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NR603 Week 6 Mental Health Treatment Plan(Analysis) – Part 2 / NR 603 Week 6 Mental Health Treatment Plan(Analysis) – Part 2 :Chamberlain College of Nursing (NEW-2022)( Download to score A)$4.49
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NR 603 Advanced Clinical Diagnosis And Practice Across The Lifespan Practicum (NR603)
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NR603 Week 6 Mental Health Treatment Plan(Analysis) – Part 2 / NR 603 Week 6 Mental Health Treatment Plan(Analysis) – Part 2 :Chamberlain College of Nursing (NEW-2022)( Download to score A)
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NR 603 Advanced Clinical Diagnosis And Practice Across The Lifespan Practicum (NR603)
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Chamberlain College Of Nursing
NR603 Week 6 Mental Health Treatment Plan(Analysis) – Part 2 / NR 603 Week 6 Mental Health Treatment Plan(Analysis) – Part 2 :Chamberlain College of Nursing (NEW-2022)( Download to score A)
nr603 week 6 mental health treatment plananalysis – part 2 nr 603 week 6 mental health treatment plananalysis – part 2 chamberlain college of nursing new 2022 download to score a
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NR 603 Advanced Clinical Diagnosis And Practice Across The Lifespan Practicum (NR603)
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NR 603 Week 6 Mental Health Treatment
Plan/Analysis – Part 2
Dr. Deering,
Major depressive disorder (MDD) is considered one of the top reasons for disability in the
United States (WHO, 2018). Depression affects 350 million people worldwide. It is more
prevalent in women than men. This disorder can go undetected for many years, often
leading to increased morbidity from other physical illnesses, substance abuse, and
increased suicidal ideations. As healthcare providers, it is important to conduct a complete
history and physical, and use appropriate screening tools, such as PHQ-9, to diagnose
depression. While many concerning histories should be referred to a mental health
specialist, healthcare providers can certainly initiate treatment to help alleviate their
symptoms. Keeping an open line of communication with patients who suffer from
depression will positively impact their lives and reduce the social stigma associated with
MDD. The following information is the full five-point treatment plan and analysis for D.W’s
plan of care.
Primary Diagnosis: Major Depressive Disorder, first episode
Diagnostic Testing: At this time, it is important to rule out medical conditions and
medication regimens that may contribute to D.W’s symptoms. Unfortunately, there is no
diagnostic testing for major depressive disorder (MDD). The guidelines from the American
Psychiatric Association (APA, 2017) recommends a comprehensive physical examination,
as well as a thorough review of medical history, medications, life stressors, and the
presence of substance use disorder. D.W does not have medications or history of
substance use that may contribute to her symptoms. She also does not have any family
history of psychiatric disorders. However, D.W does have a couple life stressors. She was
recently divorced a month ago, and is now the sole caretaker of her twin daughters. She
also reports having increased stress with work deadlines as a human resources recruiter.
The APA also recommends ruling out differential diagnoses that may mimic D.W’s
depressive symptoms (APA, 2017). Therefore, the next valid step is to obtain laboratory
tests, including complete blood count (CBC), comprehensive metabolic panel (CMP),
thyroid-stimulating hormone (TSH), lipid panel, vitamin B12, and vitamin D levels.
Assessment and screening must include a work-up to exclude other disorders, such as
hypothyroidism, anemia, renal problems, cancers, or cardiac issues, that may cause similar
symptoms (APA, 2017).
, Once differential diagnoses have been addressed, utilizing the patient health questionnaire
(PHQ) tool is the next step in D.W’s assessment. According to the US Preventive Services
Task Force (USPSTF), the PHQ screening tool is one of the most common, non-invasive
screening tools that can be performed to measure the severity of depression (Maurer,
Raymond, & Davis, 2018). The PHQ can be an important tool to monitor and address the
patient’s potential for uncontrolled depression because it encompasses a combination of the
DSM-IV criteria for depression. If D.W’s screening is indicative of depression, another
essential step is to confirm diagnosis by using the DSM-IV criteria for depression (Whooley,
2016). In addition to depressed mood or anhedonia in the past two weeks, at least five of
the following symptoms must be present for a diagnosis of depression: depressed mood,
appetite change/weight loss, insomnia, diminished ability to concentrate, fatigue/loss of
energy, feelings of worthlessness or excessive guilt, or recurrent thoughts of death
(Whooley, 2016). In this case study, D.W reports loss of interest, and at least five symptoms
including weight loss, fatigue, lack of quality sleep, difficulting concentrating, and an overall
depressed mood. Meeting the criteria can confirm the diagnosis of depression.
Medications: For the treatment of MDD, the APA guideline recommends a first line
treatment of a selective serotonin reuptake inhibitor (SSRI) (APA, 2017). With D.W’s
depressive symptoms and a moderately severe PHQ-9 score of 14, I would initially start
D.W on a low dose of fluoxetine at 20 mg once daily. I would then monitor her symptoms
and modify by increasing 10-20 mg every 4-5 weeks (Kovich & Dejong, 2015). SSRIs are
commonly the first line treatment for patients with depression due to its fewer adverse
effects (Kovich & Dejong, 2015). SSRIs increase the amount of serotonin by blocking the
presynaptic serotonin reuptake pump (Kovich & Dejong, 2015). Fluoxetine is an appropriate
drug of choice for D.W because SSRIs are associated with fewer adverse effects and drug
interactions compared with other classes of antidepressants.
Education: D.W should be educated on the common adverse effects of SSRIs, such as
dizziness, sexual dysfunction, nervousness, nausea, sleep disturbance, and weight
changes (Hollier, 2016). D.W should also be educated on not abruptly discontinuing her
SSRI because of an adverse effect called serotonin syndrome. Serotonin syndrome is a
potentially life-threatening condition from excess serotonin agonist activity (Hollier, 2016).
Symptoms of serotonin syndrome may start out as diarrhea and can progress to mental
status changes and neuromuscular abnormalities (Hollier, 2016). This is due to a rapid
titration of the medication, overdose, or a drug interaction.
It is also important to educate D.W that antidepressants have a delayed therapeutic effect.
Therefore, D.W should expect clinical improvement within two weeks and achieve full
therapeutic effect within four to eight weeks (APA, 2017). Lastly, D.W will need to be
educated on when to seek emergency treatment, such as neurological status changes
(seizures, extreme lethargy, disorientation, or slurred speech) and severe side effects such
as severe headache, dizziness, and chest pain (APA, 2017).
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