NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

Decision Point 1

The first treatment intervention involves beginning Zoloft 25 mg orally daily. The FDA recommends selective serotonin reuptake inhibitors (SSRIs) as the first antidepressant for treating depression in children and adults. Furthermore, Tini et al. (2022) reported that selective serotonin reuptake inhibitors (SSRIs) effectively treat several psychiatric symptoms, including obsessive-compulsive disorder (OCD) and depression, in children aged 6 to 12 years. Zoloft 25 mg orally daily was selected since it’s an SSRI; hence effective in managing presented depressive symptoms in the 8yo African-American male. Therefore, beginning Zoloft 25 mg orally daily is the best treatment option for this client.

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Other potential options, including beginning Paxil 10 mg orally daily and beginning Wellbutrin 75 mg orally BID, were rejected. Beginning Paxil 10 mg orally daily was dismissed since it is not recommended for treating depression in children and adults. Instead, Paxil is recommended as the first-line treatment for anxiety in pediatrics and adults (Strawn et al., 2018). Additionally, Wellbutrin was rejected due to severe side effects, including the risk of anorexia, seizure, dry mouth, headache, and insomnia (Lee et al., 2021). Hence, beginning the client’s treatment with Wellbutrin 75 mg orally BID would increase the risk of these drug-related side effects.

Beginning Zoloft 25 mg orally daily was expected to improve the client’s depressive symptoms. According to Tini et al. (2022), Zoloft 25 mg orally daily is an SSRI, effective in treating depressive symptoms in children and adolescents. Nonetheless, the client did not report a change in the initial symptoms upon returning to the clinic after 4 weeks.

Bipolar Disorder

Bipolar is a mental health disorder characterized by extreme mood changes that alter the behavior and normal function of a patient. The mood fluctuation is on extreme ends and may take days to weeks before change, accompanied by difficulties in performing daily tasks and social interactions. The mood changes are mania or hypomania; mania is a happy or irritable mood, and hypomania is a sad mood or depression (Ashok, et al, 2017). These symptoms usually occur alternatively after weeks associated with a period of the normal state. There are types of bipolar which include bipolar 1, bipolar 2, and cyclothymic bipolar. Bipolar 1 has alternating episodes of mania, hypomania, and neutral mood. Bipolar two is associated with a major depressive mood disorder and hypomania state. Cyclothymic has frequent mood swings.

The signs and symptoms of the manic episode are diminished need for sleep, increased and faster speech, increased activity, increased risky behavior, distractibility, and uncontrollable racing thoughts. Hypomania presents with intense sadness or despair, loss of interest, fatigue, difficulties in concentration, frequent thoughts, and suicidal ideation. Common causes of bipolar are genetic predisposition, family history of bipolar, stressful environment, and substance abuse. The patient in the case study is a 26years old female with bipolar. According to the American psychiatric association, she meets the DSM-5 criteria through her symptoms of the diminished need to sleep, excessive talking, increased distractibility, she is in a happy mood, rapid or pressured speech, and increased energy. She scores 22 on the young scale mania. The interventions for bipolar are the use of antipsychotics and psychotherapy. Antipsychotics relieve the symptoms of the patient while psychotherapy enables the patient to change their thinking and behavior to improve cognitive functions and quality of life. The essay describes the three decisions made in treating the patient including the impact of ethical principles.

Decision One

Which decision did you select?

Begin Seroquel XR 300mg orally at HS

Why did you select this decision?

Seroquel is a second-generation antipsychotic with a high affinity for dopamine and serotonin receptors. Its mechanism of action is by antagonizing these receptors and binding them to the norepinephrine transporter (Hamed, et al, 2017). This helps in improving memory, mood, aggression, and the muscle movement that plays a vital role in the brain for pleasure. Seroquel is the best drug for the patient because it is FDA approved for acute manic episodes and bipolar. Moreover, the American psychiatric association proves it is efficient in treating bipolar in its studies.

