COURSE:

NURS-6630N: Approaches to Treatment

Special Considerations for Patient Population Cases:

• Patient 1: 82-year-old male presenting with cognitive decline. He had always been a very active individual. Over the past year, he has become less active in the community. Previously, he played cribbage weekly with friends at the local senior center but has been struggling with the math involved with the game and no longer attends the weekly card game. He had also volunteered as a crossing guard for the local public school. He quit doing that after he took the wrong turn to get home and drove around the town feeling lost. He acknowledges he is “sensitive” to this and can be irritable towards his children when they bring up these concerns. He was diagnosed with mild neurocognitive disorder after completing neuropsychological testing. Of the following medications, which would be the most appropriate to prescribe? Explain why you chose this medication. What would be the dosing schedule for this patient? Provide education to the patient and review risks, benefits, and potential side effects of the medication. In addition, explain why the other medications listed are not appropriate for this patient. Med List: lorazepam, olanzapine, memantine
• Patient 2: 76-year-old female who recently moved from her home to an assisted living. After 1 week of moving in, she has become extremely confused. Staff have attempted to re-orient her, and she struggles to focus on what they are saying. She is only oriented to self. She has become very agitated and has even thrown breakable objects in her room. Her family is concerned stating she is “out of it.” The PCP ordered labs and UA. Labs are unremarkable outside of mild leukocytosis and positive dipstick analysis for nitrite and red blood cells. Med List: valproate, alprazolam, trimethoprim
• Patient 3: A 33-year-old female that is 6 weeks postpartum. She presents with depressed mood, sadness, easily emotional, difficulties with sleep even when the infant is sleeping. She has lost weight and has a poor appetite. You note psychomotor retardation. She has limited interests in hobbies or bonding with the infant. Her partner is concerned and reports she is typically active and “bubbly” and enjoys the outdoors. She is diagnosed with major depressive disorder, with postpartum onset. She denies suicidal ideation, homicidal ideation, or infanticidal ideation. No psychotic symptoms are present. She is nursing the infant and wants to continue this hoping it will assist with bonding with the infant. Med List: lithium, paroxetine, sertraline
• Patient 4: 10-year-old male who comes in with his father. He has been diagnosed with generalized anxiety disorder. He has constant worries that he cannot control. He feels nervous and tense. He is easily irritable. He struggles to settle down or relax. He is also quite fidgety and restless. He and his father are interested in medications to manage these symptoms. Med List: quetiapine, duloxetine, fluoxetine
• Patient 5: 27-year-old male with a diagnosis of schizophrenia. He has been hospitalized three (3) times in the past 1 year due to symptoms. When symptomatic, he becomes disorganized and paranoid. He will respond to auditory hallucinations. He will scream out at night after seeing a shadow in his room. He has delusions that the CIA is poisoning food and will not eat for multiple days. He has unintentionally hurt his mother after “slapping” food out of her hand, as he did not want her to ingest the “poisoned food.” Symptoms are treated very well with paliperidone, but he struggles to remember to take it. Med List: paliperidone palmitate, clozapine, lamotrigine

 The Assignment (4–5 pages)

Construct a paper concerning your assigned vulnerable population patient case. In your paper include the following:

• Determine which medication would be most appropriate to prescribe from the assigned vulnerable population patient case medication choices.
• Explain your rationale for choosing this medication. Explain why the other medications listed are not appropriate for this patient.
• Explain the dosing schedule for the specific patient including the therapeutic endpoint.
• Provide necessary education to the patient to review risks, benefits, and potential side effects of the medication.
• Describe any necessary labs or additional diagnostics needed prior to prescribing this medication.
• Explain how you might monitor efficacy or side effects of the medication.
• Include any additional collaboration or education to others that would be necessary for this patient. Consider family members, home health care, primary care providers, etc.
• What would you need to include in your assessment for a patient who may become nonadherent with your prescribing plan for your scenario? What are alternative treatment solutions based upon how you assessed? Describe your new treatment plan.

Solution

Special Considerations for Patient Populations

            The case scenario selected is patient 3 a 33-year-old female patient who is six weeks postpartum and diagnosed with major depressive disorder, with postpartum onset.  The patient presented to the clinic with complaints of depressed mood, difficulty with sleep sadness, being emotional, and low interest in her hobby or bonding with the infant. Based on this, this paper provides a discussion on prescribing medication for a breastfeeding client and key considerations.

Appropriate Medication to Prescribe and Rationale for selection

The medication list for the above patient includes lithium, paroxetine, and sertraline.  From these medications, the most appropriate medication to prescribe is sertraline.  The rationale for selecting this medication is that it is a selective serotonin reuptake inhibitor (SSRI) which is FDA-approved for treating MDD.  A number of studies have reported that sertraline is effective in treating postpartum depression (Frieder et al., 2019).  The other rationale for selecting this medication is because of its………………………………………..$10