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NURS 6630 Case Study An African American Child Suffering From Depression

NURS 6630 Case Study An African American Child Suffering From Depression

Pediatric Depression Therapy

Depression among children and adolescents is a developing concern in public healthcare systems. Depression has a long-lasting psychological influence on the patient as a result of its early beginning. The consequences have a detrimental effect on the child’s development in terms of social interactions, emotional development, cognitive development, and academic accomplishment (Ghandour et al., 2019). Additionally, this has a negative influence on the child’s everyday functioning, communication, and in rare cases, the child develops suicidal ideas. Depression symptoms and diagnosis in such patients are extremely hard, since they frequently overlap with changes that occur during the child’s developmental phases. However, significant milestones in the development of the diagnosis process for this group of individuals have occurred. It focuses on screening questions that are critical in the evaluation process. This method employs an interviewing technique that has aided the PMHNP in obtaining more accurate and reliable diagnoses of depression in children and adolescents. Particularly for youngsters, the interview questions are handled by the child’s caretakers, parents, or instructors (Ghandour et al., 2019).

It is critical for the PMHNP to receive an accurate diagnosis in order to design a treatment protocol and appropriate medications for the patient. Correct diagnosis also enables the PMHNP to determine the extent of the depression’s influence and to counsel parents and caregivers on health promotion strategies. Additionally, the nurse must prescribe medications based on their efficacy, indications and contraindications, as well as the interactions between the numerous pharmaceutical regimens employed. The PMHNP will monitor the patient’s development and, if necessary, will prescribe a number of medications in conjunction with behavioral psychotherapy. The purpose of this study is to examine the case of an 8-year-old African-American kid who suffers from severe depression, the course of treatment, and the outcome evaluation. When prescribing the optimum course of medication for a patient, factors such as the patient’s age and degree of depression must be addressed.

Why Select Zoloft 25mg Oral Daily Dose?

NURS 6630 Case Study An African American Child Suffering From Depression

NURS 6630 Case Study An African American Child Suffering From Depression

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Results from studies reveal that Zoloft is an effective SSRI. The drug is also referred to as sertraline and is classified as an anti-depressant that works on the principle of inhibition of the selective uptake of serotonin. The diagnosis of the patient shows the patient has a score of 30 based on the Children’s Depression Rating Scale (Dwyer & Bloch, 2019). Therefore, the patient has intense depression that requires medication treatment option using an effective SSRI like Zoloft. It is the prescribed medication for most of the depressive disorders.  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 Case Study An African American Child Suffering From Depression

Why other two options were not selected?

Paxil 10mg was not considered for this case in point because the patient has a young age of the patient and also the drug is known to have several side effects critical among them being the fact that it increases the patients feeling towards committing suicide (Paroxetine: MedlinePlus Drug Information, n.d.). Wellbutrin could not be considered because it can only be used if the first option of SSRI such as Zoloft fails to reduce the depressive symptoms in the patient. Therefore, this makes Zoloft as the best option for the treatment of the patient.

What is the expected outcome on making this decision?

25mg of Zoloft is aimed at reducing the patient’s depressive condition, improving the patient’s feelings for self and social interactions (Neavin, Joyce, & Swintak, 2018). The drug is also expected to improve the patient’s concentration within a period of two weeks. The patient’s appetite is expected to improve by the end of the third week and also reduced irritation Additionally, the patient will have improved the relationship with the classmates and the withdrawal symptoms will have subsided significantly at the end of the fourth week. NURS 6630 Case Study An African American Child Suffering From Depression

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).

Why other two options were not selected?

It is recommended that if the first dosage of Zoloft is not effective, the dosage should be doubled or change the type of anti-depressant used. However, it is strongly recommended to use the same type of drug especially if the reason for the initial dose not being effective is not known. The increased dosage is likely to mount greater stimulation for release of serotonin. Therefore, this makes the dosage of 50mg of Zoloft the best option at the moment.

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 and improve his social interactions.

