NURS 6630 Week 3 Assignment: Geriatric Depression Therapy Decision Tree

NURS 6630 Week 3 Assignment: Geriatric Depression Therapy Decision Tree

NURS 6630 Week 3 Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Advances in genetics and epigenetics have changed the traditional understanding of mood disorders, resulting in new evidence-based practices. In your role as a psychiatric mental health nurse practitioner, it is essential for you to continually educate yourself on new findings and best practices in the field. For this Assignment, you consider best practices for assessing and treating adult and geriatric clients presenting with mood disorders.

Learning Objectives

Students will:

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Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing antidepressant therapy to adult and geriatric clients Geriatric Depression Therapy Decision Tree.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication Geriatric Depression Therapy Decision Tree.

Review the following medications:

amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf

Required Media

Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy.

The 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?
Also include how ethical considerations might impact your treatment plan and communication with clients.

NURS 6630 Week 3 Discussion

Discussion: The Impact of Ethnicity on Antidepressant Therapy

Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline
bupropion
citalopram
clomipramine
desipramine

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Case 3: Volume 1, Case #29: The depressed man who thought he was out of options

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

SAMPLE APPROACH

NURS 6630 Week 3 Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Introduction

Depression in the elderly altogether influences patients, families, and groups. Familiarity with inclining and hastening variables can help recognize patients needing screening with instruments, for example, the Geriatric Depression Scale (American Psychiatric Association, 2013). After analysis, consistent development and dynamic drug administration are essential to augment treatment and reduction. Determination of a stimulant solution ought to be founded on the best reaction profile and the most reduced danger of medication collaboration. On the off chance that abatement is not accomplished, then extra medicines, including different medications and psychotherapy, might be considered (Flint & Rifat, 2013). In instances of serious, insane, or recalcitrant depression in the elderly, electroconvulsive treatment is prescribed. This paper considers a case of a 31-year-old Hispanic man with severe depression and the treatment options available. The treatment decisions made are evaluated and the outcomes compared to facilitate greater understanding of geriatric depression therapy.

Decision Point One

Selected Decision

Begin Zoloft 25 mg orally daily

Reason for Selection

Zoloft is one of the most effective drugs for treatment of severe depression in adults. The patient had a score of 51 when the PMHNP administered MADRS, this is an indication of severe depression. Considering the available antidepressants in this case, phenelzine is recommended for use in areas where other drugs have failed (Stahl, 2014b). Effexor XL on the other hand can be used but has many potential side effects considering the patients history and lifestyle. Thus, Zoloft emerges as the best option.

Expected Results

The action of Zoloft should be evident within the first two weeks as this is the pharmaceutical expectation from the experiments completed with the drug. By the time the patient comes for checkup after two weeks, he should report ability to sleep at night. The level of concentration should also undergo a boost on administering this drug (Liu, Anderson, Mittmann, Axcell & Shear, 2015). Geriatric Depression Therapy Decision Tree It is also expected that the patient will be motivated to the normal activities and even relate well with people. The patient’s feeling of being an outsider due to the past treatment should start waning off.

Differences between Expected Results and Actual Results

When the patient revisited after four weeks and reported a decrease of 25% in the symptoms. This is in the direction of the expectations. However, another outcome was not anticipated, the patient was experiencing erectile dysfunction (Gaboda, Lucas, Siegel, Kalay & Crystal, 2014). This is a side effect of the drug that was not expected when the treatment plan was made. Zoloft has a number of potential side effects and erectile dysfunction is one of them though not very common. The rest of the outcomes reflected the expected trend even though the rate was a bit lower than anticipated.

NURS 6630 Week 3 Assignment Decision Point Two

Selected Decision

Add augmenting agent such as Wellbutrin IR 150 mg in morning

Reason for Selection

The client was experiencing a decrease in the depression symptoms because of administering Zoloft but the same drug had led to erectile dysfunction. It is a good idea to maintain Zoloft for reducing depression and combine it with another antidepressant with abilities to abate erectile dysfunction. Wellbutrin is such an antidepressant that can be used to help the patient’s erection function normally while on depression therapy (Flint & Rifat, 2013). In this case, the focus is not to treat the side effect of Zoloft as this is not advisable, but it is to introduce an antidepressant and slowly withdraw Zoloft and thereby correcting erectile dysfunction.

