Captain of Ship Project-Depressive Disorder
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.Captain of Ship Project-Depressive Disorder
Learning Objectives
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.
HPI and Clinical Impression
AJ was a 30-year-old mum of 3 children and had been married for 10 years. She gave birth to the 3rd child four months previously and she reported that both her pregnancy and labor were uneventful. One month after delivery, AJ was normal. However, she later started to reveal unusual behavior of being reclusive and not speaking to anyone at home. Apart from losing interest in her activities of daily life, she also lost interest in her children and stopped caring for them. She even stopped breastfeeding the 3rd child. However, all the other people in her family were busy as usual with their own lives and the seemed to be indifferent to the condition that she had.Captain of Ship Project-Depressive Disorder
Her husband reported that one morning when all the members of the family had left to work in the fields, AJ started to cut her hand resulting in bleeding. Neighbors who saw her ran to inform the family members in the fields who came and took her to her primary care provider. She had sustained some superficial cut wounds. Although her wounds were cleaned, sutured and antibiotics prescribed, her PCP was certain that AJ had postpartum depression and referred her for further management to a mental health practitioner(Stewart & Vigod, 2016).
Psychopharmacologic Treatments Recommended
Treatment is recommended in patients with postpartum depression when the symptoms experienced by a client are noted to interfere with the occupational and social life of a client or results in a lot of distress. It is evident that AJ’s relationship with her child, friends and family members has been impaired. The best drug is Zoloft, 50mg PO qDay. Zoloft is an SSRI antidepressant whose mode of action is through the inhibition of the uptake of serotonin in the neurons (Latendresse, Elmore & Deneris, 2017). When prescribing this medication, AJ will be educated on the side effects that should be anticipated. The goal of treatment is positively influenced by her social and physical life.
Psychotherapy Choices Recommended
Existing literature suggests that outcomes in the management of depressive disorders are more effective when antidepressant medications are combined with cognitive behavioral therapy. Therefore, group CBT will be the most effective psychotherapeutic approach for this client for the installation of hope, imparting knowledge, universality, and altruism (Dennis, 2017). Group CBT will enable the client to be able to develop more effective strategies in dealing with situations that appear to be stressful. It will positively influence her thoughts, feelings, and behavior and result in improved quality of social, physical and occupational life (Vaswani et al., 2018). The group psychotherapy sessions will be started at the same time with medications to improve the patient’s health outcomes.Captain of Ship Project-Depressive Disorder
Medical Management Needs, Community Support Resources and Primary Care Needs
It will be mandatory that AJ connects with her primary care provider through whom it will be possible to obtain progress reports on a weekly basis. During follow-up by the PCP, there are mandatory basic laboratory investigations that will routinely be conducted including a kidney function test, liver function tests, and a complete blood count among others. It is undeniable that the client will experience some side effects of the prescribed medication. Commonly known side effects of Zoloft include insomnia, a reduced sex drive, sweating, diarrhea, loss of appetite, indigestion, and drowsiness (Latendresse, Elmore & Deneris, 2017). Her PCP will keep on assessing the extent of severity of these symptoms and how they impact the patient’s health.
Zoloft is an SSRI which are known to potentially raise the interval OT among people who are otherwise healthy. Therefore, she will also get an EKG done following the initiation of treatment (Latendresse, Elmore & Deneris, 2017). AJ will also be linked to local peer support groups such as those supported by the American Congress of Obstetricians and Gynecologists which help in social connectivity, providing emotional validation, ongoing and regular options for treatment, a non-judgmental and safe environment to actively participate(Dennis, 2017). It is worth noting that, the majority of these support groups are facilitated by professional healthcare providers. Therefore, in this group, AJ will be able to: get encouragement to remain consistent in resolving personal issues, receive care, appraisal and emotional support and necessary help to endure some of the frustrations likely to be experienced in life (Dennis, 2017).
Follow-Up Plan and Collaboration with Other Providers
Will come for follow-up which will aim at assessing how tolerant, effective and efficient she is to Zoloft. During the same visit, dosage adjustments will be done and her compliance to medications will be assessed (Latendresse, Elmore & Deneris, 2017). Subsequent visits will thereafter follow after every 4 weeks whose purpose will be to address any emerging concerns and to check for her progress. It should be noted that group psychotherapy will be initiated in the same week with medications. On a weekly basis, she will be monitored by her primary care provider for any reports on worsening side effect, symptoms or suicidal ideation.Captain of Ship Project-Depressive Disorder
References
Dennis, C. L. (2017). Psychological treatment is one of the several important components of the effective management of postpartum depression. Evidence-based nursing, 20(1), 9-9.
Latendresse, G., Elmore, C., & Deneris, A. (2017). Selective Serotonin Reuptake Inhibitors as First‐Line Antidepressant Therapy for Perinatal Depression. Journal of Midwifery & women’s health, 62(3), 317-328.
Stewart, D. E., & Vigod, S. (2016). Postpartum depression. New England Journal of Medicine, 375(22), 2177-2186.
Vaswani, A., Karter, J. M., Cosgrove, L., Peters, S. M., & Brodt, M. (2018). Depression screening during pregnancy and the postpartum period: Enhancing informed consent practices. Women’s Reproductive Health, 5(1), 1-12.Captain of Ship Project-Depressive Disorder