Adult/Geriatric Depression Hispanic Male With MDD

Hispanic male
BACKGROUND INFORMATION
The client is a 32-year-old Hispanic 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 “routine” 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 “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” 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 “trouble” at work.

MENTAL STATUS EXAM

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 “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Part#1 Decision Point One

Select what the PMHNP should do:

· https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-red.pngBegin zoloft 25 mg orally daily Reports a 25% decrease in symptoms

· Client is concerned over the new onset of erectile dysfunction

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-blue.pngBegin Effexor XR 37.5 mg orally daily Client returns to clinic in four weeks

· Client informed the PMHNP that he stopped taking the drug because his inability to perform sexually was worsening his self-esteem

· https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-yellow.pngBegin Phenelzine 15 mg orally TID Client returns to clinic in four weeks

· Client reports that he was rushed to the Emergency Room 2 weeks ago after collapsing at the warehouse where he works. He was taken by ambulance to the local community hospital. He was diagnosed with postural hypotension

· Client was treated with fluid bolus and told to stop taking his phenelzine and to follow up with his primary care provider within one week, and his PMHNP within that same time frame

Decision Point Two

Select what the PMHNP should do next:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-red.pngDecrease dose to 12.5 mg orally daily Client returns to clinic in four weeks

· Erectile dysfunction has subsided

· Depressive symptoms have worsened

· https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/img/pill-blue.pngContinue same dose and counsel client: Client returns to clinic in four weeks

· Client informed the PMHNP that he stopped taking the drug because his inability to perform sexually was worsening his self-esteem