Formal Decision Tree Instructions

Examine Case Study: An African American Child Suffering from Depression. https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_02/index.html. 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.
• Be aware that the writing template and grading rubric require your introduction to end with one sentence that is your thesis statement.  See the writing template for format and the grading rubric for details on how you are graded on this statement.

Body of your document

• The body of your document should contain three sections that are labeled as follows:  decision #1, decision #2, and decision #3.  Each section should address the topics below.  In your writing, you should be concise, clear, and thorough.  Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit.

Decision #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. *Ethical considerations must be clearly identified/labeled.  You can identify them within the decision section (“My ethical considerations are…”), or you can identify them separately in a section labeled “Ethical Considerations.”   Either option is acceptable.

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.

Decision #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.

Conclusion (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.

Assessing and Treating Pediatric Patients with Mood Disorders

 Student’s Name

Institutional Affiliation

Course

Instructor’s Name

Date

Assessing and Treating Pediatric Patients with Mood Disorders

Introduction

Depression can have negative health effects on the patient if not properly addressed. Depression is a mood or mental disorder that causes a persistent feeling of sadness and loss of interest. It is also known as major depressive disorder (APA, 2020). It affects how one thinks and behaves and may lead to different emotional and physical problems. People with depression or major depressive disorder may have trouble doing normal daily activities. Some may even think like it is not worth living. According to APA (2020), depression affects about 1 in 15 adults (6.7%) in any given year. Also, it is estimated that about 1 in six people (16.6) will experience depression at one point. Therefore, it is a serious issue that needs to be prevented or addressed properly.

The presented case study is about an 8-year-old African American male who arrives at the emergency department with his mother showing signs of depression. The boy complained of a feeling of sadness. The mother stated that the teacher said the boy is withdrawn from other children in the class. He also manifests reduced appetite and occasional periods of irritation. During the mental examination, the patient was alert and oriented X 3, coherent, clear speech, goal-directed spontaneous. The self-reported mood is sad and he denied visual or auditory hallucination. These symptoms are some of the factors that would affect the patient’s plan of care (APA, 2020). Additionally, the patient’s age and stage of development is a factor. Since the patient is a child, he will receive pediatric care. The body weight is also important when preparing the dose. In that regard, this paper discusses discussion points 1-3 based on the case study.

Decision #1

The selected treatment option or decision is to begin Zoloft 25 mg orally daily. This decision was selected because Zoloft is widely used and approved for the treatment of depression. According to Dwyer & Bloch (2019), Zoloft or sertraline is an antidepressant medication approved for the treatment of major depressive disorder and other mental illnesses such as posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Zoloft can be used in children ages 6 years and above.

Zoloft remains the best option compared to the other two options. Paxil is a good medication for treating depression, however, its use in pediatric patients is not recommended. Additionally, the drug has serious adverse effects on patients, which would instill more suffering to the patients (Elbe et al., 2019). On the other hand, Wellbutrin 75 mg was a good option but was not selected because it has a serious effect on the sleep patterns of babies. Wellbutrin reduces seizure threshold hence, increasing the patient’s chances of experiencing seizures.

The expectations from this decision included improved sleep and an improved feeling of sadness. The patient was expected to stop being withdrawn from others. Improved appetite and any other symptoms of depression should have gone away. Zoloft helps to improve mood, sleep, appetite, and the level of energy such that, the overall interest of an individual in daily life is restored. These were the expectations (Elbe et al., 2019). On return to the clinic after four weeks, the patient exhibited a slight increase in mood, however, there were no adverse events. My ethical considerations include patient autonomy and consent, beneficence, non-maleficence, and justice (Grace, 2018). Parents must be granted autonomy and consent before treatment.

Decision #2

Decision two is to increase the dose to 50 mg orally daily. This decision was selected because the patient experienced a slight increase in mood in the previous section. The slight increase in the client’s mood was an indication of a lower dose hence, the dose needed to be increased to 50mg. in pediatrics, the starting dose for Zoloft is usually 25 mg, then the doctor can adjust to 50mg if the symptoms persist or if there is no positive response not to exceed 200mg (Dwyer & Bloch, 2019). Increasing the dosage would help monitor the patient’s progress and the effectiveness of the treatment plan.

