Week 2

Therapeutic Intervention for Pediatric Clients with Depression

The provision of healthcare to pediatric patients may vary significantly as compared to the case of adult populations. This is considering that the symptoms of disease or any underlying health condition manifests in a different way as compared to those of an adult patient as discussed by Ghandour, et al. (2019). The fact that the process in which medication is assimilated to the body also varies in children as compared to the adult patients further shows the need of handling pediatric patients separately. This paper focuses on the development of an effective intervention for the control of the suitable features. Pediatric nurses should therefore consider handling the treatment of children more keenly to prevent the case of extreme reaction. This paper discusses the treatment of the presented child with depression. The choice of the suitable treatment and the rationale are provided in the paper. 

Case Study Summary

 The presented case study is of an African American presenting with depression. The child is described by the mother to have developed abnormal behavior. The child is presenting with withdrawn conditions. The mother also expresses that the child has been lately less active and avoids the company of the peers. The mother also indicated that the child’s appetite has declined within a short span of time. The child was also reported to be showing signs of aggressiveness while playing with peers and even while communicating at home. It was also reported that similar cases of aggression and loneliness by the patient were reported by the teachers. 

 A physical examination of the child was carried out. There was no physical injury on the skin, and the child also did not indicate any signs of extreme level of vital signs. The child also indicated to be alert and could also walk with a straight gait when they were asked to wake up from a sitting position and walk across an open space. The orientation of the child was fine, and they were also spontaneous in responding to general knowledge information like the age and the dates. The child was subjected to depression scale and the outcome indicated a score of 35. This therefore informed the diagnosis of depression.  

Decision #1

Which decision did you select?

 The choice of treatment that I would take in the first decision is to prescribe Sertraline 25 mg by mouth daily. 

Why did you select this decision? 

 Sertraline is a medication that belongs to the group of medication selective serotonin reuptake inhibitors (SSRIs) (Poweleit, et al. 2019). This medication acts by hindering certain imbalance of chemicals in the brain of individuals with depression. The rationale for selecting this medication is because it has a commendable response rate of about 70% in children with depression. 

What were you hoping to achieve by making this decision? 

 The objective for the selection of Sertraline was to ensure that any form of mental health associated with depression is managed in the child (Poweleit, et al. 2019). This is because the Sertraline is suitable for the management of several other mental health conditions besides depression. These includes anxiety disorder and panic disorder. 

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

 Some of the outcomes that were observed after using the medication did not meet the expectation of using this sertraline. one of the unexpected outcomes was that the child was still aggressive as described by Poweleit, et al. (2019). The other outcome was that the child became drowsier and the less active. Signs of confusion were also observed in the child and this contributed to the development of an effective measure for the improvement of the effective features. The symptoms of the child seemed to be getting worse after the medication as the child could not settle. These unexpected outcomes could be associated with the side effects of the medication. These outcomes were temporary. 

Decision #2

Why did you select this decision? 

 In the second set of decisions, the decision that is selected in this case is the last option whereby dose of the Sertraline is increased to 50 mg by mouth daily.

What were you hoping to achieve by making this decision? 

 The rationale for the selection of this option is considering that the medication is effective in children (Vitiello, & Ordóñez, 2016). Sertraline is highly responsive in children and takes a shorter period of time. Administering an additional dose of Sertraline is with the expectation that the effectiveness of the medication in relieving depressed is increased. The aspect of aggression is also expected to diminish much faster. The responsiveness to the medication was also expected to improve and thus the child would be able to fell less of the depression condition. 

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

 One of the outcomes that was one expected in the patient is the case of dryness of the mouth and frequently feeling thirsty (Vitiello, & Ordóñez, 2016). The other unexpected outcome was that the patient experienced confusion which occurred shortly after taking the medication. Drowsiness was also observed, and the patient became more active. These unexpected reactions would be associated with the side effects of Sertraline that may increase with the increase in the dose. The impacts of the disease were also expected to last for a short period of time and thus would help to manage the condition effectiveness. 

Decision #3

Why did you select this decision? 

The last choice of the treatment for in this case would be to select the sertraline 75 mg by mouth daily. 

What were you hoping to achieve by making this decision? 

 The rationale for the selection of the medication would be to ensure that the patient gets a maintenance dose to stabilize the depression condition and thus contribute to faster recovery (Ramsey, Bishop, & Strawn, 2019). The optimal dose for children between the age of 6 years and 13 years is between 25 mg to 200 mg once every day. Thus providing this dose would be within the set maintenance dose. From offering this medication to the patient, I would be hopping to achieve effective maintenance of the patient condition that would improve the management of the condition. The child will therefore be in position to manage their condition much faster. 

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

 Considering the the medication may have several possible side effects, the possible unexpected health conditions may include the case of reduced rate of the patient condition would also contribute to better condition of developing suitable features of concern. The patient is also likely to show signs of not settling in one position (Ramsey, Bishop, & Strawn, 2019). Sertraline is also likely to interact with some types other types of medications besides also interacting with the patient depression condition. 

Ethical considerations and impact on Treatment Plan and Communication with clients.

 Considering that the patient is a child, thus various ethical considerations may be considered (Ghandour, et al. 2019). Handling children especially when seeking to acquire information about health should consider the aspect of patient autonomy. In this case, despite the immediate caregiver being the potential surrogate decision maker, the child should also be provided with the information concerning their treatment. Communication with the child may be challenging in some situations where the child gets distracted (Vitiello, & Ordóñez, 2016). The child in other cases may also get emotional and call for the intervention of the mother to calm them. In such cases, the healthcare provider should be patient and use possible approaches to contain the child. This will ensure that effective communication is provided. The healthcare provider should provide appropriate patient education to the patient about the treatment. The age of the child would also determine whether the mother becomes the surrogate decision maker on health issues. Children below the age of 14 years should have the parent making health decisions on their behalf. 

Summary

 The process of providing healthcare to children requires that the pediatric healthcare provider addresses the needs of the child with care. The experience of children may differ from that of adults with similar health conditions. The process of developing suitable features would contribute to the development of the effective measures. Depression symptoms in children may also vary from the case of the children. The treatment approach would also be associated with the improvement of the specific features that would be associate with the control of the suitable system of concern. The reaction of medication by children also is not similar to the case of medication reaction by adults. Provision of care to children also consider the aspect of autonomy and informed consent. The parents should consent in the case of children below 14 years. 

Reference

Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of pediatrics, 206, 256-267.

Poweleit, E. A., Aldrich, S. L., Martin, L. J., Hahn, D., Strawn, J. R., & Ramsey, L. B. (2019). Pharmacogenetics of sertraline tolerability and response in pediatric anxiety and depressive disorders. Journal of child and adolescent psychopharmacology, 29(5), 348-361.

Ramsey, L. B., Bishop, J. R., & Strawn, J. R. (2019). Pharmacogenetics of treating pediatric anxiety and depression.

Vitiello, B., & Ordóñez, A. E. (2016). Pharmacological treatment of children and adolescents with depression. Expert opinion on pharmacotherapy, 17(17), 2273-2279.