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Assessing and Treating Pediatric Patients With Mood Disorders

Assessing and Treating Pediatric Patients With Mood DisordersAssessing and Treating Pediatric Patients With Mood DisordersWhen pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.To prepare for this Assignment:Review this week’s Learning Resources, including the Medication Resources indicated for this week.Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.Assessing and Treating Pediatric Patients With Mood DisordersORDER A PLAGIARISM-FREE PAPER HEREThe Assignment: 5 pagesExamine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.Introduction to the case (1 page)Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.Assessing and Treating Pediatric Patients With Mood DisordersDecision #1 (1 page)Which decision did you select?Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Decision #2 (1 page)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Assessing and Treating Pediatric Patients With Mood DisordersDecision #3 (1 page)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Assessing and Treating Pediatric Patients With Mood DisordersConclusion (1 page)Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From DepressionAssessing and Treating Pediatric Patients With Mood DisordersBACKGROUND INFORMATIONThe 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 PractitionerAssessing and Treating Pediatric Patients With Mood DisordersMENTAL STATUS EXAMAlert & 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)Assessing and Treating Pediatric Patients With Mood DisordersRESOURCES§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services. 1-Decision Point OneSelect what the PMHNP should do: 1-Begin Zoloft 25 mg orally dailyBegin Zoloft 25 mg orally dailyRESULTS OF DECISION POINT ONE·  Client returns to clinic in four weeks·  No change in depressive symptoms at allegin Zoloft 25 mg orally daily2Increase dose to 37.5 mg orally dailyAssessing and Treating Pediatric Patients With Mood Disorders·  Client returns to clinic in four weeks·  Depressive symptoms decrease by 20%. Client reports feeling a little bit better At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate. -Begin Wellbutrin 75 mg orally BID · Client returns to clinic in four weeks·  Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea Decrease dose for 7 days then return to previous 10 mg day doseGuidance to StudentGuidance to StudentThe PMHNP has two equally compelling choices at this point. The client has only been taking the current drug at its current dose for 4 weeks. It would be appropriate to continue at current dose. Additionally, the PMHNP could also increase the dose to 20 mg orally daily. A discussion of risk/benefits should be had with the childs guardian regarding this and collaborative decision making should occur. There is no indication at this point that augmentation agents are required as the child is showing a partial response to therapy.Assessing and Treating Pediatric Patients With Mood Disorders2-RESULTS OF DECISION POINT TWO Begin Paxil 10 mg orally dailyBegin Paxil 10 mg orally daily·  Client returns to clinic in four weeks·  Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea· Decrease dose for 7 days then return to previous 10 mg day dose  Client returns to clinic in four weeks·  Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose·· Attempt to decrease dose for another 7 days then return to 10 mg doseAssessing and Treating Pediatric Patients With Mood Disorders· Guidance to Student Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, the PMHNP will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects.3-Begin Wellbutrin 75 mg orally BIDBegin Wellbutrin 75 mg orally BID·  Client returns to clinic in four weeks·  Child is unable to fall asleep at nightAssessing and Treating Pediatric Patients With Mood DisordersChange from immediate release to extended release 150 mg orally daily in the morningive second dose of the day at 1:00 pm in the afternoon· Client returns to clinic in four weeks·  Child’s sleep patterns return to baseline. No change in depressive symptoms  Change to SSRI Guidance to Student The PMHNP can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.hange to Lexapro 10 mg orally dailyAssessing and Treating Pediatric Patients With Mood Disorders Give second dose of the day at 1:00 pm in the afternoon ·  Client returns to clinic in four weeks·  No change in sleeping patterns, child is getting more difficult to wake for school3-Decision Point Three· Begin Wellbutrin 75 mg orally BID Begin Wellbutrin 75 m·  Client returns to clinic in four weeks·  Child is unable to fall asleep at night Change to Lexapro 10 mg orally daily ·  Client returns to clinic in four weeks·  Child is tolerating Lexapro, and is sleeping at night. There is a 40% reduction in symptomsAssessing and Treating Pediatric Patients With Mood DisordersDecrease dose for 7 days then return to previous 10 mg day dose ·  Client returns to clinic in four weeks Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose· Attempt to decrease dose for another 7 days then return to 10 mg dose·Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, the PMHNP will need to select a different agent as these side effects are unfavorable to the client and may result in continued refusal to take treatment. Changing to a different SSRI may be appropriate if the trial decrease of dose is unsuccessful and if the nausea, vomiting, and diarrhea return with reinitiation of 20 mg orally daily. Changing the medication may be appropriate as not all SSRIs have the same side effect profile in all client. Assessing and Treating Pediatric Patients With Mood Disorders

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