NURS 6630 Week 10 Assignment 2 Special Considerations for Patient Populations Paper 

NURS 6630 Week 10 Assignment 2 Special Considerations for Patient Populations Paper

Patient 3 Case Study: Medication Selection

The most appropriate medication for this 33-year-old woman diagnosed with major depressive disorder, postpartum onset, is sertraline. This antidepressant belongs to the selective serotonin reuptake inhibitor (SSRI) class and is widely recommended as a first-line treatment for postpartum depression. Sertraline helps increase serotonin levels in the brain, which can improve mood, energy, and overall functioning. It is considered safe for use in women who are breastfeeding, as studies have shown that only trace amounts are excreted in breast milk, posing minimal risk to the infant (Simas et al., 2023).

Rationale

Sertraline is the most appropriate medication for this 33-year-old postpartum woman with major depressive disorder because it is effective, well-tolerated, and safe for breastfeeding. It has extensive research support as a first-line therapy for postpartum depression due to its favorable safety profile for both mother and infant (Simas et al., 2023). Only trace amounts pass into breast milk, and no significant adverse effects have been documented in nursing infants. Sertraline improves mood, energy, appetite, and bonding ability, which are central to recovery in postpartum depression.

Paroxetine, while also an SSRI, is less suitable for this patient because of its short half-life, which increases the risk of withdrawal symptoms if doses are missed. It can cause excessive sedation and irritability in breastfeeding infants and has been linked to congenital defects when used during pregnancy (Eleftheriou et al., 2024). Lithium is contraindicated in breastfeeding mothers because it is transferred into breast milk at high levels. Infants exposed to lithium risk toxicity, including dehydration, hypotonia, renal impairment, and thyroid dysfunction. Lithium also requires close blood level monitoring, which is impractical in this setting (Wittstrom et al., 2024). Sertraline, therefore, remains the safest and most effective choice for treating postpartum depression in this patient while allowing her to continue nursing and maintain infant safety.

Dosing and Therapeutic Endpoint

The recommended starting dose of sertraline is 25 milligrams orally once daily, taken in the morning or evening, depending on tolerance. After five to seven days, the dose can be increased to 50 milligrams once daily, which is considered the standard therapeutic dose. If the patient does not respond adequately after several weeks, the dose can be increased in 25- to 50-milligram increments every one to two weeks, up to a maximum of 200 milligrams per day (Dennis et al., 2024). The therapeutic endpoint is defined as an improvement in mood, normalization of appetite and sleep patterns, increased energy, and an enhanced ability to bond with the infant. Symptom reduction should become noticeable within four to six weeks, with continued improvement over the following months.

Patient Education

Patient education focuses on helping the patient understand how sertraline works and what to expect during treatment. She should be informed that sertraline increases serotonin levels in the brain, which helps improve mood, energy, and motivation over time. The patient should take the medication once daily at the same time each day, preferably in the morning if she experiences difficulty sleeping (Wells, 2023). It is important to continue taking the medication even if she begins to feel better, as stopping too early can cause a relapse of depressive symptoms. The patient should avoid abrupt discontinuation, which may lead to withdrawal symptoms such as dizziness, irritability, or anxiety. She should also be encouraged to maintain a good diet, stay hydrated, rest when possible, and engage in light physical activity, such as walking, to improve her overall well-being.

The patient should be informed of common side effects, which may include mild nausea, loose stools, dry mouth, or headaches, and that these effects typically improve after the first few weeks. She should report any severe or persistent side effects, such as worsening mood, agitation, or suicidal thoughts. Because she is breastfeeding, the patient should monitor her baby for signs of unusual fussiness, feeding difficulty, or sleep changes and report these immediately (Simas et al., 2023). Education should also include a discussion of the benefits of therapy in combination with medication. Attending counseling sessions or support groups for new mothers can improve mood and reduce isolation.

Labs and Diagnostics

Although SSRIs do not require routine baseline laboratory tests, certain evaluations are recommended for comprehensive care. Thyroid function tests, including TSH and free T4, are important because thyroid dysfunction can mimic or worsen depression, especially in the postpartum period. A baseline depression scale, such as the Edinburgh Postnatal Depression Scale (EPDS) or the Patient Health Questionnaire-9 (PHQ-9), should be administered to measure the initial severity of symptoms. This baseline provides a measurable reference for tracking treatment progress (Simas et al., 2023). In addition, reviewing current medications helps identify potential interactions, and assessing hepatic function may be beneficial if the patient has a history of liver disease, since sertraline is metabolized hepatically.

Monitoring

Monitoring is necessary to ensure safety and effectiveness. The patient should have a follow-up visit in two to four weeks after starting sertraline to assess symptom improvement, side effects, and adherence. The healthcare provider should evaluate mood, sleep quality, appetite, energy level, and mother-infant interaction at each visit. A repeat depression scale can help quantify progress. If there is no significant improvement after six to eight weeks, dosage adjustments or augmentation with psychotherapy should be considered (Dennis et al., 2024). Continuous monitoring also includes observation for signs of serotonin syndrome, though it is rare, especially when no other serotonergic drugs are used. Regular assessment fosters trust, promotes adherence, and enables the timely identification of complications or the need for additional interventions.

