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Research article on depression

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DATABASE: Assessment of patient

Subjective Data

Creg Gregory was admitted on 16th January 2017 basically from depression which was characterized by sadness and anger. Upon admission, he stated that; “I feel really sad and hopeless, I also feel worthless, I have not spoken with my mom and have not seen my brothers that are in Tennessee”.

Psychosocial and mental status assessment

Creg is a 16year old boy from Bay Town Texas, and is currently studying. Consequently, Creg has had a chance to participate in psychotherapy as well as family meeting which are conducted by a social worker together with other patients. Notably, his participation in the family meeting has been sporadic. In addition to the above, Creg has also been prescribed Prozac (fluoxetine) 20 mg daily for depression as well as a PRN order Tylenol for headache/pain. However, upon his admission, the client claimed that he did not take the Prozac prescribed to him because it makes him feel more nauseous and weak. However, he complains that he experiences sleeplessness, tiredness and anger towards his father who abandoned him.

Subsequently, the client is able to engage in conversation appropriately when he is asked questions. According to him, he believes that he can deal with depression and the sadness he feels by playing video games, watching the television as well as taking deep breaths. For instance, during the family meeting today, his goal is to “take a shower and proceed to the video game room to play”. Evidently, the client is strong-willed to overcome depression and utilizes the resources available to him since he cannot get access to his immediate family, that is, the father and brothers. Nonetheless, he can receive support from the mother as well as the social worker working with him.

According to the client, he claimed that he had never taken alcohol and any other drug. Additionally, he claimed that he had never had any thoughts of suicide or self-harm. He also stated that he had never experienced any pain or gastrointestinal bleeding. Nonetheless, his was on a 1:1 monitor for safety precaution. His vital signs were as indicated: Temperature – 97.8, heart rate 72, blood pressure – 121/79, resp.- 18, SaO2 – 100%. The client also

In respect to his association with his family, the client’s relationship with the family members was weak. Consequently, this had been brought about by several factors, for instance, distance had separated his from his brother who was in Tennessee. On the other hand, he had not spoken to his mother in a long time, while his father bonded him and he had not seen him in years. Irrespective of his condition, Creg engaged in conversations appropriately and was able to formulate goals as to how he will overcome depression. Nonetheless, he portrayed characteristics such as being guarded and having a flat affect. Moreover, he had slow body movements and spoke slowly as well.

In conclusion, it clear that the patient’s depression is being propagated by the loneliness and sadness he feels. He has a strong will to overcome the depression he is experiencing, using the resources that are available to him. However, his lack of taking medication prescribed to him may be a cause for the symptoms to continue. His cognitive functioning is not as an affected, however, he is emotionally disturbed.

II. THERAPEUTIC APPROACHES IN PSYCHIATRIC CARE

Pharmacologic worksheet

Prozac (fluoxetine) 20 mg

Indications and usage

• Acute and maintenance treatment of Major Depressive Disorder (MDD) (1)

• Acute and maintenance treatment of Obsessive Compulsive Disorder (OCD) (1)

• Acute and maintenance treatment of Bulimia Nervosa (1)

• Acute treatment of Panic Disorder, with or without agoraphobia

Warning and Precaution

It leads to suicidal thoughts and behavior in children, adolescent, and young adults. May cause allergic reactions and rash, therefore, it should be discontinued upon the appearance of the rash and allergic phenomena. It may result in abnormal bleeding, therefore, using it with other drugs such as NSAID, ASPRIN Warfarin that affect coagulation may potentiate gastrointestinal bleeding. Anxiety and insomnia may occur and it may also activate Mania/hypomania.

Dosage and strengths

• Pulvules: 10 mg, 20 mg, 40 mg (3)

• Weekly capsules: 90 mg (3)

Drug Interaction

Monoamine Oxidase Inhibitors (MAOI)

CNS Acting Drugs

Serotonergic Drugs

Drugs that Interfere with Hemostasis (e.g., NSAIDS, Aspirin, Warfarin)

Electroconvulsive Therapy (ECT)

III. Psychodynamic psychotherapy

Development history

The patient has not been able to live a comfortable life as a teenager due to the fact that he gets depressed from time to time. His depression often leads Creg to display anger and towards others and sometimes sadness with no specific reason. Such behavior has affected the nature in which Creg socializes with his peers. The client has not been able to see his father for several years and this might be a possible cause for his mental behavior. Given the fact that the client has not admitted to abusing any drugs, this leaves social factors as the main cause of his depression.