Expected Vs. Actual Results

On the second visit to the health facility, after period of four weeks, the patient’s state had improved by 20%.  This was just as the expectation for the patient’s situation to improve by 20% The patient demonstrated tolerance to the drug which was not much expected. However, the general outcome on the patient’s situation was just as it was expected to be. This can also be attributed to the fact that Zoloft is associated with late improvement in depression patients.

Decision Point 3

Change to a different SSRI

Why take this decision?

At the end of the eight weeks still the result from use of Zoloft are not satisfactory. It has only improved the patient’s symptoms by 20%. Studies on use of anti-depressants to alleviate depression recommends the change of drug to realize improvement especially if the patient’s condition does not improve significantly if the dosage of the initial drug was doubled. Alternatively, the PMHN can also recommend combination of the first and second medication. For this case in point, given that Zoloft has not shown much impact it is advisable to switch to another anti-depressant.

Why the other options were not selected?

The option of maintaining the same dosage cannot be taken because the patient has not shown any significant improvement. Additionally, increasing the dosage is not recommended because it has already been done at decision two and the results we not substantial. Therefore, this makes the decision of changing the drug the best option available.

What is the expected outcome on making this decision?

The option of changing the drug is consistent with the standard course of action when using anti-depressant medication. The fact that the patient had been given the maximum dosage of Zoloft but no substantial improvement, it is prudent enough to change the anti-depressant. Various studies reveal different individual react to the anti-depressant used in different ways (Cuijpers et al., 2019). One antidepressant could prove to be more effective than the other one on an individual and vice versa. Therefore, it is imperative for the PMHN to change the drug if the one in use currently does not yield significant result. This is expected to yield better results for the patient.

How Ethical Considerations Might Impact Your Treatment Plan Communication with the patient

The use of anti-depressants has been challenging because of the complications attached to it. The Federal Drug Agency (FDA) has done several studies on the use of anti-depressants and it has revealed that they are significant side effects of suicidal tendencies especially among the youth 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.

Conclusion

The cases of depression in children and adolescents calls for well thought and planned psychopharmacological intervention. The condition has greater effects on the development of the children. It negatively impacts the social interactions, emotional and academic progress of the child. The impact further impacts on the communication skills of the patient and could affect the child’s ability to develop long lasting relationship. The child’s interactions with community and family is also greatly hindered by the depression disorder. The intervention measures taken depend on the extent of the depression of the patient. It is possible to intervene by use of therapies like the cognitive behavioral therapy, interpersonal psychotherapy and mindfulness cognitive therapy if the patient is experiencing low or mild depression. However, for patients with significant depression, it is recommended to have both the therapies and use of medication treatment. The use of medication therapy employs the mechanism of selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Wellbutrin and Zoloft. These drugs function differently on various patients. Therefore, if one drug does not have significant impact on the patient it is recommended to change to another anti-depressant. This informs why for the case in point the decision three involved the change of drug to help the patient recover from depression.

References

Cuijpers, P., Quero, S., Dowrick, C., & Arroll, B. (2019). Psychological Treatment of Depression in Primary Care: Recent Developments. Current Psychiatry Reports, 21(12). https://doi.org/10.1007/s11920-019-1117-x

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for Pediatric Patients. Current Psychiatry, 18(9), 26–42F. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738970/

Ehmke, R. (2018, August 16). Treatment for Depression. Child Mind Institute; Child Mind Institute. https://childmind.org/article/treatment-for-depression/

Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. The Journal of Pediatrics, 206, 256-267.e3. https://doi.org/10.1016/j.jpeds.2018.09.021

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. https://www.ncbi.nlm.nih.gov/pmc/articles/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

Paroxetine: MedlinePlus Drug Information. (n.d.). Medlineplus.Gov. https://medlineplus.gov/druginfo/meds/a698032.html

Name:  Discussion Rubric

  Excellent

90–100

Good

80–89

Fair

70–79

Poor

0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Cited with fewer than two credible references.

0 (0%) – 30 (30%)

Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.

Main Posting:

Writing

6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 3 (3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.

7 (7%) – 7 (7%)

Posts main Discussion by due date.

0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

First Response:

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

Second Response:
Writing
6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation
5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name:  Discussion Rubric

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