If your last name begins with the letters A through L, review Natalee’s case study and answer the questions as indicated. If your last name begins with the letters M through Z, review Alejandro’s case study and answer the questions as indicated.
You have been seeing Natalee Williams for about a year. She comes in today with her mother, Trina, as usual for a regular appointment. Now 11, this Black girl originally came in with reports of depression and irritability, including a rapid decline in her schoolwork. You diagnosed her with depression, and she has been taking sertraline 12.5 mg by mouth every day. Since you last saw her two months ago, she started her period. Trina and Natalee are concerned that her medication is no longer working with her change in hormones. Both report that her â€œmood has gone downhill.â€ She has been having trouble again in school and with her friends.
Recall that there is a history of depression in the family, as Nataleeâ€™s maternal grandmother and maternal aunt both have had major depression. Her maternal grandmother was hospitalized for psychiatric care 20 years ago for depression and a suicide attempt by an overdose of Tylenol.
From your perspective as Nataleeâ€™s psychiatric nurse practitioner, answer the following questions. Include at least two peer-reviewed, evidence-based references.
- What screening tools would you use during this interview?
- Would you keep the same diagnosis? Are there any symptoms that would make you consider a different diagnosis? On what evidence/symptoms do you base your diagnosis?
- What medication changes would you prescribe for Natalee and why? Please note the medication(s), initial dose, and dosing schedule.
- Include the American Psychiatric Association Standards of Care conclusions for each medication.
- Fill out a prescription (PDF) (Links to an external site.) for one medication. Print the template, fill it out, and scan it or take a photo. Attach the image to your post.
- How do you educate and inform Trina about how this medication will work? How do you include Natalee in your conversation?
- How do you discuss with Trina the side effects and risks for a child of this age with taking this medication?