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[ANSWERED] 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

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, but they `wq`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:

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.

Expert Answer and Explanation

Decision Tress for Depression

Introduction to the Case

The assigned case is about an 8-year-old African American male brought to the emergency room by his mother. The patient was checked by health professionals at the emergency room and the caregivers found that he is showing signs of depression. the client noted that he is feeling sad. His mother also notes that the boy’s teacher observed and reported that the client is not active in school. He is withdrawn from classmates in school. He sometimes shows signs of irritation and his appetite has decreased significantly. Based on his physical appearance, the boy reached all his developmental milestones at proper ages. Physical examination shows that the patient has no medical problem. His laboratory tests show that his physical health is within normal limits. The patient was referred to a psychiatrist for a psychiatric evaluation.

During the psychiatric evaluation, the patient underwent mental status exam. the results show that he has clear speech, goal-directed, alert, and spontaneous. The exam also shows that is oriented and knows where he is, what time it is, and who I am. He reports that he feels das. He has blunted affected but was seen smiling properly at some points during the interview process. The patient notes that he has no auditory or visual hallucinations. He also denies being delusional and says that he is not paranoid. His insight and judgment match his age. He denies suicidal thoughts. However, he notes that normally thinks of what it is to be dead and often thinks of himself as a dead person. I administered the Children’s Depression Rating Scale and the child scored 20, showing that he has depression. The purpose of this paper is to discuss appropriate medication to help the patient achieve a healthy mental state. 

Decision One

Subjective and objective assessment and mental status exam show that the patient has MDD. As a result, my first decision is the patient starts Zoloft 25mg orally daily. I have selected this medication for many reasons. One of the reasons is that the medication is a Selective Serotonin Re-uptake Inhibitor (SSRI). According to Womersley et al. (2017), SSRIs are first-line medication for the treatment of the major depressive disorder, and thus should be used as the first therapy plan for patients diagnosed with MDD. I have also selected the medication because it is supported by Guo et al. (2019). Guo et al. (2019) conducted a study and found that Zoloft is an effective medication for treating people with MDD. Lastly, I selected this decision because the medication was found to be highly effective in treating MDD patients by Fann et al. (2017). The authors conducted a randomized, double-blind, placebo-controlled trial and found that MDD patients can recover by taking Zoloft for 12 weeks.

I did not select Paxil to treat the patient because it is not safe and is more likely to cause cardiovascular problems. A study conducted by Guo et al. (2019) found that Zoloft has fewer cardiovascular side effects compared to Paxil. I did not choose Wellbutrin because it does not belong to the SSRI class. I also avoided Wellbutrin because it causes side effects, such as seizures, headaches, and difficulty concentrating (Reddyn et al., 2020). I hoped to improve the patient’s mental state by 50% in four weeks (Fann et al., 2017). The treatment plan, in this case, might be affected by informed consent. Healthcare professionals are ethically and legally obligated to seek informed consent from their clients before prescribing medications to them (Akyüz et al., 2019). 

Decision Two

After four weeks, the patient came for follow-up treatment. The patient reported that his depression symptoms had not changed. As a result, I decided that the patient’s current dose should be increased to 50mg orally daily. This decision is supported by Hieronymus et al (2016). The authors note that 50mg Zoloft dosage can be used to improve the mental health of people with mental problems, such as depression. The authors recommend that sertraline 50mg, citalopram 10-20mg, and paroxetine 10mg can be effective in treating mental disorders. The authors also found that the efficacy of medications is not related to the dosage. They also say that there is no relationship between the medication dose and its response to disease. In that regard, the dosage of drugs is highly linked to the individual patient being treated.

I avoided increasing the dosage to 37.5mg orally a day because 50mg was likely to provide better treatment results (Hieronymus et al., 2016). I also avoided changing medications to Fluoxetine because the patient had not reported any side effects of Zoloft. According to Womersley et al. (2019), Zoloft is a better choice compared to Fluoxetine when it comes to the patient’s cardiovascular safety. I made this decision with the hope that the medication would improve the mental health of the patient by 50% (Fann et al., 2017). The ethical consideration that would impact the treatment, in this case, is beneficence and non-maleficence. This ethical principle requires nurses to balance the treatment benefits against the cost and risks involved and non-maleficence needs nurses not to harm patients knowingly or unknowingly (Dimitrios et al., 2018). Increasing the dosage to 50mg orally daily is more beneficial to the patient compared to changing the medication to Fluoxetine. The drug is less likely to harm the patient.  

