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NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders

NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders

According to the National Institute of Mental Health, around 9% of adolescents between the ages of 12 and 17 suffer from depression. Each year, around 7.9 percent of black youths are diagnosed with depression. According to a research, 3.2 percent of black teens expressed suicidal thoughts last year, and 1.4 percent attempted suicide (Ghandour et al., 2019). As future nurse practitioners, we must be culturally competent in order to address mental illnesses in a diverse patient population. In this assignment, I will examine the case of an African American youngster who is depressed, take into account the patient’s information, and make three therapy decisions for the patient. Additionally, I will consider the ethical implications of each decision and conclude with a summary of the patient’s treatment plan. Assessing and Treating Mood Disorders in Children and Adolescents 6630 NURS

According to the information presented, the patient is an African American child who is depressed. The patient exhibits a variety of symptoms, including sadness, withdrawal from classmates, decreased appetite, and irritability. According to the mental status evaluation, the patient frequently contemplates death and what it would be like to die. He, on the other hand, denies any suicidal thoughts or attempts, aural hallucination, or delusion. His physical examination is ordinary, as are his laboratory findings, which are within normal norms. He speaks clearly and has age-appropriate opinions. According to the clinician’s observations, the patients appear to be depressed, and he rarely smiles. Clinical guidelines and the DSM-5, together with the patient’s Children’s Depression Rating Scale score of 30, indicate that the primary diagnosis is depression (Ghandour et al., 2019). With the right treatment plan in place, the patient’s symptoms can be totally addressed, thereby improving his mental health and quality of life.

Decision #1  Top of Form

Selected Decision

Begin Zoloft 25mg orally daily.

Reason Behind Decision 1

            Managing depression among children is quite challenging as a result of the lack of adequate data to support the efficacy of most antidepressants. However, most studies recommend the use of Zoloft (sertraline) among children with positive results. Sertraline is a selective serotonin reuptake inhibitor (SSRIs) that acts by inhibiting the central nervous system neuronal uptake of serotonin (5HT).

Among children, the recommended starting dose is 25mg. The drug has displayed a desirable safety profile and effectiveness in managing depression among children above the age of 6 years, as reported by several studies (Pile, Shammas, & Smith, 2020). Zoloft also undergoes the first-pass metabolism with reduced side effects when well monitored. Other options such as daily 10 mg of Paxil, or even 75 mg of Wellbutrin twice daily could not be considered. Wellbutrin is not recommended for children below the age of 18 years as a result of inadequate information concerning its safety and effectiveness. Consequently, the drug is associated with adverse side effects such as anorexia and seizures. Paxil on the other hand is greatly discouraged for use among children as a result of reported cases of suicidal thoughts and attempts among those using the drug. This makes Zoloft 25mg the most favorable decision. Assignment Assessing and Treating Pediatric Patients With Mood Disorders NURS 6630

NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders

NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders

Expected Outcome

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            Within 4 weeks, the patient is expected to display greatly managed symptoms of depression. He should be able to feel less sad and interact appropriately with his peers in school. His appetite should be better, with fewer irritability symptoms (Ghandour et al., 2019). His Children’s Depression Rating Scale score is expected to reduce by 50%.

Ethical Considerations

Handling children with mental disorders poses great challenges. For instance, the guardian or parent has legal obligations of making health decisions for their children (Dawson, 2018). As such they must be informed of the available treatment option, and the effects of each decision made. In this case, the parent would support this decision.

Decision #2

Selected Decision

Increase Zoloft dose from 25mg to 50mg PO daily

Reason Behind Decision 2

            After four weeks, the patient was brought back to the clinic with no changes in his depressive symptoms. As a result, increasing the dose of Zoloft to 50 mg is the most appropriate decision to make. The patient displayed no adverse effects, showing great tolerance to the medication. However, studies show that with inadequate response to the starting dose of Zoloft, it is necessary to titrate the dose in 25-50 mg per day increments once weeks to a maximum dose of 200mg (Dawson, 2018). This disqualifies the option of increasing the dose to 37.5 mg, as it is below the recommended dose, and will display almost the same results as using 25mg. Consequently, when discontinuing the use of Zoloft, it is recommended that the dose be reduced gradually first. As such it is not necessary to switch the medication with Prozac at this point. This will only lead to complications and new adverse effects such as further anorexia and increased anxiety.

