E‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍xamine Case Study: An African American Child Suffering From

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 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. 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. 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 Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression African American Child BACKGROUND INFORMATION 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) RESOURCES § Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services. Decision Point One 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 Select what the PMHNP should do: Begin Zoloft 25 mg orally daily. Decision Point One Begin Zoloft 25 mg orally daily RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Slight increase in mood No HAM-D results No adverse events reported Decision Point Two Increase dose to mg orally daily RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Depressive symptoms decrease by 20%. Client reports feeling a little bit better Begin Paxil 10 mg orally daily Decision Point One Begin Paxil 10 mg orally daily RESULTS OF DECISION POINT ONE 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 Decision Point Two Decrease dose for 7 days then return to previous 10 mg day dose RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose Begin Wellbutrin 75 mg orally BID Decision Point One Begin Wellbutrin 75 mg orally BID RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Child is unable to fall asleep at night Decision Point Two Change from immediate release to extended release 150 mg orally daily in the morning RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Child’s sleep patterns return to baseline. No change in depre‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ssive symptoms

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