Justin is an 18-year-old African- American male presenting to the clin- ic per his mother’s persuasion. His mother reports that he has had fatigue, loss of energy, irritability, lack of motivation, decreased ability to concentrate, poor hygiene, low self- esteem, and weight loss. Justin refuses to interact with friends. His mother states: “He goes to school and then comes home and goes to bed or lays on the couch.” His mother says she has noticed a gradual decline in his hygiene and lack of motivation over the last six months. She also reports that his grades have dropped from A’s and B’s to B’s and C’s this quarter. His mother denies Justin having learning problems.
Past Medical History
Currently, Justin does not have a primary care provider. Justin denies any food, environmental, or drug allergies. He admits to smoking a half pack of cigarettes on weekends for the last year and marijuana on occasion or when “I can find someone selling
pot.” Justin also admits to drinking beer when at social activities. His mother states he is up to date on immunizations. Justin denies consti- pation, diarrhea, dry skin, or heart pal- pitations.
Development and Growth History
Justin exhibits normal growth and development (weight and height) for age and sex.
Family and Social History
Justin’s family medical history con- sists of diabetes, cancer, depression, and hypertension. Both of Justin’s grandfathers have a history of hyper- tension and diabetes. Justin’s father’s paternal uncle has a history of depres- sion. Justin’s grandmother has had breast cancer. Justin’s parents have been married for 20 years. He has two younger sisters who live in the home. In the past, Justin was involved in soc- cer and football; however, he does not express any interest in sports now. Justin states he had a “break up” with his girlfriend six months ago.
Nutritional History
Justin’s appetite has decreased over the last six months, and he has expe- rienced a 10-pound weight loss.
Physical Assessment Findings
General appearance: Justin comes to the clinic today at the urging of his mother due to her concerns for his mental health. He is awake, alert, and oriented to person, place, and time.
He is cooperative and appropriately responsive to questions.
Vital signs: Temp: 98.6, Height: 69.5 in, Weight: 57.1 kg (126 lbs), HR: 72, RR: 16, BP: 128/82. BMI: 18.3.
HEENT: Normocephalic, conjuncti- va clear, sclera clear bilaterally, EOMI, PERRLA, TM pearly gray with normal cone of light, no TM inflammation, no sinuses tenderness to palpation frontal, maxillary sinuses rhinitis, uvula mid- line, neck supple, no anterior cervical submental and submandibular tender- ness or lymphadenopathy, thyroid not palpable, trachea midline, and full range of motion of neck.
Integumentary: Skin warm and dry to touch without lesions and/or cuts. Multiple red papules, open and closed comedones present to face. No bruises, rashes, or scars; erythema; discol- oration; ecchymosis; or skin lesions noted.
Respiratory: Normal shape of chest with no obvious deformities. Respirations even and non-labored. Breath sounds clear bilaterally upon auscultation. No stridor, wheezes, crackles, or rubs. Good air movement.
Cardiovascular: RRR (regular, rate, and rhythm), without murmurs, rubs, or gallop, positive cap refill, 2+ pulses in all extremities noted.
Abdomen: Abdomen is soft, non- tender, and nondistended; no hernias, masses or lesions noted. Active bowel sounds in all four quadrants. No hepatosplenomegaly.
Neurological/psychiatric: Oriented to person, place, and time. Makes appropriate eye contact and tion. Speech and cranial nerves 1-X11 normal. Mood and affect are confluent and full range. Thought process is lin- ear and goal-directed. Denies suici- dal/homicidal ideation, auditory and/or visual hallucinations. Insight and judgment are good. Has poor grooming and hygiene. Is cooperative. Speech is spontaneous and normal.
Musculoskeletal: Full range of motion (ROM). 5/5 strength UE/LE bilaterally. No edema noted, ambulates with a steady gait, good ROM in all major joints, 5/5 strength against resistance. Normal, equal strong dorsi/plantar flexion.
Genitalia: Tanner Stage V noted. Extensive assessment not completed at this visit. Denies dysuria and/or urgency.
