NURS 6630 Week 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders
NURS 6630 Week 4 Assignment. 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Mother reports that teacher said child is withdrawn from peers in class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 daily Begin 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. NURS 6630 Week 4 Assignment
NURS 6630 Week 4 Assignment Answer
Assessing and Treating Pediatric Clients with Mood Disorders
Mood disorders in pediatric patients are a significant concern as they can lead to the development of related mental disorders, such as disruptive behaviors and substance use disorders. Children and adolescents with mood disorders may not exhibit the same symptoms as adults. In this case, we have an 8-year-old African American boy who complains of feeling “sad,” with his mother noting that he is withdrawn from his peers, has a decreased appetite, and experiences regular episodes of irritation. Despite reaching developmental milestones appropriate for his age, the child’s self-reported mood is consistently “sad.” His affect is blunted, though he occasionally smiles. There are no reports of visual or auditory hallucinations, paranoid or delusional thoughts. His judgment and insight are age-appropriate, and he denies suicidal thoughts but admits to having thought about not waking up again. A depression score of 30 on the Children’s Depression Rating Scale-Revised confirms the presence of mild depression (Stallwood et al., 2020).NURS 6630 Week 4 Assignment
One key factor influencing my decision when prescribing medication is the persistent sadness experienced by the patient, which may impact adherence. Additionally, the presence of suicidal ideation is a significant risk factor that must be addressed.
Decision #1
The available treatment options include Sertraline 25mg by mouth daily, Wellbutrin 75mg by mouth twice daily, and Sertraline 25mg by mouth daily. I have chosen Sertraline 25 mg by mouth daily. Sertraline is recognized as one of the most effective drugs for treating depression in children and adolescents (Dwyer & Bloch, 2019). Selective serotonin reuptake inhibitors (SSRIs) like Sertraline are considered the most effective antidepressants. While there may be limited randomized controlled trial evidence specifically for the use of Sertraline at 25 mg in pediatric cases, it is a well-established choice for adolescent depression. Paxil was not considered due to its significant drug interactions and side effects, as it was found to increase the risk of suicidality, aggression, and akathisia in children and adolescents (Nevels, Gontkovsky, & Williams, 2016). Moreover, it has been linked to increased neuroticism and decreased extraversion in depression. Wellbutrin, while tolerated well, lacks substantial evidence for its effectiveness and safety in the pediatric population, with some studies indicating discontinuation due to adverse events and poor effectiveness (Kweon & Kim, 2019). My goal is to achieve maximum symptom reduction.NURS 6630 Week 4 Assignment
Prescribing antidepressant medication to minors is ethically complex. Therefore, I will ensure that both the mother and the child understand the potential risks and short- and long-term effects of this medication.NURS 6630 Week 4 Assignment
Decision #2
The available options include Prozac 10 mg oral daily, Sertraline 35.5 mg by mouth, and Sertraline 50 mg by mouth per day. My choice is to prescribe Sertraline 50 mg. Sertraline remains a first-line treatment for major depressive disorders. The advantage is that Sertraline is available in various doses and even as a solution, making it versatile in adjusting the dose according to the patient’s needs (Jayaram et al., 2020).
I anticipate that increasing the Sertraline dose from 25 mg to 50 mg will enhance its mechanism of action and potentially lead to more effective management of the patient’s depression.
References:
Dwyer, J. B., & Bloch, M. H. (2019). Antidepressant Medications in Children and Adolescents. In Advances in Clinical Child and Adolescent Psychiatry (pp. 221-235). Springer.
Jayaram, G., Jayaram, S., & Muralidharan, K. (2020). Child and Adolescent Psychiatry. In Textbook of Psychiatry for Southern Africa (pp. 89-107). Springer.
Kweon, H. R., & Kim, H. G. (2019). Adverse events related to bupropion prescribed in psychiatric outpatient settings: A single-center naturalistic study. Psychiatry Investigation, 16(9), 660-666.
Nevels, R. M., Gontkovsky, S. T., & Williams, B. E. (2016). Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required. Neuropsychiatric Disease and Treatment, 12, 825-833.
Stallwood, E., Perepletchikova, F., Axelrod, S. R., & Lindhiem, O. (2020). Parent Perspectives on Barriers to Medication Adherence in Pediatric Anxiety and Depression. The Journal of Nervous and Mental Disease, 208(11), 889-897.
