Community health case study - Depression: Nursing

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Introduction0:00–0:31

Nurse. Betty works in a community health clinic and is caring for James.
A 65 year old male who presents for a three month follow up after being diagnosed with depression after settling James in the room.
Nurse, Betty goes through the steps of the clinical judgment measurement model to make decisions about James's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.
First, nurse, Betty recognizes important cues including James's vital signs which are temperature 98.9 °F or 37.2 °C, heart rate, 70 BPM, respirations, 14 breaths per minute, BP, 112/68 millimeters of mercury and oxygen saturation 99% on room air.

Recognizing and Analyzing Cues0:31–2:49

She also notices that James avoids making direct eye contact. Hi, James.
It's good to see you back in the clinic. How are you doing?
I'm fine. I guess I remember from your last appointment.
You recently retired from your job. Tell me how you're adjusting so far.
It's been pretty lonely. I haven't been sleeping much.
I'm sorry to hear that. Do you have any friends or family in this area?
No, not since my wife passed away last year and my daughter moved away. That sounds very isolating.
Have you ever thought about harming yourself or trying to take your own life? No.
Next nurse Betty analyzes these cues. She reviews the electronic health record or E hr and notes that James is currently prescribed a low dose antidepressant to treat his depression.
She also calculates that his score on the PHQ nine scale today indicates a moderately severe level of depression. She also notes that he's lost 7 lbs or 3.2 kg.
Since his last clinic visit. Nurse Betty knows that depression is a mental disorder that causes loss of interest in activities that were previously enjoyable and persistent feelings of sadness that interfere with daily life in older adults.
Depression can be related to social situations like loss of a spouse, recent retirement or isolation from family or friends.
She also recognizes that older adults with depression may present with somatic symptoms like insomnia or gi problems that can lead to weight loss.
Nurse, Betty knows that James's depression along with his decreased socialization can prevent him from receiving the care and support he needs.
Nurse. Betty recognizes that James needs help to effectively manage his depression.
Now using the information she's gathered along with James's medical history. Nurse Betty chooses a priority hypothesis of social isolation.

Prioritizing Hypotheses, Generating Solutions, and Taking Action2:49–4:48

Next. Nurse, Betty generates solutions to address James's depression that will include pharmacologic and non pharmacologic interventions and she establishes the expected outcome that by his next appointment, James will report participating in one social activity per week.
Nurse Betty then takes action to implement these solutions. She speaks with the health care provider about James's symptoms after the healthcare provider visits James.
Nurse Betty reenters the room to review the plan of care. Ok.
So your healthcare provider has increased your medication dosage to better treat your depression. Ok.
Now, since you don't have a strong support network living nearby, I'd like to help you come up with some coping strategies.
What do you think? That sounds fine.
What do you think about attending a local support group for retirees? I don't know, maybe that's something I could try.
Do you think it could actually help? I do I know some other patients who benefit from attending.
I can give you some information on locations that are near your house. Thanks.
Now, what about your daughter? How often are you in contact with her?
Not very often because she's so busy with her family and work. I don't wanna bother her.
I'm sure she's very busy. What about scheduling a phone call with her once a week?
Would that be something both of you can manage? I think.
So. I do feel better after I speak with her.
I'll ask her afterwards. Nurse Betty reviews the plan and strategies she and James discussed and provides him with information on the support group.
She then ensures James has his next follow up appointment scheduled. One month later, James returns to the clinic and nurse Betty evaluates the outcomes of her actions.

Evaluating Outcomes4:48–5:31

She takes James's vital signs which are temperature 98.4 °F or 36.9 °C. Heart rate, 62 BPM, respirations, 14 breaths per minute BP, 1 20/78 millimeters of mercury and oxygen saturation, 99% on room air James reports that he's been taking his medication as prescribed.
He also reports. He attended one meeting with the local support group for retirees and he's interested in continuing attending in the future.
Nurse, Betty also learns that James has been speaking on the phone once a week with his daughter. All right, it's a quick recap.

Review5:31–6:00

Nurse, Betty recognized and analyzed cues related to James's social isolation and prioritized hypotheses and generated solutions to address this problem.
Nurse Betty then implemented pharmacologic and non pharmacologic interventions and evaluated outcomes compared to the expected outcome since James reported participating in at least one social activity per week.
Nurse Betty determined the plan of care was successful.