Peer Responses:

• Relate/Compare other journal reading.
• The differentials for this patient can include depression, hypothyroid disorder, and heart failure. Since the patient has had a history of depression and she is having symptoms of fatigue, and increased sleeping, it is important to screen her for depression. There can be many types of depression such as major depression, persistent depression disorder, postpartum depression and seasonal affective disorder. There are many predisposing to depression such as lack of social support, family history of depression, frequent exposure to stressful events, chronic pain, etc. The second differential diagnosis is hypothyroidism, since the patient has weight gain, and fatigue. Predisposing factors can include iodine deficiency, chromosomal disorders, celiac disease, certain medication use, surgical removal of thyroid gland, etc. Signs and symptoms of a patient with hypothyroidism can include weight gain, fatigue, cold intolerance, dry skin, irregular menses, etc. The third differential diagnosis is heart failure since she presents with weight gain and complaints of fatigue. Other symptoms of heart failure can include dyspnea on exertion, chest pain, palpitations, cough, nausea, hemoptysis, cyanosis, etc. It is important to do a thorough physical exam, vitals, and ask further questions about her symptoms. Also, it is important to obtain a family history, social history, and any barriers to receiving care. It is important to obtain labs to get a baseline such as CBC, BMP, TSH levels, urinalysis, etc. The patient should follow up after these labs to develop a treatment plan for the plan (Cash, 2023). A community resource for veterans in Bakersfield is the Bakersfield Veterans Center. This center provides services to veterans, service members and their families for no cost. They provide services for depression, PTSD, counseling services, and referral services (U.S. Department of Veterans Affairs, n.d).