Possible Problem
The symptoms displayed by the patient indicate that the woman suffers from adrenalin fatigue (AF). By definition, the identified disorder occurs when the hypothalamus and the adrenalin glands fail to function properly. The signs and symptoms such as the inability to get up early in the morning, as well as the propensity toward weight gain, which may have been caused by a craving for salty food, indicate that the patient must have AF.
Subjective and Objective Data and Tests
Apart from determining whether the patient has the following symptoms as well: craving for caffeine, lack of enjoyment in favorite activities, etc., I will have to run some tests, such as cortisol tests. The test that requires taking four individual samples at a different time of the day should also be considered. The determination of the adrenal corticotropic hormone (ACTH) levels is the second most efficient test (Venkatesh & Cohen, 2015). Furthermore, seeing that the patient is concerned about the thyroid levels, it will be reasonable to carry out the thyroid-stimulating hormone test (TSH) as well, at least to reduce their stress levels.
Screening Tools
The pupil test can be used to determine whether the patient has AF. To be more specific, the further dilation of the pupil after its contraction as a response to light can be deemed as the sign of AF (Wang et al., 2016). Additionally, blood pressure tests can be taken to determine the presence of AF. By measuring the difference in the BP levels, while lying on the floor and after standing up, one may identify the development of AF. Particularly, a slight drop in BP can be regarded as the symptom of AF (Romm, 2015).
Referring to the Patient
The patient must be referred to a physician. Thus, their needs will be managed most efficiently. The services of a nephrologist may also be considered necessary in the case in point.
Patients’ Needs Management
As the case study shows, the patient is currently experiencing significant stress. Therefore, it is highly recommended that a soothing and comfortable environment should be provided so that the stress levels could be reduced. Furthermore, it is necessary to provide the patient with extensive information about her case so that she should not feel anxious as she starts over-thinking the issue.
Health Promotion Strategies
To address the problem, one should consider a gradual change in the patient’s diet. A drop in the levels of caffeine consumption, as well as the introduction of protein and fat into the diet, should be viewed as a necessity. A change in the patient’s sleep schedule (particularly, going to bed earlier) should be considered as well.
Circle of Caring
By using the Circle of Caring, one will be able to show the patient that different aspects of her life affect the development of the disorder to the same degree. For instance, her diet, her sleeping habits, her choice of nursing services, the frequency of visiting a doctor, etc., define the progress of the disorder.
Complementary Therapies
A study of the mechanisms of stress-response activation in the patient can be deemed as a complementary means of addressing the problem. By learning more about what affects the development of AF in the patient, one will be able to develop the most efficient treatment strategy.
Follow-up
It will be necessary to make sure that the patient’s adrenalin levels will have stabilized by the end of the treatment process. Therefore, a follow-up appointment must take place 2-3 weeks after the current one.
Patient Education
It is important to teach the patient to manage her stress levels. To be more accurate, she will have to learn to manage her anxiety by using different distractions and management techniques.
Billing for the Visit and E&M Coding
The 98960 code should be used to indicate that the patient has been instructed and taught to apply the newly acquired knowledge about their condition (American Association for Respiratory Care, 2014).
References
American Association for Respiratory Care. (2014). Coding guidelines for certain respiratory care services, 2014. Web.
Romm, A. (2015). Adrenal fatigue syndrome. Alternative and Complementary Therapies, 21(6), 242-246. Web.
Venkatesh, B., & Cohen, J. (2015). The utility of the corticotropin test to diagnose adrenal insufficiency in critical illness: an update. Clinical Endocrinology, 83(3), 289-297. Web.
Wang, Y., Zekveld, A. A., Naylor, G., Ohlenforst, B., Jansma, E. P., Lorens, A.,… Kramer., S. E. (2016). Parasympathetic nervous system dysfunction, as identified by pupil light reflex, and its possible connection to hearing impairment. PLoS ONE, 11(4), e0153566. Web.