Case Study On Assessing and Treating Patients with Pediatric Disorders

Case Study On Assessing and Treating Patients with Pediatric Disorders

Case Overview

An 8-years old American male arrives at the emergency department presenting with feeling sad, withdrawing from his peers in class, decreased appetite, and occasional periods of irritation. His mental state examination shows that he is in a sad mood and with blunted affect. However, his developmental milestones are appropriate for his age. The physical examination is unremarkable and the laboratory studies are within the normal range. The Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression) Case Study On Assessing and Treating Patients with Pediatric Disorders

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Depressive Mood Disorder

Depression is a mood disorder is a mental health disease that causes psychomotor retardation, loss of emotional expression, and agitation, affecting interpersonal relationships and work output. The annual depression incidence rate has increased by 1.2% over the last two years, with 6.4% affecting children from 6-17years. Causes of depression in children are loneliness in children, poor parenting styles, bereavement, negative life events, genetic vulnerability, family history of depression, and biochemical disturbance (Spruit, et al, 2020). Depression symptoms are changes in appetite, sleep disturbances, continuous feelings of sadness, difficulties in concentration, fatigue, low energy, irritability or anger, difficulties in concentration, feeling of worthlessness, social withdrawal, loss of interest and pleasures, increased sensitivity to rejection, and reduced ability to function to during events. The American psychiatric association diagnostic criteria for depression include the depressive mod, loss of interest, sleep disturbance, psychomotor fatigue, loss of concentration, and recurrent thoughts. The patient meets the criteria for depressive mood. This paper describes three decisions for treating a child with depression.

Decision One

1. Which decision did you select?

Begin Zoloft 25mg once daily

2. Why did you select this decision?

Zoloft is an antidepressant, selective serotonin reuptake inhibitor FDA approved for treating depressive mood disorder, social anxiety, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder (Cherukupally, et al, 2020). Zoloft has little affinity for alpha-adrenergic and histamine receptors, thus playing a role in regulating mood, personality, and wakefulness. Zoloft has increased bioavailability when taken together with food and has a plasma half-life of 26hours. Its common side effects are fatigue, drowsiness, dizziness, and somnolence. This is the best choice for the patient because it was effective in enhancing the mood and improving the child’s sleep activity. Additionally, it is FDA-approved for children because it is well tolerated and does not prompt suicidal ideation.

3. Why did you not select the other two options provided in the exercise?

Wellbutrin is an antidepressant that inhibits the reuptake of norepinephrine, dopamine receptors, and nicotinic serotonin receptors. It is FDA-approved for adult depression, seasonal affective disorder, and smoking cessation (Foss, et al, 2021). It has a plasma peak time of two hours and duration of action of two days. Its side effects are tachycardia, pharyngitis, dermatological events, seizures, and suicidal ideation. I did not select this drug because of its adverse effects and its long duration of action, it takes two weeks to achieve its effectiveness. Additionally, Wellbutrin is contraindicated in pediatric patients because it increases seizure threshold and increases suicide among children and adolescents. Paxil is a selective serotonin reuptake inhibitor FDA-approved for dysthymia, depressive mood, social anxiety, separation anxiety, and obsessive-compulsive disorder. It has a plasma peak time of 5 hours and a plasma half-life of 21hours (Lacasse, et al, 2021). It has no affinity to the muscarinic, adrenergic, and serotonin receptors. This helps in improving the mood, eating disturbances, and GIT symptoms. I did not select Paxil 10mg because it increases cardiovascular events in children Case Study On Assessing and Treating Patients with Pediatric Disorders.

4. What were you hoping to achieve by making this decision?

The expectations of prescribing Zoloft are to reduce the symptoms like feeling sad, withdrawing from his peers in class, decreased appetite, flat affect, and irritability because it has less affinity to muscarinic and alpha adrenaline receptors, thus improving the mood.

5. Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Ethics are the values that guide nursing practice to ensure effective healthcare services. The nurse incorporates the principle of informed consent and beneficence. Beneficence is the act of kindness to do what is right for a patient. This helps the nurse to use professional communication skills and empathy to address the child with depression. Additionally, the nurse selects a treatment method that relieves symptoms. The nurse must seek permission from the child’s parent before drug administration.

Decision Two

Which decision did you select?

Increased Zoloft to 50mg daily

Why did you select this decision?

The child reports back to the clinic four weeks later feeling better and having symptoms reduced by 20%. The previous dose is effective in relieving the symptoms. However, increasing the dose by 50 will reach the expected treatment outcome.

Why did you not select the other two options provided in the exercise?

Zoloft 37.5mg is not the best option for the patient because there will be no significant effect on the symptoms. The recommendable dose increase is by 25 to 50mg weekly to achieve the desired results. Wang, E. (2022,) Prozac is a selective serotonin reuptake inhibitor FDA approved for depression, anxiety disorder, obsessive-compulsive disorder, and bulimia. I did not select this drug because it associated with an increased risk in suicidal ideation, depression, and anxiety. It takes a longer time before achieving its therapeutic goals.

What were you hoping to achieve by making this decision?

