Examine Case Study: An Elderly Hispanic (the best nursing writing service, a studybay for your papers) Man With Major Depressive Disorder<\/em>. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client\u2019s pharmacokinetic and pharmacodynamic processes.<\/p>\n BACKGROUND INFORMATION<\/strong><\/p>\n The client is a 32-year-old Hispanic (the best nursing writing service, a studybay for your papers) 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 the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after \u201croutine\u201d 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 \u201cstiff\u201d shoulders which he attributes to his current work as a laborer in a warehouse.\u00a0<\/p>\n SUBJECTIVE<\/strong><\/p>\n During today\u2019s clinical interview, client reports that he always felt like an outsider as he was \u201cteased\u201d a lot for being \u201cblack\u201d in high school. States that he had few friends, and basically kept to himself. He describes his home life as \u201cgood.\u201d Stating \u201cDad did what he could for us, there were 8 of us.\u201d 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 \u201ctrouble\u201d at work.\u00a0<\/p>\n MENTAL STATUS EXAM<\/strong><\/p>\n 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. The PMHNP administers the \u201cMontgomery- Asberg Depression Rating Scale (MADRS)\u201d<\/strong> and obtained a score of 51 (indicating severe depression)<\/em>.<\/p>\n RESOURCES<\/strong><\/p>\n \u00a7 Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.<\/p>\n Decision Point One<\/p>\n Decision Point One<\/p>\n RESULTS OF DECISION POINT ONE<\/strong><\/p>\n Decision Point Two<\/p>\n Decision Point Two<\/p>\n RESULTS OF DECISION POINT TWO<\/strong><\/p>\n Decision Point Three<\/p>\n Decision Point Three<\/p>\n\n
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Select what the PMHNP should do:<\/strong><\/h5>\n
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Begin zoloft 25 mg orally daily<\/a><\/p>\n![](\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/03\/mm\/adult_geriatric_depression\/img\/pill-blue.png\")
Begin Effexor XR 37.5 mg orally daily<\/a><\/p>\n![](\"https:\/\/mym.cdn.laureate-media.com\/2dett4d\/Walden\/NURS\/6630\/03\/mm\/adult_geriatric_depression\/img\/pill-yellow.png\")
Begin Phenelzine 15 mg orally TID<\/a><\/p>\nBegin zoloft 25 mg orally daily<\/p>\n\n
Select what the PMHNP should do next:<\/strong><\/h5>\n
Decrease dose to 12.5 mg orally daily\u00a0<\/a><\/p>\nContinue same dose and counsel client<\/a><\/p>\nAdd augmenting agent such as Wellbutrin IR 150 mg in morning<\/a><\/p>\nAdd augmenting agent such as Wellbutrin IR 150 mg in morning<\/a><\/p>\n\n
Select what the PMHNP should do next:<\/strong><\/h5>\n
Discontinue Zoloft altogether and continue with Wellbutrin\u00a0<\/a><\/p>\nChange Wellbutrin to XL 150 mg orally daily in AM<\/a><\/p>\nAdd Ativan 0.5 mg orally TID\/PRN for anxiety<\/a><\/p>\n