Expected Outcome

After 4 weeks, the patient is expected to return to the clinic with greatly reduced symptoms of depression. He should be able to feel less sad and interact appropriately with his peers in school. His appetite should be better, with fewer irritability symptoms (Ghandour et al., 2019). His Children’s Depression Rating Scale score is expected to reduce from 30 to 15 or less.

Ethical Considerations

As per the results of the initial decision, the patient’s parent has the right of being informed on the reasons behind the outcome, and available alternative intervention for better results (Dawson, 2018). As per ethical requirements, nurses need to put the patient’s health at the center of care to promote health and wellbeing.

Decision #3

Selected Decision

Maintain Zoloft 50mg PO daily and continue to monitor progress

Reason Behind Decision 3

            After 4 weeks, the patient reported back to the clinic with a 50% reduction in depressive symptoms. This indicates well tolerance and effectiveness of the medication, as no side effects were also reported at this point. Despite the current treatment goal of complete remission of symptoms by a drug, a 50% reduction of symptoms with no side effects within 8 weeks is quite impressive. Consequently, Zoloft is known to display its effects towards complete remission of symptoms within 8 to 12 weeks. As such, continuing the dose is necessary for further reduction of symptoms. Increasing the dose will lead to adverse effects as a result of increased plasma levels (Walkup, 2017). Consequently, changing the regimen to another drug will only lead to complications and new adverse effects.

Expected Outcome

            Within four weeks, complete remission of the patient’s symptoms is expected. He should not feel sad at all and interact with peers freely at school. His appetite should be better with no signs of irritability. His scores on the Depression Rating Scale should reduce to less than 10 (Dawson, 2018). Generally, the patient’s symptoms should be completely managed by this time.

Ethical Considerations

The results display a positive outcome from the previous intervention which promotes the patient’s and family member’s trust in the healthcare provider. Trust is very crucial in promoting healthcare outcomes as it helps with patient commitment and adherence to the treatment plan (Dawson, 2018). As such, the patient parents will agree quite easily towards the next intervention made by the clinician.

Conclusion

            Depression among minors has been growing over the past decade globally. As a result, most researchers are currently focusing on clinical trials on the safety and effectiveness of several medications for the management of this condition. With consideration of evidence-based practice in the current healthcare system, clinicians are required to choose the safest and effective medication, based on evidence when coming up with a treatment plan. In the provided case scenario of the African American child who is suffering from depression, the introduction of a starting dose of an SSRI, such as Zoloft was necessary, given the amount of evidence supporting the drug’s safety profile and effectiveness (Leichsenring et al., 2021). Despite the drug not showing any result within the first 4 weeks, it was necessary to increase the dose from 25mg to 50 mg, following the patient’s tolerance to the medication. At this point, the patient was able to exhibit a 50% reduction in symptoms, which would be considered an adequate trial of antidepressant effectiveness. As such, continuing the dose would be necessary for another 4 weeks for optimum results and complete remission of the symptoms. Consequently, ethical considerations were encountered when taking care of the patient. For instance, the patient’s mother was involved in making all the treatment decisions given that the patient is a minor. She was informed of the treatment options available and both their positive and negative outcome before any decision was made.