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

Risperdal is a second-generation antipsychotic for treating schizophrenia and maintenance treatment in bipolar. Its mechanism of action is by decreasing the serotonin and dopamine activity in the brain thus reducing the mood symptoms, agitation, and symptoms of schizophrenia. it has 94% bioavailability and is protein-bound with an active metabolite (Schoretsanitis, et al, 2017). It has a plasma half-life of three to twenty hours. However, I did not select this drug for the patient because it has undesirable effects like drooling, nausea, weight gain, nausea, fatigue, and tiredness. Lithium is a commonly prescribed drug for prophylaxis and treatment of manic episodes. Its mechanism of action is by modulating the neurotransmitters and inhibiting the excitatory neurotransmitters like dopamine and glutamate. It has neuro-proliferative and neuroprotective effects on the brain that helps in regulating mood. It is FDA approved for mood disorders and bipolar. However, I did not select the drug because the patient has not been compliant due to its unpleasant effects.

What were you hoping to achieve by making this decision?

The expectations of starting the patient on Seroquel XR 300mg are to relieve the symptoms and reduce the score of the young scale mania. The expected side effects are dry mouth, drowsiness, constipation, and weight gain.

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

Communication is the exchange of information from the sender to the recipient to understand and interpret and eventually respond. Communicating with a patient with bipolar can be hectic because they talk fast and have racing thoughts. Therefore, the nurse incorporates the principle of justice when assessing the patient. Justice is providing equal and quality services to all despite their underlying issues. Justice enables the nurse to communicate effectively with the patient.

Decision Two

Which decision did you select?

Discontinue Seroquel and begin Geodon 40mg

Why did you select this decision?

Geodon is a second-generation antipsychotic that inhibits the reuptake of norepinephrine and serotonin, blocking the alpha and antihistaminic activities. These decrease hallucinations, improve clear and positive thinking, reduces agitation, and improve activities of daily living (Findling et al, 2022). It has 60% bioavailability and is 99% protein bound. The drug is initiated at a low dose and increased gradually within two weeks to reduce the side effects. I chose this drug because it is effective in treating bipolar and has no side effects on the patient.

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

Increasing the dose of Seroquel to 400mg to improve the patient’s symptoms is not a good option because she previously complained of weight gain and constipation. Increasing the dose worsens the drug’s side effects. The use of dietary measures to control weight gain and obesity is ineffective because the drug has the effect of muscarinic cholinergic antagonism that induces gastrointestinal hypomotility and hence constipation and weight gain. Decreasing the dosage will not have positive effects on the patient’s symptoms and will still exhibit unpleasant side effects.

What were you hoping to achieve by making this decision?

The expectation of switching the patient’s treatment to Geodon is to improve the symptoms, decrease the young scale mania, and relieve constipation and weight gain.

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

The nurse considers the principle of autonomy in this decision point. Autonomy is respect for a person’s decisions and preferences (Asl, et al, 2022). The patient is uncomfortable with Seroquel because it causes constipation despite the improvement of the symptoms. The nurse, therefore, changes the treatment to ensure patient satisfaction.

Decision Three

Which decision did you select?

Increase Geodon to 60 mg orally BID with a 500-calorie meal

Why did you select this decision?

Geodon was effective during the initial stage of treatment. Increasing from 40mg to 60mg is effective in improving the symptoms. Additionally, the recommended dose is 60mg to 80mg with a gradual increment every two weeks. I selected this choice because it will hasten the improvement of the symptoms.

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

I did not continue with the same drug dosage because the American psychiatric association recommends 60mg to 80mg to relieve the symptoms. I did not augment with lithium because it has unpleasant side effects. Additionally, augmentation is recommendable in the incidence of depression and hypomania. There is a contraindication for lithium augmentation with antipsychotics like olanzapine, haloperidol, and Geodon.

What were you hoping to achieve by making this decision?

The expectation for increasing the dosage is to hasten the improvement of the symptoms.

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

The nurse uses the principle of beneficence and non-maleficence. Beneficence is doing what is right and non-maleficence is protecting the patient from harm. The nurse carefully analyzes the best treatment for the patient to improve the symptoms and prevent adverse effects.

Conclusion

Bipolar is a mood fluctuation disorder on the extreme ends and may take days to weeks before change, accompanied by difficulties in performing daily tasks and social interactions. The signs and symptoms of the manic episode are diminished need for sleep, increased and faster speech, increased activity, increased risky behavior, distractibility, and uncontrollable racing thoughts. Hypomania presents with intense sadness or despair, loss of interest, fatigue, difficulties in concentration, frequent thoughts, and suicidal ideation. Seroquel is a second-generation antipsychotic that antagonizes these receptors to improve memory, mood, aggression, and muscle movement that plays a vital role in the brain for pleasure. However, it causes weight gain and constipation. Geodon is an effective drug for treating bipolar because it is well tolerated. Ethical principles in nursing improve assessment and communication techniques. They are beneficence, autonomy, consent, justice, and non-maleficence.

