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Assessing and Treating Pediatric Patients With Mood Disorders

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 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.

 


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

   

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Assessing and Treating Pediatric Patients With Mood Disorders

Successful patient transitions are largely dependent on interprofessional collaboration. It entails working together between different health care providers to ensure smooth patient transfer from one setting to another. Doing so is critical to reducing the potential risk of communication associated with the transfer of patient care. Therefore, a safe and effective transfer of responsibility relies on effective communication and patient understanding of discharge instruction. Although it is a health provider’s role to provide effective transitions, health care organizations must initiate measures to ensure success.  

Promotion of Interprofessional Collaboration

My organization takes patient care transitions as an important aspect of quality care delivery and engages in regular workshops about proper communication. The assumption is that effective communication is essential among health professionals and in patient instructions (ANA, 2015). Consequently, health professionals utilize care plans and organizational care pathways including a standardized hand-off report. The report provides information about patient response to medical and nursing interventions, the efficiency of the ongoing care plan, patient goals, and outcomes. The efficiency of the approach contributes to effective care transitions in the facility.

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Role of the Nurse

Nurses are an important component of the care transition process. Their interaction with patients during their vulnerable moments means that they often learn critical information about a patient’s life (Camicia & Lutz, 2016). Effective care transitions entail utilizing this information during the transition plan towards success. The role of nurses in my organization is to develop and evaluate transition plans, identify and communicate any challenges. Communicating the barriers to the interprofessional team ensures that they initiate early plans in the patient’s hospitalization towards individualized care. However, stroke survivors often present with significant challenges to nurses in my facility by reporting financial constraints and a lack of familial support post-discharge. Such limitations are a threat to the intended transition plan.

 

 

References

American Nurses Association (2015). Nursing Scope and Standards of Practice (3rd Ed.). ANA Silver Spring, MD.

Camicia, M., & Lutz, B. J. (2016). Nursing’s role in successful transitions across settings. Stroke, 47(11), e246-e249. https://doi.org/10.1161/STROKEAHA.116.012095

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