are painful
when pressed in a firm manner.
c. Along with assessing her Fibromyalgia condition, the physician will also assess the
impact of the heath issue on her phycology. For this the physician will conduct interview
with her.

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d. Diagnosis
Considering the fact that diagnoses of fibromyalgia should be conducted, if an individual
has an widespread pain for more than 3 months with no major medical condition for causing
pain, Mrs. X will be diagnosed. The first step that the physic will take includes conducting a
physical exam. For this he or she will check the tender points of Mrs. X that includes back of
the patient’s head, neck, shoulders, elbows, knees and hips (Uçar et al., 2015). The chief reason
behind conducting this physical test is that people suffering from Fibromyagia feels tenderness in
the mentioned pressure point. The next step of the diagnosis process will include interviewing
Mrs X. in order to have a detailed record of what and when she feel the pain. The physician will
ask her questions like whether the pain she feel is sharp or dull, does it comes or go or it is
constant or if she suffers from tiredness all the day or not.
In spite of the fact that no lab test is there to confirm diagnosis of fibromyalgia, physicians
needs to rule out other conditions that may possess similar symptoms. Considering the fact that
chronic pain in different parts of the body takes place due to a variety of other reasons like
Hypothyroidism, Rheumatic Arthritis, Polymyaldia rhematica, the doctor will want to rule out all
the other causes that are leading to the pain (Chang et al., 2015). For this the first diagnosis
procedure will include conducting a blood test in order to assess the blood count, erythrocyte
sedimentation rate, cyclic citrullinated peptide test and Rheumatoid factor of Mrs. X. Along with
this, the physician will conduct the Thyroid function tests as a part of the diagnosis process.
Considering the fact that Mrs. X is showing symptoms of suffering from depression along
with Fibromyalgia, the physician will also conduct tests in order to diagnose the same. For this
physician will be opting using the Beck symptom based rating scale as a tool to understand the

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degree to which Mrs. X is depressed. The Beck Depression Inventory (BDI) refers to a
commonly used tool that is used for distinguishing between clinical depression as well as
temporary happiness (Amutio et al., 2015). The BDI is a self report assessment with 21 multiple
chose questions. In order to confirm that Mrs. X is suffering from depression, this test will be
performed. A total score of 0-9 denotes the individual is not significantly depressed, 10-18
denotes mild to moderate depression, 19-29 indicates moderate to severe depression and a score
of 30-63 suggests that a person is severely depressed. In case the score goes above 15, the
Hamilton Depression Rating Scale. It is a multiple choice form which is used or rating the degree
of depression.
Treatment goals
The chief goal for treating Fibromyalgia, which Mrs. X is suffering from, will be to control
the pain as well as to enhance functioning of her body parts. A step by step treatment approach
will be taken. The total number of treatment session will be 4. The first step will including
providing the patient will a reasonable and cost effective treatment strategies keeping in mind her
financial condition. These will include introducing anti-depressants as well as exercises.
In case the patient is found not to be able to tolerate these measures for maintaining
function, an addition of hypnosis, behavior therapy, acupuncture and/or chiropractic treatment
could then be considered. If pain control or function, or both, are still poor, COAT should then
be considered (Sener et al., 2016).
Description of interventions and mock session
Considering the fact that Mrs. X is a geriatric patient, a multimodal treatment approach will
be taken in order to treat Mrs X. At first, non drug therapy will be given to Mrs X. According to

