Feb 23, 2024 Assignment: Assessing and Treating Pediatric Clients With Mood Disorders NURS 6630N
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders NURS 6630N
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders NURS 6630N
In this case study, the patient is an African-American child admitted to the healthcare facility accompanied by the mother. The boy is experiencing symptoms of depression. Some of the reported symptoms include withdrawal, reduced appetite, and often gets angry on the slightest provocation (Laureate Education, 2016). However, the patient exhibits good physical outlook with normal results from the laboratory testing. Additionally, the patient’s developmental stages were all attained at the appropriate age hence the need to carry out more assessment on the patient’s psychological condition.
Further analysis reveals the patient has sad feelings and always thinks about being dead and how it would be like when he is dead. However, he does not approve of committing suicide and has no such ideas in mind. The patient is in a sad mood during the interview but at some points during the interview he smiles normally (Laureate Education, 2016). The purpose of this paper is to consider a proper plan for the treatment of the patient. The plan focuses on the decision tree with emphasis on proper communication with the patient and observance of all the related ethical standards to be met.
Decision Point 1
Begin Zoloft 25 mg orally daily
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Why Select Zoloft 25mg Oral Daily Dose?
The drug is classified as an anti-depressant that works on the principle of inhibition of the selective uptake of serotonin. It is the prescribed medication for major depressive disorder (MDD), obsessive compulsive disorder(OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder and premenstrual dysphoric disorder (PMDD). The 25mg daily dosage is the appropriate and recommended oral dose for children. Zoloft has proved to be effective in treatment of children with OCD for ages between six and seventeen years (Garland et al., 2016).
What is the expected outcome on making this decision?
This prescribed drug is aimed at reducing the patient’s sad mood, improving the patient’s appetite and boosting their feelings for self and social interactions (Neavin, Joyce & Swintak, 2018). The drug will also alleviate the feelings of death hence making the patient appreciate life and improve his general feeling about life. Additionally, Zoloft is appropriate for the age of the patient who is eight years old and there is less side effects expected on the patient.
Expected Vs. Actual Results
After a period of four weeks the patient returned to the health facility for follow up. The patient still had symptoms of depression. This was contrary from the expected outcome because the SSRIs have a slow action mechanism associated with late improvement of the depression symptoms.
Decision Point 2
Double up the dosage to 50mg daily
Why take this decision?
It is recommended to double up the dosage if the patient does not show any improvement within a period of four weeks (Garland et al., 2016). The use of Prozac 10mg daily dosage is not the appropriate decision at the moment because it is only recommended if there is no improvement of the patient’s condition after six weeks (Neavin et al., 2018).
What is the expected outcome on making this decision?
By doubling up the dosage I hope to improve the patient’s feelings on depression by half and make him feel better emotionally, improve his appetite and social interactions.
Expected Vs. Actual Results
On the second visit to the health facility after period of four weeks, the patient’s state has remarkably improved by half. The patient’s body has shown great tolerance to the drug and the expected and actual results are similar. This can also be attributed to the fact that Zoloft is associated with late improvement in depression patients.
Decision Point 3
Increase to 75 mg orally daily.
Why take this decision?
This decision was achieved at by checking on the patient’s progress. The patient had not achieved full recovery from depression and social withdrawal symptoms. This dosage will sustain the current dosage and improve on the patient’s recovery process. (Neavin et al., 2018).
Other options like the use of SSRI is not appropriate at the moment because the patient has exhibited good response to Zoloft in both treatment and the ability of the patient’s body to tolerate the drug. Additional SSRI has been associated with strong withdrawal symptoms especially when its use is discontinued and this like pose similar symptoms of the relapse to depression (Garland et al., 2016). The relapse of the withdrawal symptoms occurs after a period of between six and eight weeks after treatment with SSRI hence is not the outcome we need for this patient at the moment.
What is the expected outcome on making this decision?
By taking this decision, the aim is to achieve full recovery of the patient from depression and the related symptoms. It is expected after four weeks the patient’s mood would have changed and exhibit happiness coupled with euthymia (Dwyer & Bloch, 2019). Additionally, the patient is expected to have better appetite, proper sleeping patterns, improved social interactions and reduced or no feelings of death.
Expected Vs. Actual Results
After four weeks the patient returned with improved conditions. He was feeling happy and with improved social interactions. This actual results are similar to the expected results.
