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Adult depression

he Assignment

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.

  • 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?

      Adult/Geriatric
      Depression
      Hispanic Male With MDD

      Hispanic male

      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.

      Decision Point One

      Select what the PMHNP should do:


      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-red.pngBegin
      zoloft 25 mg orally daily

      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-blue.pngBegin
      Effexor XR 37.5 mg orally daily


      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-yellow.pngBegin
      Phenelzine 15 mg orally TID



      Adult/Geriatric Depression
      Hispanic Male With MDD


      Hispanic male

      Decision Point One

      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-red.pngBegin
      zoloft 25 mg orally daily

      RESULTS OF DECISION POINT ONE

      ·
      Client
      returns to clinic in four weeks


      ·
      Reports
      a 25% decrease in symptoms


      ·
      Client
      is concerned over the new onset of erectile dysfunction


      Decision
      Point Two

      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-blue.pngContinue same dose and counsel client

      RESULTS OF DECISION POINT
      TWO

      ·
      Client
      returns to clinic in four weeks


      ·
      Client
      informed the PMHNP that he stopped taking the drug because his inability to
      perform sexually was worsening his self-esteem


      Decision
      Point Three

      Select what the PMHNP
      should do next:

      Decision Point Three

      Select what the PMHNP should do next:


      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-red.pngEncourage
      client to re-start drug at previous dose

      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-blue.pngRe-start
      drug at 50% initial dose

      https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-yellow.pngChange to Wellbutrin XL
      Guidance to Student
      Encouraging client to restart at previous dose would not be
      appropriate. Obviously, the side effect did not abate- so there is no reason to
      assume that it would abate at the previous dose. Re-starting the drug at 50% of
      starting dose may be appropriate to determine whether or not side effect is
      dose dependent. If the side effect of erectile dysfunction returns once the
      drug is returned to full dose, the PMHNP would need to change the drug.
      Changing to Wellbutrin XL may be appropriate at this point, but may worsen his
      insomnia. Additionally, guidelines tell us that another SSRI should be
      attempted for an adequate trial before switching drug classes.

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