Examine Case Study An African American Child Suffering From Depression.
Assignment: Assessing and Treating Pediatric Patients With Mood Disorders
When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders.
As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.
To prepare for this Assignment:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.
The Assignment: 5 pages
Examine Case Study An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
CASE STUDY LINK: https://cdnfiles.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
- Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
- Which decision did you select?
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Expert Answer and Explanation
Decision Tress for Depression
Introduction to the Case
An 8-year-old African American was brought to the emergency room by his mother for medical assessment and treatment. The patient was exhibiting depression signs. According to the patient, he experiences sad feelings. His mother notes that the patient’s teacher reported that he is withdrawn in school and is not interacting with his classmates. The patient has also lost his appetite and is often irritated. His body appearance shows that he is well developed and has reached all milestones and his development is appropriate to his age.
His physical exam shows that the patient healthy, physically. The patient’s vital signs are within normal limits and lab tests are normal. The patient was referred to a psychiatrist for a further mental evaluation. His mental exam shows that he knows where he is, what time is it, and who I am. He reports that he experiences a sad mood. He has been smiling often in some moments during the interview though he has a blunt affect. He denies hallucination symptoms. He also denies having delusional and paranoid thinking.
The patient notes that he has not thought of committing suicide but often thinks about himself as dead. He also reports that he sometimes thinks of the meaning of being dead. The Children’s Depression Rating Scale (CDRS) and the child scored 30. The purpose of this assignment is to make treatment decisions that will help the patient improve his depression by 50% as per CDRS within 12 weeks of treatment.
Decision One
My first decision was that he begins Zoloft 25mg orally daily. I selected the decision due to the following reasons. First, Locher et al. (2017) note that SSRIs are safe and effective in treating adolescents with mental problems, such as depression and anxiety. Zoloft is an SSRI and thus is safe and effective in treating the patient.
Second, a study conducted by Fann et al. (2017) found that Zoloft is an effective antidepressant that can completely treat a patient with depression within 12 weeks of treatment. The authors also noted that the has positive long-term effects on people with depression. Another randomized control trial by Duffy et al. (2019) found that Zoloft can reduce depressive symptoms in people with depression within 12 weeks, thus improving the patients’ quality of life.
I avoided Paxil because it is more likely to heart problems compared to Zoloft. A study by Guo et al. (2019) found that some antidepressants can make patients taking them to experience some cardiovascular problems. When ranking the medications, the authors ranked Zoloft above Paxil in terms of safety. I also avoided Wellbutrin because the medication does not belong to the SSRI class. SSRI medications are considered the more effective and safe drugs for the treatment of patients with depressive symptoms (Locher et al., 2017).
Womersley et al. (2017) report that SSRIs are the first line of treating depression and other mental conditions. My hope was to improve the patient’s mental health by 50% within 12 weeks (Duffy et al., 2019). The ethical considerations that may have impacted this treatment plan are patient autonomy and informed consent. Molina‐Mula et al. (2019) note that patients have the decision to make their decisions regarding their care. In this instance, the patient’s mother has the responsibility to decide for him because he is a minor. My next steps will be based on the mother’s decision.
Decision Two
In four weeks, the patient was brought back for follow-up care. His symptoms have not reduced. Thus, I decided that he should change the dosage. As a result, I selected the decision that the patient’s dosage is increased to 50mg orally daily. I selected this decision because Cheung et al. (2018) note that nurses should take specific steps in an instance where the initial treatment produces partial or no improvement.
The initial treatment did not produce significant clinical benefits, hence I decided to increase the dosage to 50mg. I also selected the decision because Hieronymus et al (2016) note that Zoloft 50mg can decrease symptoms in people with depression. The authors also note that dosage should be decided based on the individual patient’s response to medication.
I avoided the first decision because according to Hieronymus et al (2016), Zoloft 50mg can decrease symptoms in people with depression. The authors also the Zoloft dosage of 50mg has been recommended by the FDA. I avoided the last decision because compared to Zoloft, Prozac because can cause negative effects on the patient’s cardiovascular system (Guo et al., 2019).
When deciding that the patient should take Zoloft 50mg orally daily, I hoped that the patient would completely recover by end of the 12th week (Duffy et al., 2019). The ethical consideration that might have impacted my treatment plan is beneficence and non-maleficence. The ethical consideration is concerned with the patient’s safety while he is taking the medication.
