NURS 6521 Case Study: An Elderly Hispanic Man with Depressive Disorder | Walden University

Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact t ...

Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client's pharmacokinetic and pharmacodynamic processes. From the three decisions there will be results in which you must use to answer the questions. In the end you will use your answers to form a paper. At each decision point stop to complete the following: Decision #1 Which decision did you select? Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Decision #2 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients. Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen). 2. Write paper addressing all section listed based on the decision tree. Case Study: Hispanic Male w/Major Depressive Disorder (MDD) BACKGROUND INFORMATION The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after "routine" medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and "stiff" shoulders which he attributes to his current work as a laborer in a warehouse. SUBJECTIVE During today's clinical interview, client reports that he always felt like an outsider as he was "teased" a lot for being "black" in high school. States that he had few friends, and basically kept to himself. He describes his home life as "good." Stating "Dad did what he could for us, there were 8 of us." He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in "trouble" at work. MENTAL STATUS EXAM The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the "Montgomery- Asberg Depression Rating Scale (MADRS)" and obtained a score of 51 (indicating severe depression). RESOURCES § Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Decisions Made and Outcomes (Needed to formulate the paper) Choices for Decision 1: Start Zoloft 25 mg orally daily, Effexor XR 37.5 mg orally daily, or Phenelzine 15 mg orally TID. My decision: I chose to begin Effexor XR 37.5 mg orally daily. Outcome: RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Client reports that there is no change in depressive symptoms at all. Now choose what to do. Choices for Decision 2: Increase Effexor XR to 75 mg orally daily, Change to Cymbalta 30 mg orally daily, or augment with an atypical antipsychotic. My decision: I chose to increased dose of Effexor XR to 75 mg orally daily Outcome: RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Client reports an improvement in depressive symptoms Montgomery- Asberg Depression Rating Scale (MADRS) decreased from 51 to 38 (25% reduction) Choices for Decision 3: Increase Effexor XR dose to 112.5 mg orally daily, continue same dose of medication (Effexor XR 75 mg), or augment with Wellbutrin XL 150 mg orally daily My decision: Increase Effexor XR dose to 112.5 mg orally daily Outcome: Guidance to Student At this point, the PMHNP would have two choices to discuss with the client- the current dose of drug can be maintained if the client is feeling better and is not offering any complaints of side effects. The dose can also be increased at this point, but the PMHNP must counsel client regarding the possibility of side effects. The use of an augmenting agent is not appropriate at this time as we have not reached a maximum dose with Effexor (in fact, 75 mg is still a relatively small dose), displaying primarily SSRI properties only (recall that at lower doses, Effexor exerts a greater effect on serotonergic receptors than norepinephrine at low doses).