NURS 6630 WEEK 2 : Psychopharmacology

NURS 6630 WEEK 2 Assignment : Psychopharmacology

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 client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

• At each decision point stop to complete the following:
  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

 

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NURS 6630 Week2 Assignment Rubric

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		Excellent	Good	Fair	Poor
Quality of Work Submitted: The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.		27 (27%) – 30 (30%) Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.	24 (24%) – 26 (26%) Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.	21 (21%) – 23 (23%) Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.	0 (0%) – 20 (20%) Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
Quality of Work Submitted: The purpose of the paper is clear.		5 (5%) – 5 (5%) A clear and comprehensive purpose statement is provided which delineates all required criteria.	4 (4%) – 4 (4%) Purpose of the assignment is stated, yet is brief and not descriptive.	3.5 (3.5%) – 3.5 (3.5%) Purpose of the assignment is vague or off topic.	0 (0%) – 3 (3%) No purpose statement was provided.
Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:  Understand and interpret the assignment’s key concepts.		9 (9%) – 10 (10%) Demonstrates the ability to critically appraise and intellectually explore key concepts.	8 (8%) – 8 (8%) Demonstrates a clear understanding of key concepts.	7 (7%) – 7 (7%) Shows some degree of understanding of key concepts.	0 (0%) – 6 (6%) Shows a lack of understanding of key concepts, deviates from topics.
Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:  Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.		18 (18%) – 20 (20%) Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.	16 (16%) – 17 (17%) Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.	14 (14%) – 15 (15%) Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.	0 (0%) – 13 (13%) Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.
Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:  Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.		18 (18%) – 20 (20%) Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.	16 (16%) – 17 (17%) Summarizes information gleaned from sources to support major points, but does not synthesize.	14 (14%) – 15 (15%) Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.	0 (0%) – 13 (13%) Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
Written Expression and Formatting Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.		5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.
Written Expression and Formatting English writing standards: Correct grammar, mechanics, and proper punctuation		5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors.	3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors.	0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.		5 (5%) – 5 (5%) Uses correct APA format with no errors.	4 (4%) – 4 (4%) Contains a few (1-2) APA format errors.	3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors.	0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors.
Total Points: 100

Name: NURS_6630_Week2_Assignment_Rubric

 

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Sample solution this paper : Psychopharmacology NURS 6630

Introduction

This assignment involves a case study of an 8-year-old African American boy who presented with the mother manifesting signs of depression. The client reported feeling sad. According to the mother, the client has withdrawn from peers in the class, reduced appetite, and manifests irritability. The mental status exam showed that the client was alert and oriented to time, place, and person, and his speech was clear and coherent. The mood was sad, with blunted affect. The client reported that he sometimes thinks about death. The client score in the Children’s Depression Rating Scale was 30, manifesting significant depression. This paper will discuss three decisions about the treatment plan for the client and discuss the ethical aspects likely to affect his treatment.

Decision Point One

The selected decision is for the client to start Zoloft 25 mg orally daily. Zoloft was chosen because it is an antidepressant that belongs to the group of SSRIs and it increases the amount of serotonin within the brain and then balances the chemical in the brain (Garland et al., 2016). The medication was selected because Zoloft is a recommended antidepressant in children aged 6-years and above. Even though the medication is recommended in the treatment of OCD, it can be prescribed as off-label to treat depression for the client (Garland et al., 2016).

Paxil was not selected because the FDA prohibits the use of the medication in the pediatric population due to the increased risk of suicide. Wellbutrin was also not selected because the safety of the medication has not been determined in the pediatric population (Mullen, 2018).

By selecting Zoloft, it is expected that the client will show significant improvement as indicated by improved mood and appetite, reduced irritability, and starting to socialize with his peers in the class. This is because Zoloft is an effective antidepressant. It is also expected that the client would tolerate the medication because the safety of Zoloft has been established in children (Garland et al., 2016).

However, the client did not manifest any symptom improvement because after four weeks there was no change in depressive symptoms. The lack of symptom improvement can be attributable to the low dose of Zoloft. This is because the efficacy of an SSRI like Zoloft is dose-dependent (Hieronymus et al., 2016). However, the client did not report any side effect and this indicates that he tolerated the administered medication.