Decision Three
After another four weeks, the patient came for follow-up. The patient said that he tolerated well to the drug. He also had a significant reduction of depressive symptoms in that it reduced by 50%. As a result, my third decision was that the patient should continue taking the current medication at the current dosage. I selected this decision because the patient had not complained about any side effects and was well tolerating the drug.
Cheung et al. (2018) note that nurse practitioners should closely monitor for side effects of medications before deciding the next step of action. Another study by Ng et al. (2017) shows that drug prescription should start with a low dose and increase until a significant clinical benefit is achieved. I monitored the patient and found significant side effects and 50mg produced the intended treatment outcome, hence there was no need for another plan.
I did not select the second decision because Ng et al. (2017) note that doses should be increased until a significant clinical benefit is achieved. Zoloft 50mg had improved the patient’s depression by 50%, and therefore, there was no need to increase the dosage to 75mg orally daily. I avoided the third decision because it involves prescribing SNRI. Locher et al. (2017) report that SSRIs are more effective and safe to use in treating adolescents with depression and other mental disorders compared to SNRIs.
Womersley et al. (2017) report that SSRIs are the first line of treating depression and other mental conditions. I hoped that the patient recovers completely after continuing the medication for four more weeks (Duffy et al., 2019). The ethical consideration that might impact my treatment plan, in this case, is respect for the patient. When making medical decisions, nurses are required to make decisions that respect the patient’s culture and objections (Bipeta, 2019). My decision has respected the client and his culture.
Conclusion
After the patient assessment, three recommendations were made to improve the patient’s mental health. The first recommendation was that the client begins Zoloft 25mg orally daily. I made the recommendation because Locher et al. (2017) note that SSRIs are safe and effective in treating adolescents with mental problems, such as depression and anxiety. I also recommended this decision because Fann et al. (2017) found that Zoloft is an effective antidepressant that can completely treat a patient with depression within 12 weeks of treatment.
Lastly, I recommended the decision because Duffy et al. (2019) found that Zoloft can reduce depressive symptoms in people with depression within 12 weeks, thus improving the patients’ quality of life. The patient reported no change after using the medication for four weeks.
Therefore, my second recommendation was that his dosage is increased to 50mg orally daily. I made the decision because Cheung et al. (2018) note that nurses should take specific steps in an instance where the initial treatment produces partial or no improvement. I also made the decision because Hieronymus et al (2016) note that Zoloft 50mg can decrease symptoms in people with depression.
The patient reported significant depression symptoms reduction by 50%. Hence, my last recommendation was that the patient maintains the initial dosage. Cheung et al. (2018) note that nurse practitioners should closely monitor for side effects of medications before deciding the next step of action. Another study by Ng et al. (2017) shows that drug prescription should start with a low dose and increase until a significant clinical benefit is achieved.
References
Akyüz, E., Bulut, H., & Karadağ, M. (2019). Surgical nurses’ knowledge and practices about informed consent. Nursing Ethics, 26(7-8), 2172-2184. https://journals.sagepub.com/doi/abs/10.1177/0969733018810767
Bipeta R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian Journal of Psychological Medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19
Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Laraque, D., Stein, R. E., & Glad-PC Steering Group. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics, 141(3). https://doi.org/10.1542/peds.2017-4082
Duffy, L., Lewis, G., Ades, A., Araya, R., Bone, J., Brabyn, S., … & Woodhouse, R. (2019). Antidepressant treatment with sertraline for adults with depressive symptoms in primary care: the PANDA research programme including RCT. Programme Grants for Applied Research, 7(10), 108. https://doi.org/10.3310/pgfar07100
Fann, J. R., Bombardier, C. H., Temkin, N., Esselman, P., Warms, C., Barber, J., & Dikmen, S. (2017). Sertraline for Major Depression During the Year Following Traumatic Brain Injury: A Randomized Controlled Trial. The Journal of head trauma rehabilitation, 32(5), 332–342. https://doi.org/10.1097/HTR.0000000000000322
Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I., … & Kossowsky, J. (2017). Efficacy and safety of selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and placebo for common psychiatric disorders among children and adolescents: a systematic review and meta-analysis. JAMA psychiatry, 74(10), 1011-1020. https://dx.doi.org/10.1001%2Fjamapsychiatry.2017.2432
Molina‐Mula, J., Peter, E., Gallo‐Estrada, J., & Perelló‐Campaner, C. (2018). Instrumentalisation of the health system: An examination of the impact on nursing practice and patient autonomy. Nursing Inquiry, 25(1), e12201. https://doi.org/10.1111/nin.12201
Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.
Use Coupon Code: NEW30 to Get 30% OFF Your First Order
FAQs