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Onieva-Zafra, García & del Valle, (2015), individuals suffering from Fibromyalgia should be
proved with non rug treatment along with the medicines suggested by the doctors.
The first non drug therapy that will be given to Mrs. X will be physical exercise. Mrs. X
will be prescribing to conduct aerobic exercise for at least 30 minutes a day for 10 days initially.
In case positive outcome is noticed, the time period of the exercise will be increased. A care
giver will be recruited whose chief aim will be motivating her for completing attest 30 minutes
of exercising per day (Arnold et al., 2015). A physical therapist will be assigned in order to teach
Mrs. X exercises that will enhance her strengths, stamina as well as flexibility. The regular
routine of exercise will be beneficial for her mental health as well as her physical health. In order
to reduce her depression, Mrs. X will be given Cognitive behavioral therapy. CBT and related
treatments, such as mindfulness, can help patients learn symptom reduction skills that lessen
pain. She will be prescribed to meditate for at least 20 minutes a day in order to reduce her stress
as well as negative thoughts that are responsible for depression.
Along with non-drug therapy, Mrs X will also be given medication. Medication will start
from the second session. She will be provided with pain relievers, antidepressant as well as anti-
seizure drugs. The US food and Drug Administration has approved two pain relievers when it
comes to Fibromyalgia. These include serotonin and norepinephrine. Any one of the two
mentioned drug will be given to Mrs X in order to control the pain level. Duloxetine (Cymbalta)
as well as milnacipran (Savella) will help ease the pain and fatigue associated with
fibromyalgia. In order to deal with her sleeping problem, Mrs. X will be provided with
cyclobenzaprine (Flexeril) or amitriptyline (Elavil). The two medicines will be given to her for
treating pain and thus improve sleep.

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Before session 1, Mrs. X will be given a mock session for exercises so that she can
understand the type of exercises she will be performing and the pressure points that will be
addressed through the exercise. A physical trainer and a volunteer who will be performing the
exercise in front of Mrs X will be recruited for the mock session. 4 chief aerobic exercises will
be shown to Mrs X in the mock session.
Ethical and cultural considerations
All the 6 session will be carried out keeping in mind the confidentiality as well as
consent of the patient. The care giver will state in details the impact of the medicines, why they
are necessary and the possible side effects before each session and the medication will be given
only after obtaining the consent of Mrs. X. Also, keeping in mind her cultural factor, Mrs. X will
be provided with a female physical instructor so that she can perform the exercise comfortably.

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References
Amutio, A., Franco, C., Pérez-Fuentes, M. D. C., Gázquez, J. J., & Mercader, I. (2015).
Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia
patients. Frontiers in psychology, 5, 1572.
Arnold, L. M., Sarzi-Puttini, P., Arsenault, P., Khan, T., Brown, P. B., Clair, A., ... & Pauer, L.
(2015). Efficacy and safety of pregabalin in patients with fibromyalgia and comorbid
depression taking concurrent antidepressant medication: a randomized, placebo-
controlled study. The Journal of rheumatology, 42(7), 1237-1244.
Chang, M. H., Hsu, J. W., Huang, K. L., Su, T. P., Bai, Y. M., Li, C. T., ... & Chen, M. H.
(2015). Bidirectional association between depression and fibromyalgia syndrome: a
nationwide longitudinal study. The Journal of Pain, 16(9), 895-902.
Onieva-Zafra, M. D., García, L. H., & del Valle, M. G. (2015). Effectiveness of guided imagery
relaxation on levels of pain and depression in patients diagnosed with
fibromyalgia. Holistic nursing practice, 29(1), 13-21.
Sener, U., Ucok, K., Ulasli, A. M., Genc, A., Karabacak, H., Coban, N. F., ... & Cevik, H.
(2016). Evaluation of health‐related physical fitness parameters and association analysis
with depression, anxiety, and quality of life in patients with fibromyalgia. International
journal of rheumatic diseases, 19(8), 763-772.
Taymur, I., Ozdel, K., Gundogdu, I., Efe, C., Tulaci, R. G., & Kervancioglu, A. (2015).
Personality-related core beliefs in patients diagnosed with fibromyalgia plus depression:
A comparison with depressed and healthy control groups. Nordic journal of
psychiatry, 69(5), 386-391.

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Uçar, M., Sarp, Ü., Karaaslan, Ö., Gül, A. I., Tanik, N., & Arik, H. O. (2015). Health anxiety and
depression in patients with fibromyalgia syndrome. Journal of International Medical
Research, 43(5), 679-685.