Sample Answer for NURS 6630 An African American Child Suffering From Depression Essay Included After Question
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.
- Client complained of feeling “sad”
- Mother reports that teacher said child is withdrawn from peers in class
- Mother notes decreased appetite and occasional periods of irritation
- Client reached all developmental landmarks at appropriate ages
- Physical exam unremarkable
- Laboratory studies WNL
- Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.
You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)
RESOURCES
- Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Decision Point One
Select what you should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID
Decision Point One
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Begin Zoloft 25 mg orally daily
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- No change in depressive symptoms at all
Decision Point Two
Select what you should do next:
Increase dose to 37.5 mg orally daily
Increase dose to 50 mg orally daily
Change to Prozac 10 mg orally daily
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Select what you should do next:
Decrease dose for 7 days then return to previous 10 mg day dose
Increase dose to 20 mg orally daily
Change to Prozac 10 mg orally daily
ecision Point One
Begin Wellbutrin 75 mg orally BID
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Child is unable to fall asleep at night
Decision Point Two
Select what you should do next:
Change from immediate release to extended release 150 mg orally daily in the morning
Give second dose of the day at 1:00 pm in the afternoon
Change to Lexapro 10 mg orally daily
A Sample Answer For the Assignment: NURS 6630 An African American Child Suffering From Depression Essay
Title: NURS 6630 An African American Child Suffering From Depression Essay
Geriatric Depression Therapy
Among the elderly, depression has been associated with several negative impacts to both the patient and his or her family members. It is the role of the healthcare workers to familiarize themselves with depression’s causative variables to be able to identify patients who may require screening with instruments like Montgomery- Asberg Depression Rating Scale (Vuorilehto, Melartin, Riihimäki, & Isometsä, 2016). A clear understanding of the depression symptoms among the elderly forms the first basis for the development of appropriate interventions and the best choice of drugs to include in a patient’s care plan. The choice of a drug depends on its effectiveness and safety profile. Nonetheless, when the first choice seems to fail, an alternative drug within the same class might be combined with the first drug, or the medication can be entirely replaced. At this point, the nurse might consider a psychotherapeutic approach (Cowen, 2017; Stahl, 2013). Depression is diagnosed differently since the condition exists on varied scales. Thus, inasmuch as pharmacotherapy and psychotherapy are the main interventions used to manage the condition, electroconvulsive intervention might be considered in severe cases of depression. In the current paper, the case scenario provided is of a 31-year-old Hispanic man who was diagnosed with a severe depressive state, as per his scores on the Montgomery-Asberg Depression Rating Scale, which was 51. All the options of drug regiments that can be utilized in managing the patient’s symptoms of depression will be revealed in the present discussion. As a result, the analysis of this case will offer a comprehensive understanding of the therapeutic management of depression among geriatrics.
Decision Point One
Selected Decision
Begin Zoloft 25 mg OD
Reason for Selection
The first line choice of drug for the treatment of depression is usually Zoloft, which belongs to the broad class of SSRIs. The Hispanic male patient was diagnosed with severe depression as per the scale that was used. Hence, the best choice of drug, in this case, based on the provided options, is Zoloft. The drug has proven to be the most effective and safest compared to other SSRIs (Polatin, Bevers, & Gatchel, 2017: Stahl, 2014b). On the other hand, the PMHNP can only recommend phenelzine if Zoloft, among other drugs, has proven to be ineffective, but not as a first line choice of treatment. Further, Effexor XL is usually associated with several side effects and should only be used as a last resort.
Expected Results
Most studies show that the effects of Zoloft start showing after continuous use for at least 14 days. By the end of week two, the drug should have been able to improve the patients sleeping patterns and concentration. Generally, most of the patient’s symptoms will be relieved after two weeks of using the drug (Coplan, 2015). Additionally, the patient should be able to interact appropriately with other people by this time with a reduced recollection of past mistreatments showing.
Differences between Expected Results and Actual Results
The patient came back to the hospital after two weeks with a 25% reduction of the depression symptoms just as expected by the PMHNP. However, the patient reported erectile dysfunction, which is one of the side effects of Zoloft. This effect was however not anticipated by the PMHNP since erectile dysfunction is usually very rare as compared to other side effects of Zoloft (Cipriani et al., 2016).
Decision Point Two
Selected Decision
Add augmenting agent such as Wellbutrin IR 150 mg in the morning
Reasons for the Selection
After two weeks, the patient responded appropriately to Zoloft with a 25% reduction in depression symptoms. However, he also reported signs of erectile dysfunction, which needs to be addressed if the patient continues using the drug. In this case, the best intervention would be to include Wellbutrin, which is an effective augmenting agent that helps in the management of Zoloft induced erectile dysfunction. The two-drug combination therapy has been used over the years to prevent drug-induced erectile dysfunction in young and elderly men (Linde, Kriston, & Rucker, 2015). The other drugs provided for this case study cannot be used as they do not have the required pharmacological activity to manage erectile dysfunction. In this scenario, Wellbutrin will be administered slowly at first, while slowly withdrawing Zoloft, to be able to correct the erectile dysfunction as the depression symptoms of the patients are managed as well. Consequently, low doses of Zoloft are ineffective, hence cannot be recommended by the nurse. Continuous use of the drug might also worsen the erectile dysfunction among other side effects; hence, it is best to withdraw the use of Zoloft.
