NURS 6630 Case Study An African American Child Suffering From Depression
NURS 6630 Case Study An African American Child Suffering From Depression
NURS 6630 Case Study An African American Child Suffering From Depression
Assessing and Treating Pediatric Patients With Mood Disorders
According to theNational Institute of Mental Health,approximately 9% of teenagers from the age of 12 to 17 years have depression disorder in the United States.Ghandour et al., (2019) reported that about 3.2% of African American adolescents presented with suicidal thoughtsin 2018as 1.4%tried to commit. Despite the burden associated with this mental disorder, several treatment options are available to help manage the symptoms and promote the quality of life of children and adolescents with this disorder.
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The assigned case study demonstrates an African American boy child diagnosed with depression. The patient reports symptoms such as irritability, feeling sad, decreased appetite, and withdrawalfrom social gatherings like school. The conducted mental status examination revealed that the patient is suicidal, but has never tried to kill himself. The patient however denies hallucinations and delirium among other psychotic symptoms. Based on clinical practice guidelines and DSM-5 diagnostic criteria,together with a score of 30 on theChildren’s Depression Rating Scale,the patient’s primary diagnosis is depression.
The patient’s age, African American race, and anxiety diagnosis are some of the factors which might affect the choice of drugs for the management of the patient’s symptoms. For instance, most antipsychotic agents are associated with suicidal attempts, among other side effects hence must be monitored closely when use among children and adolescents. Additionally, a study conducted by (Leichsenring et al., 2021) reported that African Americans are more likely tocarry alleles that slow down the metabolism of most antidepressants such as tricyclic antidepressants (TCA), leading to a ‘slowmetabolizer’ phenotype hence higher blood TCA plasma level, in addition to more rapid response. The purpose of this paper is to demonstrate the decision-making process of the most effective medication to include in the patient’s treatment plan, while observing pharmacokinetic and pharmacodynamic factors, in addition to ethical considerations which might impact this care process.
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Decision #1
Selected Decision and Rationale
The initial intervention is to start the patient on Zoloft 25 mg orally once daily. Sertraline belongs to the class of selective serotonin reuptake inhibitors (SSRIs), recommended in national clinical guidelines as the first-line for the management of depression in children and adults (Walkup, 2017).
Considering the patient’s specific factors, Zoloft is the best choice of drug for the management of depressive symptoms displayed by the patient. anxiety symptoms. For instance,most studies recommend the use of sertraline among children as a result of its great effectiveness and desirable safety profile reported by the few conducted clinical trials. The drug acts by inhibiting the central nervous system (CNS) neuronal uptake of serotonin(5HT) (Pile et al., 2020). Among children, the recommended starting dose is 25mg. The drug is absorbed slowly in the GIT with a peak plasma level being attained after 6 to 8 hours, necessary to elicit optimal therapeutic action. Studies have also identified several polymorphisms in genes encoding P-450 isoenzymes (2D6 and 2C19) among African Americans which affect the metabolism of the drug. However, when used in low disease, the drugs have displayed great effectiveness with an appealing safety profile.
Wellbutrin on the other hand is not recommended for children less than 18 years due to evidence deficits in its safety and effectiveness (Ghandour et al., 2019). The drug is also associated with high suicidal incidence, hence not appropriate for this patient as he already displayed symptoms of suicidal ideation. Paxil is also not appropriate for this patient as it is also associated with high suicide incidences as the FDA issued a black box warning for use of the drug among this vulnerable population (Leichsenring et al., 2021). It should only be considered in case there is no other suitable option which in this case is Zoloft as described above.
Expected Outcome
The drug is expected to display at least 50% remission of the patient’s depression symptoms within the next 4 to 8 weeks. As a result, theChildren’s Depression Rating Scalescores are expected to decrease to less than 10 from 30. Only common self-limiting side effects such as dry mouth increased sweating and headache might be expected(Walkup, 2017).
Ethical Considerations
Given that the patient is under the age of 18 years, it will be necessary for the PMHNP to adequately inform the patient’s parents about the available treatment options and their benefits and risks to involve them in decision making concerning the health of their child(Pile et al., 2020). Parents and guardians have legal authority in making healthcare decisions for their children.
Based on the National Institute of Mental Health research outcome, approximately 9% of adolescents between the age of 12 to 17 years are diagnosed with depression yearly (Dawson, 2018). Most patients however ignore the symptoms of depression until when the condition worsens. They end up having comorbidities that affect their quality of life. However, studies reveal that early diagnosis of depression can lead to early treatment which helps in promoting the patient’swell-being. several medications have been proposed by the FDA for the management of patients diagnosed with mood disorders, in addition to psychotherapeutic approaches (Ghandour et al., 2019). The purpose of this paper is to demonstrate the case of an African American male patient diagnosed with depression and the treatment plan recommended for the patient. The pharmacokinetic and pharmacodynamic factors of the patients will be used to inform the decision process on the psychotropic agent to apply in patient management.
