Running head: CASE STUDY

Case Study: An Elderly Hispanic Man with Depressive Disorder

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CASE STUDY

Case Study: An Elderly Hispanic Man with Depressive Disorder

Decision #1

This decision is designed for start up medication for patients with mild depressive disorder.

Starting an Effexor XR 37.5gm oral medication daily.

Reasons for choosing the decision

Normally the patient will not be immediately introduced to a higher amount of prescriptions of

the oral dosage of Effexor XR. Therefore, the reason for this decision is to introduce him patient

to Effexor XR 37.5 mg that is taken orally on a daily basis (Leahy, Holland & McGinn, 2012).

This is where physicians can determine the drug reactions and the outcome to pick on another

decision to work in case this does not materialize.

Anticipated results of the decision

The results I expected were an improvement or rather a slight difference in what was recorded

before the patient started the medication. Perhaps the patient will start having some sleep

however little it may be, be participative actively in some activities and exhibiting reduction of

pain. Since oral dosage of Effexor XR is a typically recommended treatment for all these

problems, I hoped either two or so problems would be solved with this therapy because this is

like a trial (Leahy, Holland & McGinn, 2012).

Difference in expected results and the real initial results of the decision
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The expectations that there would be some changes in the depressive disorder did not correspond

to the outcome. When the patient made a visit to the physician, it was noted that there were no

notable changesat all. The drug had not affected him in any way since the initial symptoms for

the disorder were just intact. There was not doubt another option was to be met.

Decision #2

Out of the three decisions reached, decision #2 is the most effective and appropriate for

the elderly Hispanic Man with Depressive Disorder. Increasing the oral Effexor XR dose from

37.5 mg to 75 mg on a daily basis is definitely the most effective therapeutic approach towards

the patient (Jamesburg, 2000). The other decisions are not effective for they cater for mild and

severe conditions of the disorder as in decision #1 and decision #3 respectively. The patient’s

condition is a moderate depressive disorder.

Reason for choosing the decision

From the medical exam results, the patient exhibits post-traumatic stress disorder,

attention deficit disorder and neuropathic pain, which correspond to his testimony on his general

health as in lack of interest in participating in some social activities, insomnia problem and poor

concentration, which is potentially at an alteration. Oral dosage of Effexor XR is a typically

recommended treatment for all these problems. However, not just any given amount of the drug

is workable in this case. At 37.5 mg, the drug is not so effective because there might not be any

changes resulting from the medication leading to resolutions to engage another therapy
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(Jamesburg, 2000). Entirely an increase of Effexor XR oral dose from 37.5 mg to 75 mg solves

these problems since it is at this prescription that the drug works effectively. The patient has a

moderate depressive condition and is likely to benefit from this decision.

Anticipated results of the decision

The patient reported cases of insomnia, lack of concentration, inactiveness and stressful

memories from his experiences (McGinn, L. K.2012). “Dad did what he could for us, there were

8 of us.”From this decision, I expected the patient would gain some concentration, become

actively participative and clear most of the past frustrating memories he keeps thinking about.

The back pain he experiences withstiff shoulders could also be remedied with the prescribed

Effexor XR treatment. Sleep is as essential as other factors therefore in one way of the other;

with the treatment dosage, the patient would at least reduce levels of sleeplessness. I hoped to

achieve these results because Effexor XR 75 mg oral dose is the most appropriate medically

recommended way of treating the above problems to do with general depressive disorder.

Difference in expected results and the real initial results of the decision

On choosing to implement the dosage of Effexor XR 75 mg on a daily basis, I expected

to have the level of the depressive disorder reduced in a gradual manner. This means at least

there would be some slight improvementin Montgomery-Asberg Depression Rating Scale when

the patient visits the PMHNP for the test. The initial examination rated the condition as severe

depression at a score of 51 (McGinn, L. K.2012). Therefore, I had hoped that the therapy would
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reduce the results by at most a score of 8 to 43. However, there was a big difference in the results

when the patient visited the clinic after two fortnights. There was a remarkable improvement in

depressive symptoms with a 25% reduction in the Montgomery-Asberg Depression Rating Scale.

Decision #3

The third decision is a very different approach that applies to special cases in for this category of

medical problem. This decision resided in increasing the dosage instead of maintaining the same

amount of prescription of Effexor XR 75gm.

Reasons for choosing the decision

Whenever the prescribed dosage does not affect a patient in any positive manner, there

must be changes. There must be alteration of the dosage form the previous prescription. This

decision is mostly for patients with severe depressive disorder. The Effexor XR oral dosage

administered daily must be altered from 75 gm. to 112.5 gm. or even more to effectively deal

with the critical condition of the medical problem.

Anticipated results of the decision

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On introducing the increased dosage for the patient at for the critical condition of

depression, it was expected that there would be a difference (Thomson, 2015). The severity of

the depressive disorder will definitely be reduced to a certain level though not a complete

eradication of the symptoms of the condition.

Difference in expected results and the real initial results of the decision

Increasing the dosage to that level to counter severity in this case did not really help it.

The patient seems to even get to a more critical condition at the administration of the new

dosage. Instead of having some relief for the patient as expected, the patient needed to consult a

physician for more advice and therapeutic actions. This decision also calls for counseling of the

client because of the worsened state of his condition (Thomson, 2015).

Ethical considerations in treatment plan and communication with clients

 Appropriate prescriptions for each level of disorder

In treatment of depressive disorder, this ethical consideration (McGinn, L. K.2012) helps

physicians to administer the most appropriate prescriptions to each case as whether mild,

moderate of severe depressive conditions. For example, mild conditions need a start of 37.5 gm.

of Effexor XR; the moderate patients can be increased to 75 gm. like in the above incident while

those with severe depressive disorder may have prescriptions of up to 225 gm.

 Proper administration
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This reminds physicians that patients should take the right course of drug administration

ensuring they follow all instructions given (Romaine, 1969). For example, patients may need to

take the drug with food or be subjected to taper dosage in cases of discontinuation of the drug.

 Modifications of dosage

Just like for prescriptions as discussed above, modifying the correct dosage for a given

disorder is an ethical consideration. This may help nursing team to reduce the dosage as

appropriate depending on the condition of the patient.

 Provision of Patient-education

This is mostly knowledge about what to expect during the medication and after (McGinn,

L. K. (2012). This helps nurses to highlight potential side effects of the prescribed treatment for

patients to get to know what might happen in the end.

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Reference

American Psychiatric Association. (2000). Major depressive disorder: A patient and family

guide. Washington, D.C: American Psychiatric Association.

Leahy, R. L., Holland, S. J., & McGinn, L. K. (2012). Treatment plans and interventions for

depression and anxiety disorders. New York: Guilford Press.

Thomson PDR. (2015). Physicians' desk reference. Montvale, NJ: Thomson PDR.

Preventive medicine in managed care. (2000). Jamesburg, NJ: American Medical Pub.

Resident & staff physician. (1969). Port Washington, NY, etc.: Romaine Pierson Publishers, etc.
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Reference

American Psychiatric Association. (2000). Major depressive disorder: A patient and family

guide. Washington, D.C: American Psychiatric Association.

Leahy, R. L., Holland, S. J., & McGinn, L. K. (2012).Treatment plans and interventions for

depression and anxiety disorders. New York: Guilford Press.

Thomson PDR. (2005). Physicians' desk reference. Montvale, NJ: Thomson PDR.

Preventive medicine in managed care. (2000). Jamesburg, NJ: American Medical Pub.

Resident & staff physician. (1969). Port Washington, NY, etc.: Romaine Pierson Publishers, etc.