1Abby is a 32 yo female administrative assistant who presents for suicidal thoughts. She says that she lost her husband three years ago and has not gone out much since. She used to enjoy playing cards and going out with neighborhood couples with her husband and now just stays home on the weekends. She is not interested in dating anyone and has no children. She says that she has gained 40 pounds since her husband died and takes daytime naps when she can. She says that she has a hard time both falling and staying asleep at night and never feels good. She has had thoughts that she wished that she could die but has never attempted to hurt herself. She endorses feeling lonely but said that she is more comfortable just keeping to herself. She said that she does not care about anything anymore. She has been on Zoloft 50 mg qhs for three years since her husband died but does not feel that it gives her relief anymore.

With this new course of treatment that you have ordered, and the inpatient stay in the psychiatric hospital, what outcomes do see being obtainable for Abby?

• Any differential diagnoses (Include a short line indicating why each one should be considered for the case)
• Major depressive disorder-
• Persistent depressive disorder
• Depressive disorder due to medical condition.
• Your diagnosis and reasoning (What would your primary diagnosis be?The pt diagnosis is Major depressive disorder recurrent severe. Due to Abby losing her husband three and her inability to function socially and occupationally. She also no interest any activities in activities. She report of lack of energy and weight gain. According DSM 5 the criteria for the specifier included Abby has more more than 5 sypmtoms required to make a diagnois. Patietn present suidal thoughts and ditress.
• The patient has experienced loss in her life nd has not been abe to function due to serious ditress What are some specifiers from the DSM 5 for depressive disorders?) ( number of symtpms . Specifire recurrent 2 or more months
• Any additional questions you would have asked to get more needed information

Are feeling suicidal

Do you have a plan

Do you any medical history

Last hospilization

• Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent. (What is important to educate your patients on when prescribing SSRIs/SNRIs in regards to how long it takes to take full effect and the black box warnings?) What medications would you change her to from the Zoloft and why? Make your orders very clear, and use in-text citations, black box warnings for the meds, and what each med is being used for.
• If prescribing trazadone for sleep to a male patient what side effect should you include in your education? What about cardiac effects of trazadone with some other psychotropics? What test could you order for a baseline with this medication to monitor?
• Any labs and why they may be indicated (including ruling out any organic causes of depression).Do you need any blood test or medical tests? If yes, explain what they are and why.
• CMP and TSH
• Screener scales or diagnostic tools that may be beneficial
• List all 5 components of a suicide risk assessment, in addition to any other questions you may have (be specific).
• Additional resources to give (Therapy modalities, support groups, activities, etc.)Would you place an order for CBT or Behavioral therapy and why?Make sure to include a hotline and support group in this section of your plan.
• Discuss and answer questions related to the case presentations on the discussion board. You will need to utilize all of your nursing skills when evaluating the data.