Assignment: “Captain of the Ship” Project – Depressive Disorder

Assignment “Captain of the Ship Project – Depressive Disorder

Assignment: “Captain of the Ship” Project – Depressive Disorder

Professional autonomy allows one to make decisions and act in line with the professional knowledge base (Labrague et al., 2019). Nursing is one of the professions that require autonomous decision as a way of expanding and extending specialty nursing roles. With autonomy, nurses can question the status quo, establish ways to enhance the healthcare system, reduce adverse events, improve health outcomes, and improve quality and patient satisfaction. The purpose of this paper is to use the autonomy to manage a patient with major depressive disorder. Moreover, the present paper will examine other aspects of the patient’s situation such as elucidating their clinical impressions as well as HPI, make treatment recommendations from given options, elect an appropriate psychotherapy, demonstrate the patient’s medical management requirements, establish appropriate community support resources and finally formulate an effective follow-up plan.

History of Presenting Illness

The patient is a 29 years old Caucasian female who reported to the clinic complaining of depression. She complained of daily crying spells, feeling sad “all the time”, trouble sleeping and overeating. She stated that it takes her several hours to fall asleep and at times she does not fall asleep at all or only sleeps for a few hours. The patient reported that she suffers from insomnia by constantly worrying and thinking at night. She attributed the above to feelings of inadequacy as a mother and supposed nagging nature to the husband. These thoughts were also influenced by her dysfunctional relationship with her mother. She indicated that her depression worsened after she conceived her third child ten months ago. Her constant thinking and worrying made her feel like everyone was looking at her. The patient rejected having suicidal tendencies. She reported that although running away from problems was ideal, she could not do that. She reported that due to depression her relationship with her husband and children has been severely affected.

Clinical Impression

The patient has characteristics that match the DSM-V criteria for Major depressive disorder (Fekadu et al., 2017). She has lost interest or pleasure in most activities and her sleep habit has changed. She also complains of weight, appetite and energy levels and her psychomotor activity is affected. She reports feeling guilty and worthless and her thinking and concentration are affected making it hard for her to make decisions. Paradoxically, the patient rejects suicidal ideations yet would be comfortable with escapism. Her daily functioning is affected and her relationship with her family is also affected.

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Psychopharmacological Approach

The patient should start on Zoloft 50mg orally OD during bedtime. The medication is selected because it is a selective serotonin

reuptake inhibitor with well-established anxiolytic and antidepressant activities. A meta-analysis of 12 antidepressants suggested that sertraline has a favorable balance of benefits and acceptability and thus an ideal choice when starting treatment for major depression (Potter, 2019).  The patient should report improved depressed mood after taking the medication for one week. However, after four weeks, she should report reduced sadness, better sleep patterns, reduced anxiety, better concentration and improved relationship with her family. The dosage is initiated at the lowest dose of 50mg but in case she reports no akathisia and her symptoms improve, her dosage will be titrated weekly with 50m/g increments to a maximum of 200mg depending on tolerability and therapeutic response (Stahl, 2017).

Psychotherapy Approach

The PMNHP will formulate an individual cognitive-behavioral therapy (CBT) for the patient. CBT has research backing regarding its effectiveness towards MDD management. It aids in identifying negative thought patterns and behavioral responses to stressful and challenging situations (Zhang et al., 2018). It also guides one on developing a constructive and balanced way of coping with stressors. The client will undergo 20 sessions to ensure that she meets five specific goals. The relationship with her husband and children should be restored, she should feel happy and reduce crying spells, her sleep should improve, she should manage to handle family members and friends’ requests by saying no without feeling guilty and her anxiety on the various topics should reduce.

Medical Management Needs

The patient has a moderate major depressive disorder and she has no suicidal ideation. She should undergo a complete blood count to assess for anemia as well as TSH to ensure that her thyroid is functioning properly (Fekadu et al., 2017). Secondly, there is a need to use motivational interviewing techniques to discuss available treatment options, how to manage adverse events and how to measure results. Rating scales should be used to monitor treatment progress.  A discussion of patient needs regarding relationship issues and health goals is essential to help the patient restore daily functioning and quality of life (Fekadu et al., 2017).  Patient education should be offered to help in recognizing prodromal symptoms, learning stress management and increasing protective factors.

Community Support Resource

The patient should enroll in a gym to help her handle her weight problem and as an avenue to learn meditation techniques to aid in dealing with depression. She should also identify trusted family members or friends to talk to when she feels overwhelmed. As Goodwin et al (2108) point out, she should join a depression support group to create new connections and access a place to vent frustrations and fears and receive encouragement and comfort from others.

Follow-up Plan

The patient is expected to attend weekly sessions of individual CBT. She is also expected to report to the clinic after every four weeks for assessment. She will be assigned a case manager whose mandate is to monitor compliance, symptoms improvements and presence of adverse events (Garrison et al., 2016). The case manager will contact the patient after two weeks to establish if she is adhering to the recommendations, the presence of side effects and offer supportive counseling.

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource