The initial assessment for the woman will entail physical examination. I will take a look at the patient medical history, and that includes some of the medication that the patient was taking. I will also consider if the patient has any history of mental illness or disorders among her family members. The main aim of the initial assessment will be to put aside any physical causes that are associated with the current mental health issue. The recent experience of the patient is her first delivery which did not turn out an expected. The fracture in the pelvic bone causes a lot of pain, and that might be the leading cause of the anxiety. However, as an assessment of the history will provide information on the possibility of an additional contribution. Maybe one of her family members or herself might have gone through a mental health problem in the past.
I would prescribe an antidepressant. The antidepressant that I would prescribe to the patient is sertraline. Such is because sertraline is a selective serotonin reuptake inhibitor (SSRI). Because the patient is pregnant with her second child, it will be appropriate to have an antidepressant that will not affect the condition of the baby. Sertraline has fewer side effects that are bothersome when compared to the other antidepressants such as venlafaxine (Lewis, G. et al., 2019). Also, antidepressants are less likely to cause problems when there is a high therapeutic dose. Sertraline is an inhibitor for the uptake of serotonin in the body. The antidepressant improves serotoninergic transmission in the body platelets. The elimination of the drug in the body is through the various metabolic pathways. The metabolic pathways form alcohol which gets out through real functions like conjugates (Lewis, G. et al., 2019). Manic behaviour and suicidal thoughts are the central contradictions of the antidepressant. For pregnant mothers who take sertraline in the second phase of their pregnancy, they are likely to suffer from an increase in pulmonary hypertension and lung problem during delivery.
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One of the legal/ethical considerations of using the antidepressant is consent. The patient has to be aware of the type of medication that they are using to deal with anxiety and depression. Thus, it will be critical to informing the woman together with the husband that sertraline is the antidepressant drug that is in prescription. However, declaring then is not enough, it will be necessary to notify and explain to them some of the side effects of the drug so that they can be aware. It is from the consent that the patient with assistance from the husband will decide to go on with medication. During the first trimester, there is a high risk of cardiovascular malformation (Shen, 2018). Some of the side effects of sertraline include heartburn, nausea, constipation and hardship in getting sleep.
Plan care involves starting by creating an environment that is not threatening to the patient. The domain will create a good relationship of trust. Then there will be an assertiveness training which will act and the physiotherapy intervention. The training will aim and making the patient have control of the life situation that she is in at the moment. The therapy will give the patient room to negotiate with the interpersonal problems and come into a consensus of self-assurance. The assurance is the first step to healing as the patient would have accepted the situation and will be willing to make a change. Her family members, especially the husband, will be a good collaboration as it will make the patient feel she is not in the situation alone. The partnership will be a support system for the patient to push through with the treatment.
References
Lewis, G. et al. (2019). The Clinical Effectiveness of Sertraline in Primary Care and the Role of Depression Severity and Duration (PANDA): A Pragmatic, Double-Blind, Placebo- Controlled Randomized Trial. The Lancet Psychiatric, 6 (11), 903-914.
Shen, Z., Gao, S., Li, S., Zhang, T., Liu, C., Lv, H., Zhang, Y., Gong, T., Ji, C., Wu, Q., & Li, D. (2018). Sertraline Use in the First Trimester and Risk of Congenital Anomalies: A Systemic Review and Meta-Analysis of Cohort Studies. British Journal of Clinical Pharmacology, 83 (4), 909-922.
