case study

Samanthah pleaseTherapy for Pediatric Clients With Mood DisordersMood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.Photo Credit: GettyLicense_185239711.jpgAssignment: Assessing and Treating Pediatric Clients With Mood DisordersWhen pediatric clients 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 clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.Learning ObjectivesStudents will:Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clientsAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapyEvaluate efficacy of treatment plansAnalyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clientsLearning ResourcesNote: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.Required ReadingsNote: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.Chapter 6, “Mood Disorders”Chapter 7, “Antidepressants”Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.Review the following medications:amitriptylinebupropioncitalopramclomipraminedesipraminedesvenlafaxinedoxepinduloxetineescitalopramfluoxetinefluvoxamineimipramineketaminemirtazapinenortriptylineparoxetineselegilinesertralinetrazodonevenlafaxinevilazodonevortioxetineMagellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from https://www.magellanprovider.com/media/11740/psychotropicdrugsinkids.pdfRao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171Note: Retrieved from Walden Library databases.Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdfPoznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.Note: Retrieved from Walden Library databases.Required MediaLaureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.Note: This case study will serve as the foundation for this week’s Assignment.Optional ResourcesEl Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497To prepare for this Assignment:Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.The AssignmentExamine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.At each decision point stop to complete the following:Decision #1Which decision did you select?  See below.Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?Decision #2Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Decision #3Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Also include how ethical considerations might impact your treatment plan and communication with clients.BACKGROUND INFORMATIONThe 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 classMother notes decreased appetite and occasional periods of irritationClient reached all developmental landmarks at appropriate agesPhysical exam unremarkableLaboratory studies WNLChild referred to psychiatry for evaluationClient seen by Psychiatric Nurse PractitionerMENTAL STATUS EXAMAlert & 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.The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)RESOURCES§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.Decision Point OneSelect what the PMHNP should do:Begin Zoloft 25 mg orally dailyBegin Paxil 10 mg orally dailyBegin Wellbutrin 75 mg orally BIDCase Study of the above clientDecision Point OneI selected  Zoloft 25 mg orally dailyRESULTS OF DECISION POINT ONEClient returns to clinic in four weeksNo change in depressive symptoms at allDecision Point TwoIncrease dose to 50 mg orally dailyRESULTS OF DECISION POINT TWOClient returns to clinic in four weeksDepressive symptoms decrease by 50%. Cleint tolerating wellDecision Point ThreeMaintain current doseGuidance to StudentAt 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

 
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