Collaboration and Education

Effective treatment for postpartum depression requires coordinated care between healthcare providers, the patient, and her support system. Collaboration with the primary care provider, psychiatrist, and obstetrician-gynecologist is necessary to maintain a consistent plan of care. These professionals should share updates on the patient’s progress, medication response, and any side effects noted during follow-up visits. Involving a therapist to provide cognitive-behavioral or interpersonal therapy enhances recovery and provides emotional coping tools (Wells, 2023). Consistent communication among providers prevents medication duplication, supports adherence, and ensures holistic care for both mother and infant.

Family involvement plays a major role in improving outcomes. The patient’s partner and family members should receive education on the symptoms of postpartum depression and how to recognize early signs of relapse or suicidal ideation. They can assist by encouraging rest, helping with infant care, and reminding the patient to take her medication consistently. Family members should be informed that postpartum depression is a medical condition and not a personal failure, which helps reduce stigma and promote empathy. Including home health nurses or community health workers can provide additional monitoring and emotional support, especially if the patient experiences fatigue or isolation (Simas et al., 2023).

Addressing Nonadherence

If the patient exhibits signs of nonadherence, a thorough assessment is necessary to identify the underlying causes. Factors such as fear of medication side effects, stigma, forgetfulness, or lack of family support may contribute. Open discussion should focus on her beliefs and concerns regarding antidepressants. If adherence remains problematic despite counseling, an alternative approach should be developed. Non-pharmacologic options, such as psychotherapy or support groups, can be emphasized to maintain progress. In more severe or resistant cases, consideration of brexanolone or zuranolone may be warranted (Wells, 2023). The revised plan should include regular counseling sessions, adherence aids such as pill organizers or reminder apps, and involvement of family members to encourage continued participation in care. Follow-up every two weeks until stability is achieved helps ensure safety and promotes long-term recovery.

Conclusion

The management of postpartum depression in a breastfeeding mother requires a careful balance between maternal mental health and infant safety. Sertraline is the most appropriate medication for this patient because it effectively treats depressive symptoms while posing minimal risk to the nursing infant. A structured dosing plan, regular monitoring, and collaboration among healthcare providers and family members are essential to achieving recovery. Ongoing education helps the patient understand the importance of adherence and recognize potential side effects early. Family involvement and supportive therapy further enhance emotional well-being and reduce the risk of relapse. Addressing barriers to adherence through open communication and individualized strategies ensures long-term stability.

References

Dennis, C. L., Singla, D. R., Brown, H. K., Savel, K., Clark, C. T., Grigoriadis, S., & Vigod, S. N. (2024). Postpartum depression: A clinical review of impact and current treatment solutions. Drugs, 84(6), 645–659. https://doi.org/10.1007/s40265-024-02038-z

Eleftheriou, G., Zandonella Callegher, R., Butera, R., De Santis, M., Cavaliere, A. F., Vecchio, S., & Albert, U. (2024). Consensus panel recommendations for the pharmacological management of breastfeeding women with postpartum depression. International Journal of Environmental Research and Public Health, 21(5), 551. https://doi.org/10.3390/ijerph21050551

Simas, T. A. M., Whelan, A., & Byatt, N. (2023). Postpartum depression: New screening recommendations and treatments. JAMA, 330(23), 2295-2296. https://doi.org/10.1001/jama.2023.21311

Wells, T. (2023). Postpartum depression: Screening and collaborative management. Primary Care: Clinics in Office Practice, 50(1), 127–142. https://doi.org/10.1016/j.pop.2022.10.011

Wittstrom, F., Cesta, C. E., Bateman, B. T., Bendix, M., Bliddal, M., Chan, A. Y., & Reutfors, J. (2024). Lithium use during pregnancy in 14 countries. JAMA Network Open, 7(12), e2451117-e2451117. https://doi.org/10.1001/jamanetworkopen.2024.51117

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To complete this assignment, you will utilize the case study assigned to you by faculty for a patient population for special consideration during prescribing practices. You will consider the specific patient and determine the appropriate medication to prescribe, based on the patient specifics and medication attributes in various case studies. You will construct a 4- to 5-page paper in which you determine the medication, the dosing, necessary patient education, and potential side effects. You will also indicate why the other medications would not be appropriate, as well as any necessary labs or diagnostics that might be needed. You will develop a plan to enhance medication adherence for the nonadherent patient.

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

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

• Review the Learning Resources.
• Carefully review your assigned vulnerable population patient.
• Carefully review the medication list to determine the best medication to prescribe.
• Consider the implications, impact, advantages, and disadvantages of the listed medications.

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.

This Assignment requires a minimum of five (5) peer-reviewed, evidence-based scholarly references outside of course resources.

Note: You will need to include the APA style formatting.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Walden Writing Center Sample PaperLinks to an external site. provides an example of those required elements. All papers submitted must use this formatting.

By Day 7 of Week 10

Submit by Day 7 of Week 10.

submission information

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1. To submit your completed assignment, save your Assignment as WK10Assgn2_LastName_Firstinitial
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Rubric

NURS_6630_Week10_Assignment2_Rubric

Total Points: 100