What Do You Suspect?
Justin is an 18-year-old male being seen for fatigue, loss of energy, irri- tability, lack of motivation, decreased ability to concentrate, poor hygiene, low self-esteem, and weight loss.
Differentials
Depression
Depression is a condition that includes disruptive mood disorders and major depression disorder, and is characterized by fatigue, sadness, and irritable mood, with impaired func- tioning (Lacuesta & Gladwell, 2018). Depression and anxiety also represent the second and fifth leading causes of years lived with a disability and losses in work productivity (Kroenke et al., 2016). Common systems are fatigue, weight loss or gain, loss of energy, diminished interest or pleasure, agita- tion, feeling of worthlessness, recur- rent thoughts of death or suicide, decreased ability to process thoughts, and lack of motivation.
Diagnostic tests are crucial for prompt interventions and improved outcomes. The Patient Health Ques- tionnaire Anxiety-Depression Scale (PHQ-ADS) and the Depression, Anxiety and Stress Scale (DASS) diag- nose anxiety and depression. Ac- cording to Thapar, Collishaw, Pine, and Thapar (2012), depression in ado- lescents is often missed more than in adults.
Suicide Ideation
Suicide refers to a self-inflicted, willful, life-threatening act that has
resulted in death (Berman, Silverman, & Bongar, 2000). According to the Centers for Disease Control and Prevention (CDC) (2018), suicide is a major public health concern that affected over 45,000 individuals in 2016 in the United States. Risk factors can include substance abuse, family history of suicide, physical illness, depression similar to an adult, and not feeling connected with friends and family (Shain, 2016). Identi- fication of suicidal behaviors is essen- tial. Active strategies to include gener- al screening programs, training in schools to help identify suicidal behaviors, and education about sui- cide, crisis centers, and hotlines num- bers are available for clients and fam- ilies (Shain, 2016).
Management Plan and Recommendations
Justin was diagnosed with depres- sion. Lab test ordered are Total and Free Testosterone, TSH, Vitamin D3, CBC, CMP, TSH Total T4, and Free T3. According to the National Institute of
Mental Health (2018), most people benefit from therapy or counseling to discuss thoughts, feelings, and issues regarding what is happening current- ly in life. Justin should return to clinic in two weeks to recheck, but if con- cerns of suicidality emerge, he is to return to clinic sooner. There should be a careful screening to identify any recent thoughts or actions about sui- cide. See Figure 1 for the full recom- mended treatment plan.
Conclusion
Justin will return to the clinic in two weeks to reevaluate the effective- ness of medication. Counseling will be arranged for Justin to allow him to talk about his thoughts and feelings. His mother will monitor nutritional intake to help improve his overall well-being. Encouraging daily exercise can reduce the risk of chronic disease and promote overall health. Justin and his mother were given the National Suicide Prevention Lifeline 1−800−273−TALK (8255),
Recommended Treatment Plan for Adolescent Depression (Based on This Case Study)
The recommended plan includes: • Medication.
Discuss prescribing sertraline (Zoloft®), an antidepressant.
How to take the medication: May increase dose after one week to 100 mg if no improvements, may have GI upset initially with medication but needs
to keep taking and GI upset will resolve. Take medication at night to help
prevent GI upset.
Side effect of the medication: Do not drink alcohol with medication.
Underlying symptoms of depression or anxiety may worsen because
alcohol is a depressant that can have an affect on the brain. • Psychotherapies.
Cognitive behavioral therapy (CBT).
Dialectical behavioral therapy (DBT).
Stress management.
Frequency of encounters with the health care team to discuss feelings and
thoughts. If having hallucinations (visual/auditory), seek emergent care.
Peer support programs.
Crisis center hotline.
Physical activity.
Engage in 30 to 60 minutes of moderate exercise per day and/or use the
stairs at work, home, or school if available for at least four days/week
Start low and go slow, such as starting at 15 minutes then 30 minutes then
50 minutes based on individual tolerance.
Exercise options: Park at a distance from work door, shopping door, etc.;
swimming; climbing stairs; dancing; walking the dog; bicycling.
Ongoing healthy nutrition.
Meal replacement daily + 2 meals daily.
Avoid skipping meals.
3 healthy snacks daily (<100 kcal).
64 oz water daily (diet green tea, zero-calorie flavored water, unsweetened
tea or coffee, or plain water).
Study Report structure:
he following levels of criteria will be used to grade this assessment task:
This analysis focuses on the case study of Justin, an 18-year-old African-American male presenting with symptoms of depression. The case study highlights the health characteristics, risks, and barriers to healthcare in a disadvantaged population. It emphasizes the role of nurses in providing person-centered care within the community, while proposing health promotion and education strategies to address adolescent depression.
The case study underscores the prevalence of depression among adolescents and its impact on their daily functioning. The symptoms Justin experiences – fatigue, lack of motivation, low self-esteem, and weight loss – point towards a significant mental health challenge. Disadvantaged populations, like adolescents from ethnic minorities, often face barriers to accessing mental health services due to socioeconomic factors, stigma, and lack of awareness.
Nurses play a pivotal role in addressing adolescent depression in a community setting. They serve as advocates, educators, and empathetic caregivers. Communication skills enable nurses to establish trust with adolescents, facilitate open dialogue about their mental health, and provide holistic care. In the context of interdisciplinary teams, nurses collaborate with psychologists, social workers, and educators to develop comprehensive care plans that address not only the medical aspects but also the psychosocial and educational needs of the individual.
To address adolescent depression, several health promotion and education strategies can be implemented:
Promote Mental Health Awareness: Organize workshops in schools to raise awareness about mental health issues, reduce stigma, and educate students, teachers, and parents about the signs of depression.
Implement School-Based Programs: Introduce programs that focus on stress management, coping skills, and emotional resilience. Peer support groups can create a safe space for adolescents to share their experiences and receive peer mentorship.
Engage in Exercise and Physical Activities: Encourage participation in physical activities that release endorphins and improve mood. Collaborate with local organizations to provide accessible sports and recreational activities.
Provide Online Resources: Develop a website or mobile app offering reliable information, resources, and self-assessment tools for adolescents and their families. This promotes easy access to information and support.
Community Workshops: Organize workshops for parents to help them recognize signs of depression, improve communication with their children, and offer appropriate support.
Adolescent depression is a critical issue that requires a comprehensive nursing approach. By understanding the context, prioritizing healthcare needs, and assuming the role of a supportive caregiver, nurses can significantly impact the lives of adolescents like Justin. Through well-designed health promotion and education strategies, nurses can create an environment that fosters mental well-being, empowers adolescents, and enhances their overall quality of life.
As a renowned provider of the best writing services, we have selected unique features which we offer to our customers as their guarantees that will make your user experience stress-free.
Unlike other companies, our money-back guarantee ensures the safety of our customers' money. For whatever reason, the customer may request a refund; our support team assesses the ground on which the refund is requested and processes it instantly. However, our customers are lucky as they have the least chances to experience this as we are always prepared to serve you with the best.
Plagiarism is the worst academic offense that is highly punishable by all educational institutions. It's for this reason that Peachy Tutors does not condone any plagiarism. We use advanced plagiarism detection software that ensures there are no chances of similarity on your papers.
Sometimes your professor may be a little bit stubborn and needs some changes made on your paper, or you might need some customization done. All at your service, we will work on your revision till you are satisfied with the quality of work. All for Free!
We take our client's confidentiality as our highest priority; thus, we never share our client's information with third parties. Our company uses the standard encryption technology to store data and only uses trusted payment gateways.
Anytime you order your paper with us, be assured of the paper quality. Our tutors are highly skilled in researching and writing quality content that is relevant to the paper instructions and presented professionally. This makes us the best in the industry as our tutors can handle any type of paper despite its complexity.
Recent Comments