Decision Three

The patient returned after four weeks for follow-up care. A mental health assessment during the third visit shows that the patient’s symptoms have decreased by 50% and the client has not complained of any side effects indicating that he is responding well to treatment. I made this decision because 50mg Zoloft daily has achieved minimum effectiveness. According to Ng et al. (2017) note that when prescribing medication, caregivers should start with a low dose and gradually increase the dose until a minimum effect is reported and the patient responds well to the dosage. I started with 25mg Zoloft and increased it to 50mg after four weeks. The patient reported positively to the initial dosage, and thus it should be maintained and assessment is done after another four weeks. I also selected the decision because the FDA recommends that 50mg Zoloft can be prescribed to children with mental problems (Womersley et al., 2019).

I avoided the second decision because my decision is most effective. The patient’s symptoms reduced by 50% after taking Zoloft 50mg orally daily. I also avoided the third decision because SNRI is not the first-line treatment for depression. Caregivers should always consider SSRI as their first choice for treating depression (Womersley et al., 2019). I hoped that the patient would completely heal after another four weeks of taking Zoloft 50mg orally daily. The ethical consideration that guided my decision, in this case, is beneficence and non-maleficence. I did not increase the dosage to 75mg daily because it might harm the patient considering he is a child. I also ensured that I have not harmed the patient by prescribing the medication. 

Conclusion

After Children’s Depression Rating Scale showed that the patient has depression the first medication I recommended is that the patient starts Zoloft 25mg orally daily. I decided because the drug is an SSRI. According to Womersley et al. (2017), SSRIs are first-line medication for the treatment of a major depressive disorder, and thus should be used as the first therapy plan for patients diagnosed with MDD. I also selected the medication because it is supported by Guo et al. (2019). Guo et al. (2019) conducted a study and found that Zoloft is an effective medication for treating people with MDD. The patient returned to the clinic and noted that there was no change in depressive symptoms.

Hence, I recommended that the patient’s current medication be increased to 50mg orally daily. This decision is supported by Hieronymus et al (2016). The authors note that 50mg Zoloft dosage can be used to improve the mental health of people with mental problems, such as depression. The patient returned after four weeks for a check-up and reported that the signs have reduced by 50%. Hence, I recommended that the current medication be maintained because the minimal effect has been achieved. According to Ng et al. (2017) note that when prescribing medication, caregivers should start with a low dose and gradually increase the dose until a minimum effect is reported and the patient responds well to the dosage.

References

Akyüz, E., Bulut, H., & Karadağ, M. (2019). Surgical nurses’ knowledge and practices about informed consent. Nursing Ethics, 26(7-8), 2172-2184. https://journals.sagepub.com/doi/abs/10.1177/0969733018810767

Dimitrios, T., Antigoni, F., & Kotrotsiou, S. (2018). Ethics and deontology in nursing research: A discussion paper. International Journal of Caring Sciences, 11(3), 1982-1989. https://www.researchgate.net/profile/Kotrotsiou-Stiliani-2/publication/344321160_Special_Article_Ethics_and_Deontology_in_Nursing_Research_A_Discussion_Paper/links/5f676ea892851c14bc899bef/Special-Article-Ethics-and-Deontology-in-Nursing-Research-A-Discussion-Paper.pdf

Fann, J. R., Bombardier, C. H., Temkin, N., Esselman, P., Warms, C., Barber, J., & Dikmen, S. (2017). Sertraline for Major Depression During the Year Following Traumatic Brain Injury: A Randomized Controlled Trial. The Journal of Head Trauma Rehabilitation32(5), 332–342. https://doi.org/10.1097/HTR.0000000000000322

Guo, S., Chen, L., Cheng, S., & Xu, H. (2019). Comparative cardiovascular safety of selective serotonin reuptake inhibitors (SSRIs) among Chinese senile depression patients: A network meta-analysis of randomized controlled trials. Medicine98(22), e15786. https://doi.org/10.1097/MD.0000000000015786

Hieronymus, F., Nilsson, S., & Eriksson, E. (2016). A mega-analysis of fixed-dose trials reveals dose-dependency and a rapid onset of action for the antidepressant effect of three selective serotonin reuptake inhibitors. Translational psychiatry6(6), e834-e834. https://doi.org/10.1038/tp.2016.104

Ng, C. W., How, C. H., & Ng, Y. P. (2017). Managing depression in primary care. Singapore Medical Journal58(8), 459–466. https://doi.org/10.11622/smedj.2017080

Reddy, K., Kher, S., & Kathuria, H. (2020). Prescription medications to help you stop smoking. American Journal of Respiratory and Critical Care Medicine201(6), P11-P12. https://www.atsjournals.org/doi/pdf/10.1164/rccm.2016P11

Womersley, K., Ripullone, K., & Agius, M. (2017). What are the risks associated with different Selective Serotonin Re-uptake Inhibitors (SSRIs) to treat depression and anxiety in pregnancy? An evaluation of current evidence. Psychiatr Danub29(Suppl 3), 629-44. http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol29_noSuppl%203/dnb_vol29_noSuppl%203_629.pdf

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