-Go onto this website: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_02/index.html
-Follow these steps:
*Decision Point One select: \”Begin Zoloft 25mg\”
*Decision Point Two select: \”Increase to 50mg\”
*Decision Point Three select:\”Maintain current dose\”
This assignment is needed for the paper and can be used as resource.
-Assignment Instructions:
-Page 1:Introduction to the case-
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.
Page 2: Decision #1-
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.
Page 3: Decision #2-
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.
Page 4:Decision #3-
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.
Page 5: Conclusion
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Assessing and Treating Pediatric Mood Disorders
Student’s Name
Institutional Affiliation
Course
Instructor’s Name
Date
Assessing and Treating Pediatric Mood Disorders
Introduction
Depression causes severe symptoms that affect how one thinks, feels and handles daily activities. It is a common mental disorder that affects people globally: over 3.8% of the world population are affected by the illness. According to WHO (2021), 5.0% of the adult population and 5.7% of older adults of 69 years and above are affected. About 280 million people in the world have depression. Depression is also called major depressive disorder and is often different from the usual mood fluctuations and short-lived emotional reactions to challenges of daily life. People who have depression often experience feeling of sadness, irritability, and emptiness (WHO, 2021). Other symptoms of depression include loss of interest or pleasure in certain activities that were once loved, decreased appetite, trouble sleeping, fatigue, feeling of guilt or worthless, and social withdrawal, among others.
In the case study, the patient is an 8-year-old African American male who was brought to the emergency room by his mother. The child is exhibiting symptoms of depression (McIntyre et al., 2020). The patient complains of a feeling of sadness. The mother reported that the teacher had recognized that the boy is withdrawn from peers in class. Additionally, the mother reported that the patient has decreased appetite and occasional periods of irritation. Mental examination showed the patient is alert and oriented X 3, speech is clear, goal-directed, and coherent. The self-reported mood is sad. Affect is somewhat blunted, however, the child smiled appropriately at different points throughout the clinical interview. He denied hallucination and delusional and paranoid thoughts. The diagnosis revealed that the patient had a major depressive disorder. In that regard, this paper presents three treatment decisions to help the patient improve his mental condition.
Decision Point One
The selected decision point one is to Begin Zoloft 25 mg orally daily. Zoloft was selected because it is widely used as a first-line treatment for major depressive disorder both in adults and children. Zoloft 25mg is usually the starting dose for both adults and children to treat depression (Potter, 2019). It works by preventing the reuptake of serotonin in the brain, leading to an increased concentration of serotonin within the synapse. Serotonin is a neurotransmitter that helps people regulate their mood, among other functions.
The other two options were not selected for one reason or the other. Although Paxil 10 mg was not preferred because it is associated with many side effects in children compared to Zoloft (Potter, 2019). Paxil is not recommended for use among children below 18 years. Side effects such as drowsiness, nausea, vomiting, and diarrhea are more common in Paxil than Zoloft. Also, Paxil is widely prescribed for generalized anxiety disorder (Potter, 2019). While Wellbutrin and Zoloft are both classified as antidepressants, Wellbutrin can be stimulating, leading to anxiety or insomnia the first few days, which can be uncomfortable for the child.
With Zoloft 25 mg orally daily, the expectation is that the depressive symptoms would reduce to 50%. For example, the feeling of sadness should reduce or end. The symptoms of being withdrawn from peers in class should also improve (McIntyre et al., 2020). Additionally, appetite is expected to improve and the weird thought about self should improve. There should be an improvement on the children’s depression rating scale. The actual results showed a slight improvement in mood. There were no side effects or adverse events. Some of the ethical conditions to consider while working with the patient include patient autonomy, beneficence, and non-maleficence (Butts & Rich, 2019). The parent must be consulted before making treatment decisions. All decisions should be beneficial and harmless to the patient.
Decision Point Two
The selected decision two is to increase the dose from Zoloft 25 mg to Zoloft 50 mg. This option was selected because the patient showed a slight improvement of the symptoms and there was neither harm nor adverse events reported. Therefore, the medication seemed to be working effectively (Potter, 2019). Also, in children, subsequent dosages should increase by 25mg, therefore, Zoloft 50mg was appropriate.