How Ethical Considerations Might Impact Your Treatment Plan Communication with Clients
One of the key ethical issue to be considered is the right to information and the independence of the client to make the decision that suits the needs. It is important to explain to the patient or the care giver the treatment plans available, their cost and the expected side effects (Katz et al., 2016). This will empower the client with knowledge and ensure that the client makes informed decisions. The case in point involves a child therefore the consent should be obtained from the mother who is the immediate care giver to the child. Therefore, the mother’s decision will have an impact on the patient’s treatment plan. Another ethical issue to consider is beneficence.
This will call upon the health practitioner to offer a treatment plan that is best suited to the patient and will deliver the best desired outcomes. I also allow the health practitioner to modify and improve the treatment plan if the existing one does not produce the desired outcomes. (Katz et al., 2016). Additionally, non-maleficence is another ethical issue that is likely to impact on the treatment plan, this allows the medical practitioner to modify the treatment plan in case the existing one has adverse effects to the patient. It is imperative for the healthcare practitioner to consider all the ethical issues before coming up with the treatment plan and modify it along the way with key emphasis being to ensure that the patient’s outcome is improved and patient satisfaction is met.
Conclusion
The case in point was an eight-year-old African-American boy with a depression disorder that exhibited various symptoms such as reduced appetite, social withdrawal and feelings of death. The boy is treated with Zoloft initial dosage of 25mg daily but after four weeks the symptoms had not improved is can be attributed to the late action of the Zoloft drug The dosage was doubled to 50mg daily and the symptoms improved by half after another four weeks. On further increase of the dosage to 75mg daily for another four weeks, the patient’s condition greatly improved and the patient exhibited happiness, improved appetite, better sleep and general feeling of euthymia. The treatment plan considered ethical factors such as patient’s autonomy, beneficence and non-maleficence as the key to better patient outcomes.
References
Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for Pediatric Patients. Current Psychiatry, 18(9), 26–42F. PMC6738970/
Jane Garland, E., Kutcher, S., Virani, A., & Elbe, D. (2016). Update on the Use of SSRIs and SNRIs with Children and Adolescents in Clinical Practice. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie Canadienne de Psychiatrie de l’enfant et de l’adolescent, 25(1), 4–10. PMC4791100/
Katz, A. L., & Webb, S. A. (2016). Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 138(2), e20161485. https://doi.org/10.1542/peds.2016-1485
Neavin, D., Joyce, J., & Swintak, C. (2018). Treatment of Major Depressive Disorder in Pediatric Populations. Diseases, 6(2), 48. https://doi.org/10.3390/diseases6020048
The Assignment
Examine Case Study: An African American Child Suffering From Depression. You willbe asked to make three decisions concerning the medication to prescribe to this client.Be sure to consider factors that might impact the client’s pharmacokinetic andpharmacodynamic processes. At each decision point stop to complete the following:
https://nursingmasters.blog/assignment-assessing-and-treating-pediatric-clients-with-mood-disorders-nurs-6630n/o Decision #1
Which decision did you select? Why did you select this decision? Support your response with evidence and references to theLearning Resources. What were you hoping to achieve by making this decision? Support your response withevidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the resultsof the decision. Why were they different?o Decision #2 Why did you select this decision? Support your response with evidence and references to theLearning Resources. What were you hoping to achieve by making this decision? Support your response withevidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the resultsof the decision. Why were they different?o Decision #3 Why did you select this decision? Support your response with evidence and references to theLearning Resources. What were you hoping to achieve by making this decision? Support your response withevidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the resultsof the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communicationwith clients.Note: Support your rationale with a minimum of three academic resources. While youmay use the course text to support your rationale, it will not count toward the resourcerequirement.
Read Also: NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders
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Making Connections
Now that you have: Assessed pediatric clients presenting with mood disorders Developed personalized plans of antidepressant therapy for pediatric clients Examined factors that influence pharmacokinetic and pharmacodynamic processes in pediatricclients requiring antidepressant therapy Explored ethical and legal implications of prescribing antidepressant therapy to pediatric clientsNext week, you will build on your assessment and treatment skills as you examine adultand geriatric clients presenting for antidepressant therapy.
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Learning Resources
Note: To access this week’s required library resources, please click on the link to theCourse Readings List, found in the Course Materials section of your Syllabus.Required ReadingsNote: All Stahl resources can be accessed through this link provided.Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis andpractical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology,4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure toread all sections on the left navigation bar for each chapter. Chapter 6, “Mood Disorders” Chapter 7, “Antidepressants”Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: CambridgeUniversity Press.
Note: To access the following medications, click on the The Prescriber's Guide, 5thed tab on the Stahl Online website and select the appropriate chapter. Be sure to readall sections on the left navigation bar for each chapter.
