NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

Walden University NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

The introduction for the Walden University NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

After the introduction, move into the main part of the NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for 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

Sample Answer 2 for NURS 6630 Assignment 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.

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.

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.

Decision #2

Selected Decision and Rationale

The second decision is to increase the Zoloft dose from 25mg to 50mg PO daily. Studies show that the dose of Zoloft should be increased at intervals of 25mg to 50 mg per day once weekly when the desired therapeutic response has not been attained among children, while closely monitoring the patient’s symptoms(Ghandour et al., 2019).

This decision was based on the treatment outcome as the patient reported no changes in his depressive symptoms after four weeks of therapy. Increasing the dose of Zoloft to 50 mg is the best decision at this point, and evaluate the patient outcome after another 4 weeks. Studies show t that it takes between 8 to 12 weeks for sertraline to attain optimum therapeutic action in completely managing depression symptoms(Leichsenring et al., 2021). However, the dose must be increased gradually, while monitoring patient symptoms to attain an optimum dose. The patient also displayed no adverse effects, indicating great tolerance to the medication, hence no reason to alter the medication.

Increasing the dose to 37.5mg is not appropriate as this would only display similar results, as that titration rate is not recommended in several clinical guidelines(Walkup, 2017). Consequently, this will only prolong the period of use of the drug to the point where optimum dose will be attained. Discontinuing the use of sertraline, is also not necessary at this point, as studies only recommend it in case the maximum dose has been reached with no effect or the patient displays adverse effects(Pile et al., 2020). Consequently, studies recommend that the dose be reduced gradually first before switching to another drug like Prozac which is associated with several adverse effects as described above.

Expected Outcome

With the dose increment of Zoloft to 50mg, the patient is expected to display atleast 50% remission of symptoms this time round unlike within the first 4 weeks(Ghandour et al., 2019). His score on the Children’s Depression Rating Scalescores is also expected to decrease to less than 10. No side effects are expected since the patient already displayed great tolerance to the drug.

Ethical Considerations

The PMHNP has a legal obligation of preventing harm and promoting the health of the patient (Dawson, 2018). As such, considering a dose increment of the drug was the best choice in managing the patient’s symptoms, with limited side effects (Walkup, 2017). This decision promotes ethical principles such as beneficence and non-maleficence.

Decision #3

Selected Decision and Rationale

The last decision is to maintain the dose of Zoloft at 50mg once daily and continue evaluating the progress of the patient. The evidence-based practice recommends dose maintenance once the optimum level has been maintained until the patient’s symptoms have been resolved completely (Pile et al., 2020).

This decision was supported by the outcome the patient displayed in the last four weeks with a 50% reduction in depressive symptoms. The outcome shows great effectiveness and adherence to the medication by the patient, hence the need to maintain the dose. Studies show that it may take the drug another 4 to 8 weeks for Zoloft to completely manage symptoms of depression once the optimum dose has been achieved (Leichsenring et al., 2021). Additionally, this dose is still low hence limiting the possibility of side effects or toxicity.

Increasing the dose of Zoloft is not necessary as this will only lead to increased risks of adverse effects and toxicity due to increased plasma levels(Dawson, 2018). Additionally, the patient’s age does not allow a higher dose of the drug, as this could lead to increased suicidal ideation. Changing the treatment regimen to another drug, is also not appropriate as this will only lead to new complications (Walkup, 2017). This will also affect the patient compliance with the treatment regimen.

Expected Outcome

The patient is expected to display completely managed depression symptoms within the next four weeks. His score on the Children’s Depression Rating Scalescores is also expected to decrease to less than 10(Dawson, 2018). The patient’s quality of life will improve within this time, with no side effects reported as a result of the displayed tolerance and adherence to the treatment.

Ethical Considerations

At this point, the PMHNP is required to consider the ethical principle of nonmaleficence. Out of all the available options, maintaining the dose is the only choice that will benefit the patient with no harm (Pile et al., 2020). The patient’s parents must however be informed of the red flags like suicidal ideation and the importance of sticking to the treatment regimen to enhance optimal care outcomes.

