Answer 2 for NURS 6630 Treatment for a Patient With a Common Condition

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Answer 2 for NURS 6630 Treatment for a Patient With a Common Condition

I am using the Geriatric Depression Scale (GDS). This would help determine the severity of the patient’s symptoms by revealing how much worse their GDS score is. Although the patient’s current medication regimen, Zoloft 100 mg daily, and medical history both point to a diagnosis of major depressive disorder. The instrument takes about seven minutes to complete, which is suitable for reassessing Depression (Bains, 2020).

  1. Questions for the Patient:
  • How has your daily routine changed since your husband’s passing, and are there specific activities that have become more challenging or less enjoyable?
    • This question helps assess the impact of grief on her daily functioning and provides insights into potential depressive symptoms.
  • Can you describe any changes in your appetite, weight, or energy levels since your husband’s death?
    • This question aims to explore additional symptoms related to depression and assess the overall impact on her physical health.
  • Have you had any recent thoughts or feelings that life is not worth living or that you would be better off dead?
    • While the patient denies suicidal ideations initially, regularly checking for mood changes is crucial, as depressive symptoms can evolve.
  1. People to Speak to:
  • A close friend:
    • How has the patient been coping since her husband’s passing? Have you noticed any changes in her mood, behavior, or daily activities?”
    • External perspectives can provide valuable information about the patient’s emotional state and daily functioning.
  • Patient’s offspring or close family member:
    • Has the patient reported side effects or concerns related to the patient’s current medications?”
    • Ensuring medication adherence and addressing any potential drug-related issues is crucial, considering the patient’s multiple medications.
  1. Physical Exams and Diagnostic Tests:
  • Physical Exam:
    • Assessment of psychomotor activity, facial expressions, and overall appearance for signs of depression.
    • Rationale: Physical signs may contribute to the clinical diagnosis of depression and guide treatment planning.
  • Laboratory Tests:
    • Thyroid function tests and metabolic panel.
    • Rationale: To rule out medical conditions (hypothyroidism, metabolic disturbances) that may contribute to or mimic depressive symptoms.
  1. Differential Diagnosis:

Major Depressive Disorder: The patient’s symptoms, history, and duration point to the likelihood that she is suffering from MDD. The bereavement exclusion criterion supports the diagnosis because the symptoms have persisted beyond the expected mourning period.

  1. Antidepressant Therapy:
  • Selective Serotonin Reuptake Inhibitor (SSRI): Escitalopram 10mg daily.
    • Rationale: Escitalopram has a favorable side effect profile and is well-tolerated in older adults. Its potency as an SSRI makes it a suitable choice.
  • Serotonin-Norepinephrine Reuptake Inhibitor (SNRI): Duloxetine 30mg daily.
    • Rationale: Duloxetine, with its dual neurotransmitter modulation, can be considered if there is a lack of response or tolerance to SSRIs (Karrouri et al., 2021; Dhaliwal, 2023)
  1. Contraindications or Alterations:
  • Escitalopram: Caution with concurrent use of certain antihypertensive medications due to potential interactions; regular blood pressure monitoring is essential.
  • Duloxetine: Monitor for potential interactions with the patient’s current medications, especially those affecting blood pressure and blood glucose levels. (Karrouri et al., 2021; Dhaliwal, 2023)
  1. Follow-up and Therapeutic Changes:
  • Week 4: Assess for early response and side effects. Consider adjusting the dose if needed.
  • Week 8: Reevaluate the patient’s progress. If there’s an inadequate improvement, consider dose adjustments or transitioning to a different antidepressant class.
  • Week 12: Continue monitoring for efficacy and tolerability. If necessary, explore psychotherapy options. Consider consultation with a mental health specialist for further recommendations.

References

Bains, N. (2020) Major Depressive Disorder. https://www.ncbi.nlm.nih.gov/books/NBK559078

Dhaliwal, J. S. (2023). Duloxetine. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK549806 

Karrouri R, Hammani Z, Benjelloun R, & Otheman Y. (2021). Major depressive disorder: Validated treatments and future challenges. World J Clin Cases. Nov 6;9(31):9350-9367. Doi: 10.12998/wjcc.v9.i31.9350. PMID: 34877271; PMCID: PMC8610877.

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