Increasing Zoloft to 50mg increases the concentration of therapeutic efficacy. The expectations are improving the symptoms by 50%.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Nurses consider the principles of beneficence and non-maleficence. Beneficence is the act of kindness for the benefit of the patient. It involves increasing the dosage by 25mg to improve the clinical outcome of the illness. Non-maleficence is avoiding harm by preventing drug adverse effects and complications. The nurse chose to increase the drug dose over switching to other regimen to avoid drug adverse effects

 

 

Decision Three

Which decision did you select?

Maintain the current dose

Why did you select this decision?

Maintaining the current dose of 50mg once daily is the best option for this patient because it will gradually improve the symptoms. The drug has shown its effectiveness by relieving symptoms by 50% Case Study On Assessing and Treating Patients with Pediatric Disorders.

Why did you not select the other two options provided in the exercise?

Increasing the dose to 75mg is not the best option for the patient because it will increase the risk of adverse effects of the drug. Switching to another SSRI is not the best option for the child because Zoloft is the recommendable SSRI for children.

What were you hoping to achieve by making this decision?

This decision expects to ensure full recovery of the symptoms and restore functional mental health. Increasing the dose increase the therapeutic concentration of the drug.

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

In this decision, the nurse ensures the patient’s full recovery and restoration of cognitive functions. The nurse considers respect for autonomy by allowing the patient to make decisions on drug continuation and follow-up therapy. The nurse explains to the patient and guardian about the illness, provides the treatment alternatives, and leaves them to make a decision. Autonomy is an ethical principles that enables patients to make informed medical decisions.

Conclusion

Depression is a mood disorder characterized by a change in mood, loss of cognitive functions, irritability, suicidal ideation, and withdrawal. Treatment methods I n depression are the use of antidepressants and psychotherapy sessions. Antidepressants recommendable are SSRI and particularly Zoloft because it well tolerated in children and had no risk for suicidal ideation in small doses. Ethical principles are the moral values that guide nursing practice. Beneficence, autonomy, and consent promote good communication and quality healthcare.

References

Assessing And Treating Pediatrics Patients with Mood Disorder: CASE SCENARIO: The patient is an 8-year-old African American male who arrives at ER with his mother. He is exhibiting signs of depression. The client complained of feeling “sad”. The mother reports that the teacher said the child is withdrawn from peers in class. The mother notes decreased appetite and occasional periods of irritation. The client reached all developmental landmarks at appropriate ages, Physical examination is unremarkable. Laboratory studies are within normal level. The child was referred to psychiatry for evaluation. In this Assignment, 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 therapy process.

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ASSIGNMENT INSTRUCTIONS ARE (1) 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) : Medications: (a) Begin Zoloft 25mg orally daily,(b) Begin Paxil 10mg orally daily (c) Begin Wellbutrin 75 orally BID.
(1) Which decision did you select?
(2) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(3) 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.
(4) What were you hoping to achieve by making this decision? Support your response with evidence and references to the learning resources.
(5) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
DECISION #2 (1 Page):
(a) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(b) 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.
(c) What were you hoping to achieve by making this decision? Support your response with evidence and reference to the learning Resources ( including the primary literature).
(d) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
DECISION #3 (1 page ):
(1) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources including the primary literature.
(2) 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 to the learning resources ( including the primary literature).
(3) 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).
(4) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
SUMMARIZE your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendation and support your response with clinically relevant and specific patient resources including the primary literature.
NOTE: Support your rationale with a minimum of FIVE academic resources. you should be utilizing the primary and secondary literature
NOTE: PLEASE this paper is required to be submitted including a title page, Introduction, Summary, and references. please write clearly without grammar or spelling, or errors using APA writing rules and style.

 References

Cherukupally, K. R., Kodjo, K., Ogunsakin, O., Olayinka, O., & Fouron, P. (2020). Comorbid Depressive and Anxiety Symptoms in a Patient with Myasthenia Gravis. Case Reports in Psychiatry, 2020. https://doi.org/10.1155/2020/8967818

Foss, M. G., Nyckowski, T., & Steffes, W. (2021). Erythrodermic Psoriasis Exacerbated by Bupropion. Cureus, 13(10). doi:10.7759/cureus.1846

Lacasse, J.R., Dunleavy, D.J. & Hughes, S. Psychiatric Prescribing in Child Welfare: Barriers to Evidence-Based Practice and an Agenda for Reform. Child Adolesc Soc Work J (2021). https://doi.org/10.1007/s10560-020-00731-y

Spruit, A., Goos, L., Weenink, N. et al. The Relation Between Attachment and Depression in Children and Adolescents: A Multilevel Meta-Analysis. Clin Child Fam Psychol Rev 23, 54–69 (2020). https://doi.org/10.1007/s10567-019-00299-9

Wang, E. (2022, January). The Controversy Over the Use of Prozac Because of Side Effects. In 2021 International Conference on Public Art and Human Development (ICPAHD 2021) (pp. 128-132). Atlantis Press. https://dx.doi.org/10.2991/assehr.k.220110.025 Case Study On Assessing and Treating Patients with Pediatric Disorders