Review the following medications: amitriptyline bupropion citalopram clomipramine desipramine desvenlafaxine doxepin duloxetine escitalopram fluoxetine fluvoxamine imipramine ketamine mirtazapine nortriptyline paroxetine selegiline sertraline trazodone venlafaxine vilazodone vortioxetine
Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in usingpsychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.),IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: InternationalAssociation for Child and Adolescent Psychiatry and Allied Professions. Retrieved fromhttps://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdfMagellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children andadolescents: A clinical monograph. Retrieved fromhttp://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdfPoznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. LosAngeles, CA: Western Psychological Services.Note: Retrieved from Walden Library databases.Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787-791. doi:10.1002/da.22171Required MediaLaureate Education (2016e). Case study: An African American child suffering fromdepression [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.Optional ResourcesEl Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use ofantidepressant or anxiolytic medication during pregnancy and childhoodneurodevelopmental outcomes: A systematic review. European Child & AdolescentPsychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children andadolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854.doi:10.1111/jpc.12655Seedat, S. (2014). Controversies in the use of antidepressants in children andadolescents: A decade since the storm and where do we stand now? Journal of Child &Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497To prepare for this Assignment: Review this week’s Learning Resources. Consider how to assess and treat pediatric clientsrequiring antidepressant therapy.
According to theNational Institute of Mental Health,approximately 9% of teenagers from the age of 12 to 17 years have depression disorder in the United States.Ghandour et al., (2019) reported that about 3.2% of African American adolescents presented with suicidal thoughtsin 2018as 1.4%tried to commit. Despite the burden associated with this mental disorder, several treatment options are available to help manage the symptoms and promote the quality of life of children and adolescents with this disorder.
The assigned case study demonstrates an African American boy child diagnosed with depression. The patient reports symptoms such as irritability, feeling sad, decreased appetite, and withdrawalfrom social gatherings like school. The conducted mental status examination revealed that the patient is suicidal, but has never tried to kill himself. The patient however denies hallucinations and delirium among other psychotic symptoms. Based on clinical practice guidelines and DSM-5 diagnostic criteria,together with a score of 30 on theChildren’s Depression Rating Scale,the patient’s primary diagnosis is depression.
The patient’s age, African American race, and anxiety diagnosis are some of the factors which might affect the choice of drugs for the management of the patient’s symptoms. For instance, most antipsychotic agents are associated with suicidal attempts, among other side effects hence must be monitored closely when use among children and adolescents. Additionally, a study conducted by (Leichsenring et al., 2021) reported that African Americans are more likely tocarry alleles that slow down the metabolism of most antidepressants such as tricyclic antidepressants (TCA), leading to a ‘slowmetabolizer’ phenotype hence higher blood TCA plasma level, in addition to more rapid response. The purpose of this paper is to demonstrate the decision-making process of the most effective medication to include in the patient’s treatment plan, while observing pharmacokinetic and pharmacodynamic factors, in addition to ethical considerations which might impact this care process.
Decision #1 Top of Form
Selected Decision and Rationale
The initial intervention is to start the patient on Zoloft 25 mg orally once daily. Sertraline belongs to the class of selective serotonin reuptake inhibitors (SSRIs), recommended in national clinical guidelines as the first-line for the management of depression in children and adults (Walkup, 2017).
Considering the patient’s specific factors, Zoloft is the best choice of drug for the management of depressive symptoms displayed by the patient. anxiety symptoms. For instance,most studies recommend the use of sertraline among children as a result of its great effectiveness and desirable safety profile reported by the few conducted clinical trials. The drug acts by inhibiting the central nervous system (CNS) neuronal uptake of serotonin(5HT) (Pile et al., 2020).
Among children, the recommended starting dose is 25mg. The drug is absorbed slowly in the GIT with a peak plasma level being attained after 6 to 8 hours, necessary to elicit optimal therapeutic action. Studies have also identified several polymorphisms in genes encoding P-450 isoenzymes (2D6 and 2C19) among African Americans which affect the metabolism of the drug. However, when used in low disease, the drugs have displayed great effectiveness with an appealing safety profile.
Wellbutrin on the other hand is not recommended for children less than 18 years due to evidence deficits in its safety and effectiveness (Ghandour et al., 2019). The drug is also associated with high suicidal incidence, hence not appropriate for this patient as he already displayed symptoms of suicidal ideation. Paxil is also not appropriate for this patient as it is also associated with high suicide incidences as the FDA issued a black box warning for use of the drug among this vulnerable population (Leichsenring et al., 2021). It should only be considered in case there is no other suitable option which in this case is Zoloft as described above.