Conclusion

Depression is a common mental problem among children below the age of 17 years. It affects both their social and academic life with additional mental and physical health burdens. Researchers have however been able to confirm the effectiveness of several treatment options for the management of depression among this vulnerable population (Ghandour et al., 2019). For the African American child with depression, factors such as his race and age were considered in choosing the best drug in the management of his symptoms. The first choice was Zoloft 25 mg once daily, which is an SSRI recommended by most clinical guidelines as a first-line for the management of depression among children due to its great effectiveness reported in most studies (Pile et al., 2020). Other alternatives such as Paxil and Wellbutrin were not appropriate due to their increased risk of suicide.

The second decision was to increase the dose to 50mg given the lack of effectiveness within the first 4 weeks. Increasing the dose to 37.5mg or replacing the drug with Prozac is not necessary as the former will lead to a similar outcome as the latter will compromise the patient’s tolerance (Walkup, 2017). The last decision was to maintain the dose at 50mg and monitor patient outcome for the next 4 weeks. The patient displayed great effectiveness and tolerance of the second intervention hence the need to maintain the dose. Increasing the dose to 75 or replacing the drug was not necessary as a result of the increased risk of toxicity and adverse events (Leichsenring et al., 2021). On the other hand, the PMHNP had to observe several legal and ethical considerations given that the patient is a minor such as the right to information, beneficence, and non-maleficence (Dawson, 2018).

References

Dawson, R. S. (July 01, 2018). Depression in children and adolescents: The pediatrician at the front lines. Pediatric Annals, 47, 7.)https://doi.org/10.3928/19382359-20180618-01

Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (January 01, 2019). Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. The Journal of Pediatrics, 206, 256-267.https://doi.org/10.1016/j.jpeds.2018.09.021

Leichsenring, F., Luyten, P., Abbass, A., Rabung, S., & Steinert, C. (January 01, 2021). Treatment of depression in children and adolescents. The Lancet. Psychiatry, 8, 2, 96-97.DOI:https://doi.org/10.1016/S2215-0366(20)30492-2

Pile, V., Shammas, D., & Smith, P. (January 01, 2020). Assessment and treatment of depression in children and young people in the United Kingdom: Comparison of access to services and provision at two-time points. Clinical Child Psychology and Psychiatry, 25, 1, 119-132.https://doi.org/10.1177/1359104519858112

Walkup, J. T. (May 01, 2017). Antidepressant efficacy for depression in children and adolescents: Industry- and NIMH-funded studies. American Journal of Psychiatry, 174, 5, 430-437.https://doi.org/10.1176/appi.ajp.2017.16091059

Sample Answer 3 for NURS 6630 Assignment Treating Pediatric Patients With Mood Disorders

According to the National Institution of Mental Health, approximately 9% of children and adolescents from age 12 years to age 17 years, are diagnosed with depression each year (Lamy & Erickson, 2018). Despite the negative impact of depression on the patient’s life, only a few individuals seek medical attention, which worsens the condition in the majority of the population. However, thanks to evidence-based practice for the current pharmacological and psychotherapeutic interventions available in the management of depressive disorders among children and adolescents (Bitsko et al., 2022). The purpose of this discussion is to illustrate the clinical decision-making on the most appropriate drug of choice for the treatment of an African American male patient with depression based on pharmacodynamic and pharmacokinetic factors.

The provided case study demonstrates an 8-year-old African American male patient with symptoms of depression. The patient is positive for loss of appetite, feeling sad, being irritable and withdrawn, even from his peers at school. Upon conducting a mental status examination, the patient acknowledges that he often thinks about death and how it would feel like to be dead. He however denies a history of suicidal attempts. The patient recorded a score of 30 on the Children’s Depression Rating Scale (CDRS), which led to the diagnosis of major depressive disorder. Other than the patient’s symptoms, CDRS scores, and diagnosis of MDD, additional factors which might affect the pharmacodynamic and pharmacokinetic process of drugs administered include his African American race and his age. These factors will affect the choice of drug for this patient.