Changing to Prozac 10 mg orally daily was not selected because there was no need to discontinue Zoloft. The drug could only be discontinued if the symptoms increased severely or if it introduced some serious adverse effects that could have threatened the patient’s life (Elbe et al., 2019). Increasing the Zoloft dose to 37.5 mg orally would not help. It is recommended to increase Zoloft medications from 25mg to 50mg and keep adjusting the dose by 25mg. The discussion above explains why the other two decisions were not selected.

The expected result was to treat and reduce the patient’s mood. The therapist expected that the Zoloft doses would reduce the symptoms by 50%.  It is always a positive response with medications when the symptoms are reduced by 50%. After the fourth week, the patient returned to the hospital and started to have experienced the significant change (Elbe et al., 2019). The assessment revealed that the depressive symptoms decreased by 50% and that he was tolerating well. Therefore, the objective was achieved. Up to this point, the ethical considerations have not changed. The parents’ consent and autonomy must be exercised (Grace, 2018). All the treatment plans must be beneficial and cause no harm to the patient. the patient must be treated with dignity and respect just like others.

Decision #3

The selected decision three is to maintain the current dose (50 mg orally daily). This decision was reached due to the positive response of the patient. The patient achieved 50% symptom reduction which is a good sign (Elbe et al., 2019). At this point, there is a need to maintain the dose for the next four weeks. Increasing the dose to 75 mg orally daily might cause adverse effects to the patient. The medication works best at 50mg, hence, should be maintained. Additionally, there was no need to change to an SNRI since Zoloft was doing great (Dwyer & Bloch, 2019). It is considered a full response to therapy when symptoms are reduced by 50% or more on the HAM-D.

In decision point three, it is expected that the patient will improve all symptoms. It is expected that at the end of the fourth week. The patient will achieve 100% recovery from the depressive symptoms. For example, the feeling of sadness will completely go away. The patient will gain interest in daily activities (Elbe et al., 2019). Additionally, withdrawal symptoms and the feeling of sadness are expected to end. These expectations will be compared against the outcome after four weeks. A new treatment plan will be developed after seeing the outcomes for decision point 3. The same ethical considerations above will apply here. These ethical considerations have direct implications on the patient’s treatment plan (Grace, 2018). For instance, patient consent and autonomy must be applied. The plan must be beneficial and non-maleficent to the patient. Additionally, the patient has the right to confidentiality. The parents must be included in the decision-making process (Grace, 2018). Additionally, communication between the patient, family, and the facility must be effective and appropriate.

 

Conclusion

The presented case study was about an 8-year-old African American male who arrives at the emergency department with his mother showing signs of depression. Depression leads to negative health effects on the patient. It affects how one thinks and behaves and may lead to different emotional and physical problems. Decision point one involves beginning Zoloft 25mg daily. Zoloft is a widely used antidepressant and its use is acceptable in pediatric patients. The patient reported a slight increase in mood and no adverse events.

Decision pint two involves increasing the Zoloft dose to 50 mg orally daily. Zoloft 25mg is normally the starting dose in pediatric patients. The dose is then increased to 50mg to improve the symptoms. The patients experienced symptoms reduction by 50%. This situation is indicated as a full response but not a full recovery. There was the need to maintain the current dose, therefore, the third decision point was to maintain Zoloft 50mg orally daily. The patient is expected to gain full recovery from the symptoms. During the treatment, certain ethical considerations must be made to ensure the successful treatment of the patient. For instance, the treatment plans must be beneficial and cause no harm to the patient. the patient must be treated with dignity and respect just like others.

References

APA. (2020). What Is Depression? https://www.psychiatry.org/patients-families/depression/what-is-depression

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for pediatric patients. Current psychiatry, 18(9), 26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738970/

Elbe, D., Black, T. R., McGrane, I. R., & Procyshyn, R. M. (2019). Clinical handbook of psychotropic drugs for children and adolescents. Hogrefe Publishing.

Grace, P. J. (2018). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.