Expected Results

When Wellbutrin is introduced as augmenting agent, the patient should experience much reduced symptoms. This is because both Zoloft and Wellbutrin will be working to reduce depression and thus the combined effect should be bigger (Flint & Rifat, 2013). In addition, the patient should start having normal erection as a result of the working of Wellbutrin. This should even make the patient better and more motivated.

Differences between Expected Results and Actual Results

The patient visited again after four weeks and he stated that the depressive symptoms had even reduced further. He also informed that the erection dysfunction had been abated. These two outcomes were expected as the therapy was being administered. Geriatric Depression Therapy Decision Tree. Nevertheless, different other outcomes from the ones anticipated arose (Gaboda, Lucas, Siegel, Kalay & Crystal, 2014). The patient was feeling jittery and nervous. Either of the two drugs could influence this; Zoloft and Wellbutrin as both are known to cause feelings of anxiety in some cases. Sometimes the feeling of jittery is caused by the kind of dosage of the two drugs.

Decision Point Three

Selected Decision

Change Wellbutrin to XL 150 mg orally in AM

Reason for Selection

The patient is experiencing jitteriness as the only problem with the current therapy. The effect of medication is as intended and so it is not proper to change just because of the side effect. Jitteriness may be caused by the immediate release of Wellbutrin. Trying to change the administration of Wellbutrin may be the solution to jitteriness. Administering Wellbutrin in its extended release form can help to reduce depression and remove jitteriness. It is not proper to introduce a new drug to treat the side effects of another before trying to modify the dosage of the original drug.

Expected Results

Administration Wellbutrin in its extended release form is anticipated to treat jitteriness if in fact the problem is the immediate release of Wellbutrin. It is also expected that the patient will continue experiencing an improved rate of depression reduction (Liu, Anderson, Mittmann, Axcell & Shear, 2015). The ceasing of jitteriness should allow the patient to have confidence in the therapy and are motivated to continue using the medication. The concentration ability of the patient should increase tremendously. The patient should also not have problems with sleeping at night.

Differences between Expected Results and Actual Results

The decision seems to be in agreement with the standard way of dealing with side effects of therapy administered to a patient (Laureate Education, 2016g). Geriatric Depression Therapy Decision Tree. It was recommended that a drug can be modified in the way it is administered in an attempt to handle the side effects rather than introduce another drug to treat the side effect (Liu, Anderson, Mittmann, Axcell & Shear, 2015). This is because every drug has side effects and so treating one may be just as good as introducing another.

Impact of Ethical Considerations on Treatment Plan

Ant-depression therapy in adults has many complications that accompany any medication plan adopted. It involves taking risks, as there are many side effects of the drugs used in this therapy. Some drugs cause patients to have suicidal tendencies (Flint, 2012) Geriatric Depression Therapy Decision Tree. Based on the doctor’s evaluation of the patient, some drugs may not be included in the therapy of certain patients. In this case, some drugs may not be used especially those that induce suicidal tendencies as this patient is not interacting with people and that make is risky.

Conclusion

Depression in the elderly is a noteworthy, normal, and developing issue that requires treatment. It has genuine ramifications for the patient, family, and group. Recognizable proof took after by a careful evaluation can help manage the determination of a proper upper prescription. There are a few variables to consider when choosing, altering, and changing antidepressants in the elderly. Together, these techniques can help advance the sheltered utilization of antidepressants in the elderly (Flint & Rifat, 2013). Geriatric Depression Therapy Decision Tree Other than medicines, different treatments for wretchedness that may be considered incorporate different types of psychotherapy and neurostimulation, with electroconvulsive treatment as yet being the highest quality level for extreme or crazy discouragement