Decision #1

Selected Decision and Rationale

Initiate Zoloft 25mg once daily. Previous evidence demonstrates great effectiveness in the use of selective serotonin reuptake inhibitors like Zoloft in the management of depression among children below the age of 18 years (Mullen, 2018). The mode of action of this medication is through neuronal inhibition of serotonin (5HT) uptake in the central nervous system. The drug has a desirable safety profile, which led to its approval by the FDA for the management of depressive disorders among pediatric patients except for those with obsessive-compulsive disorder (Kupfer, 2022). However, due to the risks of suicidal ideation and suicidality among children, close monitoring of the patient and the use of low doses (25mg) are recommended. Studies show great adherence and tolerance of the medication by most pediatric patients as the drug undergoes first-pass metabolism in the liver with reduced side effects.

Paxil could not be considered at this point, as studies show that the drug is associated with increased side effects and high risks of suicidality among children as compared to Zoloft (Hetrick et al., 2021). As such, the drug is only recommended when there is no other alternative for children above the age of 10 years.

Wellbutrin is also not recommended for children below the age of 18 years due to its increased risk of seizure (Lamy & Erickson, 2018). As such, the drug is only recommended for use as send option, when the first drug is ineffective, or if the patient has depression with comorbid ADD.

Expected Outcome

The patient is expected to report at least 50% remission of symptoms within the next 4 weeks. His CDRS scores are expected to reduce to less than 20 (Mullen, 2018). He is also expected to be more joyful and engage with his peers appropriately within this time.

Ethical Consideration

Since the patient is below the age of 18 years, her parents or caregivers have legal responsibilities for making decisions concerning his health (Hetrick et al., 2021). As such, the PMHNP must educate the patient’s parents on the diagnosis, and available treatment options before deciding on which drug to go with.

Decision #2

Selected Decision and Rationale

The second intervention is to increase the dose of Zoloft from 25mg to 50mg once daily. The patient displayed great adherence and compliance to the initial intervention, as no side effects were reported. However, no changes in the patient’s symptoms were realized which calls for dose increment to attain optimal therapeutic levels (Bitsko et al., 2022). Clinical guidelines recommend a dose increment of Zoloft by 25mg every week from an initial dose of 25mg once daily to attain the optimal threshold (Kupfer, 2022). This helps reduce the risks of side effects and toxicity.

Increasing the Zoloft dose to 37.5mg is inadequate as no changes will be experienced (Hetrick et al., 2021). The patient may also end up losing trust in the PMHNP and refuse to take the medication, even when the optimum dosage has not been attained, compromising the entire treatment process.

Changing the drug to Prozac was also not appropriate as the patient had already displayed great tolerance and adherence to Zoloft (Mullen, 2018). Prozac is also associated with increased risks of suicidal ideation which is inappropriate for the patient given the history of suicidal ideation.

Expected Outcome

Within the next 4 weeks, the patient is expected to report back to the clinic with at least 50% remission of symptoms, with the increased dose (Bitsko et al., 2022). His CDRS scores as mentioned earlier are expected to reduce to less than 20. He is also expected to sleep and eat well and engage with her peers in school.

Ethical Consideration

Legal and ethical guidelines require clinicians to prevent harm and promote the health of the patient (Lamy & Erickson, 2018). As such, this intervention to maintain the same drug and increase the dose was necessary since the patient displayed great tolerance and adherence to the medication. Changing the regime could otherwise harm the patient.

Decision #3

Selected Decision and Rationale

The last decision was to maintain the dose of Zoloft at 50mg orally once daily and continue monitoring the patient for progress. This decision was based on the outcome reported by the patient’s mother from the initial intervention. The patient displayed great compliance and adherence to the medication which lead to more than 50% remission of depressive symptoms with no side effects reported. Studies show that when the optimal dose of Zoloft has been attained, the drug will take between 6 to 8 weeks for the complete remission of depressive symptoms (Mullen, 2018). As such, it was necessary to maintain the dose to avoid side effects and monitor the patient’s progress for a better outcome.

Increasing the Zoloft dose to 75mg was not necessary as this would otherwise have led to the occurrence of side effects like increased agitation. Consequently, studies show that at high doses, Zoloft can increase the risks of suicidality among children below the age of 18 years (Kupfer, 2022).

Changing the treatment regimen to an SNRI was also not appropriate, as this would only compromise the patient’s compliance and adherence, leading to side effects. Previous evidence also demonstrates increased incidences of suicidal ideation with the use of SNRIs as compared to SSRIs like Zoloft (Bitsko et al., 2022).

