When pediatric clients 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 clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Case Study

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• Mother reports that teacher said child is withdrawn from peers in class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)

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

Please discuss each medication option listed in Decision Point 1. Why did you not chose the alternative options? What is the mechanism of action for each medication? What are first line FDA approved medications for pediatric depression? Must use and cite 4 sources 

 

Requirements: 

1. In order to prepare for this assignment, read the lessons as well as the assigned readings BEFORE attempting the self-assessment. 
2. Please use the following hyperlink to access and complete the survey: Week 2 Pre-TANIC Self-Assessment Survey    (Links to an external site.)
3. FAILURE TO COMPLETE THE SURVEY WILL RESULT IN A GRADE OF ZERO (0) FOR THE ASSIGNMENT. 
4. After completing the survey, navigate to the Week 2 Module in Canvas and respond to EACH of the q uestion s for your Reflection Post.    
5. The Reflection Posts DOES NOT require cross-posting to a peer or faculty .  
6. Scholarly sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer reviewed publications, government reports, or sources written by a professional or scholar in the field. Your textbook and lesson are not considered to be an outside scholarly source. For the discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.  You are encouraged to use the Chamberlain library and search one of the available data bases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These web  sites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality.  It is the responsibility of the student to determine the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.  

ATTENTION: Students will not receive results following completion of this survey. For the reflection questions, please recall how you rated your proficiency/competency with the skills on the survey.

*IMPORTANT* Upon completing the TANIC self-assessment survey, please TAKE A SCREENSHOT of the last page of the survey using a program such as Snipping Tool and save as a PDF or JPG and for your records. If you are unable to take a screenshot, please inform your faculty.

Reflection Questions: 

Reflect upon your current or most recent clinical practice and answer the following:  

1. How is informatics used? 
2. Regarding the Pre-TANIC Self-Assessment for this week, how did your perceived competency level prior to the self-assessment compared to after the self-assessment? Explain in detail.  
3. What TWO competencies do you use in your current clinical role? Provide examples.  
4. Identify TWO resources to develop a strategic plan to enhance your competency skills.   
5. Which resources are suited to your needs and why?  
6. How do you intend to enact this improvement plan? 

 

Healthcare provider shortage is a real problem faced by the nation which was exacerbated by implementation of the Affordable Care Act. So, having more providers will definitely impact the quality of patient care highly positively. The quality of patient care will improve when more skilled primary care providers, nurse practitioners (NP’s), focused on disease prevention will have the full scope of practice. Also, since NP’s have a different angle and approach to patient care, patients will enjoy a different experience with them. The difference lies within how the patient is treated. NP’s are educated in holistic care, focusing on wellness and disease prevention but not all physicians treat patients in that manner (Tracy & O’Grady, 2019). NPs are touted by the nursing profession as less expensive, same quality providers that are able to increase access to the uninsured by charging lower fees (Tracy & O’Grady, 2019). Also, there are a few studies that have shown that patient readmission rates and hospital usage are lower with medical doctors (Nickitas, Middaugh, & Aries, 2016). On the contrary, studies demonstrate that NP’s improve patient outcomes on the units they serve (Nickitas et al., 2016). 

References

Tracy, M. F., & O’Grady, E. T. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach (6th ed.). St. Louis, MO: Elsevier.

Nickitas, D., Middaugh, D., & Aries, N. (2016). Policy and Politics for Nurses and other Health Professionals: Advocacy and Action. Burlington, MA: Jones & Bartlett Learning.

 

In a 5- to 10-slide PowerPoint presentation, address the following:

• Provide an overview of the article you selected.
  • What population is under consideration?
  • What was the specific intervention that was used? Is this a new intervention or one that was already used?
  • What were the author’s claims?
• Explain the findings/outcomes of the study in the article. Include  whether this will translate into practice with your own clients. If so,  how? If not, why?
• Explain whether the limitations of the study might impact your  ability to use the findings/outcomes presented in the article. Support  your position with evidence-based literature.
• Three references required.

Link to article:

https://psycnet.apa.org/fulltext/2013-03648-001.pdf?auth_token=d0add8ac0e331958f0e7f458ffe293b0ca34c246

What are your thoughts 

There are many barriers that holds nursing practice from achieving their goal, two of which are lack of time and lack of education. To ensure that future healthcare users can be assured of receiving such care, healthcare professions must effectively incorporate the necessary knowledge, skills and attitudes required for EBP into education programs (Lehane et al., 2019). Ways in which the barriers may be addressed is by collaborating with nurse leaders, managers, stakeholders and staff to promote changes in policies and procedures and implement the use of current EBP to create positive patient outcomes. Educating why and allowing nurses to have easy access to quality information from reliable sources can increase positivity when it comes to research and EBP. Another important strategy would be to work with staff and create time for them to find the information and review findings and ways to implement the strategies. Support from managers and influence from an administrative level that supports EBP and the expansion of knowledge.