References

Dawson, R. S. (July 01, 2018). Depression in children and adolescents: The pediatrician at the front lines. Pediatric Annals, 47, 7.) https://doi.org/10.3928/19382359-20180618-01

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Leichsenring, F., Luyten, P., Abbass, A., Rabung, S., & Steinert, C. (January 01, 2021). Treatment of depression in children and adolescents. The Lancet. Psychiatry, 8, 2, 96-97. DOI: https://doi.org/10.1016/S2215-0366(20)30492-2

Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (January 01, 2019). Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. The Journal of Pediatrics, 206, 256-267. https://doi.org/10.1016/j.jpeds.2018.09.021Top of Form

Pile, V., Shammas, D., & Smith, P. (January 01, 2020). Assessment and treatment of depression in children and young people in the United Kingdom: Comparison of access to services and provision at two-time points. Clinical Child Psychology and Psychiatry, 25, 1, 119-132. https://doi.org/10.1177/1359104519858112

 

Walkup, J. T. (May 01, 2017). Antidepressant efficacy for depression in children and adolescents: Industry- and NIMH-funded studies. American Journal of Psychiatry, 174, 5, 430-437. https://doi.org/10.1176/appi.ajp.2017.16091059

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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.

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.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

By Day 7

Submit your Assignment.

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Week 4 Assignment

NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders

Name:  Assignment Rubric

  Excellent Good Fair Poor
Summarize your interpretation of the frequency data provided in the output for respondent’s age, highest school grade completed, and family income from prior month. 32 (32%) – 35 (35%)

The response accurately and clearly explains, in detail, a summary of the frequency distributions for the variables presented.

The response accurately and clearly explains, in detail, the number of times the value occurs in the data.

The response accurately and clearly explains, in detail, the appearance of the data, the range of data values, and an explanation of extreme values in describing intervals that sufficiently provides an analysis that fully supports the categorization of each variable value.

The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the areas described.

28 (28%) – 31 (31%)

The response accurately summarizes the frequency distributions for the variables presented.

The response accurately explains the number of times the value occurs in the data.

The response accurately explains the appearance of the data, the range of data values, and explains extreme values in describing intervals that provides an analysis which supports the categorization of each variable value.

The response includes relevant, specific, and accurate examples that support the explanations provided for each of the areas described.

25 (25%) – 27 (27%)

The response inaccurately or vaguely summarizes the frequency distributions for the variables presented.

The response inaccurately or vaguely explains the number of times the value occurs in the data.

The response inaccurately or vaguely explains the appearance of the data, the range of data values, and inaccurately or vaguely explains extreme values.

An analysis that may support the categorization of each variable value is inaccurate or vague.

The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the areas described.

0 (0%) – 24 (24%)

The response inaccurately and vaguely summarizes the frequency distributions for the variables presented, or it is missing.

The response inaccurately and vaguely explains the number of times the value occurs in the data, or it is missing.

The response inaccurately and vaguely explains the appearance of the data, the range of data values, and an explanation of extreme values, or it is missing.

An analysis that does not support the categorization of each variable values is provided, or it is missing.

The response includes inaccurate and vague examples that do not support the explanations provided for each of the areas described, or it is missing.

Summarize your interpretation of the descriptive statistics provided in the output for respondent’s age, highest school grade completed, race and ethnicity, currently employed, and family income from prior month. 45 (45%) – 50 (50%)

The response accurately and clearly summarizes in detail the interpretation of the descriptive statistics provided.

The response accurately and clearly evaluates in detail each of the variables presented, including an accurate and complete description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

40 (40%) – 44 (44%)

The response accurately summarizes the interpretation of the descriptive statistics provided.

The response accurately explains evaluates each of the variables presented, including an accurate description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.

35 (35%) – 39 (39%)

The response inaccurately or vaguely summarizes the interpretation of the descriptive statistics provided.

The response inaccurately or vaguely evaluates each of the variables presented, including an inaccurate or vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data.

0 (0%) – 34 (34%)

The response inaccurately and vaguely summarizes the interpretation of the descriptive statistics provided, or it is missing.

The response inaccurately and vaguely evaluates each of the variables presented, including an inaccurate and vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data, or it is missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3 (3%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 2 (2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3 (3%) – 3 (3%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 (0%) – 2 (2%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

0 (0%) – 2 (2%)

Contains many (≥ 5) APA format errors.

Total Points: 100

Name:  Assignment Rubric

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