Write My Paper Button

WhatsApp Widget

Examine Case Study: An African American Child Suffering From Depression

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 client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

 

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  • Mother reports that teacher said child is withdrawn from peers in class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
  • Client seen by Psychiatric Nurse Practitioner

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.

The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

In summary: What needs to be in your essay. Use this as a checklist prior to submitting each decision tree essay. Introduction regarding disease state High-level summary of patient case Purpose of the essay statement

  • At each decision point stop to complete the following:
    • Decision #1
      • Which decision did you select?
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
    • Decision #2
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
    • Decision #3
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • Also include how ethical considerations might impact your treatment plan and communication with clients.

Below are the answers I have selected on the decision tree scenario

The results for scenario one is on the attached file included. The instruction sheet provided by the instructor. Please read carefully and ask questions for clarification if you do not understand.

Decision 1: Begin Zoloft 25mg orally daily

Decision Point One

Select what the PMHNP should do:

 

Begin Zoloft 25 mg orally daily

 

Begin Paxil 10 mg orally daily

 

Begin Wellbutrin 75 mg orally BID

 

Decision 2: Increase dose to 50mg orally daily

Decision Point Two

Select what the PMHNP should do next:

 

Increase dose to 37.5 mg orally daily

 

Increase dose to 50 mg orally daily

 

Change to Prozac 10 mg orally daily

 

Results for decision point 2.

Client returns toclinic in 4 weeks

Depressive symptoms decrease by 50%. client tolerating well

 

Increase dose to 50 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Depressive symptoms decrease by 50%. Cleint tolerating well

Decision Point Three

Decision 3: maintain current dose

Decision Point Three

Select what the PMHNP should do next:

 

Maintain current dose

 

Increase to 75 mg orally daily

 

Change to a SNRI

 

ecision Point Two

 

Maintain current dose

Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.

Introduction:

 

Depression in children, particularly in African American youth, presents a complex clinical challenge. In this case study, an 8-year-old African American male presents with symptoms of depression, including sadness, withdrawal from peers, decreased appetite, and occasional irritability. The PMHNP administers the Children’s Depression Rating Scale, obtaining a score indicating significant depression. The purpose of this essay is to explore three decisions concerning medication for this client, considering pharmacokinetic and pharmacodynamic processes, as well as ethical considerations in treatment planning and communication.

 

Decision #1: Begin Zoloft 25mg orally daily

 

Decision:

Begin Zoloft 25 mg orally daily.

 

Reasoning:

Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression in children and adolescents. Research indicates its efficacy and safety profile in this population (Birmaher et al., 2007). Starting with a low dose minimizes the risk of adverse effects and allows for titration based on individual response.

 

Expected Outcome:

By initiating Zoloft, the goal is to alleviate depressive symptoms, improve mood, and enhance functioning. Research suggests that SSRIs are effective in reducing depressive symptoms in pediatric patients (Cheung et al., 2019). Monitoring for adverse effects such as gastrointestinal upset, insomnia, or activation is essential.

 

Difference in Expectation and Result:

The decision aligns with expectations, as Zoloft initiation aims to target depressive symptoms. However, individual response may vary, necessitating dose adjustments or consideration of alternative medications.

 

Decision #2: Increase dose to 50mg orally daily

 

Decision:

Increase dose to 50 mg orally daily.

 

Reasoning:

Increasing the dose of Zoloft to 50 mg daily is supported by the client’s partial response and tolerability. Research indicates that dose optimization is often necessary to achieve full remission in pediatric depression (Emslie et al., 2006). This decision balances symptom reduction with minimizing adverse effects.

 

Expected Outcome:

The aim of dose escalation is to further alleviate depressive symptoms and improve overall functioning. Research suggests that increasing the dose of SSRIs can lead to improved treatment response in children with depression (Emslie et al., 2007).

 

Difference in Expectation and Result:

The decision aligns with expectations, resulting in a 50% reduction in depressive symptoms and good tolerability. However, individual variability in response may necessitate ongoing monitoring and potential dose adjustments.

 

Decision #3: Maintain current dose

 

Decision:

Maintain the current dose of Zoloft.

 

Reasoning:

Given the client’s 50% reduction in depressive symptoms and good tolerability, maintaining the current dose allows for continued observation of treatment response. Full remission has not been achieved, but the client is considered a responder to therapy, warranting ongoing monitoring before considering further interventions.

 

Expected Outcome:

Continuing with the current dose aims to sustain the observed symptom improvement while minimizing the risk of adverse effects. Research suggests that maintaining treatment at an effective dose can lead to sustained remission in pediatric depression (Cheung et al., 2019).

 

Difference in Expectation and Result:

The decision aligns with expectations, as the client demonstrates a positive response to the current treatment regimen. However, ongoing monitoring is crucial to assess for any changes in symptoms or adverse effects.

 

Ethical Considerations:

Ethical considerations in this treatment plan include informed consent, shared decision-making, and cultural competence. It is essential to involve the client and family in treatment decisions, considering their preferences, values, and cultural beliefs. Additionally, ongoing communication and education about the medication, its potential benefits, and risks are vital to promote adherence and trust in the therapeutic relationship.

 

References:

– Birmaher, B., Brent, D., Bernet, W., et al. (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(11), 1503–1526.

– Cheung, A., Zuckerbrot, R., Jensen, P., et al. (2019). Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics, 141(3), e20174081.

– Emslie, G. J., Findling, R. L., Yeung, P. P., Kunz, N. R., Li, Y., & Venlafaxine Pediatric Depression Study Group. (2007). Venlafaxine ER for the treatment of pediatric subjects with depression: results of two placebo-controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 46(4), 479–488.

The post Examine Case Study: An African American Child Suffering From Depression appeared first on Destiny Papers.

Examine Case Study: An African American Child Suffering From Depression
Scroll to top