Major Depression
Introduction
The purpose of this paper is to examine the patient management process based on an actual patient observation in the clinical setting. In this particular case, the patient is a 75-year-old African American male. The patient has been diagnosed with depression and sleeping disorders. The patient was treated with Paxil 20 mg PO at bedtime, Remeron 30 mg PO daily, and Melatonin 5 mg PO at bedtime. The patient information was observed once, and the data was collected from lab values, treatments, medications, etc. The data collected was relevant to the fusion of nursing practitioner management. The diagnosis was made after the patient’s symptoms were evaluated and determined to be depression and sleep disturbance by a qualified medical practitioner. For accurate results, the paper analyzes evidence-based literature in the nursing practice. The importance of using such literature is to ensure that the outcomes of this research improve patient outcomes. Also, the paper helps improve the nurse’s practice and active engagement in the process of patient care.
Review of Treatment Guidelines
The guidelines for treating major depression were obtained from peer-reviewed and evidenced-based journal of nursing practice and psychiatry. The first guidelines were on the assessment and evaluation of the patient. First, the instruction finds a complete history/record from all available sources. This process includes medical records and information from the patient and caregivers. The second step is a physical examination, where the patient is examined for things such as specific nutritional deficiency, weight, blood pressure, and BMI (Base Mass Index). A mental state examination follows this. The current diagnostic procedures were employed where the patient was assessed to ensure conditions such as bipolar and secondary depression are ruled out. The severity of the depression is assessed next to the rate of how severe it is. The severity of the symptoms was determined by measuring whether the patient displayed psychotic, melancholic, reverse vegetative, and cognitive symptoms. Also, the patient was assessed whether he was a danger to others or himself had a history of substance abuse, how functional the patient was, and the sociocultural setting of the patient. From the results, the patient’s blood sugar levels and renal and liver functions were examined. The caregiver’s understanding of the condition and the patient attitudes towards treatment were determined. The treatment process followed this. As the treatment was administered, the response and adherence to treatment were a critical factor. Another healthcare need including the relationship with caregivers was accessed to improve the patient’s outcomes (Gelenberg 2010)
Nature of the problem
Depression is a frequent problem, and when it evolves to major depression disorder, it leads to impaired functioning of the patient, and as a consequence, the patient has a poor quality of life. According to the World Health Organization, depression is among the major disabilities. When it leads to a patient seeking medical attention or being hospitalized, then it increases healthcare costs due to more extended periods of treatment and hospitalization, poor adherence to treatment or response, and clinical morbidity. People with major depression suffer from several problems. For instance, workplace performance is poor, marital problems, and poor learning outcomes. In some cases, it leads to secondary conditions. In addition to these, research indicates that a significant number of patients with depression suffer from at least one incident of recurrence in their lifetime following medical treatment (Gautam et al. 2017).
Patients require a complete diagnostic assessment to determine whether they are suffering from a major depressive disorder. The diagnostic tests are crucial because they help medical caregivers to rule out other medical conditions that can cause depression symptoms. Differential diagnostic probabilities are necessary. There are some medical conditions; for instance, Parkinson’s disease can cause the patient to display major depression symptoms. In the course of the assessment, psychosocial stressors must be considered as major depression symptoms are often an outcome of these stressors. A full differential diagnostic process must ensure the patient’s safety is considered first. Also, diagnostic procedures have better patient outcomes when caregivers coordinate their efforts. When new symptoms emerge, it is maybe necessary to conduct a diagnostic reassessment. Some conditions, such as borderline personality disorder, can affect the diagnosis of major depression since these conditions have a higher frequency of major depression disorder (AFP 2011).
Management of the patient
The management of the patient is a multifaceted process. There are several considerations. For one, the patient is elderly (75 years) and suffers from significant depression. The literature available recommends several management plans. The first is pharmacotherapy, where the patient is administered with antidepressants. The next step of management is psychotherapy. Electroconvulsive therapy (ETC) is an option if the patient shows suicidal signs. It is an excellent tool for short term therapeutic outcomes. Exercise therapy is another option that can help the patient in addition to pharmacotherapy.
Patient goals
The short term goal of the patient is to start treatment. Also, the patient will attend a therapy session, take medications as prescribed, respond positively to caregivers, and perform daily routines such as taking a bath, etc. In the long-term, the patient should adopt skills that will make him feel better about himself, return to normal functioning, adopt coping strategies, reduce the frequency of anxiety and report significantly fewer levels of depressed moods weekly. All these goals are measurable and realistic. The follow-up assessment should collect data to ensure that the patient is accomplishing his goals. Meaningful and realistic goals will aid the patient in treating his depression (Battle et al. 2014).
