Reference no: EM133554193
Case Study: Mr. B. is an 81-year-old white widowed man living in a rural area 20 miles from a small city. The nurse practitioner who treated Mr. B. for sinusitis referred him to the outreach nurse for an evaluation. The nurse practitioner was concerned when she noted that Mr. B. had lost weight and started to cry when talking about his wife who had died several years before. During the initial visit the nurse noted that Mr. B. weighed only 110 lb., was not sleeping, had stopped going to church, and was quite anxious and sad about his finances, his limitations from arthritis, his relationship with his 27-year-old stepson, Bart, and the possibility of nursing home placement. The nurse conducted a suicide assessment, knowing that Mr. B. was at high risk because of his age, his mood, and the presence of guns in the home. Mr. B. stated that he had considered shooting himself, but he was reluctant to have the rifles removed at the nurse's suggestion because Bart used the guns for hunting. Mr. B. agreed to a family meeting with his stepson, and Bart agreed to remove the guns from the house. Both Mr. B. and Bart needed significant education about the biological basis of depression and the efficacy of using a new antidepressant along with support to treat his condition. Mr. B., like many older adults, did not wish to see a psychiatrist or use the community mental health system. He did agree to a trial of antidepressants, however. The nurse, through the primary care nurse practitioner, arranged for a prescription of an antidepressant (an SSRI) that is safe for use with older adults, and Mr. B. started the medication within two weeks of the initial visit. In addition to medication and counseling, Mr. B. needed help with nutrition. Because Bart was away 10 hours a day, at work in the city, Mr. B. was alone all day. Mr. B. was not able to prepare meals because of his arthritis. The nurse arranged with the local board for aging to provide home-delivered meals. This not only helped with nutrition, but also gave Mr. B. a visit from the volunteer twice a week. Mr. B. and Bart needed help with financial planning, as they did not want to lose the farm should Mr. B. need more assistance or nursing home placement in the future. The nurse arranged for them to talk with a social worker regarding long-term care planning. In addition to addressing the immediate concerns, the nurse continued to provide weekly visits to Mr. B. for support and counseling, medication monitoring, and case management activities. Family meetings with Bart and Mr. B. to discuss mutual concerns were arranged every two months and as needed. The significant improvement of depressive symptoms (that is, sleep, appetite, weight, and mood) in Mr. B. was monitored both clinically and through use of a depression rating scale. Psychological, physical, and social problems of older adults are closely intertwined and are best evaluated and treated by a multidisciplinary team. Psychiatric illness often presents first with physical symptoms, and physical limitations create further psychological distress. Older adults often prefer not to use formal mental health services, so careful assessment in primary care settings is critical to detect their mental health problems.
Questions: After reading the attached case study answer the following questions:
A. In addition to his stepson and the nurse, who else might notice if Mr. B.'s condition began to deteriorate?
B. What nursing measures are important in monitoring Mr. B.'s response to the antidepressant?
C. What secondary prevention measures did the nurse use?
D. What resources might be available for Bart should he need more information about depression?