Comprehensive Discussion Essay On Treatment For A Patient With A Common Condition For Nursing Students

In the scenario provided, the patient is a 71 years old female that recently lost her husband of 41 years. Since her husband’s recent passing away, her depression symptoms have been getting worse; per patient, she has no history of depression before her husband’s death. Major depressive disorder affects approximately 6.7 percent of American adults (Major depression, 2021). The disease is linked with several comorbidities that carry a high risk of mortality and even death.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

How has your sleep pattern been?

The reason I would ask that is that greater sleep disturbance indicates a greater risk for depression.

Do you prefer to stay at home rather than going out and doing new things?

This question asks for a yes or no answer and recognizes that isolation and withdrawal are common signs of depression — especially in the elderly.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

I would also ask if she takes her medications as prescribed and if she misses any doses. Finding out if the patient is compliant with her medications can help determine the next step in treatment.

Identify people in the patient’s life you would need to speak to or get feedback from to assess the patient’s situation further. Include specific questions you might ask these people and why.

In the scenario given, it says if the patient has children or possibly a guardian. Before proceeding with any decision, I would inquire on whether or not the patient has any children. Furthermore, I would also inquire about the patient’s living arrangement. At the beginning of the scenario, it says the patient arrived at the facility via private transport, and it does not state if she is driving or by a transport vehicle or if a family drove her. It also does not state if she leaves alone or at a facility. I will have to inquire about all of that information, including her social-economic status and her support network. I would ask these people, how are her sleeping habits like? Does she nap during the day? Does she go out at all with her friends? How has her behavior been in the last two weeks? These questions will help me to understand if the patient depression is working or if the patient is relapsing into depression.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

Since this is the first time I’m seeing the patient, my priority would be to gather as much information as possible about the patient’s health conditions. Which include but not limited to a thorough health history that includes demographics, medical, social, and family history. I would also perform a thorough physical exam, including mental health exam. I would order an HGBA1C to examine her glycemic control. I would get a CBC and a BMP to check for any abnormal labs and baseline values if not recently obtained by her PCP. I would also use the Hamilton or (DSM-5) depression scale with this patient to monitor the effects of the treatment on her depression symptoms.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why

The patient recently lost her husband of 41 years; I believe that the patient is still grieving her husband’s loss. A differential diagnosis for this patient would be insomnia associated with situational depression.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

List two pharmacologic agents and their dosing appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

For this particular patient, I would increase the Sertraline to 150 mg. daily, and I would also add Trazadone 25mg at bedtime to help with insomnia. Trazadone is an antidepressant that has been used off-label for insomnia. A low dose such as 25mg will ‘induces and maintains sleep without causing daytime drowsiness or tolerance’ (Jaffer et al., 2017). (Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

For the drug therapy, you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

They did not mention the patient ethnicity in the scenario. However, some ethnicity is more prone to be carriers of CYP2D6; this can cause a problem with the metabolism of antidepressants, which can cause a buildup of toxic levels in the neurological system (Fabbri & Serreti, 2020). (Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

A follow-up plan is essential in evaluating the progress of the patient regarding the condition. It is also an assessment of the effectiveness of the treatment approach. The follow- up care plan starts immediately after the discharge of the patient; I would talk with the patient-caregiver and instructs them to closely monitor the patient because the patient is at an increased risk for suicide; furthermore, I would instruct the patient to return in 4 weeks to monitor the patient for any improvement in their MDD symptoms and insomnia. I also want this patient to keep a “sleep log” and document how many hours of sleep and quality of the sleep she is getting nightly. Plus, I will collaborate with other health care practitioners to measure, track, and document the patient progress towards the recovery process. If the patients do not have any improvement in symptoms in four weeks, changes will be made to the patient’s medication, and patients will have to return four weeks later.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

References

Fabbri,C., & Serretti,A. (2020). How to utilize clinical and genetic information for personalized treatment of major depressive disorder: Step by step strategic approach.Clinical Psychopharmacology and Neuroscience,18(4), 484-492. doi:10.9758/cpn.2020.18.4.484

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., Abdelmesseh, M., Danovitch, I., & Ishak, W. W. (2017). Trazodone for Insomnia: A Systematic Review. Innovations in clinical neuroscience, 14(7-8), 24–34

Major depression (2021). Retrieved April 15, 2021, from https://www.health.harvard.edu/a_to_z/major-depression-a-to-z

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Sample Discussion: Treatment for a Patient With a Common Condition

Discussion: Treatment for a Patient With a Common Condition. List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

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Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experienced sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.(Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

Reference:

Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs. Discussion: Treatment for a Patient With a Common Condition. List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: (Comprehensive Discussion Essay on Treatment for a Patient With a Common Condition for Nursing Students)

Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

By Day 3 of Week 7

Post a response to each of the following:

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

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Discussion: Treatment for a Patient With a Common Condition