NURS6521 Week 8 Discussion: Decision Making When Treating Psychological Disorders

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

Review this week’s interactive media pieces and select one to focus on for this Discussion.
Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

By Day 6 of Week 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

To Participate in this Discussion:

Week 8 Discussion

Rubric Detail

	Excellent	Good	Fair	Poor
Main Posting	45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	10 (10%) – 10 (10%) Posts main post by day 3	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not post by day 3
First Response	17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. . Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days

Total Points: 100

Sample Paper

Geriatric Depression

Geriatric depression affects many older adults. There are many different medications that can be used to treat depression. Some medications will work alone, and sometimes dosages and medications need to be changed to see what is going to work to treat the depression. The purpose of this discussion is to discuss geriatric depression, the steps applied in completing the interactive media, explain how the drug I chose can impact the pathophysiology, and discuss how these impacts would inform me of the treatment plan.

Geriatric depression and decision steps applied in interactive media

Geriatric depression is depression that is seen in older adults. Symptoms can range from mild symptoms to more severe symptoms. People with depression have a feeling of decreased mood and loss of pleasure in activities (Krans, 2017). Some people have insomnia, inability to concentrate, anorexia, weight gain, feeling of worthlessness, and helplessness, some people even feel suicidal (Rosenthal & Burchum. 2017).

The steps I applied in completing the interactive media piece were, first I looked at the patient’s history and his symptoms. I then went through each of the medication scenarios that were available and made a choice from the medications. With each of the medications I looked to see which medication caused the least amount of side effects, I looked at which medication worked alone without having to add a second medication, and I also looked at which medications treated the patient’s symptoms. I chose that I would prescribe Effexor XR.

How pharmacotherapeutics impact pathophysiology

I would choose to prescribe Effexor XR from the drugs available. Treatment with SSRIs and SNRIs is usually safe in older adults and they tend to have less medication side effects and fewer medication interactions (Rosenthal & Burchum, 2017). MAOIs should be the last option for treating depression when other medications do not work. Patients who take MAOIs must follow a diet that does not include tyramine. Effexor XR blocks NE and 5-HT reuptake in the brain and this decreases the symptoms of depression in patients. Effexor XR side effects are usually minimal and go away after a couple of days (Effexor XR: Side effects, usages, doses, and more, 2019). In this scenario, the Effexor XR was started at a low dose and the patient did not see any improvement, so the dose was increased to 75mg daily and then after another 4 weeks, the patient began feeling much better. At this time, I would continue the same dose of medication and see the patient in another four weeks. When the patient returns in another four weeks if he is not completely better the dose can be increased even more. The patient would need to be counseled on side effects when increasing the dose.

How impact would suggest treatment plans

Out of the drugs available in this scenario, Effexor XR seemed to work the best with the least amount of side effects and not having to add a second medication. The Effexor dose had to be increased, but with the increase in dose, the patient saw a decrease in his depression. The Zoloft caused erectile dysfunction so when adding Wellbutrin, erectile dysfunction was better but then the patient started having jitteriness and feeling nervous so then the Wellbutrin would then need to be changed to XL instead of the IR. Phenelzine caused hypotension and caused the patient to collapse and would need to be stopped. When stopping Phenelzine there must be a washout period before an SSRI can be given, in this scenario, the option was Lexapro (Nardil, Uses, Side effects & Warnings, 2018). This would mean that a five-week period would need to go by, and the patient would not be on any medications. His depression could be getting worse while waiting. The best option of the drugs presented I think would be Effexor XR.

Conclusion

Geriatric depression is a depression in older adults. There are many different medications that can be used to treat depression. When choosing a medication, it is important to find a medication with the least amount of side effects while treating the patient’s symptoms. For this patient, I think that the best drug would be Effexor XR.

References

Effexor XR: Side effects, dosage, uses, and more. (2019). Retrieved July 22, 2020, from https://www.medicalnewstoday.com/articles/326678

Krans, B. (2017, July 28). Geriatric Depression (Depression in Older Adults). Retrieved July 22, 2020, from https://www.healthline.com/health/depression/elderly

Nardil Uses, Side Effects & Warnings. (2018). Retrieved July 21, 2020, from https://www.drugs.com/mtm/nardil.html

Rosenthal, L., & Burchum, J. (2017). Lehne’s Pharmacotherapeutics for Nurse Practitioners and Physician Assistants. Saunders.