Expected Results
Augmentation of Zoloft with Wellbutrin is expected to reduce the erectile dysfunction side effects. The depression symptoms of the patient are also expected to reduce even further from the results of the first two weeks. A combination therapy comprising of Wellbutrin and Zoloft has shown great synergism in the past, with one drug boosting the effect of the other, hence having maximum benefit in the management of depression (Linde, Kriston, & Rucker, 2015). At the end of the treatment period, the patient should negligible depression symptoms with resolved erectile dysfunction.
Differences between Expected Results and Actual Results
The patient came back to the hospital later, after the introduction of Wellbutrin, with positive results. His erectile dysfunction had been resolved. He also claimed that he felt better, with significantly reduced symptoms of depression. This was precisely what was expected after the intervention. The patient, however, complained of a feeling of nervousness and jittery in some cases (Arroll et al., 2016). This was not strange as they are the main side effect of most antidepressants. In this case, both Zoloft and Wellbutrin could have been the reason behind these side effects. The synergistic effect on the dose of both drugs could have been a factor that led to these symptoms.
Discussion Point Three
Selected Decision
Change Wellbutrin to XL 150 mg orally daily in AM
Reasons for the Selection
During follow up assessment, the patient only reported signs of jittery, as the side effect of the combination therapy. Both the antidepressants can cause this side effect. However, the side effect most likely came as a result of Wellbutrin’s mode of release, given that the drug is formulated as an immediate release. Hence, the most appropriate intervention, in this case, is to change the formulation of Wellbutrin to extended release, instead of slow release, to track down the main cause of the jittery feeling displayed by the patient. The slow release formulation has also proven to be effective in managing depression symptoms (Linde, Kriston, & Rucker, 2015). Ativan should be avoided, as the introduction of a new pharmacological agent as a result of the side effects of another drug is greatly discouraged. Moreover, withdrawal of Zoloft is also not necessary as the drug is not the reason behind the displayed side effects.
Expected Results
If the feeling of jittery was as a result of the Wellbutrin’s immediate release formulation, then the formulation change to extended-release should be able to resolve the problem. The depressions symptoms will be reduced even further as both drugs are maintained. The patient’s confidence will be improved once the jitteriness has been resolved, which is one of the main goals of the intervention. Additionally, other symptoms of depression are expected to be entirely resolved by the end of the prescribed duration.
Differences between Expected Results and Actual Results
The treatment outcome of the patient was consistent with the nurse’s expected results. Just like the intervention made by the PMHNP nurse, most side effects are usually managed by altering the formulation of the drug first, rather than changing the drug regimen. Introduction of another drug, or replacing the existing one, could result in other side effects which will also become a problem (Linde, Kriston, & Rucker, 2015).
Impact of Ethical Consideration on Treatment Plan
From an ethical perspective, the management of depression using the most appropriate antidepressants surpasses the administration of other drugs. It is the moral obligation of the PMHNP nurse to provide the patient with adequate information on the drugs used in terms of both the benefits and side effects. Consequently, before picking on a specific drug to use, the nurse is obliged to utilize the patient’s past medical history and comprehensively evaluate the prompt diagnosis. The nurse must also inform the patient about the reasons behind the use of different pharmacological agents (Lee, 2013). On the other hand, the nurse needs to be aware of the hopes of the patient, what motivates them and their most significant concerns, to create a root basis for psychotherapeutic interventions in addition to pharmacological especially in the management of specific depression symptoms. Consequently, concerning evidence-based practice, drugs with high suicidal risks should be eliminated from the patients care plan.
Conclusion
Depression can cause substantial impacts on the patient’s social and economic status, in addition to that of their family. Hence, the management of this condition should be taken very seriously with proper diagnostic assessment methods to be able to come up with the most appropriate intervention. Additionally, the choice of drugs for such cases are usually based on several factors and might even require altering in the course of treatment depending on the treatment outcome. Other pharmacological agents in addition to psychotherapy might also be used in the management of depression.
References
Cowen, P. J. (January 01, 2017). Backing into the future: pharmacological approaches to the management of resistant depression. Psychological Medicine, 47, 15, 2569-2577.
Vuorilehto, M. S., Melartin, T. K., Riihimäki, K., & Isometsä, E. T. (September 15, 2016). Pharmacological and psychosocial treatment of depression in primary care: Low intensity and poor adherence and continuity. Journal of Affective Disorders, 202, 145-152.
Polatin, P., Bevers, K., & Gatchel, R. J. (June 14, 2017). Pharmacological treatment of depression in geriatric chronic pain patients: a biopsychosocial approach integrating functional restoration. Expert Review of Clinical Pharmacology, 1-7.
Coplan, J. D. (January 01, 2015). Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World Journal of Psychiatry, 5, 4, 366.
Lee, Hpdabpp. (2013). Psychological Treatment of Older Adults: A Holistic Model. Springer Publishing Company.
Cipriani, A., Zhou, X., Del, G. C., Hetrick, S. E., Qin, B., Whittington, C., Coghill, D., … Xie, P. (August 01, 2016). Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. The Lancet, 388, 10047, 881-890.
Arroll, B., Chin, W., Martis, W., Goodyear-Smith, F., Mount, V., Kingsford, D., Humm, S., … MacGillivray, S. (January 01, 2016). Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis. Journal of Primary Health Care, 8, 4, 325.
Linde, K., Kriston, L., & Rucker, G. (January 01, 2015). Efficacy and Acceptability of Pharmacological Treatments for Depressive Disorders in Primary Care: Systematic Review and Network Meta-Analysis. Annals of Family Medicine, 13, 1, 69-79.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
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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.
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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