References

Ashok, A., Marques, T., Jauhar, S. et al. The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment. Mol Psychiatry 22, 666–679 (2017). https://doi.org/10.1038/mp.2017.16

Asl, R. G., Taghinejad, R., Parizad, N., & Jasemi, M. (2022). The relationship between professional autonomy and job stress among intensive care unit nurses: A descriptive correlational study. Iranian Journal of Nursing and Midwifery Research, 27(2), 119. https://doi.org/10.4103%2Fijnmr.ijnmr_375_20

Findling, R. L., Atkinson, S., Bachinsky, M., Raiter, Y., Abreu, P., Ianos, C., & Chappell, P. (2022). Efficacy, Safety, and Tolerability of Flexibly Dosed Ziprasidone in Children and Adolescents with Mania in Bipolar I Disorder: A Randomized Placebo-Controlled Replication Study. Journal of Child and Adolescent Psychopharmacology, 32(3), 143-152. https://doi.org/10.1089/cap.2021.0121

Hamed, R., AlJanabi, R., Sunoqrot, S., & Abbas, A. (2017). The effect of pH, buffer capacity and ionic strength on quetiapine fumarate release from matrix tablets prepared using two different polymeric blends. Drug Development and Industrial Pharmacy, 43(8), 1330-1342. https://doi.org/10.1080/03639045.2017.1318897

Schoretsanitis, G., Spina, E., Hiemke, C., & de Leon, J. (2017). A systematic review and combined analysis of therapeutic drug monitoring studies for long-acting risperidone. Expert review of clinical pharmacology, 10(9), 965-981.

https://doi.org/10.1080/17512433.2017.1345623

In developing this treatment, the PMHNP adhered to the ethical consideration of beneficence that holds that mental health providers should focus on benefiting their clients through the administered treatment. Hence, the PMHNP started the client’s treatment with Zoloft 25 mg orally since it would improve his depressive symptoms.

When pediatric patients come with mood problems, the procedure of examination, diagnosis, and therapy can be rather challenging. Children not only have different signs and symptoms than adults, but they also metabolize medications very differently. However, in both pediatric and adult forms of major depressive illness, the same psychopharmacologic therapy may be used. As a result, psychiatric nurse practitioners must exercise discretion while providing psychotropic drugs to these patients. Examine the patient case study in this week’s Learning Resources for this Assignment to consider how you would assess and treat pediatric patients with mood problems.
• To prepare for this Assignment, review this week’s Learning Resources, including the Medication Resources listed.
• Consider the psychopharmacologic treatments you might recommend for pediatric patients who require antidepressant therapy.
The task is 5 pages long.
Consider the following example: Depression in an African American Child You must make three decisions regarding the medication to be prescribed to this patient. Consider any circumstances that may affect the patient’s pharmacokinetic and pharmacodynamic processes.
Consider all choices before making a decision and continuing on with the exercise at each decision point. Ascertain that you have thoroughly examined each choice and that you have assessed your decision. Make a point of conducting primary literature study on each choice.

NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

Module 2, Disorders With Affective Components, is a 6-week module. During Week 4, you will begin applying your assessment and therapy skills as you engage in your first Assignment assessing and treating pediatric patients with mood disorders. In Week 5, you will continue to apply your assessment and therapy skills as you assess and treat patients presenting with bipolar disorders. As you engage with the decision tree exercises, reflect on the critical decision-making skills that you, as a psychiatric nurse practitioner, are making, as these skills are essential to your current and future practice. In Week 6, you will assess and treat patients presenting with anxiety and posttraumatic stress disorder (PTSD). You will also complete your Midterm Exam. During Week 7, you will assess and treat patients presenting with schizophrenia. In Week 8, you will complete a Short Answer Assessment in which you will synthesize your understanding of sleep/wake disorders. You will also continue to apply your assessment and therapy skills as you assess and treat patients presenting with sleep/wake disorders. During Week 9, you will examine psychopharmacologic therapies for patients with ADHD/ODD and you will complete a Quiz to test your understanding of the content explored in this module

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Introduction to the Case (1 page)

• In a few phrases, explain and outline the case for this Assignment. Make sure to add any specific patient circumstances that may impact your decision when providing medication for this patient.

