solved

Chief Complaint: Mr. Bert Colton is an 89-year-old Caucasian male who presents to the clinic with his granddaughter, complaining of “I’m so panicked, I feel like I can’t calm down and I feel like I want to cry.”
History of Present Illness:
Onset: Patient described feeling restless, on edge, fatigued, and irritable since his diagnosis of open-heart surgery one year ago.
Past Medical History:
Coronary Artery Disease – dx (“dx” is pronounced “diagnosed”) age 76.
Hypertension – dx (“dx” is pronounced “diagnosed”) age 66.
Osteoarthritis – dx (“dx” is pronounced “diagnosed”) age 74
Diabetes – dx (“dx” is pronounced “diagnosed’) age 68
Past Surgical History:
Cholecystectomy – age 49
Location: Mostly when at home alone.
Duration: Over the past year, he has started to excessively worry more and more about multiple issues.
Characteristics: He endorsed worrying and being anxious most all day, most every day of the week, about what will happen to his daughter when he dies; if she will die a terrible death because of his disease being passed to her, or if she might get breast cancer like his wife died of.
He worries about what if the day comes when she cannot walk or care for herself anymore. What will her church family do without her if she can’t attend biweekly anymore, or the places where she volunteers, like he does. He sees the impact that his disease has and does not want that for his family, too.
For the last six months, in addition to feeling restless, on edge, fatigued, and irritable, he has also had difficulty concentrating and cannot “turn his mind off sometimes” at night to fall asleep.
He has started having trouble walking to the store, which is one block away, for his groceries, paying his bills, going to social gatherings, and going to his neighborhood group meetings, and he has recently decreased his church attendance and volunteer experiences at the local hospital because of his symptoms.
Aggravating: Thinking about dying and leaving family, all the work that needs done to my home, thinking about and missing my wife.
Relieving: Spending time with family.
Temporal: Worse in late evenings and sometimes in middle of the night.
Severity: “I can’t stand this feeling every day, like I need to jump out of my skin.”
Questions:
Differentials: List the three most likely differential diagnoses based on her objective findings, with cited rationale.
What is the etiology/pathophysiology associated with each diagnosis?
What is the prevalence of each of these diagnoses?
Develop a plan of care for each of the three differential diagnoses, including the following:
Diagnostic testing
Pharmacologic interventions, including dosage, route, and frequency
Nonpharmacologic interventions, including modality and frequency
Education, including health promotion, maintenance, and psychosocial needs
Safety plan
Referrals required
Follow-up, including the return to the clinic (RTC) in what time frame and reason, including any labs needed for the next visit.

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