Expected Outcome
The drug is expected to display at least 50% remission of the patient’s depression symptoms within the next 4 to 8 weeks. As a result, theChildren’s Depression Rating Scalescores are expected to decrease to less than 10 from 30. Only common self-limiting side effects such as dry mouth increased sweating and headache might be expected(Walkup, 2017).
Ethical Considerations
Given that the patient is under the age of 18 years, it will be necessary for the PMHNP to adequately inform the patient’s parents about the available treatment options and their benefits and risks to involve them in decision making concerning the health of their child(Pile et al., 2020). Parents and guardians have legal authority in making healthcare decisions for their children.
Decision #2
Selected Decision and Rationale
The second decision is to increase the Zoloft dose from 25mg to 50mg PO daily. Studies show that the dose of Zoloft should be increased at intervals of 25mg to 50 mg per day once weekly when the desired therapeutic response has not been attained among children, while closely monitoring the patient’s symptoms(Ghandour et al., 2019).
This decision was based on the treatment outcome as the patient reported no changes in his depressive symptoms after four weeks of therapy. Increasing the dose of Zoloft to 50 mg is the best decision at this point, and evaluate the patient outcome after another 4 weeks. Studies show t that it takes between 8 to 12 weeks for sertraline to attain optimum therapeutic action in completely managing depression symptoms(Leichsenring et al., 2021). However, the dose must be increased gradually, while monitoring patient symptoms to attain an optimum dose. The patient also displayed no adverse effects, indicating great tolerance to the medication, hence no reason to alter the medication.
Increasing the dose to 37.5mg is not appropriate as this would only display similar results, as that titration rate is not recommended in several clinical guidelines(Walkup, 2017). Consequently, this will only prolong the period of use of the drug to the point where optimum dose will be attained. Discontinuing the use of sertraline, is also not necessary at this point, as studies only recommend it in case the maximum dose has been reached with no effect or the patient displays adverse effects(Pile et al., 2020). Consequently, studies recommend that the dose be reduced gradually first before switching to another drug like Prozac which is associated with several adverse effects as described above.
Expected Outcome
With the dose increment of Zoloft to 50mg, the patient is expected to display atleast 50% remission of symptoms this time round unlike within the first 4 weeks(Ghandour et al., 2019). His score on the Children’s Depression Rating Scalescores is also expected to decrease to less than 10. No side effects are expected since the patient already displayed great tolerance to the drug.
Ethical Considerations
The PMHNP has a legal obligation of preventing harm and promoting the health of the patient (Dawson, 2018). As such, considering a dose increment of the drug was the best choice in managing the patient’s symptoms, with limited side effects (Walkup, 2017). This decision promotes ethical principles such as beneficence and non-maleficence.
Decision #3
Selected Decision and Rationale
The last decision is to maintain the dose of Zoloft at 50mg once daily and continue evaluating the progress of the patient. The evidence-based practice recommends dose maintenance once the optimum level has been maintained until the patient’s symptoms have been resolved completely (Pile et al., 2020).
This decision was supported by the outcome the patient displayed in the last four weeks with a 50% reduction in depressive symptoms. The outcome shows great effectiveness and adherence to the medication by the patient, hence the need to maintain the dose. Studies show that it may take the drug another 4 to 8 weeks for Zoloft to completely manage symptoms of depression once the optimum dose has been achieved (Leichsenring et al., 2021). Additionally, this dose is still low hence limiting the possibility of side effects or toxicity.
Increasing the dose of Zoloft is not necessary as this will only lead to increased risks of adverse effects and toxicity due to increased plasma levels(Dawson, 2018). Additionally, the patient’s age does not allow a higher dose of the drug, as this could lead to increased suicidal ideation. Changing the treatment regimen to another drug, is also not appropriate as this will only lead to new complications (Walkup, 2017). This will also affect the patient compliance with the treatment regimen.
Expected Outcome
The patient is expected to display completely managed depression symptoms within the next four weeks. His score on the Children’s Depression Rating Scalescores is also expected to decrease to less than 10(Dawson, 2018). The patient’s quality of life will improve within this time, with no side effects reported as a result of the displayed tolerance and adherence to the treatment.
Ethical Considerations
At this point, the PMHNP is required to consider the ethical principle of nonmaleficence. Out of all the available options, maintaining the dose is the only choice that will benefit the patient with no harm (Pile et al., 2020). The patient’s parent
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