Assignment 1: “Captain of the Ship” Project – Depressive Disorder

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.
Students will:
Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders
Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
Identify medical management needs for clients with depression disorders
Identify community support resources for clients with depression disorders
Recommend follow-up plans for clients with depression disorders
To prepare for this Assignment:

Select an adult or older adult client with a depressive disorder you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which you do the following:

Describe the HPI and clinical impression for the client.
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
Identify medical management needs, including primary care needs, specific to this client.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

ANSWER

Depressive Disorder

A depressive disorder refers to a clinical condition in which the patient loses interest in normal activities that they once considered enjoyable. Their life is characterized by loss of appetite, sleep, and moodiness. Mrs. Jean Richards is a 55-year-old woman who has a depressive disorder. Of late, she has not had any motivation and zeal to do anything she loved doing. She has two children who testify to experiencing and feeling the mood changes in their mother. They have also noted that she seems to be getting slimmer and excessively tired (MayoClinic, 2018). She is also not able to do any of the chores that were part of her routine, such as walking the dog.

HPI and Clinical Impressions

Mrs. Richards’s history of present illness (HPI) is as follows. The quality of her life has been worsening since she cannot function as expected. This is especially due to the personality changes, memory difficulties, and acute physical pain she has been experiencing. The severity of her pain, on a scale of 1 to 10, has been at 6 constantly since her symptoms began. The children say that her symptoms showed up 3 weeks ago, after which they continued to worsen consistently as the days went by. However, her condition seems to worsen substantially in the evening as she walks the dog on the beach. After noticing the changes, her children tried to change her schedule and started traveling with her to give her a change of scenery. Some of the associated signs and symptoms that helped in bringing the patient’s condition to the family’s attention include furrowed brows, slumped posture, poor eye contact, speech changes, severe malnutrition due to a lack of appetite and little body movement (MayoClinic, 2018). The clinical impression formulated from the HPI information is that Mrs. Richards is suffering from major depression.

Psychopharmacologic Treatments

Psychopharmacology involves the use of medication to treat a patient’s depressive disorder. Given Mrs. Richards HPI information, the nurse can prescribe some medication that would help in dealing with the disorder more effectively, as well as give her family some much-needed peace of mind (Kerr, 2017). The patient needs Benzodiazepines to deal with severe anxiety and sleep disorders. Secondly, she needs anti-depressants, which will work through the neurotransmitters in her brain such as dopamine, serotonin, and norepinephrine to significantly change her mood and disposition not only to her environment but towards herself and her family as well. They help in dealing and treating g any anxiety and moodiness that Richards has been experiencing. She will also need some pain killers to deal with the physical pains.

There are several therapeutic endpoints to the treatments provided. The first is that the painkillers will help in improving her quality of life by reducing her physical pain, which has been a hindrance to doing the chores she loves. She should be in a position to go for her evening walks and handle her dog. The antidepressants will help in dealing with her anxiety and moodiness, making it easier for her to socialize and engage with her family members without feeling overwhelmed. Lastly, the Benzodiazepines will help deal with insomnia, hence ensuring she can get the rest she needs to function effectively and stabilize her moods as well.

Psychotherapy Choices

There are several psychotherapy choices that the nurse could recommend to the patient and her family. The first applicable form of psychotherapy is cognitive behavior therapy, which emphasizes on the need for the patient to remodel their dysfunctional thinking and actions. It involves focusing on communication, present thinking and behavior to solve and address the problems the patient is facing at the time (APA, 2019). This could be a family therapy session since they will all need help to understand and address their loved one’s condition. The therapeutic endpoint to this approach is that it will help in alleviating any feelings of panic, fear personality problems, and eating disorders. The humanistic approach is also applicable not only for the patient but for the family as well. In this therapeutic approach, the need for empathy towards the plight of the patient is greatly emphasized. The psychologist focuses on methods and techniques in which to improve the patient’s self-actualization and self-image. The entire…