PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW:

1). ZERO (0) PLAGIARISM

2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS

3).  PLEASE SEE THE ATTACHMENT FOR RUBRIC DETAILS. 

4). Please review and follow the grading rubric details well, and include each component in the assignment as required. Also, follow the APA writing rules and style, introduction, conclusion.

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. 

 

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.

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.

 

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.

  Decision Point One

Select what you should do: 

Begin zoloft 25 mg orally dailyBegin Effexor XR 37.5 mg orally dailyBegin Phenelzine 15 mg orally TID. 

(There are three different medications above; Zoloft, Effexor, and Phenelzine. Choose Zoloft 25mg for me and follow the Decision Points one, two, and three as indicated).

 Decision Point One

Begin 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 One

Begin Effexor XR 37.5 mg orally daily

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Client reports that there is no change in depressive symptoms at all

 Decision Point One

Begin Phenelzine 15 mg orally TID

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Client reports that he was rushed to the Emergency Room 2 weeks ago after collapsing at the warehouse where he works. He was taken by ambulance to the local community hospital. He was diagnosed with postural hypotension
• Client was treated with fluid bolus and told to stop taking his phenelzine and to follow up with his primary care provider within one week, and you within that same time frame

Decision Point Two

Select what you should do next:

Restart Phenelzine and counsel client on dietary choices and importance of hydrationPhenelzine is not reinitiated. Instead, we began therapy with Lexapro 20 mg orally daily after an appropriate “wash out” period (5 half-lives).Re-start Phenelzine 7.5 mg orally TID 

 Decision Point Two

Restart Phenelzine and counsel client on dietary choices and importance of hydration

RESULTS OF DECISION POINT TWO

• Client reports that although he had no more episodes of passing out, he has been dizzy when he gets up at night to use the bathroom
• Client also reports that at various times throughout the day when he goes from a sitting to a standing position, he feels light-headed

 Decision Point Two

Re-start Phenelzine 7.5 mg orally TID

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Client reported that he still has a little dizziness
• Client also reports that that his depression has improved greatly (a 35% decrease in MADR scale from 51 to 33)

 Decision Point Three

Select what you should do next:

Continue current drug dose and counsel client on dietary modifications and orthostatic hypotension safetyAugment with Lexapro 10 mg orally dailyIncrease dose of Phenelzine back to 15 mg orally TID now that the client is tolerating lower dose 

 Decision Point Three

Continue current drug dose and counsel client on dietary modifications and orthostatic hypotension safety

Guidance to Student
The initiation of an SSRI or SNRI should not begin until an adequate “wash out” period of MAOI- this is generally defined as the time it takes for 5 half-lives of the drug to be metabolized. Co-administration of SSRI, SNRI, or TCA with MAOI is contraindicated as it can cause serotonin syndrome and can actually be fatal. You can continue the current dose and counsel client as to dietary modifications as well as orthostatic hypotension safety, however, it should be remembered that he works in a warehouse and may be at risk for falls/injury due to orthostatic hypotension. A “watch and wait” approach may be appropriate if the client has failed all other antidepressants. Increasing the dose back to 15 mg orally TID is not indicated as his orthostatic hypotension will likely worsen.

“PLEASE LET ME KNOW IF YOU NEED ANY CLARIFICATION”.

To support your work, use your course and text readings as well as the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format. Patient or lay person medical information portals such as webMD, Medscape, Mayo Clinic, or any disease foundations, such as the arthritis foundation or the diabetic foundation, are not acceptable resources for your scholarly work.

Response #2 Orthostatic hypotension can occur as an adverse effect of medications used to manage hypertension. Go back to your initial post and describe the pathophysiologic process that causes orthostatic hypotension.

 TOPIC: Planning for Evaluation

The purpose of this assignment is to develop an evaluation plan for your evidence-based intervention in order to reflect on its effectiveness.

You may choose to include key slides from your Population-Based Intervention Implementation Plan from Topic 5 in order to ensure that stakeholders have an understanding of the data collection and intervention planning processes.

Create a 5-8 slide PowerPoint presentation, not including title or reference slides, with the following information:

1. Describe the population and health disparity targeted in the intervention.
2. Identify features and strategies for evaluation.
3. Identify performance measures.
4. Write short-term and long-term outcomes with plans for measurement and benchmarking.
5. Plan for the next steps in the intervention. What will you do with this evaluation data?

Include speaker notes for each slide, detailing how you would present this information to stakeholders.

Include up to two or more resources in your presentation.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines.

You are required to submit this assignment to LopesWrite. 

STUDY MATERIALS

Read Chapter 18 and review Chapter 10 in Public Health Nursing: Population-Centered Health Care in the Community.

Read “A Framework for Program Evaluation” (2017), located on the Centers for Disease Control and Prevention (CDC) website.  URL: https://www.cdc.gov/eval/framework/index.htm

Review “The Public Health Approach to Violence Prevention,” located on the Centers for Disease Control and Prevention (CDC) website. URL: https://www.cdc.gov/violenceprevention/pdf/PH_App_Violence-a.pdf

Read “Evaluation” (2015), located on the Centers for Disease Control and Prevention (CDC) website. URL: https://www.cdc.gov/workplacehealthpromotion/model/evaluation/index.html

 For this project, you will critique a QUALITATIVE research article. The goal of the following assignment is to provide an opportunity for you to apply your knowledge of research methods and processes gained in this course to evaluate research. Articles are provided below. A template table for the critique is provided – use of the template is REQUIRED.