| Course | NUR 636 Primary Care of Infants, Children and Adolescents |
|---|---|
| Module | Module 7 |
| Paper type | case analysis of adolescent depression in primary care |
| Length | About 1,130 words, 7 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 636 Module 7
Milestone Two: Identification, Risk Assessment and Initial Management of Major Depression in a Fifteen-Year-Old
[Student Name]
Southern New Hampshire University
NUR 636: Primary Care of Infants, Children and Adolescents
Module Seven Milestone Two
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone Two: Identification, Risk Assessment and Initial Management of Major Depression in a Fifteen-Year-Old
About one in five adolescents will experience a major depressive episode before adulthood, yet most are never treated. Primary care is often the only health setting a teenager visits, so the nurse practitioner is well placed to find depression early. Teenagers rarely say they are depressed; they present with falling grades, irritability, withdrawal or physical complaints, and parents often attribute these changes to normal adolescence. This analysis follows a fifteen-year-old through screening, diagnosis, risk assessment and initial management in a family practice. It argues that a confidential, structured approach guided by GLAD-PC lets primary care treat moderate depression safely while knowing when to bring in mental health specialists.
Case Presentation
Mateo is a fifteen-year-old in tenth grade. His mother reports that over the past three months his grades have fallen, he left the soccer team he had played on since age eight and he snaps at his younger sister. He sleeps until noon on weekends and says he is always tired. He has lost about 3 kg. There is no known substance use. His parents separated eight months ago and his father moved to another state. Family history includes depression in his maternal grandmother and an uncle who died by suicide. He has no chronic illness and takes no medications. His examination is normal apart from flat affect and poor eye contact; thyroid is not enlarged, and his weight has dropped from the 55th to the 45th percentile.
Confidential Interview
After the joint history, Mateo's mother was asked to step out, following the practice's standard that every adolescent spends part of the visit alone with the clinician. Mateo was told what confidentiality covers and its limit: information stays private unless he or someone else is at risk of serious harm. Using the HEADSS framework, he described home as "quiet and weird" since his father left, school as pointless, and said he stopped soccer because he "didn't care anymore." He denied alcohol, vaping and other drugs, and denied sexual activity. He said he feels sad most days, has lost interest in things he enjoyed and lies awake for hours before sleeping.
Screening and Diagnosis
The USPSTF recommends screening for major depressive disorder in adolescents aged twelve to eighteen, while finding the evidence insufficient to recommend routine suicide risk screening in this group (Mangione et al., 2022). GLAD-PC also recommends annual universal screening with a validated self-report tool from age twelve (Zuckerbrot et al., 2018). Mateo completed the PHQ-9 Modified for Adolescents and scored 16, in the moderately severe range, and answered positively to the item about thoughts of being better off dead.
A diagnostic interview confirmed five or more DSM-5-TR criteria for at least two weeks: depressed mood, loss of interest, insomnia, fatigue, weight loss and poor concentration, with clear impairment at school and with friends. There was no history of a manic episode, which matters because an SSRI given to a child with undetected bipolar disorder can trigger mania. Hypothyroidism, anemia and substance use were considered; a TSH and complete blood count were ordered and a urine drug screen was discussed with his consent. The working diagnosis is major depressive disorder, single episode, moderate.
Suicide Risk Assessment
Because of the positive item and his family history, a structured suicide risk assessment followed. Mateo reported passive thoughts of not wanting to wake up over the past two weeks, but no plan, no intent and no past attempts. He had not researched methods. His father's hunting rifle had been left in the garage. Protective factors included his relationship with his mother, a close friend he still texts and his wish to finish school. He was judged to be at moderate risk: current passive ideation with major risk factors, including a family history of suicide and firearm access, but no plan or intent.
With Mateo's knowledge, his mother was told that he is having thoughts of death, that this is common in depression and treatable, and that the firearm must be removed from the home or locked away with ammunition stored separately, since access to a gun greatly raises the risk that a suicide attempt will be fatal. A written safety plan was completed with Mateo, listing his warning signs, coping strategies, people he can contact, the 988 Suicide and Crisis Lifeline and steps to make the home safer.
Initial Management
For moderate depression, GLAD-PC supports active treatment in primary care with evidence-based psychotherapy, medication or both, in collaboration with mental health services (Zuckerbrot et al., 2018). The TADS trial randomized 439 adolescents with major depression to fluoxetine, cognitive behavioral therapy, the combination or placebo; by week twelve, 71.0% of the combination arm had responded, against 60.6% on the drug by itself, 43.2% in therapy by itself and 34.8% taking placebo (Treatment for Adolescents With Depression Study [TADS] Team, 2004). Given his moderately severe score, family history and ideation, Mateo and his mother chose combination treatment.
He was referred to a therapist for CBT, with an appointment within two weeks through the practice's integrated behavioral health program. Fluoxetine 10 mg daily was started, with a plan to increase to 20 mg after one week if tolerated. Both Mateo and his mother were told about the FDA black box warning: antidepressants carry a small increase in suicidal thoughts and behavior in young people, most often in the first weeks, so any new or worsening thoughts, restlessness or out-of-character actions should prompt a same-day call. The warning was explained as a reason for close monitoring, not a reason to avoid treatment that is needed.