Present status and maintenance

The absence of Creg’s father seems to be one of the major causes of the depression. Creg is often sad that he has not seen his father for several years and this has mentally affected him.

Defense mechanisms

The client has adopted a number of defense mechanism that helps in creating moments of destruction and pre-occupation. The patient has opted for entertainment as a way of reducing his anger towards life and other social issues. Some of the activities that the patient often uses include playing video games, watching TV and deep breathing. The patient also admitted to using Prozac (fluoxetine) 20mg daily to tame depression.

IV. Adolescence Depression Analysis of Data

Nursing diagnosis

The characteristics of the patient imply that Creg suffers from a depression mental disorder that is characterized by anger and sadness. Sadness leaves the patient in a low mood due to certain social issues such as missing a father. The patient is quick to express anger towards other people’s actions. The DSM-V criteria have identified eight major symptoms for diagnosing major depression disorder (Videbeck, 2013). Creg exhibit a depressed mood for most time of the day forcing him to concentrate on entertainment activities as a source of preoccupation. Creg rarely attend family meetings which makes him detached from many social activities. DSM-V suggests that clients may attain weight loss or weight gain due to diet irregularities and stress (Videbeck, 2011). The patient often has instances of sleeplessness as well as tiredness. These symptoms meet the threshold established by DSM-V for depression disorder.

Creg needs to understand how to control anger as well as depression by learning how to associate with other people.

Expected outcome

The short-term treatment goals are to help the patient reduce restlessness and have a positive outlook on life. The treatment plan also intends to help the patient realize the importance of attending a family meeting. The third short-term goal is to help the patient manage anger and avoid sadness. The fourth goal is to help the patient overcome sleeplessness and instances fatigue.

Modality

The patient will be handled with the recommended professionalism to ensure that the outcome of every component in the treatment plan turns positive. The lead psychiatric will take charge of identifying various experts such as diet and guiding and counseling. Since the patient is selective in some foods, a dietician will be in place to provide the best remedy. A nurse will also be required for helping the patient follow-up medication.

Checking intervals

Since the response of the treatment plan is dependent on the response of the patient, it would be difficult to establish a clear timeline for the medication period. However, the patient will be subjected to weekly check-up to establish how he responds to the current plan. This will enable the psychiatrist to determine whether to continue with the plan or alter it to suit the patient's preferences. A nurse, as well as a dietician, will be required to conduct daily follow-up to ensure that medication and diet are adhered to.

Nursing orders

A psychiatrist will be responsible for diagnosing and monitoring the improvement of the patient (Videbeck, 2013). A guiding and counseling expert will provide Creg with professional guiding and counseling to help him fit in the society. Another nurse will be required to follow up all medication administered to the patient. Also, the family is expected to play a major role in helping the patient recover.

Evaluation

The nursing intervention will be evaluated to establish how best it contributes to the healing progress of the patient.

V. Termination of care and discharge planning

At the end of the treatment plan, the termination of care will be considered provided the patient meets specific conditions (Videbeck, 2011). Creg must show enhanced ability to avoid being sad most parts of the day. The patient must exhibit improved performance in controlling anger as well as reduced sleeplessness. It is also important to ensure that the patient plays an active part as well as express passion in rebuilding his social life.

Once the patient has met the above goals, he will be discharged and his records kept for future references. A discharge plan will be provided once the psychiatric in-charge approves the fitness of the patient to fit in the society.

References

Videbeck, S. (2011). Psychiatric-Mental Health Nursing. (5th edition). New York: Lippincott Williams & Wilkins.

Videbeck, S. (2013). Nursing, Psychiatric-Mental Health. (5th edition). New York: Lippincott Williams & Wilkins.