BACKGROUND INFORMATION The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse. SUBJECTIVE During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work. MENTAL STATUS EXAM The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression). RESOURCES § Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Decision Point One Select what the PMHNP should do; Begin Zoloft 25mg orally daily Begin Effexor XR 37.5 orally daily Begin Phenelzine 15mg orally TID In summary: What needs to be in your essay. Introduction regarding disease state High-level summary of patient case Purpose of the essay statement Decision 1 What options were listed What option did you choose? Why did you select that option? Why didn’t you select the other two options? What was your goal of treatment Was the outcome what you expected? Why? Decision 2 What options were listed What option did you choose? Why did you select that option? Why didn’t you select the other two options? What was your goal of treatment Was the outcome what you expected? Why? Decision 3 What options were listed What option did you choose? Why did you select that option? Why didn’t you select the other two options? What was your goal of treatment Was the outcome what you expected? Why? Conclusion with Ethical considerations
Purchase answer to see full attachment