In the case at hand, the patient is an African American male aged eight years. He was presented to the facility with depression symptoms. The patient’s informant reported symptoms such as decreased appetite, irritability, sad feeling, and being withdrawn from peers in class. According to the results obtained from the mental status examination, the patient frequently thinks about death and how it feels to be dead. The patient refutes previous suicide contemplation. He equally refutes deliria or visual or auditory fantasy. Based on the examination by the clinician, the patient appears sad and hardly smiles. The patient recorded a score of 30 upon administration of the Children’s Depression Rating Scale. He was thus diagnosed with major depressive disorder. Both pharmacological and psychotherapeutic interventions are recommended for the management of the patient’s condition.
NURS 6630 Case Study An African American Child Suffering From Depression Decision #1
Selected Decision
Initiate patient with Zoloft 25mg orally each day.
Reason for Decision One
Pediatric depression management is often problematic due to safety concerns and side effects emanating from the psychotropic agents. However, through evidence-based practice, selective serotonin reuptake inhibitors such as Zoloft are recommended as the first line for the management of depression among both children and adults (Ghandour et al., 2019). This drug acts by inhibiting the uptake of serotonin(5HT) in the central nervous system. The recommended starting dose among children is 25mg, which can be titrated at intervals of 25 mg weekly depending on the patient’s treatment outcome. Zoloft undergoes first-pass metabolism in the liver with minimal side effects hence great adherence and compliance among most patients.
Paxil is not the best choice at this point, as this drug is not recommended among children as a result of its adverse side effects of increased suicidal incidences (Dawson, 2018). Consequently, the dosage recommendation among children below the age of 10 years is quite complex with this medication.
Wellbutrin on the other hand is also not recommended among patients below the age of 18 years (Leichsenring et al., 2021). Wellbutrin is linked to serious dire effects including suicidal thoughts, anorexia, self-harm, and seizure.
BACKGROUND INFORMATION
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)
RESOURCES
- Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Decision Point One
Select what you should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID
Decision Point One
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
Select what you should do next:
Increase dose to 37.5 mg orally daily
Increase dose to 50 mg orally daily
Change to Prozac 10 mg orally daily
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Select what you should do next:
Decrease dose for 7 days then return to previous 10 mg day dose
Increase dose to 20 mg orally daily
Change to Prozac 10 mg orally daily
ecision Point One
Begin Wellbutrin 75 mg orally BID
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Child is unable to fall asleep at night
Decision Point Two
Select what you should do next:
Change from immediate release to extended release 150 mg orally daily in the morning
Give second dose of the day at 1:00 pm in the afternoon
Change to Lexapro 10 mg orally daily
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, 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 option did you choose?
Why did you make this choice?
Be specific and cite clinically relevant and patient-specific resources, including primary literature, to support your response.
Why didn’t you choose one of the other two options in the exercise?
Be specific and cite clinically relevant and patient-specific resources, including primary literature, to support your response.
What were your intentions when you made this choice?
Your response should be backed up by evidence and references to the Learning Resources (including the primary literature).
Justify how ethical considerations may affect your treatment plan and patient communication.
Provide specifics and 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.
NURS 6630 Case Study An African American Child Suffering From Depression 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.
By Day 7
Submit your Assignment.
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- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
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NURS 6630 Case Study An African American Child Suffering From Depression Grading Criteria
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Week 4 Assignment Rubric
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Submit your Week 4 Assignment draft and review the originality report.
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Week 4 Assignment
What’s Coming Up in Week 5?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will build on your assessment and treatment skills as you examine patients presenting with bipolar disorders.
Next Week
NURS 6630 Case Study An African American Child Suffering From Depression Rubric Detail
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Content
Name: NURS_6630_Week4_Assignment_Rubric
| ExcellentPoint range: 90–100 | GoodPoint range: 80–89 | FairPoint range: 70–79 | PoorPoint range: 0–69 | ||
| 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. | Points Range: 9 (9%) – 10 (10%)The response accurately, clearly, and fully summarizes in detail the case for the Assignment.
The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. |
Points Range: 8 (8%) – 8 (8%)The response accurately summarizes the case for the Assignment.
The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. |
Points Range: 7 (7%) – 7 (7%)The response inaccurately or vaguely summarizes the case for the Assignment.
The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
Points Range: 0 (0%) – 6 (6%)The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.
The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
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| Decision #1 (1–2 pages)• 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. |
Points Range: 18 (18%) – 20 (20%)The response accurately and clearly explains in detail the decision selected.
The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
Points Range: 16 (16%) – 17 (17%)The response accurately explains the decision selected.
The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
Points Range: 14 (14%) – 15 (15%)The response inaccurately or vaguely explains the decision selected.
The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
Points Range: 0 (0%) – 13 (13%)The response inaccurately and vaguely explains the decision selected.
The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
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| Decision #2
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