Assessing And Treating Pediatric Patients With Mood Disorders

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Week 4: Therapy for Patients With Major Depressive Disorder (MDD)

Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.

 

As a PNP working with pediatric patients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision tree, will specifically center on one of the most vulnerable populations, pediatrics. Please remember, you must also consider the ethical and legal implications of these therapies. You will also complete a Quiz on the concepts addressed throughout this module.

 

Learning Objectives

Students will:

· Assess patient factors and history to develop personalized plans of antidepressant therapy across the lifespan

· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric, adult, and geriatric patients requiring antidepressant therapy

· Synthesize knowledge of providing care to pediatric, adult, and geriatric patients presenting for antidepressant therapy

· Analyze ethical and legal implications related to prescribing antidepressant therapy to patients across the lifespan

 

 

Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

When 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.

 

The Assignment: 5 pages

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.

Note:  Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

 

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632).All papers submitted must use this formatting.

 

 

 

 

// Pediatric depression Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression

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

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

 

 

// Pediatric depression

Therapy for Pediatric Clients with Mood Disorders

An African American Child Suffering From Depression

 

 

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

 

 

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

 

  // Pediatric depression

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

 

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.

You administer 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

Select what you should do:

 

Begin Zoloft 25 mg orally daily

 

Begin Paxil 10 mg orally daily

 

Begin Wellbutrin 75 mg orally BID

Recommending An Evidence-Based Practice Change

To Prepare:

  • Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
  • Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
  • Consider the best method of disseminating the results of your presentation to an audience.

The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

  • Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
  • Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
  • Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
  • Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
  • Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
  • Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
  • Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
  • Add a lessons learned section that includes the following:
    • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
    • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

      image1.emf

      Evaluation Table

      Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

      Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4
               
      Evidence Level *

      (I, II, or III)

       

             
      Conceptual Framework

      Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

       

             
      Design/Method

      Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

             
      Sample/Setting

      The number and characteristics of

      patients, attrition rate, etc.

             
      Major Variables Studied

      List and define dependent and independent variables

             
      Measurement

      Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

             
      Data Analysis Statistical or

      Qualitative findings

      (You need to enter the actual numbers determined by the statistical tests or qualitative data).

             
      Findings and Recommendations

      General findings and recommendations of the research

             
      Appraisal and Study Quality

      Describe the general worth of this research to practice.

      What are the strengths and limitations of study?

      What are the risks associated with implementation of the suggested practices or processes detailed in the research?

      What is the feasibility of use in your practice?

             
      Key findings

       

             
      Outcomes

       

             
      General Notes/Comments        

      * These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

      · Level I

      Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

      · Level II

      Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

      · Level III

      Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

      · Level IV

      Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

      · Level V

      Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

      **Note on Conceptual Framework

      · The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework

      · Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

      · As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

      · Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

      · Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

      References

      The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

      Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

      Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework

      Critical Appraisal Tool Worksheet Template

       

       

      © 2018 Laureate Education Inc. 2

NURSING LEADERSHIP

Module 05 Assignment – Scheduling and Staffing

Module 05 Content

  1. Scheduling and Staffing
    Competency
    Collaborate in healthcare delivery systems settings for improved patient outcomes.
    Scenario
    You are making a staffing assignment knowing that you are short-staffed. You have five registered nurses (RNs), two licensed practical nurses (LPNs), and two nursing assistants. Those nine employees need to provide a 12-hour shift of services to 30 clients with a high acuity required to a ratio of nurse to client at 1:3.
    Client acuity level

    • Six acuity level 1
    • Eight acuity level 2
    • Nine acuity level 3
    • Seven acuity level 4
    • You will use the acuity-based staffing model to develop the staffing assignment based on the needs of the clients. You will use the created template.

      NUR2832_Staffing

      Instructions
      As you create this assignment, include the following in an email to your manager to justify your short-staffing plan:

    • Complete the staffing assignment based on the acuity level.
    • Defend how you would direct the staff to their assigned roles for this shift and provide a rationale for the staffing assignment.
    • Describe how you would communicate with each level of care provider to assure the best outcomes possible.
    • Address how you would ensure client equity in the delivery of services.
    • Provide stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar.
    • Resources
      For assistance completing this assignment, review the article titled Patient Acuity Model.
      Submit your completed assignment by following the directions linked below. Please check theLeadership and Professional Identity Staffing Assignment Template

      Staffing Available

      · 5 RN 2 LPN 2 NA

      · 30 patients

      Acuity Level 1 – 6 Patients

      1. Room 2301 Susan is a 93-year-old who fell at home and is waiting for nursing home placement who uses a walker and requires assistance to the bathroom and ADLs

      2. Room 2312 Fredrick is a 57-year-old who is recovering from a knee replacement who needs educational reinforcement and is going home today.

