(Solution) NURS 6630 Week 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

 

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

  •  Client complained of feeling “sad”
  •  Mother reports that teacher said child is withdrawn from peers in class
  •  Mother notes decreased appetite and occasional periods of irritation
  •  Client reached all developmental landmarks at appropriate ages
  •  Physical exam unremarkable
  •  Laboratory studies WNL
  •  Child referred to psychiatry for evaluation

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

Decision Point One

Begin Zoloft 25 mg orally dailyBegin Zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  No change in depressive symptoms at all

Decision Point Two

Increase dose to 50 mg orally daily

RESULTS OF DECISION POINT TWO

  •  Client returns to clinic in four weeks
  •  Depressive symptoms decrease by 50%. Cleint tolerating well

Decision Point Three

Maintain current DOSE

Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.

 

 

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.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632).All papers submitted must use this formatting.

By Day 7

Submit your Assignment.

Solution:

Assessing and Treating Pediatric Clients with Mood Disorders

Case Summary

Mood disorders among the pediatric population remain a critical health concern. Undiagnosed mood conditions may increase the risk of developing other related mental disorders such as disruptive behaviors and substance use disorders. As it is evident in this case, children and teens with mood disorders do not always demonstrate similar symptoms seen in adults. The case involves an 8-year-old African American boy child who complains of feeling “sad”. The accompanying mother mentioned that the child is withdrawn from his peers in the class. The mother also reports decreased appetite and regular episodes of irritation. The child had reached all the developmental Stages in the respective ages. Upon physical assessment, the patient is alert and oriented. The speech is clear and coherent.  The patient is goal-directed and spontaneous. However, the self-reported mood is “sad”.  The patient’s affect is blunted though she smiled several times during the clinical interview. The patient denies having experienced any visual or auditory hallucinations. Similarly, there are no paranoid and delusional thought processes.  Regarding judgment and insight, the patient is age-appropriate.  He denies any suicidal thoughts. However, he agrees to have thought about how it would be like to sleep and never wake up again. Later after subjecting the patient to the depression core scale, the patient scored a 30 score and thus confirming the presence of mild depression. The Children’s Depression Rating Scale-Revised is a common instrument for the assessment of depressive symptomatology among minors(Stallwood et al., 2020). One of the key factors that might influence my decision while when prescribing medication is persistent sadness. The unending feelings of sadness can be disruptive and may affect adherence. Also, the patient’s suicidal ideation is a major risk factor that might exacerbate the condition.

Decision #1 

The available options include Sertraline 25mg by mouth daily, Wellbutrin 75mg by mouth 2x/daily, and Sertraline 25mg by mouth daily. Out of these options, I chose Sertraline 25 mg by mouth daily. Sertraline is one of the most effective drugs in treating depression among the teen. According to Dwyer, & Bloch (2019), Selective serotonin reuptake inhibitors (SSRIs) are the most effective antidepressants for bothadults and children. Although there lacks sufficient testing in randomized control trials for the Sertraline 25 mg pediatric indications. I did not consider Paxil as it is attributed to sizable drug interactions and medication side effects.  I am recent Canadian epidemiological study, paroxetine(Paxil) was found to consist 620% increase in risk for suicidality, aggression, and akathisia in children and adolescents Nevels, Gontkovsky, & Williams, 2016). Out of all antidepressants, Paroxetine consists of the highest inhibitory constant for the isoenzyme. Additionally, research findings have demonstrated the capability of Paxil in increasing the levels of neuroticism why lowering the levels of extraversion symptoms in depression. The patient is already sensitive to anger and has negative thoughts include suicidal ideation. Wellbutrin has shown higher tolerance and thus a good alternative therapy for depression. However, there is little or no evidence for its effectiveness and safety in the pediatric population. However, a study was done by Kweon, and Kim, (2019), discovered that Forty-six active patient-participants discontinue bupropion before 12 weeks due to adverse physical events and poor effectiveness respectively.  I am hoping to get a maximum reduction of symptoms that were not previously achieved.

Finally the prescribing of antidepressant medication to minors is often restricted due to various ethical implications. Hence, I would ensure that the mother and the child know the risks, short-term and long-term effects of this drug.

Decision # 2

The available option includes Prozac 10 mg oral daily, Sertraline 35.5mg by mouth, and Sertraline 50 mg by mouth per day. I would prescribe Sertraline 50 mg. Sertraline remains to be the first-line drug for major depressive disorders. The good thing is that Sertraline is readily available in 25 mg, 50 mg, 100 mg, and even a solution from 20mg/ml. Adjusting the dose from 25mg to 50 mg will increase theSertraline’s mechanism of action and hence make it more….Please click the icon below to purchase full answer at only $15