Medication Intervention
Paxil 20 mg: To be taken at bedtime. This is the pharmaceutical used to treat depression. It can help the patient reduce anxiety, compulsive behaviors panic attacks. The regimen, as per the patient’s diagnosis and to reduce the chances of nausea, the patient is encouraged to take it after eating food. Some of its side effects include nausea, vomiting, loss of appetite, and muscle weakness. The patient is also advised not to take the drug alongside other drugs or substances that may cause interaction, for example, ibuprofen and alcohol. Doses should be taken at the same time or as soon as the dose time was missed (WebMD)
Remeron 30 mg PO: This is an antidepressant drug, especially for patients suffering from a major depressive disorder. The drug is administered orally. The 30 mg PO daily range was deemed the most effective for this patient. To be effective, the patient must take the drug for several weeks. Commonly observed side effects include nausea, somnolence, and dizziness (Rx Professional).
Melatonin 5 mg PO at bedtime: It is a synthetically made hormone that helps improve sleep for the patient. As such, it is prescribed for the night. According to studies, sleep disorders due to depression can be enhanced by melatonin. Melatonin does not have side effects for most patients, but the patient can look out for signs side effects such as day time dizziness and irritability. Also, it can sometimes worsen some symptoms of depression. It is administered by mouth, and the 5 mg dosing is recommended.
The healthcare providers can best give patient teaching related to the diagnosis. A healthcare provider will answer the patient’s questions. If the patient wants additional information, a journal in depression care can offer more details. The patient may get a referral if depending on several factors. First, when the patient needs counseling services, he may be referred to a psychiatrist. The patient may be referred to due to his resources, or the healthcare provider decides to refer him to a mental special who is very familiar with the case. This has to be assessed. Several assessment tools can be used. First is the symptom-based rating scale where screening and diagnostic tools are employed. Self-report inventories are also important. Diagnosis and screening often use question-based scales to assess and these will be used for the patient as well.
Factors influencing the diagnosis
The diagnosis of depression is influenced by several factors which are: sociocultural, ethical, legal, economic and spiritual. Culture is intertwined with mental healthcare and hence as a healthcare provider, one needs to understand cultural norms because depression can sometimes lead to certain cultural syndromes. Ethical issues as regards to the treatment of depression include how to maintain therapeutic boundaries, providing care by portraying beneficence principles, treatment choices, confidentiality, and informed consent and treating justly diverse populations (Hoop, DiPasquale, Hernandez, and Roberts 2008). Social constructions of certain communities prevent them from seeking proper medication and this is one factor to consider because it is prevalent among African Americans a journal of men’s health study (Holden, McGregor, Blanks and Mahaffey 2012). Economically, depression becomes a burden to healthcare institutions and also takes socioeconomic resources away from the community. Another factor to consider is the link between spirituality and depression since it is a fundamental cultural value for many communities.
Teaching needs for patients & families.
The first lesson for family and patient is to understand and detect depression. The rationale here is to identify the symptoms present, when they occur and their frequency, and the effect on the patient’s functioning. The next is where to get the right information. The idea is to seek medical advice from reliable sources or healthcare providers. The next lesson is to develop a healthy activity program. This will help the patient to change his feeling, thoughts, and body, and family can aid in this program. The family must express genuine warmth, be nonjudgmental, and be encouraging. The lesson to learn is how to do activities that help alleviate the patient’s depression symptoms. The collaboration of the patient, family and healthcare providers in the next teaching need. This will help in the assessment of the patient’s progress.
Conclusion
This paper has provided a framework that can guide the healthcare provider when evaluating the patient with the final diagnosis. The first section of the paper gives a detailed description of the disorder and hence the healthcare provider has answers to the patient’s questions. The medication, regimen and side effects of the pharmaceutical required have also been provided. The management of depression is a delicate process and therefore the assessment tools outline, the lessons patient and family learn from the diagnosis and the sociocultural and socioeconomic factors that influence depression management will guide treatment.
References
American Family Physician (AFP). (2011). APA Releases Guideline on Treatment of Patients
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Battle, C. L.,Uebelacker, L., Friedman, A., Cardemil, E. V., Beevers, C. G. and Miller, I. W.
(2014). Treatment Goals of Depressed Outpatients: A Qualitative Investigation of Goals Identified by Participants in a Depression Treatment Trial. J Psychiatr Pract. 2014 Nov; 16(6): 425–430.
Gautam, S., Jain, A., Gautam, M., Vahian, V. N. and Grover, S. (2017). Clinical Practice
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