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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

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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

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS:  NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders

            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.

NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders

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

Top of Form

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

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.

Discussion Week 2

Agonist-to-Antagonist Spectrum of Action

Psychopharmacologic drugs have agonist to antagonist effects. A neurotransmitter agonist is a molecule that resembles neurotransmitter action. This is accomplished by attaching to and improving the function of the receptor site. An antagonist blocks neurotransmission to counteract the effects of an agonist. In psychiatric disorders, antagonists are things that cause negative side effects as well as things that help (Camprodon & Roffman, 2016). Full agonists, partial agonists, silent antagonists, and inverse agonists are all part of the agonist-antagonist spectrum (Camprodon & Roffman, 2016).

Compare and contrast the actions of g couple proteins and ion gated channels.

G couple proteins are made up of seven different protein segments that cross the membrane seven times and send signals to neurotransmitter binding sites (Camprodon & Roffman, 2016). This will let the therapeutic effects of the drug happen. When drugs attach to these receptor sites, they stop neurotransmitters from doing their job completely or partly. Neurotransmission can change which enzymes, receptors, or ion channels by affecting the molecular changes. Ion gated channels are electrically controlled, because of their charge, ions cannot cross the membrane, but g-couple proteins can. This means they have the ability to alter the way a cell functions. Ions open and close neuronal channels. Neurotransmitters can open ion channels depending on the type. The agonist spectrum allows you to compare ion channels and G-protein-coupled receptors. G couple proteins and ion gated channels are both types of protein receptors that bind to molecules and are built into cell membranes. In contrast to drugs that target g protein-linked receptor sites, which take longer to work, medicines that change the flow of ions can have an immediate clinical effect.

Explain how the role of epigenetics may contribute to pharmacologic action.

Epigenetics is a separate system that controls whether a gene makes its own RNA and protein, is ignored, or is turned off. Drugs are being made and tested to restore gene activity in diseases like those caused by stress, cancer, and inflammation. Epigenetics can be used to treat addiction, help people deal with anxiety, and stop people from getting chronic pain (Kaliman, 2019).

How information impacts prescribing medications

When a client is diagnosed with major depression, for example, the psychiatric nurse practitioner must understand how the medication works. The drug prescribed to treat MDD was sertraline, which is a selective serotonin reuptake inhibitor (SSRI).  You must inform the patient of all side effects and dosage instructions as a psychiatric nurse practitioner. Because sertraline has a slow onset of action, the time required to feel better should have been discussed. In the antidepressant medication class, serotonin acts as an agonist by increasing serotonin production at all serotonin receptors (Camprodon & Roffman, 2016). Patients feel and sleep better as a result. Safety and efficacy should be the top priorities regardless of the type of medication provided. The nurse practitioner is in charge of determining how well the medication works. When taking multiple medications, this is important to preventing unwanted side effects and to help the patient achieve the intended therapeutic benefit.

 

References:

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating

pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F.

Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier.

Kaliman, P. (2019). Epigenetics and meditation. Current Opinion in Psychology, 28, 76–80.

https://doi-org.ezp.waldenulibrary.org/10.1016/j.copsyc.2018.11.010

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