Decision Point Two

The selected decision is to increase the Zoloft dose to 37.5 mg daily. This decision was selected because the medication is an approved antidepressant in children aged 6 years and above. Moreover, SSRIs like Zoloft are dose-dependent, and thus increasing the dose will increase the efficacy of the medication, leading to symptom improvement for the client (Hieronymus et al., 2016). The decision to increase the dose to 50 mg was not selected because dose increment should be gradual to monitor the client’s tolerance to the increased dose. The decision to change the treatment to Prozac 10 mg was not selected because there is no clinical reason to change the treatment.

By increasing the dose to 37.5 mg, it is expected that the client would start responding to the treatment and manifest symptom improvement. This is because the efficacy of SSRIs is dose-dependent and thus increased dose will have higher efficacy (Hieronymus et al., 2016). It is also expected that the client would tolerate the increased dose and would not experience any significant side effects.

As expected, after four weeks the client reported feeling better and there was a 20% reduction of the depressive symptoms. The symptoms improvement is attributable to the efficacy of Zoloft in improving depressive symptoms. Zoloft inhibits the reabsorption of serotonin and thus increases the amount of serotonin in the brain (Gao et al., 2018). Serotonin is the chemical responsible for improving the mood, and thus the efficacy of the medication in treating depression.

Decision Point Three

The third decision is to increase the dose of Zoloft to 50 mg daily. This decision was selected because the client is already manifesting symptom improvement with the medication. The efficacy of SSRIs like Zoloft is dose-dependent and thus it is expected that an increased dose will lead to increased efficacy (Gao et al., 2018). The decision to maintain the dose was not selected because with the 37.5 mg, adequate symptom reduction has not been achieved. The decision to change to a different SSRI was not selected because the client is already showing symptom improvement with the current medication.

With the increased dose, it is expected that the client will continue manifesting symptom improvement and eventually achieve complete symptom remission. This is because the efficacy of Zoloft is dose-dependent and thus the increased dose will have an increased efficacy (Hieronymus et al., 2016).

Ethical Considerations

The ethical aspects relevant to the treatment of this client include decision-making ability, informed consent, and confidentiality. The client is an 8-year-old and thus he is a minor who cannot make his treatment decisions or consent to the treatment. Accordingly, the parents will make the treatment decision for him. Additionally, the PMHNP will need to seek informed consent from the client’s parents (Ford & Hecke, 2015). Moreover, the confidentiality of the client’s information should be respected (Ford & Hecke, 2015). Therefore, the PMHNP should not reveal the client’s health information to third parties, unless the client and the parent consent to it.

Conclusion

The first decision is for the client to start Zoloft 25 because the medication is recommended for use in the pediatric population. However, with this decision, the client did not show any symptom improvement and thus the second decision is to increase the dose to 37.5 mg. With the increased dose, the client manifested symptom improvement and thus the third decision is to increase the dose of Zoloft to 50 mg. With the increased dose, it is expected that the client will continue showing symptom improvement and eventually manifest complete symptom remission. The ethical considerations relevant to this client include confidentiality, decision-making ability, and informed consent.

 

 

References

Ford C & Hecke L. (2015). Ethical and Legal Considerations When Counseling Children and Families. Journal of Family Therapy,36(4).

Gao, S. Y., Wu, Q. J., Sun, C., Zhang, T. N., Shen, Z. Q., Liu, C. X., … & Chang, Q. (2018). Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births. BMC medicine, 16(1), 1-14.

Garland, E., Kutcher, S., Virani, A., & Elbe, D. (2016). Update on the Use of SSRIs and SNRIs with Children and Adolescents in Clinical Practice. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent, 25(1), 4–10.

Hieronymus, F., Nilsson, S., & Eriksson, E. (2016). A meta-analysis of fixed-dose trials reveals dose-dependency and rapid onset of action for the antidepressant effect of three selective serotonin reuptake inhibitors. Translational psychiatry, 6(6), e834. https://doi.org/10.1038/tp.2016.104.

Mullen S. (2018). Major depressive disorder in children and adolescents. The mental health clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275.