      3. Room 2319 Joshua is a 63-year-old who was in for cardioversion and is going home today.

      4. Room 2329 Brian is a 49-year-old who has been diagnosed with hypertension and Alzheimer’s Disease who wanders off the unit and needs assistance with ADLs.

      5. Room 2304 James is a 95-year-old who has osteoarthritis and needs help getting out of bed, bathing, and dressing.

      6. Room 2307 Francis is a 39-year-old who will be discharged today. She received discharge teaching yesterday about her ruptured appendix wound and wants to review the care instructions before she leaves.

      Acuity Level 2 – 8 Patients

      1. Room 2302 Brooke is a 33-year-old who was admitted with new-onset DM with uncontrolled blood sugars. She has started on new medications, including insulin, and needs additional patient and family education.

      2. Room 2311 Mark is an 83-year-old who is on isolation for MRSA and is on IV antibiotics and ten other medications.

      3. Room 2320 Jeffrey is a 63-year-old who is non-compliant with his medications and came in with hypertension and crackles in his lungs. He has daily labs and has a wound on his left foot.

      4. Room 2330 Leslie is a 46-year-old who had unstable angina and had a cardiac catheterization yesterday late afternoon and stayed over for observation.

      5. Room 2305 Traci is a 72-year-old who has a history of heart disease, a history of myocardial infarction, and mild dementia.

      6. Room 2308 Alecia is a 33-year-old who was experiencing chest pain and is scheduled for a stress test later today.

      7. Room 2303 Theodore is a 22-year-old who has had DM since he was a 10-years-old who requires medication adjustments.

      8. Room 2318 Bruce is a 45-year-old who was placed on isolation for C-Diff and is on several IV mediations.

      Acuity Level 3 – 9 Patients

      1. Room 2306 Amelia is an 83-year-old after a stroke and requires total care.

      2. Room 2313 Audrey is a 78-year-old with newly diagnosed COPD.

      3. Room 2317 Abigail is a 90-year-old who is a diabetic with a chronic leg infection.

      4. Room 2328 Roxanne is an 82-year-old with newly diagnosed lung cancer.

      5. Room 2322 Nancy is a 56-year-old with chronic kidney disease and on peritoneal dialysis.

      6. Room 2323 Dennis is a 35-year-old who was admitted with right upper quadrant pain that radiates to the right shoulder.

      7. Room 2314 Roger is a 46-year-old who is wasted and malnourished. She has severe diarrhea.

      8. Room 2309 Terry is a 59-year-old who has bladder cancer with painless hematuria.

      9. Room 2310 Barry is a 54-year-old who has a history of mitral valve regurgitation.

      Acuity Level 4 – 7 Patients

      1. Room 2315 Karen is a 45-year-old who had an acute myocardial infarction with percutaneous coronary intervention.

      2. Room 2321 Fredrick is a 43-year-old who was admitted after an overdose and required close monitoring.

      3. Room 2327, Samantha is a 57-year-old with severe abdominal pain with no bowel sounds.

      4. Room 2324 Robbie is a 62-year-old who has been vomiting and pain in the abdomen.

      5. Room 2325 Jenny is a 58-year-old MVA who has a tracheostomy.

      6. Room 2326 Annette is a 68-year-old who had a bowel resection and colostomy.

      7. Room 2316, David is a 54-year-old with weakness and a decreased level of consciousness.

       

      RN 1 RN 2 RN 3 RN 4 RN 5
      Room # Acuity Room # Acuity Room # Acuity Room # Acuity Room # Acuity
                         
                         
                         
                         
                         
                         
      LPN 1 LPN 2 CNA 1 CNA 2 Staff

      · 5 RN

      · 2 LPN

      · 2 CNA

      30 patients

      · 6 acuity level 1

      · 8 acuity level 2

      · 9 acuity level 3

      · 7 acuity level 4

      Room # Acuity Room # Acuity Room # Acuity Room # Acuity  
                       
                       
                       
                       
                       
                       
                       
                       

       

       

       

       

      06/16/2020

Explain multicultural communication and its origins.

Write a 650-1300 word response to the following questions:

  1. Explain multicultural communication and its origins.
  2. Compare and contrast culture, ethnicity, and acculturation.
  3. Explain how cultural and religious differences affect the health care professional and the issues that can arise in cross-cultural communications.
  4. Discuss family culture and its effect on patient education.
  5. List some approaches the health care professional can use to address religious and cultural diversity.
  6. List the types of illiteracy.
  7. Discuss illiteracy as a disability.
  8. Give examples of some myths about illiteracy.
  9. Explain how to assess literacy skills and evaluate written material for readability.
  10. Identify ways a health care professional may establish effective communication.
  11. Suggest ways the health care professional can help a patient remember instructions.