Monitoring and Follow-Up
Mateo will be contacted by phone in one week and seen in two weeks, then at intervals of no more than a month through week twelve, with the PHQ-A repeated at each visit. The goal is at least a 50% fall in the score by eight to twelve weeks and eventually remission. If he has not improved by six to eight weeks at an adequate dose, the plan will be reviewed, including a dose increase and a consultation with child psychiatry. Immediate referral to crisis services would follow any plan, intent, attempt or escalating ideation, psychotic symptoms or signs of mania. With his permission, the school counselor will be asked to support attendance and workload.
Conclusion
Mateo's decline would easily have been dismissed as a teenager's reaction to his parents' separation. Routine screening, a confidential interview and a structured suicide assessment revealed moderate depression with passive ideation, a family history of suicide and a gun in the home. Management guided by GLAD-PC and the TADS evidence, with safety planning, means restriction and close follow-up, allows primary care to treat him effectively while keeping a clear path to specialty care if he does not improve.
References
Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Chelmow, D., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Ruiz, J. M., Silverstein, M., Stevermer, J., & Wong, J. B. (2022). Screening for depression and suicide risk in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA, 328(15), 1534-1542. https://doi.org/10.1001/jama.2022.16946
Treatment for Adolescents With Depression Study (TADS) Team. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA, 292(7), 807-820. https://doi.org/10.1001/jama.292.7.807
Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E. K., Laraque, D., & GLAD-PC Steering Group. (2018). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics, 141(3), Article e20174081. https://doi.org/10.1542/peds.2017-4081
What the NUR 636 Module 7 instructions ask for
Milestone Two in NUR 636 is typically a case analysis in which you take a child or adolescent from presentation through assessment, diagnosis and an evidence-based plan, with the reasoning shown at each step. For a mental health case, expect to cover confidential interviewing, a validated screening tool, diagnostic criteria, a risk assessment and management with follow-up. Plan on five to seven pages in APA 7 with current guidelines. Separate screening from diagnosis, grade the severity of the condition, state the risk level with the factors that support it and write a monitoring plan with measurable targets and specific triggers for referral or escalation. Many prompts also ask how you would involve the parent without breaking the teenager's trust.
How this NUR 636 Module 7 milestone two example is built
This analysis follows a composite fifteen-year-old boy with falling grades and withdrawal after his parents separated. A confidential HEADSS interview, a PHQ-A score of 16 and DSM-5-TR criteria support moderate major depression, and bipolar disorder and medical mimics are addressed. A structured suicide assessment finds passive ideation with a family history of suicide and a firearm at home, leading to means restriction and a written safety plan. Management cites the Mangione USPSTF statement, GLAD-PC from Zuckerbrot and colleagues and the TADS response rates to justify CBT with fluoxetine, and the monitoring plan sets PHQ-A targets and escalation triggers. School support is arranged only with the teenager's permission, which shows the confidentiality boundary in practice.
Where the NUR 636 Module 7 rubric puts the points
Grading of this milestone commonly weighs the assessment, the diagnosis and its reasoning, the risk assessment, an evidence-based plan, patient and family education, follow-up and APA 7 writing. Top-band papers interview the adolescent alone with a clear statement of confidentiality, use a validated tool and confirm the diagnosis with criteria rather than the score alone. For depression, graders look for a screen for bipolar disorder before an SSRI, an honest explanation of the black box warning, firearm counseling and a safety plan. Measurable targets, such as a 50% fall in the score, and named escalation triggers usually separate strong papers from adequate ones. Involving school supports with consent adds credit.
NUR 636 Module 7 help: the mistakes that cost points
Adolescent depression papers lose points when the diagnosis rests on the screening score alone, when the teenager is never interviewed privately, when suicide risk is noted but not graded or when firearm access is never asked about. Another common gap is starting an SSRI without screening for mania or without explaining the black box warning and monitoring schedule. Confirm criteria, grade risk with named factors, restrict means, write a safety plan and set a follow-up schedule with targets. If your milestone involves anxiety, an eating disorder or substance use instead, share the case and your NUR 636 guidelines so the analysis follows the right evidence. Name the crisis resources, too.
Get NUR 636 Module 7 written to your instructions
Send the NUR 636 milestone case, the guidelines and the rubric. The analysis you receive will separate screening from diagnosis, grade risk with named factors, justify treatment with trial evidence and set measurable follow-up targets, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 636 Module 7 questions, answered
Where can I find a free NUR 636 Module 7 Milestone Two sample?
The full analysis is on this page: a fifteen-year-old with moderate depression, the PHQ-A, a suicide risk assessment with safety planning and GLAD-PC management with fluoxetine and CBT.
At what age should adolescents be screened for depression?
The USPSTF and GLAD-PC recommend screening adolescents for major depression from age twelve, using a validated tool such as the PHQ-A.
What did the TADS trial find?
Twelve weeks in, 71.0% responded to fluoxetine combined with CBT, compared with 60.6% for the drug alone, 43.2% for therapy alone and 34.8% for placebo.
What is the black box warning on antidepressants for teens?
It warns of a small increase in suicidal thoughts and behavior in young people, especially early in treatment, which calls for close monitoring rather than avoiding needed treatment.
Why ask about firearms in a depressed adolescent?
Access to a gun greatly raises the chance that a suicide attempt is fatal, so removing or securely locking firearms is a key part of the safety plan.