Expected Outcome

Based on the previous outcome, the patient is expected to report even further remission of depression symptoms over the next four weeks. He should display a CDRS score of less than 10 (Mullen, 2018). He should improve in school performance and play with peers more frequently.

Ethical Consideration

The PMHNP is required to observe the legal and ethical obligation of promoting the patient’s well-being and preventing harm (Lamy & Erickson, 2018). As such, the nurse needs to make decisions that are well supported by the patient’s parents, based on positive outcomes as displayed by previous interventions.

Conclusion

Depression is a common mental illness reported among pediatric patients. Despite limited evidence supporting the use of antidepressants, several studies have proven their effectiveness and reduced risks of side effects in the management of depression among children such as SSRIs like Zoloft (Lamy & Erickson, 2018). As such, for the pediatric patient in the provided case study, the first intervention for the management of depression was to administer Zoloft 25mg once daily and monitor the patient for dose adjustment aiming at attaining the optimal dose (Mullen, 2018). The other two medications were not appropriate for the patient as Paxil is known to increase the risks of suicidal ideation, while Wellbutrin is not recommended for patients under the age of 18 years (Hetrick et al., 2021). The second intervention was to increase the dose of Zoloft to 50mg once daily, based on the reported outcome from the initial intervention (Hetrick et al., 2021). The patient displayed great adherence and tolerance to the medication which called for no change of regimen. Increasing the dose to 37.5 mg was not appropriate as a similar effect would have been realized.

The last intervention was to maintain the dose at 50 mg once daily as the patient displayed great tolerance and compliance to the medication with no side effects. Increasing the dose to 75 mg once daily would lead to side effects while changing the regimen to an SNRI would compromise patients’ compliance and increase the risks of suicidal ideation (Bitsko et al., 2022). Given that the patient is a minor, several ethical considerations were to be considered by the PMHNP. For instance, the patient’s parents have a legal obligation of deciding the health of her child hence the need to be adequately informed about the diagnosis and the treatment options (Kupfer, 2022). The PMHNP also has the legal obligation of promoting the health of the child and prevent harm.

References

Bitsko, R. H., Claussen, A. H., Lichstein, J., Black, L. I., Jones, S. E., Danielson, M. L., … & Meyer, L. N. (2022). Mental health surveillance among children—the United States, 2013–2019. MMWR supplements, 71(2), 1. DOI: 10.15585/mmwr.su7102a1

Hetrick, S. E., McKenzie, J. E., Bailey, A. P., Sharma, V., Moller, C. I., Badcock, P. B., … & Meader, N. (2021). New generation antidepressants for depression in children and adolescents: a network meta‐analysis. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD013674.pub2

Kupfer, D. J. (2022). The pharmacological management of depression. Dialogues in clinical neuroscience.
https://doi.org/10.31887/DCNS.2005.7.3/dkupfer

Lamy, M., & Erickson, C. A. (2018). Pharmacological management of behavioral disturbances in children and adolescents with autism spectrum disorders. Current problems in pediatric and adolescent health care, 48(10), 250-264. https://doi.org/10.1016/j.cppeds.2018.08.015

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275-283. https://doi.org/10.9740/mhc.2018.11.275

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

Submit your assignment by Day 7.

Submission and Grading Details

Do the following to submit your completed Assignment for review and grading:
• Please save your Assignment with the name “WK4Assgn+last name+first initial.(extension)” as the extension.
• Review the Grading Criteria for the Assignment by clicking the Week 4 Assignment Rubric.
• Navigate to the Week 4 Assignment link. You will also be able to “View Rubric” for this area’s grading criteria.
• Then, in the Attach File section, click the Browse My Computer button. Open the document you saved as “WK4Assgn+last name+first initial. (extension)”.
• If applicable, tick the button next to I agree to submit my paper(s) to the Global Reference Database in the Plagiarism Tools section.
• To finish your entry, click the Submit button.

Criteria for Evaluation

To view your rubric, go to Week 4 Assignment Rubric.

Examine the Authenticity of Your Assignment Draft

To ensure the legitimacy of your Assignment draft:
Submit a draft of your Week 4 Assignment and review the originality report.

Submit your assignment by Week 4’s Day 7

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.
Go to the Weekly Content

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Rubric Detail

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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