NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
The patient in this case study is an African-American child who was admitted to the healthcare facility with his mother. The youngster is exhibiting signs of depression. Among the claimed symptoms are withdrawal, decreased appetite, and a tendency to become enraged at the slightest provocation (Laureate Education, 2016). However, the patient is in good physical health and has normal laboratory results. Additionally, the patient completed all developmental stages at the right age, indicating the necessity for additional assessment of the patient’s psychological health.
Additional analysis reveals that the patient has gloomy feelings and is constantly thinking about death and what it will be like once he dies. He does not, however, condone suicide and has no plans to do so. The patient is depressed during the interview, yet he does occasionally grin normally (Laureate Education, 2016). The goal of this study is to discuss a feasible treatment strategy for the patient. The plan is organized around a decision tree, with an emphasis on effective communication with the patient and adherence to all applicable ethical norms.
Decision Point 1
Begin Zoloft 25 mg orally daily
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). NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
What is the expected outcome on making this decision?
NURS 6630 Assignment Assessing and Treating Pediatric Patients With Mood Disorders
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.
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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