Increasing the dose to 37.5 mg orally daily was not selected because it is not the most effective dose in this case. Zoloft tables are normally available in three dosage strengths such as 25mg, 50mg, and 100 mg. The maximum should be 200mg (Potter, 2019). Changing to Prozac 10 mg orally daily was not selected because it was not necessary. Medication changes occur only when there are not desirable results (Kim, 2018). The patient is showing improvement with Zoloft and there were no adverse events reported, hence, there was no need to change to Prozac.
With the current dose, the therapist expects that the patient will have 50% and above in symptom improvement when the patient returns to the clinic in four weeks. Most of the depressive symptoms are expected to resolve (McIntyre et al., 2020). For example, the symptoms such as sad feelings, social isolation, and weird thoughts about self should resolve or decrease to insignificant levels. The actual results matched the expected ones. The patient returned to the clinic in four weeks. The depressive symptoms decreased by 50%. The patient is tolerating well with the medication. It is ethical to educate the patient regarding medication adherence (Butts & Rich, 2019). Also, patient autonomy is to be respected by considering the patient’s preferences and involving the mother in decision-making processes. The mother should make decisions without external influence.
Decision Point Three
The selected decision point three is to maintain the current dose of Zoloft 50mg. This option was selected because the patient is showing positive results. Since there is a 50% improvement in symptoms, which shows a full response to medication (Kim, 2018). Therefore, it is recommended that the dose should be maintained and reassessed in 4 weeks.
Increasing the current dose to 75 mg was not selected because it is not warranted at this time. Increasing the dose would lead to an increased potential for adverse events. Adverse events may fracture the therapeutic alliance already created with the patient and further health problems (Potter, 2019). Additionally, there is no indication that the drug should be changed to an SNRI at this point. The client is responding well to Zoloft.
At this point, all the depressive symptoms are expected to disappear in four weeks. The client should restore his mood and the feelings of sadness should disappear. The appetite should have fully improved by the fourth week. Signs of withdrawal should end (McIntyre et al., 2020). The patient should achieve 100% recovery. The HAM-D results should not indicate significant depression and should read the lowest number possible (Kim, 2018). During the treatment, the therapist must consider patient autonomy by explaining to the patient everything regarding the illness and possible treatment options. Patient education and a good follow-up plan should be established. Patient education is necessary for the patient to understand how to support the child further (Butts & Rich, 2019). Patient autonomy has been recommended throughout the treatment period.
Conclusion
Depression is also known as major depressive disorder. It is a mental disorder that affects both children and adults. Globally, about 280 million people are diagnosed with depression. It is associated with symptoms such as a feeling of sadness, social withdrawal, loss of appetite, and others. The 8-year-old boy in the case study was diagnosed with depression. The patient was brought to be hospital by her mother due to complaints of a feeling of sadness. The mother had received a report from a teacher that the patient is withdrawn from peer classmates. He manifested the symptoms of depression. The patient needed proper intervention to improve her mood and other symptoms of depression.
Three decisions were made to help the patient improve the depressive symptoms. The selected decision one was to begin Zoloft 25mg. Zoloft was selected because it is widely used as a first-line treatment for major depressive disorder both in adults and children. The second decision was to increase the dose to 50mg. This was an appropriate decision because the patient showed positive progress with Zoloft. Decision three was to maintain the dose. The decision was selected because the patient indicated further positive results. Ethical considerations include beneficence, non-maleficence, and patient autonomy. Beneficence is an ethical principle that ensures all the decisions made by caregivers bring only advantages or benefits. Non-maleficence, on the other hand, is based on the idea that all decisions should not harm the patient. Patient autonomy ensures that all patient preferences are put into consideration.
References
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.
Kim, Y.-K. (2018). Understanding depression: Volume 2. Springer.
McIntyre, R. S., Rong, C., Subramaniapillai, M., & Lee, Y. (2020). Major depressive disorder. Elsevier.
Potter, D. R. (2019). Major depression disorder in adults: a review of antidepressants. Int. J. Caring Sci, 12, 1936. http://internationaljournalofcaringsciences.org/docs/69_potter_review_12_3.pdf
WHO. (2021). Depression. https://www.who.int/news-room/fact-sheets/detail/depression