Sample Answer for NURS 6521 Adult Geriatric Depression Hispanic Male With MDD Decision Tree Included After Question
Discussion: Decision Making When Treating Psychological Disorders
Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.
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For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
To Prepare
- Review this week’s interactive media pieces and select one to focus on for this Discussion.
- Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
By Day 3 of Week 8
Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
By Day 6 of Week 8
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 of Week 8 and Respond by Day 6 of Week 8
To Participate in this Discussion:
Week 8 Discussion
A Sample Answer For the Assignment: NURS 6521 Adult Geriatric Depression Hispanic Male With MDD Decision Tree
Title: NURS 6521 Adult Geriatric Depression Hispanic Male With MDD Decision Tree
Adult/Geriatric Depression Hispanic Male With MDD
BACKGROUND INFORMATION
The client is a 70 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 your 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. You administer 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.
A Sample Answer 2 For the Assignment: NURS 6521 Adult Geriatric Depression Hispanic Male With MDD Decision Tree
Title: NURS 6521 Adult Geriatric Depression Hispanic Male With MDD Decision Tree
Attention Deficit Hyperactivity Disorder
Attentiondeficit hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders of childhood and adolescence and is associated with significant impairment in academic, social, and occupational functioning (Ng, 2017). “Neuroimaging studies indicate structural and functional abnormalities in multiple brain areas, including the frontal cortez, basal ganglia, brainstem, and cerebellum- regoins involved with regulating attention , impulsivity, and motor activity” (Rosenthal & Burchum, 2021, p. 250-251).
Case Scenario
My selected scenario describes an eight year old girl (Katie), who was referred to psychiatry by her primary care provider to be evaluated for ADHD. Background information consists of a completed Conner’s Teacher Rating Scale-Revised along with the teacher’s report. Katie exhibited inattention, forgetfulness, was easily distracted, had poor follow through, and struggled in spelling and math. The diagnosis is confirmed as attention deficit hyperactivity disorder-predominantly inattentive type.
First medication to be prescribed would be Ritalin 10mg chewable tablet every morning. Stimulants are the first line choice for treatment of ADHD (Rosenthal & Burchum, 2021). Intuniv would not be my choice for the patient as it is a nonstimulant medication. On the same lines, Wellbutrin XR is not considered a stimulant and has not been well studied in its safety and efficacy in children (Ng, 2017). Nonstimulants are less affective that stimulants and are considered second –choice drugs (Rosenthal & Burchum, 2021). The search for nonstimulant alternatives for the management of ADHD in children is ongoing. As many as 20% of patients do not respond to stimulants, and stimulants may also worsen comorbid sleep, mood, and anxiety disorders and lead to problems of misuse and diversion (Ng, 2017).
At the four week follow up visit, the teacher reports seeing improvement in her behavior and performance during the morning hours but little improvement through the afternoon. Katie also reports a “funny feeling in her chest” with a heart rate in the 130’s. Stimulants will produce a small increase in heart rate and blood pressure at recommended doses. In the absence of cardiovascular disease, this increase in heart rate and blood pressure lacks clinical significance (Rosenthal & Burchum, 2021). A provider at this point could do additional testing to rule out any heart defects or heart disease. Additionally, obtaining an EKG could be done to confirm rhythm and rate.
My choice would be to continue with the Ritalin in an extended release form. I would then change the medication to Ritalin LA 20mg to be taken in the morning. Taking a long acting form of the medication will enable Katie to have positive effects for a longer duration which will sustain her focus and academic success throughout the school day.
The four week follow up with the Ritalin LA shows the medication is helping Katie throughout her school day and heart rate is within normal limits. I would maintain this current dosing of medication as it seems to be effective with no reported negative side effects at this time.
Other Considerations
As a provider, I would want documentation of testing done to rule of a learning disorder as some of Katie’s symptoms could also be attributed to this. Identifying a learning disorder in the presence of ADHD could change the course of treatment. Attention deficit hyperactivity disorder–predominantly inattentive presentation and specific learning disorder (SLD) are commonly co-occurring conditions (Friedman et al., 2019). Children with ADHD and SLD are poorer responders to psychostimulant medications than those with ADHD alone (Friedman et al., 2019).
There also needs to be additional education for Katie’s parents, explaining the diagnosis of ADHD and the differences between the sub classifications; the predominately hyperactive-impulsive type, predominately inattentive type, or combined type. The parents currently deny the idea of ADHD because they do not have an accurate understanding of an ADHD diagnosis and that it can exist without the presence of hyperactivity.
References
Friedman, L. M., McBurnett, K., Dvorsky, M. R., Hinshaw, S. P., & Pfiffner, L. J. (2019). Learning disorder confers setting-specific treatment resistance for children with ADHD, predominantly inattentive presentation. Journal of Clinical Child & Adolescent Psychology, 49(6), 854-867. https://doi.org/10.1080/15374416.2019.1644647
Ng, Q. X. (2017). A systematic review of the use of Bupropion for attention-deficit/Hyperactivity disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 27(2), 112-116. https://doi.org/10.1089/cap.2016.0124
Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences.