Mirtazapine, a cautious bedtime start, a sodium recheck and a two-week visit: for a composite 81-year-old, this Unit 3 management plan from MN663 gives every choice its reason. Searches like "mn 663 unit 3 assignment example", "mn663 unit 3 sample" and "mn663 unit 3 example" land here.
Management Plan for Recurrent Depression in an 81-Year-Old Woman With Previous SSRI-Related Hyponatremia
[Student Name]
Purdue University Global
MN663: PMHNP Diagnosis and Management Across the Lifespan I
Unit 3 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Doses are bracketed; nothing here is a prescribing instruction.
Assessment Summary
Recurrent major depressive disorder, current episode moderate. Geriatric Depression Scale (15-item) score of 11 (Sheikh & Yesavage, 1986). Weight loss of 4.5 kg over three months; early waking at 4 a.m. No psychotic features. No current suicidal ideation on direct questioning. Previous sertraline trial last spring stopped when sodium fell to 128 mmol/L. Lives alone; her daughter visits twice a week. Mild chronic kidney disease; takes a thiazide diuretic for blood pressure.
Goals of Treatment
Her own goals, stated at the visit, are to "sleep past five," to "want to eat again" and to go back to her Thursday quilting group, which she stopped attending two months ago. Clinical goals are a Geriatric Depression Scale score below 5 within twelve weeks, stable weight followed by regain toward her usual weight, and no new falls or episodes of low sodium. Progress will be judged against both sets, and her own goals will be revisited at each visit because they are the ones she will notice first.
Intervention
Medication: mirtazapine at a [low bedtime starting dose]. Mirtazapine was chosen because it improves appetite and sleep, the two symptoms troubling her most, and because it has been associated with a lower risk of hyponatremia than SSRIs, although the risk is not absent (Leth-Møller et al., 2016). Two alternatives were considered. A different SSRI was set aside because hyponatremia is a class-related risk and she has already had it once. Bupropion was set aside because it can reduce appetite and worsen insomnia, the opposite of what she needs, and it lowers the seizure threshold.
Psychotherapy: referral for problem-solving therapy, which has evidence of benefit in older adults with depression, including those with executive dysfunction (Areán et al., 2010). She has agreed to try it, with sessions at home by video if transportation is difficult.
Dose Reasoning
The starting dose is lower than for a younger adult for three reasons: older adults clear mirtazapine more slowly, its sedation could raise her risk of a fall if she gets up at night, and antidepressants in older adults carry a caution for hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion. The AGS Beers Criteria list antidepressants among medications to use with caution in older adults because of that risk, particularly with diuretics, which she takes (American Geriatrics Society Beers Criteria Update Expert Panel, 2023). Any increase would be made slowly, after at least two weeks, and only if sodium and alertness are stable.
Monitoring
Sodium at two weeks and again at four weeks, then at each dose change; a result below 130 mmol/L prompts a call to her and a review of both the mirtazapine and the thiazide. Weight at every visit, with the aim of stopping further loss. A falls question at every contact: any fall or near fall since the last visit, and whether she gets up at night. Repeat Geriatric Depression Scale at six weeks and twelve weeks. Morning sedation and dizziness asked at each contact, with a lower threshold for concern in the first two weeks.
Safety
She denies suicidal thoughts, but older adults who live alone, have lost weight and have recurrent depression carry real risk, so suicidal thoughts are asked about at every contact, not only at the first visit. She keeps no firearms at home. Her medications are dispensed in weekly blister packs, which limits the amount available at any time and makes missed or doubled doses visible to her daughter.
Follow-Up
Telephone call at one week to ask about sleep, sedation, falls and suicidal thoughts. Visit at two weeks with sodium result. Her daughter is included in calls and visits, with the patient's consent, and has been asked to report confusion, unsteadiness or new falls immediately, since these can be early signs of low sodium.
Coordination
The plan is sent to her primary care provider with a specific request: to review the thiazide diuretic in light of her previous hyponatremia and consider an alternative for blood pressure if her sodium falls again. Her pharmacist is informed of the new medication and asked to check for interactions at each refill. With her consent, the problem-solving therapist receives a brief summary of her goals so that therapy and medication aim at the same targets.
What the Plan Leaves Out
No benzodiazepine or other hypnotic is added for sleep, because mirtazapine is expected to help sleep and a second sedating drug would raise her fall risk further. The thiazide is not stopped in this plan, but its contribution to her low sodium is flagged for her primary care provider, who manages her blood pressure. Electroconvulsive therapy is not considered at this stage, because her depression has no psychotic features and she has not failed multiple adequate trials.
References
American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Areán, P. A., Raue, P., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Alexopoulos, G. S. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. American Journal of Psychiatry, 167(11), 1391-1398. https://doi.org/10.1176/appi.ajp.2010.09091327
Leth-Møller, K. B., Hansen, A. H., Torstensson, M., Andersen, S. E., Ødum, L., Gislasson, G., Torp-Pedersen, C., & Holm, E. A. (2016). Antidepressants and the risk of hyponatremia: A Danish register-based population study. BMJ Open, 6(5), e011200. https://doi.org/10.1136/bmjopen-2016-011200
Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5(1-2), 165-173. https://doi.org/10.1300/J018v05n01_09
How this MN663 Unit 3 example is structured
Settled facts are compressed so the reasoning has room: the diagnosis gets a single line and is never argued again. Every later part answers a separate question a covering clinician would ask. What is being started, and why this drug over the two alternatives considered, a different SSRI and bupropion? At what step, and what about her makes that step lower than for a younger adult? What will be checked, when, and what result would change the plan? When is the next contact, and who else is involved? Psychotherapy appears inside the intervention part rather than as an afterthought, with a referral for problem-solving therapy and a note that she has agreed to try it. A short final paragraph records what the plan deliberately left out, including any benzodiazepine for sleep, and gives the reason.
Get an MN663 Unit 3 example written to your instructions
Send the Unit 3 case your MN663 instructor posted, lab values included, together with the rubric. The first plan costs nothing. Within 24-48h it comes back with intervention, dose reasoning in brackets, monitoring that carries a trigger for each check, a dated follow-up and a note on what was deliberately withheld. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN663 Unit 3 questions, answered
How should a management plan handle an older adult?
Name the specific ways age changes the decision rather than writing that caution is needed. Slower clearance, fall risk, sodium, drug interactions and cognition are the usual candidates, and each should connect to a choice in the plan. Citing the current Beers Criteria helps when a drug on its lists is involved, as long as the edition year is correct.
Does the plan need a psychotherapy component?
In most management courses, yes. A plan that treats medication as the whole intervention usually loses marks, because guidelines for depression pair pharmacotherapy with psychotherapy for many patients. Name the modality, say why it suits this person, and note whether they have agreed. For an older adult living alone, social contact and practical support often belong here as well.
What if the case omits a lab value the plan depends on?
State that it is missing, say that the plan would obtain it before or soon after starting, and proceed on a clearly labeled assumption. A plan that orders the test and says what result would change course shows sound reasoning. Inventing a value, or stalling the whole plan, is what costs marks.