The first decision (1 page)

• What option did you select?
• What motivated you to make this decision? Provide precise responses that are supported by clinically relevant and patient-specific resources, such as original literature.
• Why did you not select any of the other two possibilities offered in the exercise? Provide precise responses that are supported by clinically relevant and patient-specific resources, such as original literature.
• What did you intend to achieve by making this choice? Back up your argument with proof and referrals to Learning Resources (including the primary literature).
• Describe how ethical issues may affect your treatment approach and patient communication. Give details and examples.

NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

No. 2 Decision (1 page)

Third choice (1 page)

• What motivated you to make this decision? Provide precise responses that are supported by clinically relevant and patient-specific resources, such as original literature.
• Why did you not select any of the other two possibilities offered in the exercise? Provide precise responses that are supported by clinically relevant and patient-specific resources, such as original literature.
• What did you intend to achieve by making this choice? Back up your argument with proof and referrals to Learning Resources (including the primary literature).
• Explain how ethical issues might influence your treatment plan and patient communication. Give details and examples.
Summarize your thoughts on the therapy options you chose for this patient (1 page). Make sure your recommendations are justified and supported by clinically relevant and patient-specific resources, such as primary literature.
Please include at least five academic resources to support your arguments. The course text may be used to support your reasoning, but it does not count as a resource. You should consult both primary and secondary sources.

NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

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NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

To participate in this Assignment:
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

To go to the next week:
Week 5

Module 2: Disorders With Affective Components

As a psychiatric nurse practitioner (PNP), does that research finding surprise you? How do PNPs ensure that effective psychopharmacologic treatments are prescribed to address the prevalence of affective disorders?
Consider for example that current treatments are sub-optimal, resulting in poor patient responses and uncertain modes-of-action (Plant, 2017). While it is no surprise that mental health medicine and clinical approaches are constantly evolving, novel insights into the underlying mechanisms of how affective disorders arise, remain. Additionally, the use of psychopharmacologic treatments may not always be consistent with a patient’s preferred treatment plan. Thus, your skills and understanding of how to assess and treat patients with affective disorders are important in ensuring positive patient outcomes and may also contribute to the research needed to connect clinical observations to the neuroscience, physiology, and pharmacologic processes needed to treat these disorders.

NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

Reference:

Plant, N. (2017). Can a systems approach produce a better understanding of mood disorders? Biochimica et Biophysica Acta, 1861(1), 3335-3344. https://doi.org/10.1016/J.BBAGEN.2016.08.016
What’s Happening This Module?
What do I have to do? When do I have to do it?
Review your Learning Resources. Days 1–7, Weeks 4–9
Assignment: Assessing and Treating Pediatric Patients With Mood Disorders Submit your Assignment by Day 7 of Week 4.
Assignment: Assessing and Treating Patients With Bipolar Disorder Submit your Assignment by Day 7 of Week 5.
Assignment: Assessing and Treating Patients With Anxiety Disorders Submit your Assignment by Day 7 of Week 6.
Midterm Exam Complete Midterm Exam by Day 7 of Week 6.
Discussion: Treatment for a Patient With Insomnia Post by Day 3 of Week 7 and respond to your colleagues by Day 6 of Week 7.
Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia Submit your Assignment by Day 7 of Week 7.
Assignment 1: Short Answer Assessment Submit your Assignment by Day 7 of Week 8.
Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders Submit your Assignment by Day 7 of Week 8.
Assignment: Assessing and Treating Patients With ADHD/ODD Submit your Assignment by Day 7 of Week 9.
Quiz: Assessing and Treating Patients With Psychopharmacology Complete Quiz by Day 7 of Week 9.
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Name: NURS_6630_Week4_Assignment_Rubric
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Excellent

Point range: 90–100 Good

Point range: 80–89 Fair

Point range: 70–79 Poor

Point 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.

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.

Decision #2 (1–2 pages)

NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders