Tag: Clinical-Nursing

Case Study: An African American Child Suffering From Depression

Therapy for Pediatric Clients with Mood Disorders

Introduction

Pediatric Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders.    Recent studies have shown a correlation between  affective disorders in children, and depression or anxiety disorders in the adult years. It is suggestive that the onset of adult psychopathologic disorders can be linked to behavioral or emotional symptoms displayed as  a child or adolescent.(Medscape, 2018). Case Study: An African American Child Suffering From Depression.

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Mood disorders in children remain one of the most under diagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don’t always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.(chop,2018).  Treatments vary depending on the symptoms of the depression. Treatment is aimed at decreasing the signs of the illness. In order to properly treat a patient, there needs to be a complete assessment , past mental health history, psychological therapies and pharmacological interventions should be part of the treatment plan.

The purpose of this assignment is to discuss mood disorders and its effect on children and treatment options available.

Summary of patient

The patient is an 8 year old African American male with chief complaints of feeling “sad, withdrawn, decreased appetite and occasional irritation. Upon assessment the child is alert and oriented x 3, overall mood is sad. He denies visual or auditory hallucinations, however, admits to thinking about himself being dead. The Children’s Depression rating scale is 30, translates to significant depression. The CDRS was devised by Poznanski, Cook, and Carroll in 1979, to diagnose depression in 6- to 12-year-olds.(Poznanski,1986). Case Study: An African American Child Suffering From Depression.

Decision 1

Options:  Sertraline 25mg by mouth daily, Paxil 10 mg by mouth daily and Wellbutrin 75mg by mouth 2x/daily

I chose Sertraline 25 mg by mouth daily. Studies have shown that Sertaline is appropriate for treating depression in young children.”(SSRIs) have a relatively good response rate (40-70%)”(p.7). Paxil   is contraindicated for children younger than 18 and Wellbutrin is contraindicated as well. Wellbutrin has other risks for anorexia and seizures (p.16). The initial goal of treatment of mood disorders is a decrease in symptoms. The outcome of treatment was not as I expected , I expected a minimal reduction in symptoms. However, the client reported no change in symptoms.

Decision 2

Options: Prozac 10 mg by mouth daily, Sertraline 37.5 mg by mouth daily, Sertraline 50 mg by mouth daily

I chose to increase the Sertraline to 50 mg  by mouth daily. Sertraline is appropriate for treating children and the dosage can be titrated to up 200 mgs (p.18). The 25 mg dose might not be the right therapeutic dose and  to give it more time to become effective. I did not pick Sertraline 37.5 because it is below the therapeutic  dose suggestion. The reason for not choosing Prozac 10 mg by mouth daily, is to stay with the current medication and titrate up till symptoms decrease and client does not report depression symptoms. The goal of treatment is  to have a reduction in symptoms. The results were some of what I expected, I did not expect a 50% reduction in depressive symptoms. Case Study: An African American Child Suffering From Depression.

Decision 3

Options:  Maintain current dose, change to SNRI, or Increase to Sertraline 75 mg by mouth daily

My choice is to maintain the current dose. Stahl (2013) has mentioned that a 50% reduction in symptoms after treatment with an antidepressant is a “response”. If there is a positive response to a medication it is best to maintain that current treatment. There reason I did not chose the other two options was because the client had a 50% reduction in symptoms without any further symptoms. The goal is for the client to respond positively to medication leading to complete reduction of symptoms. The outcome was as I expected. The goal of titrating a medication that has shown positive results .After a 50% reduction, there should be more reduction after the next 4 weeks, leading to a complete remission of symptoms.

Conclusion with Ethical considerations

Children, including adolescents can display disruptive or irritability as a normal part of this stage in development. But key signs to watch for include irritability and not getting along with other children, stating other children do not like them, the feeling of rejection, these are “bridge symptoms” that can be early signs of risk for a anxiety or affective disorder. Parents, teachers, and care givers need to be aware of what is typical teen behavior and what is atypical to help prevent future mental health disorders.

The ethics and responsibility of prescribing medication falls in the hands of the provider. The provider is responsible for educating the client and the parents in this case of the risk. Children that are younger than 14 are not able to consent to treatment.” They cannot give legal permission for treatment, which must come from their parents. It is the responsibility of the prescribing clinician to inform the parents of the expected benefits and risks of the medication” (Vitiello, 2012, p.12).  The clinician has the responsibility  to monitor the clients  response to medication and compliance . Involving the parents in the plan of care can help monitor the effectiveness of the treatment. Case Study: An African American Child Suffering From Depression.

References

Children’s Hospital of Philadelphia.(2018) Retrieved from https://www.chop.edu/conditions-    diseases/mood-disorders-children-and-adolescents

Laurate Education (2016e).
Case study. An African American Child Suffering From Depression
[Interactive             media file]. Baltimore, MD: Author.

Medscape (2018).  Retrieved from https://www.medscape.com

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical     applications (
4th ed. New York, NY: Cambridge University Press.

Vitiello B. (2012). Principles in using psychotropic medication in children and adolescents. In Rey JM (ed),              IACAPAP
e-Textbook of Child and Adolescent Mental Health. Geneva: International Association       for Child and Adolescent Psychiatry and Allied Professions.
Retrieved from http://iacapap.org/wp-content/uploads/A.7-

 

 

Case Study: An African American Child Suffering From Depression NURS 6630 – Week 2

To prepare for this Assignment:

 

Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

 

The Assignment

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. Case Study: An African American Child Suffering From Depression.

 

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? Case Study: An African American Child Suffering From Depression.

 

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.

 

Therapy for Pediatric Clients with Mood Disorders – Case Study: An African American Child Suffering From Depression

Decision #1

Which decision did you select?

Begin Zoloft 25 mg orally daily.

Why did you select this decision?

Zoloft is a selective serotonin reuptake inhibitor (SSRI) that functions by restoring serotonin balance in the brain to improve mood, particularly the client’s depression. Besides that, it is highly effective in treating mood disorders and depression among children. In addition, starting at the lower dose of 25 mg since antidepressants tend to increase anxiety when first used Stahl, 2014) Case Study: An African American Child Suffering From Depression.

What were you hoping to achieve by making this decision?

The prescribed medication was intended to improve the client’s mood and address the depression by restoring the serotonin balance in the brain (Stahl, 2014).

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

The prescription and its dosage was intended to improve the client’s mood and address the depression (Stahl, 2014). But, this objective was not achieved. Instead, the client returned to the clinic after four weeks reporting that she had not experienced any changes to her depressive symptoms. The lack of response is likely the result of the low medication dosage with a higher dose anticipated to further improve the serotonin balance in the brain to alleviate the depressive symptoms (Stahl, 2013). Case Study: An African American Child Suffering From Depression

Decision #2

Increase Zoloft dose to 50 mg orally daily.

Why did you select this decision?

The dosage was increased since the initial dose did not achieve the desired outcome of reducing the depressive symptoms. The increased dose is anticipated to further improve serotonin balance in the brain thereby reducing the depressive symptoms (Stahl, 2014).

What were you hoping to achieve by making this decision?

The decision to increase the prescribed medication dose was intended to reduce the client’s depressive symptoms by improving serotonin balance in the brain (Stahl, 2014).

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

The expected result from increasing the dosage to 50 mg was to reduce the depressive symptoms. This was achieved since the client visited the clinic four weeks later with the depressive symptoms reduced by 50% and client reporting that he was tolerating well (Stahl, 2014).

Decision #3

Maintain the current dose of Zoloft at 50 mg orally daily.

Why did you select this decision?

The decision to maintain the current dose was made for two reasons. Firstly, the client was responding well to the current dosage with clear symptoms reduction. Secondly, the client had adjusted well to the current dosage to imply that it was an optimum dosage for reducing the symptoms without presenting adverse effects (Stahl, 2014).

What were you hoping to achieve by making this decision?

The decision to maintain the current dosage was made with the intention of building on the current positive results. The dosage is already working in relieving the depressive symptoms, and maintaining it is expected to continue the current trend of relieving the symptoms (Stahl, 2014) Case Study: An African American Child Suffering From Depression.

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

It was expected that additional symptoms reduction would be reported beyond the current 50%. But this was not the case with no further reduction in symptoms reported after four weeks. Given that the 50% reduction in symptoms was not full remission, the client was responding to the medication so that a change in drugs was not warranted, then the next step would be to recommend the use of psychotherapy as an additive therapy to complement the prescription medication. This decision is informed by ethical justifications that the client is already responding to medication whose dosage cannot be increased so that psychotherapy is recommended as a complement that would provide additional benefits (Stahl, 2013; Stahl, 2014). Besides that, the standard safe Zoloft dose for children is 50 mg daily for mood disorders and depression. Increasing the dose beyond 50 mg daily is likely to reduce the symptoms further but also result in client intolerance and adverse side effects that include suicide tendencies (Gordon & Melvin, 2014; Magellan Health, Inc., 2013; Vitiello, 2012).

 

 

References

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal?
Journal of Pediatrics and Child Health
, 50(11), 847-854. doi:10.1111/jpc.12655 Case Study: An African American Child Suffering From Depression

Magellan Health, Inc. (2013).
Appropriate use of psychotropic drugs in children and adolescents: a clinical monograph
. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: neuroscientific basis and practical applications
(4
th
ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014).
The prescriber’s guide
(5
th
ed.). New York, NY: Cambridge University Press.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.),
IACAPAP e-textbook of child and adolescent mental health
. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf Case Study: An African American Child Suffering From Depression

Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Analyzing an Ethical Decision

Article: “Zhang S, Graham M, Brink J & Wang X. (2015). Involuntary admission and treatment of patients with mental disorder.
Neurosci Bull
. 31(1), 99–112”.

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Ethical Issue in the Article

Ethics involving involuntary treatment for people with mental illness revolve about protecting patients and other people and the ethical and legal aspects of balancing the autonomy and rights of the patient with the public rights (Sadock et al, 2014). Sometimes psychiatric patients do not consider themselves to be ill while other times they refuse to undergo treatment and therefore they may end up being forced to undergo treatment against their will (Zhang et al, 2015). Moreover, majority of voluntary psychiatric patients are coerced into accepting treatment maybe by the family, employer, friends or medical personnel. Accordingly, the involuntary treatment of psychiatric people brings in ethical issues in regard to autonomy and informed consent (Zhang et al, 2015). This is because involuntary treatment may be viewed to be violating the autonomy of the patient as well as the principle of informed consent. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Moral and Ethical Dilemmas Surrounding the Issue

The moral and ethical dilemma surrounding the issue of voluntary vs. involuntary treatment occurs when the healthcare provider is forced to honor the autonomy of the patient and seek informed consent, and at the same time ensure that the patient gets the suitable treatment (Opsal et al, 2016). Mental illness can impair the patient’s judgment and their decision-making ability and hence such patients may not be able to make decisions regarding their treatment. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment. Accordingly, the healthcare provider has to make a decision between respecting the autonomy of the patient and being beneficent by providing treatment to be patient (Hustoft et al, 2018). The line separating the respect for the patient autonomy and beneficent care brings in moral and ethical dilemmas especially when handling individuals with severe mental illness. A healthcare provider should be able to justify and be heedful of any removal of the patient’s right and learn the responsibility of stripping a patient their freedom in order to provide the appropriate care (Hustoft et al, 2018).

Comparison to State Health Laws and Regulations in Missouri

Missouri has civil commitment laws that set out the procedure to determine when involuntary treatment is suitable for people with severe mental illness. Laws of Missouri permit the use of court-ordered treatment which is referred to as assisted outpatient treatment (AOT). For a person to be provided with the court-ordered treatment, the person must demonstrate probability of serious harm to self and other people, and show significant risk of physical harm that may result due to the inability of the individual to make treatment decisions because of the mental impairment (Lebenbaum et al, 2018) Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment. Missouri laws also list the designated facilities acknowledged by the Department of Mental Health to offer involuntary detention services. Similarly, the principle of beneficence supports treatment for the best interests of the patient and if the patient is perceived to pose danger to self or other people, and is unwilling to get treatment (Lebenbaum et al, 2018). Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Process of Ethical Decision Making

The first step would be to recognize the ethical dilemma and gather the relevant factors about the dilemma. The second step would be to examine for the right-versus-wrong issues and test for right-versus-right paradigms. Finally, the organization policies regarding ethics and Missouri laws about involuntary treatment would be analyzed in order to make the appropriate ethical decisions (Brayley et al, 2015). Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

References

Brayley J, Alston A & Rogers K. (2015). Legal criteria for involuntary mental health admission: clinician performance in recording grounds for decision.
Med J Aust
. 203 (8): 334.

Hustoft K, Larsen K et al. (2018). Voluntary or involuntary acute psychiatric hospitalization in Norway:A 24 h follow up study.
International Journal of Law and Psychiatry
. 56 (2018), 27-34

Lebenbaum M, Chiu M, Vigod S & Paul K. (2018). Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study.
BJPsych Open
. 4(2), 31–38. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Opsal A, Kare J & Clausen T. (2016). Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders.
BMC Health Serv Res
. 16(656).

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.

 

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

•Standard 5D “Prescriptive Authority and Treatment” (page 58)

Note: Throughout the program you will be reading excerpts from the ANA’s Scope & Standards of Practice for Psychiatric-Mental Health Nursing. It is essential to your success on the ANCC board certification exam for Psychiatric/Mental Health Nurse Practitioners that you know the scope of practice of the advanced practice psychiatric/mental health nurse. You should also be able to differentiate between the generalist RN role in psychiatric/mental health nursing and the advanced practice nurse role.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

•Chapter 5, “Examination and Diagnosis of the Psychiatric Patient” (pp. 192–289)

•Chapter 31, “Child Psychiatry” (pp. 1082–1107)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Introduction”

•“Use of the Manual”

•“Cultural Formulation”

Note: You will access this book from the Walden Library databases.

Kaplan, C. (2017). Ethical dilemmas. Advanced Healthcare Network. Retrieved from https://web.archive.org/web/20160416180027/http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., . . . Smith, J. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1101–1115. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 541–557. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf

American Psychological Association. (2017). Code of Ethics. Retrieved from http://www.apa.org/ethics/code/

Document: Child and Adolescent Diagnostic Assessment Worksheet (Word document)

Document: Practicum Journal Template (Word document) Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Required Media

Gajbhare, P. (2014, March 8). Mental status examination [Video file]. Retrieved from https://www.youtube.com/watch?v=VjWVYgf2UcU

Note: The approximate length of this media piece is 36 minutes.

YMH Boston. (2013a, May 22). Vignette 1 – Introduction to a preventive services visit [Video file]. Retrieved from https://www.youtube.com/watch?v=pQy-jwiu7gM

Note: The approximate length of this media piece is 3 minutes.

YMH Boston. (2013c, May 22). Vignette 4 – Introduction to a mental health assessment [Video file]. Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE

Note: The approximate length of this media piece is 4 minutes. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Optional Resources

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

•Chapter 1, “Neural Sciences” (pp. 1–92)

•Chapter 31.2, “Assessment, Examination, and Psychological testing” (pp. 1107–1118)

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

Students will:

•Analyze salient ethical issues in psychiatric mental health practice

•Compare ethical dilemmas with state health laws and regulations

•Analyze ethical decision-making processes Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

To prepare:

•Review literature for moral/ethical issues encountered by a PMHNP.

•Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

Write a 2-page paper in which you do the following:

•Summarize the moral/ethical issue in the article (no more than 1 paragraph).

•Describe the moral and ethical dilemmas surrounding the issue.

•Analyze the ethical issue and compare them to the state health laws and regulations in your state.

•Outline the process of ethical decision making you would use to address this ethical dilemma. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree

Assignment 1: Practicum: Decision Tree

Introduction

The focus of the assignment is on making three decisions regarding the diagnosis and treatment of a client, 8-year-old Caucasian female with school difficulties. The first decision will involve making a differential diagnosis for the client and providing a rationale for selecting the decision. The second decision will involve making a decision about the treatment pan psychotherapy and providing a rationale for the decision. The last decision will be about treatment plan psychopharmacology and justifying the decision. In addition, the co-morbid physical and mental factors that may affect the diagnosis and treatment of the client will be considered. Finally, the paper will discuss the ethical considerations that may influence the treatment plan and communication with the client and her family. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

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Decision #1: Differential Diagnosis

The selected decision for the differential diagnosis of the client is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This decision was selected because the client meets the criterion for A1 (inattention) for ADHD.  According to American Psychiatric Association (2013) the DSM-5 criteria confirming diagnosis of ADHD inattention include: the person fails to be attentive to details or makes mistakes in work, classwork, and other activities; difficulties in maintaining attention in tasks or play activities; often seems like one is not listening when spoken to directly; fails to follow through on instructions, does not finish classwork, chore or workplace duties; experiences difficulties in tasks and activities organization; normally avoids, does not like or is unwilling to take part in activities or tasks that need sustained mental efforts such as classwork or homework; regularly misplaces things essential for activities or tasks such as pens, books, toys; gets easily diverted and distracted by unnecessary stimuli and is often forgetful in daily activities (Volkmar et al, 2014). The client meets most of the above symptoms as indicated by the scoring of the Conner’s Teacher Rating Scale, subjective data and mental status exam. The Conner’s Teacher Rating Scale indicated that the client is inattentive, gets distracted easily, makes careless mistakes in her classwork, forgetful about the already learned content, poor in arithmetic, spelling and reading, short attention span and has difficulties in peer interactions. Subjective data indicated that the client could not sit still during the interview, was interruptive and reported that her mind wanders during class Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. The mental status exam revealed that the client’s attention and concentration were somehow limited.  Other standardized assessment instruments that might be essential in identifying symptoms of ADHD include
ACTeRS and the Vanderbilt Assessment Scale.
In addition, the
Child Behavior Checklist can be used to further assess the behavior of the client (Sadock et al, 2014).

By selecting this decision, the expectation was that the correct diagnosis for the client would facilitate appropriate prescribing of the treatment regimen for the client.

Decision #2: Treatment Plan for Psychotherapy

The selected decision is to begin Adderall XR 10 mg orally daily. Adderall is a branded combination of (75%) dextroamphetamine along with (25%) levoamphetamine salts. This decision was selected because Adderall is FDA approved for the treatment of ADHD. In addition, evidence shows that Adderall is a stimulant that is effective in improving and balancing neurotransmitters level within the brain. Adderall also has minimal side effects and has fewer rebound symptoms because the medication wears off gradually and it is typically a long-lasting medication (Lakhan & Kirchgessner, 2013). According to Lakhan & Kirchgessner (2013), Adderall is an extended-release formulation that has a duration action of about 10-12 hours. This is a notably longer duration of action when compared to the majority of other methylphenidate formulations whose duration of action is a maximum of 6 hours. In addition, studies show that Adderall is a neuro-enhancement medication that is effective in memory improvement, improving focus and attention span (Lakhan & Kirchgessner, 2013). Accordingly, Adderall would be effective in treating the symptoms and signs of ADHD for the client. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

By choosing this decision, it was expected that symptoms and signs of ADHD for the client would improve since Adderall has been shown to be effective in improving symptoms such as attention span. Specifically, it was hoped that the client’s disruptive behavior would reduce as well as her ability to focus and pay attention. It was also hoped that the medication would improve the client’s episodic memory and hence reduce her forgetfulness. This is because a study conducted by Advokat & Mindy (2013) demonstrated that Adderall is a stimulant that has the ability to improve episodic memory in individuals with ADHD and also has some cognitive benefit.

The result for this decision was that there was an improvement in signs and symptoms of ADHD for the client as manifested by the ability of the client to be more attentive at school and the ability to maintain attention throughout the morning classes. This outcome was consistent with the expected outcome. However, during the afternoon the client would “daydream” which means she was not able to maintain attention in the afternoon. The reason for the client being not able to maintain attention in the afternoon was that the medication dose administered had worn off and therefore the inattentive symptoms would begin manifesting again prior to the administration of the subsequent dose of Adderall (Advokat & Mindy, 2013).  It was also reported that the client started losing appetite after she started taking Adderall. The loss of appetite for the client can be attributed to the medication’s side effects. Appetite loss is a common side effect with this medication because it suppresses appetite (Sallee, 2015).

Decision #3: Treatment Plan for Psychopharmacology

The selected decision for the client’s treatment plan for psychopharmacology is the addition of a small dose of immediate release of Adderall in the early afternoon. This decision was selected because the client has been showing inattentiveness during the afternoon because by afternoon the medication wears off. Therefore, the addition of a small dose of Adderall in the afternoon for the client will ensure that the client will maintain attention in the afternoon as well. In addition, the addition of a small dose of immediate release of Adderall would help the client to maintain attention during early evening and hence she will be able to do any homework given at school (Heal et al, 2013).

The reason why the decision to assure the parents that weight loss is a common side effect with Adderall was not chosen is because this option will not assist the client in maintaining attention in the afternoon classes. Secondly, the option of augmenting the Adderall treatment with family therapy was not selected because the family therapy would not solve the issue of return of the return of inattentive symptoms during the afternoon classes (Heal et al, 2013). Accordingly, this justifies the decision to add a small dose of immediate release of Adderall in the early afternoon in order to enable the client to maintain attention even during the afternoon. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Ethical Considerations in Treatment Plan

It will be important to ensure that the professional legal obligations of ensuring optimal treatment for the client are met. Therefore, it should be ensured that the assessment and treatment of Katie is I accordance with the current professional guidelines (American Nurses Association, 2014). Informed consent should be sought from the parents of Katie while Katie should also be allowed to assent to the treatment. This is because any assessment or treatment without seeking informed consent involves a legal misdemeanor of battery. Accordingly, in this case, it will be important to seek consent from the client’s parents but at the same time try to take into account the views and wishes of Katie (Merman et al, 2017). The treatment process for the client will also involve respect for autonomy by obtaining suitable consent Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. Moreover, the hyperactivity presents an ethical conflict between justice and beneficence/non‐maleficence. Other ethical aspects include the addictive effects of ADHD treatments and also evidence shows that ADHD treatment may have irreversible effects on the central nervous system. Accordingly, the healthcare practitioner should educate the client’s parents regarding the potential side effects of the proposed treatment to ensure the parents are fully informed before they consent into the treatment (Merman et al, 2017).

Conclusion

The selected decision for the differential diagnosis of the client is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This is because the client meets the criterion for A1 (inattention) for ADHD as per DSM-5. The selected decision for decision point two is to begin Adderall XR 10 mg orally daily. The rationale for selecting this decision is because Adderall has been shown to be effective in improving signs and symptoms of ADHD by improving and balancing neurotransmitters level within the brain. The selected decision for decision point three is to add a small dose of immediate release of Adderall in the early afternoon. The rationale for selecting this decision is to ensure that the client will be able to maintain attention even during the afternoon.  Finally, it will be important to seek consent from the parents of Katie and also integrate wishes and views of Katie in the treatment plan. It is also important to educate the parents about the possible side effects of the proposed treatment regimen.

 

 

References

Advokat C & Mindy S. (2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers.
Front Neurosci
. 7(82).

American Nurses Association. (2014).
Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.

Heal D, Smith S, Gosden  & Nutt D. (2013). Amphetamine, past and present – a pharmacological and clinical perspective.
J Psychopharmacology
. 27(6), 479–496.

Lakhan S & Kirchgessner A. (2013). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects.
Brain Behav
. 2(5), 661–677.

Merman S, Laura B, Hans G & Frances A. (2017). ADHD: a critical update for educational professionals.
Int J Qual Stud Health Well-being
. 12(1): 1298267.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.)
. Philadelphia, PA: Wolters Kluwe

Sallee F. (2015). Early Morning Functioning in Stimulant-Treated Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, and its Impact on Caregivers.
J Child Adolesc Psychopharmacol
. 25(7): 558–565.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder.
Journal of the American Academy of Child & Adolescent Psychiatry
. 53(2), 237–257.

 

Week 3: Autism Spectrum Disorder, ADHD, ODD, and ICD

”I can’t believe I am sitting here talking to this lady. Mom thinks I am nuts just because I will not do what she asks. She does not care about me. She only cares about my little brother and that man that keeps coming around. I don’t care anything about her. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.  That is why I throw things and won’t do what she asks. I don’t care about anyone. Those kids at school who used to be my friends don’t know anything. I am so much smarter than they are.

Jacob, age 11”

There are many mental disorders that occur early in the life course. The DSM-5 describes neurodevelopmental disorders such as autism spectrum disorder and ADHD and disruptive, impulse-control, and conduct disorders, such as oppositional defiant disorder and conduct disorder. These disorders are examined together with a particular emphasis on comparing and contrasting presenting features. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree. Diagnosis of these various conditions can rarely be made in a single office setting and often require a comprehensive approach involving multiple stakeholders, including the child, as well as his or her parents, teachers, and other significant figures in the child’s life and mental health professionals, such as psychologists who can conduct comprehensive neuropsychological testing.

The PMHNP must coordinate and integrate several sources of information to arrive at an accurate diagnosis of these disorders. Early and accurate diagnosis is essential to developing an effective treatment plan, which will have the potential to minimize the impact of these disorders on the child’s developmental trajectory. When one considers appropriate diagnosis from this perspective, the importance of diagnostic accuracy becomes quite apparent Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

This week, you begin exploring disorders that occur early in the life course by working with your group to develop a Parent Guide. You also examine a case to determine a differential diagnosis and treatment plan that incorporates both psychotherapy and psychopharmacology.

Photo Credit: Cultura/Seb Oliver / Cultura / Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

•Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

•Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–150)

•Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253) Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Neurodevelopmental Disorders”

•“Intellectual Disabilities”

•“Communication Disorders”

•“Disruptive, Impulse-Control, and Conduct Disorders”

Note: You will access this book from the Walden Library databases.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Irritability in autism

Attention-deficit/hyperactivity disorder

aripiprazole

risperidone

armodafinil

amphetamine (d)

amphetamine (d,l)

atomoxetine

bupropion

chlorpromazine (hyperactivity)

clonidine

guanfacine

haloperidol (hyperactivity)

lisdexamfetamine

methylphenidate (d)

methylphenidate (d,l)

modafinil

reboxetine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Required Media

Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author.

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

•Chapter 51, “Autism Spectrum Disorder” (pp. 665–682)

Assignment 1: Practicum: Decision Tree

For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.

Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Learning Objectives

Students will:

•Evaluate clients for treatment of mental health disorders

•Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

The Assignment:

Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

•Decision #1: Differential Diagnosis

•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. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree

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

•Decision #2: Treatment Plan for Psychotherapy

•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: Treatment Plan for Psychopharmacology

•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. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

•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 and their families. Autism Spectrum Disorder, ADHD, ODD, and ICD Decision Tree.

Conduct Disorder Parent Guide

Introduction

Conduct disorder is classified among disorders of disruptive behavior which are often comorbid with other defiant disorders. Conduct disorder is characterized by a pattern of behaviors which demonstrate a violation of rights and aggression. It has a complex etiology which is as a result of the interaction of several psychosocial and biological factors. Biologically, a low level of p5-hydroxy indole acetic acid levels in CSF tends to correlate with violence and aggression among children and adolescents Conduct Disorder Parent Guide. A family which lacks structure and supervision with occasional conflicts between parents and siblings results to maladaptive behaviors. This paper discusses the Conduct disorder including its signs and symptoms, pathophysiology, diagnosis, and currently available treatment options.

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Signs and Symptoms

The signs and symptoms of conduct disorder vary with age and are highly dependent on whether the condition is moderate, mild or severe. The first sign is aggressive behavior which may result in physical harm. Aggressive behavior may be in the form of fighting, bullying, forced sexual activity and cruelty to animals or others. Children may also display destructive behavior where they intentionally destroy and vandalize property (Blair, Leibenluft & Pine, 2014). Other children may display deceitful behavior where they repeatedly lie, break into cars or homes to steal or even shoplift. The last sign is that of violating rules such that, a child frequently goes against societal accepted rules or even engage in behaviors which are not appropriate for the child’s age (Blair, Leibenluft & Pine, 2014). Key examples of such behaviors may include sexual activity at a very young age, running away and skipping school Conduct Disorder Parent Guide.

Pathophysiology

 

Behaviors which are a problematic result from a child’s temperamental characteristics and environmental influences that shape the child’s temperament. As young as 2 years, the signs of irritability, inattentiveness, impulsivity, and compliance can result in behavioral patterns which negatively influence conduct in later ages (Sadock, Sadock & Ruiz, 2014). Due to difficulties with a child’s temperament, even parents with good intentions get involved in a negative cycle and can even isolate themselves from communal and family support. As a child advances, those with problems in conduct progressively display aggression and impulsivity with peers since they lack the skills for socializing (Sadock, Sadock & Ruiz, 2014). By the time they reach adolescence, most of them experience anger episodes and resort to being aggressive rather than responses that are verbally mediated.

Diagnosis of Conduct Disorder

Based on the DSM-V criteria for diagnosing mental health disorders, conduct disorder is diagnosed among individuals with a positive history of habitually violating the rights of other people such that, he/she fails to confirm individual behaviors to social norms that are appropriate for age. Besides, an individual ought to have at least four of the signs and symptoms in the categories of being aggressive to animals and people, destroying property, theft and deceit and serious violation of rules (American Psychiatric Association, 2013).   Some of the behaviors may include: using a weapon to harm others, frequent physical confrontations with others, aggressive behavior towards animals or others, destroying property with arson or other means, an incident of forcibly influencing another to engage in sex, engaging in economic crimes and running away from home at least twice(American Psychiatric Association, 2013).  The behaviors should also have significant impairment on the physical, social and mental functioning of the individual who should either be an adolescent or a child.  The child or adolescent may also have limited prosocial emotions such as lack of empathy, guilt or remorse, not concerned about his/her performance and a deficient effect.

Treatment Options

           
Treatment for conduct disorder aims at decreasing or eliminating behavioral problems in the short term while working towards the long-term goal of preventing the behavioral problems of children from worsening with time. Multiple modalities of treatment have proven to be highly effective in treatment especially the combination of psychotherapy with medications. The most effective psychotherapeutic approach is cognitive behavioral therapy (Sadock, Sadock & Ruiz, 2014). In this case, CBT is used in the context that behavioral which are not appropriate can be unlearned and replaced with pro-social ones which are more meaningful.  This is done through a systematic manipulation of consequences and rewards which promote behaviors which are pro-social and discourage those that are antisocial. Majority of the parents with children who have conduct disorder tend to blame themselves for creating a number of problems in a child’s life(Sadock, Sadock & Ruiz, 2014). Therefore, Family therapy can also be used to improve the interactions and communication among family members by addressing family conflict. For instance, parent management training can be used to teach parents how to positively change the behavior of a child at home.

Medications that have proven to be effective in the management of conduct disorder aim at reducing a child’s distressing symptoms such as aggression, impulse and other underlying mental illnesses that may be in existence. Generally, atypical antipsychotics such as risperidone are indicated for the management of mood lability (Pringsheim et al., 2015).  Clonidine, a beta blocker may also be used to control aggression and impulsivity. Anticonvulsants such as lithium have also proven to be effective in managing aggression and symptoms of mood disorders. Fluoxetine, which is a selective serotonin reuptake inhibitor, has proven to benefit patients with rigid, depressive aggressive behaviors (Pringsheim et al., 2015).   Stimulants are also effective in managing aggressiveness and impulsivity but need close parental monitoring due to high street value and a high potential for abuse from peers.

 

 

References

.American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Blair, R. J. R., Leibenluft, E., & Pine, D. S. (2014). Conduct disorder and callous-unemotional traits in youth.
New England Journal of Medicine
, 
371
(23), 2207-2216.

Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behavior, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and atomoxetine.
The Canadian Journal of Psychiatry
, 
60
(2), 42-51.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer Conduct Disorder Parent Guide

 

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

•Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Conduct Disorder Parent Guide.

•Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–150)

•Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Neurodevelopmental Disorders”

•“Intellectual Disabilities”

•“Communication Disorders”

•“Disruptive, Impulse-Control, and Conduct Disorders”

Note: You will access this book from the Walden Library databases.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf Conduct Disorder Parent Guide

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication. Conduct Disorder Parent Guide

Review the following medications:

Irritability in autism

Attention-deficit/hyperactivity disorder

aripiprazole

risperidone

armodafinil

amphetamine (d)

amphetamine (d,l)

atomoxetine

bupropion

chlorpromazine (hyperactivity)

clonidine

guanfacine

haloperidol (hyperactivity)

lisdexamfetamine

methylphenidate (d)

methylphenidate (d,l)

modafinil

reboxetine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

Required Media

Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author. Conduct Disorder Parent Guide

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

•Chapter 51, “Autism Spectrum Disorder” (pp. 665–682)

Discussion: Parent Guide

Note: You and your group will use the wiki function to develop three Parent Guides (one in Week 3, one in Week 7, and one in Week 10). A wiki is a site that allows collaborative editing by all users. Each group will have its own place to communicate and collaborate on the assignments. Once your group has completed each assignment, one member should transfer the information to its final format and submit it through the group submission link in the Discussion. Do not delete the assignment from the wiki format, as your Instructor will review this area to determine each member’s participation.

Collaboration is essential to accurate diagnosis of the conditions under consideration in this week. For this week’s Discussion, you practice collaboration by working in a group on developing a “Parent Guide,” which will serve as a teaching tool for parents with children who have been diagnosed with a specific mental health disorder Conduct Disorder Parent Guide.

It is recommended that you make your project as attractive as possible and consider using the finished product as teaching tools for families that you will work with in your own practices.

Learning Objectives

Students will:

•Analyze signs and symptoms of neurodevelopmental disorders

•Analyze the pathophysiology of neurodevelopmental disorders

•Analyze diagnosis and treatment methods for neurodevelopmental disorders

•Evaluate Parent Guides Conduct Disorder Parent Guide

To Prepare for this Discussion:

•Your Instructor will assign you to a group and a disorder by Day 1 of Week 2.

•Review the resources concerning your assigned disorder.

•Review the Blackboard Help website concerning wikis.

•Use your group’s Discussion Board to design and develop the Parent Guide before posting to the group wiki. For further guidance, refer to the Accessing Group Discussions instructions below.

Using evidence-based research, design and develop a Parent Guide for your assigned disorder including:

•Signs and symptoms

•Pathophysiology

•How the disorder is diagnosed

•Treatment options

Provide a minimum of three academic references. Conduct Disorder Parent Guide

Working With Children and Adolescents Versus Adults Essay Discussion

Discussion: Working with Children and Adolescents versus Adults

Importance of Developmental Assessments

Developmental assessment in children is used to evaluate different facets of the child’s functioning like behavior, social interaction, cognition, communication, sensory abilities, motor abilities, as well as adaptive skills (Sadock, et al, 2014). Developmental assessment entails conducting accurate evaluations to determine the ability of a child to meet the essential developmental milestones and objectives. Working With Children and Adolescents Versus Adults Essay Discussion. In addition, it examines the performance and the ability of the child to perform common daily activities and tasks. Therefore, developmental assessment can help in identifying potential developmental problems and the need for more diagnostic examination; provides an objective account of the child’s deficits and abilities; and also helps in planning for suitable interventions (Thapar et al, 2015). In children diagnosed with or with suspected autism, all developmental domains should be assessed.

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Assessment Instruments to Evaluate Children and adolescents

The Modified Checklist for Autism in Toddlers (M-CHAT) instrument: This tool is utilized to evaluate children aged 16 months to 2 years and a half to examine their risk for autism. The tool has a set of 23 questions and it can be administered and scored as a component of well-child review and can also be utilized by specialists and other healthcare providers to assess a child’s risk to autism spectrum disorders.  The main aim of this instrument is to make the most of sensitivity and hence identify a high number of children with autism (Kleinman et al, 2013). Children who fail more than three items are supposed to be referred for diagnostic assessment by a specialist. Working With Children and Adolescents Versus Adults Essay Discussion.

Pediatric Symptom Checklist-17 (PSC-17): This is a brief questionnaire that is used to identify and evaluate for any emotional and behavioral changes and problems in children. This tool covers numerous behavioral and psychological problems. It is purposely used to examine the psychosocial functioning of the child. The tool has 35-item parent-reported questions as well as a youth self-report, a graphic version as well as a shorter 17-item version for parents and children (Murphy et al, 2016).

Treatment Options for Children and Adolescents

Floortime: This treatment entails the parent lying on the floor with the child and playing and performing the activities the childlike playing. Therapist and the parents engage the child through the activities preferred and enjoyed by the child and follow the child’s lead while playing. Floortime intervention aims at supporting the child’s emotional and cognitive development by assisting the child to learn emotional and communication skills (Mercer, 2015).

Kapvay: This is a non-stimulant and a long-acting clonidine used to treat AD/HD in children/adolescents aged between 6 to 17 years. The medication is normally prescribed two times a day and it is normally started at 0.1 mg and can be increased up to 0.2 mg two times a day.

The Parents’ Role

Parents play an important role in the assessment and treatment of children. First, parents have the duty of giving consent when children are being assessed and treated because minors are not supposed to give consent to their treatment. Secondly, during assessment parents act as informants and providing important information that may facilitate making an accurate diagnosis. Lastly, parents play a key role in ensuring that their children adhere to the treatment regimen (Sadock, et al, 2014). Working With Children and Adolescents Versus Adults Essay Discussion.

References

Kleinman J, Robins D, Ventola P, Juhi P, Hilarly B, Esser E, Wilson L et al. (2013). The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders.
J Autism Dev Disord
. 38(5), 827–839.

Mercer J. (2015). Examining DIR/Floortime™ as a Treatment for Children With Autism Spectrum Disorders: A Review of Research and Theory.
SAGE Journals
. 27(5), 625-635

Murphy M, Paul B, Chiang C, Sturner R, Howard B, Abel M & Michael J. (2016). The PSC-17: Subscale Scores, Reliability, and Factor Structure in a New National Sample.
Pediatrics
. 138(3), e20160038.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.)
. Philadelphia, PA: Wolters Kluwer.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015).
Rutter’s child and adolescent psychiatry
(6th ed.). Hoboken, NJ: Wiley Blackwell. Working With Children and Adolescents Versus Adults Essay Discussion.

 

 

Discussion: Working With Children and Adolescents Versus Adults

Infant, childhood, and adolescent development are a continual interplay between nature (genetic or biologic predisposition) and nurture (environmental experiences). The nature/nurture continuum and debate will always be a part of your career as a PMHNP. Knowing common developmental milestone is important in the role as a child provider. Not only is it essential to the diagnostic process, but it is also important to the interdisciplinary interactions with other mental health professionals. The study of normal developmental processes, however, is only one tool that allows the mental health professional to understand the child being evaluated. There are many different assessment instruments and interviewing techniques that PMHNPs can have in their toolkit when working with children and adolescents.

In this Discussion, you examine the differences in assessing and treating children and adolescents versus adults. You take into consideration your own clinical experiences, as well as your experiences in your clinical rotation, and the information from the readings thus far.

Learning Objectives

Students will:

•Analyze the importance of developmental assessments

•Analyze assessment instruments used for evaluating children and adolescents

•Analyze treatment options used for children and adolescents

•Analyze roles parents play in assessment and treatment

To Prepare for the Discussion

•Review the Learning Resources concerning psychiatric assessments and assessment tools.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post your answers to the following:

•Explain why a developmental assessment of children and adolescents is important.

•Describe two assessment instruments and explain why they are used for children and adolescents but not adults.

•Describe two treatment options for children and adolescents that may not be used when treating adults.

•Explain the role parents play in assessment and treatment. Working With Children and Adolescents Versus Adults Essay Discussion

 

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

•Chapter 2, “Contributions of the Psychosocial Sciences” (pp. 93–130)

•Chapter 6, “Classification in Psychiatry” (pp. 290–299)

•Chapter 31, “Child Psychiatry” (pp. 1107–1152)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

•“Neurodevelopmental Disorders”

•“Intellectual Disabilities”

•“Communication Disorders”

Note: You will access this book from the Walden Library databases.

Resume, Portfolio, and Cover Letter Resources

CoverLetter.us. (2017). Nurse practitioner cover letter sample 1. Retrieved from http://www.coverletter.us/nurse-practitioner-cover-letter/ Working With Children and Adolescents Versus Adults Essay Discussion

Dahring, R. (2013). Cover letter caveats. Retrieved from https://web.archive.org/web/20161117160433/http://nurse-practitioners-and-physician-assistants.advanceweb.com:80/Columns/Career-Coach/Cover-Letter-Caveats.aspx

Porche, D. J., & Danna, D. (2015). Cover letter & resume preparation: Every detail is important when applying for a job. Advance Healthcare Network for NPs & PAs. Retrieved from https://web.archive.org/web/20160818183515/http://nurse-practitioners-and-physician-assistants.advanceweb.com:80/Features/Articles/Cover-Letter-Resume-Preparation.aspx

Walden University Career Services Center. (2017). Resumes & CVs: Home. Retrieved from http://academicguides.waldenu.edu/careerservices/resumesandcvs

Document: Cover Letter, Resume, and Portfolio Assignment Guide (PDF)

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

•Chapter 2, “Diagnosis, Diagnostic Formulations, and Classification” (pp. 17–30) Working With Children and Adolescents Versus Adults Essay Discussion

Case Study or Share an Experience – End of Life Care- A Related Experience

Stephanie was a 65 year old who was enrolled to hospice after a difficult and prolonged admission in hospital. She had spent most of her time in the rural areas managing rural property and race horses. At first, Stephanie was admitted in a NSW hospital secondary to a basal cell carcinoma, which had spread, to the brain tissue despite surgical intervention. This was followed by a long duration in the ICU where she experienced seizures and was intubated. She was later discharged following successful management with anti-convulsants and intubation. Unfortunately, she thereafter developed a deep intracranial infection as a secondary complication from the surgery whose chances of resolving were minimal.

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As the health status of Stephanie deteriorated, Stephanie’s sister requested to consult on palliative care. Since she had become unresponsive to treatment, it was unanimously decided that she was to be referred to the hospice center for end-of life care. Stephanie had a number of symptoms which significantly contributed to a deteriorating health status. The most serious symptoms were that of a hyperactive delirium, on and off headaches and seizures. Severally, Stephanie’s seizure, depression, anxiety and seizure medications were revised. Although she became very weak, symptomatic and largely dependent, she stabilized. Case Study or Share an Experience – End of Life Care- A Related Experience.

Stephanie’s family  was her  power of attorney and   were precise that she was not to receive further interventions that would burden her such as being transferred to another facility, cannulation, resuscitation  and surgical interventions (Chan, Webster & Bowers, 2016). Her preferred place of death was hospice. Nursing care for this patient involved: continuous management of her mobility which was worsening and issues related to a high fall risk. Regularly, her mobility was reviewed by the hospitals occupational therapist and physiotherapist. Stephanie also had issues with the integrity of her skin and continence. This needed some modification in her care needs as her health status continued to deteriorate. Since the wound on her scalp was purulent and foul-smelling, her care needs had to include wound care and aesthetic matters. Since she was confused most of the time, she severally attempted to remove the dressing. Therefore, in order to suit her needs, nursing care utilized a variety of head gears.

As her condition improved, in collaboration with the senior nursing staff and the clinical nursing counselor, we became more actively involved in her care for it to be effective such as by genuinely desiring to link with Stephanie’s love for dogs and horses. It was undeniable that Stephanie had a lot of sense of humor which made it easy and possible to positively connect with her. In order to ensure that staff had clinical and emotional support regarding her care, several education sessions were held. Despite the fact that most staff were surprised on how her condition had generally stabilized, others were concerned that a short-term special unit was not the most appropriate strategy for her in the long term.

As recommended by Kisorio & Langley (2016), Stephanie’s care revolved in the entire nursing team for the purpose of ensuring that staff not only cared for their own health but also upheld a positive and compassionate outlook on her overall health status. A pastoral team was also contacted which provided her with the audience to discuss all her fears and other stressing issues. The hospitals social worker, who was also a highly trained counselor spent time with both the family and Stephanie discussing complex issues. After quite a long period of stability, Stephanie eventually deteriorated. Her end-of-life care was immediately initiated six days before a peaceful death in hospice. In the moths that preceded, Stephanie had developed a lot of trust in the staff working in the hospice while her friends and family came to terms that she would die in the long run. Whenever they could, the often visited and when she finally died, everyone was happy to go console and comfort Stephanie. Our mission as the care team was to ensure that Stephanie smiled which she actually did. Case Study or Share an Experience – End of Life Care- A Related Experience

References

Chan, R. J., Webster, J., & Bowers, A. (2016). End‐of‐life care pathways for improving outcomes in caring for the dying. 
Cochrane Database of Systematic Reviews
, (2).

Kisorio, L. C., & Langley, G. C. (2016). Intensive care nurses’ experiences of end-of-life care. 
Intensive and Critical Care Nursing
, 
33
, 30-38.

 

 

Week 8: Case Study or Share an Experience (graded)

Purpose

This week’s graded topics relate to the following Course Outcome (CO).

CO 2 – Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO #1)

The Assignment

This week you have two options for your initial discussion post. Select the option that is best for you! Please remember to use and credit the lesson or required NIH website (there was not a textbook reading this week), AND one outside scholarly source.

Option #1 – Case Study to Consider

Ann and Michael have been married for 55 years. Ann is 80 years-old, and suffers from lung cancer and advanced Alzheimer’s disease. She currently resides in a nursing home, and often does not recognize Michael when he visits. Last night she was admitted to the hospital with difficulty breathing. Today, you are the nurse caring for Ann, and her physician is suggesting surgery to remove part of her lung to potentially slow the progression of her cancer. Michael is feeling unsure about this course of treatment, and asks for your advice and guidance. Case Study or Share an Experience – End of Life Care- A Related Experience.

How would you respond to Michael and serve as advocate for your patient?

Option #2 – Share a Related Experience

Share with your classmates a time when you cared for a patient at the end of their life. This may be a time when you assisted the patient (or their support system) with decisions related to end of life care; or a time when you were present for the death of a patient.

What were your observations related to this experience? Do you believe it was a peaceful death? What went well? Can you think of anything that could have made the experience better for the patient and/or family?

Grading

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric. Case Study or Share an Experience – End of Life Care- A Related Experience

NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

 

T. is a 30 year-old paralegal assistant that came to your clinic because she thinks she has a breast lump in her right breast. She first noticed it 2 weeks ago. It is tender to the touch, and it has decreased in size since her period.  There are no changes in the skin over her breast.  She denies having fever or chills, and she is not breastfeeding. NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

 

Her medical history is unremarkable.  She has never had surgery. She does not smoke, drink or use illicit drugs.  She jogs 3 miles daily.  She eats a low-fat, low-carbohydrate diet.  She is married and has 2 children, ages 3 and 5.  Her aunt on her mother’s side had breast cancer at the age of 55. 

 
The physical examination revealed:

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General Survey:      Alert, anxious-appearing woman, resting comfortably on the exam table.

 

Vital  Signs:              BP 128/70 mm Hg; HR 75 bpm and regular; respiratory rate

                               14 breaths/min; temperature 98.8  F.

Skin:                          Warm and moist

HEENT:                     Normocephalic, atraumatic

                                    No occipital, pre-auricular or posterior auricular adenopathy

Neck:                         Supple, without thyromegaly;  no cervical lymphadenopathy

Thorax:                     Thorax symmetric, with good expansion NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

Cardiovascular:      Good S1, S2; no S3, S4; no murmurs

Breasts and

Axillae                    Skin without dimpling or retractions; breast contours

                                symmetric.

                                Nipples without scaling or discharge. One freely mobile 3 cm

                                round circumscribed mass, located in the right upper outer

                                quadrant; left breast without masses.

 

Day 1 – Monday, 6/10/2019

 

Based on the above history and physical examination, what is your likely primary diagnosis?

What would you include in your differential diagnosis(es)? Provide rationale for your decision-making based on the literature and the appropriate clinical guidelines? 

Describe how you would discuss the findings of your exam with this patient.

What would you include in your plan of care for this patient? What further investigations are warranted?  (Consider diagnostic testing, laboratory testing, etc.). Include rationale for decision-making based on current clinical guidelines and national recommendations (USTFPS, other) NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

 

Days 2 & 3 – Tuesday, 6/11/2019 & Wednesday, 6/12/2019

 

Students are required to respond to at least 2 student posts.  Review each post and provide evidenced based comments related to each post.  If you agree with the diagnosis and differential diagnoses and aspects of the plan, state why and support your decision with evidence from the literature, including national guidelines, national recommendations, and other reliable sources.  If you disagree with the aspects of the plan, state why and support your decision with evidence from the literature. 

 

Day 4 – Thursday, 6/13/2019

 

Provide a brief summary of this clinical experience.  Discuss the learning experience and how this will guide your patient interview/history taking in the clinical area. 

 

Student responses should be written in full sentences or clearly written bullets when appropriate; literature citations are required within the context of the case responses as well as in a Reference List at the end of each case, using APA format (using single spacing, sub-headings – separate each post and respond accordingly to each one).  This TSD is worth 5 points or 5% of the final grade.  Refer to the TSD Grading Rubrics in the Course Syllabus for additional grading criteria.  NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

 

The TSD will close at 11:59 pm on Thursday, 6/13/2019.   Students that do not submit posts or responses on the required due dates, will be penalized 1 point for each day the assignment is not submitted.

 

The most likely primary diagnosis is a cyst. Breast cysts are commonly benign and can either be oval or round in shape with edges that are distinct. Cysts occur commonly among women aged 30-50 years but can also occur among post-menopausal women on hormonal therapy (Uzan, Seror & Seror, 2015).  The most significant clinical signs that the patient presented with that suggests the likelihood of a breast cyst include: a freely mobile round mass with circumscribed edges and the affected breast area was tender to touch. It is also worth noting that, the client had noted a gradual decrease in the size of the breast mass after her period, a primary characteristic symptom of cysts (Uzan, Seror & Seror, 2015).

The most likely differential diagnoses that I would include are:

Breast Abscess- this is simply a complication of mastitis that commonly occurs among women who are lactating.  If it progresses without necessary intervention, breast tissues necrotize and become an abscess cavity. Patients with breast abscess commonly present with breast tenderness and erythema and a fever (Orr & Kelley, 2016).  In comparison, in this case, the patient’s temperatures were within normal range (98.8 F) and neither was she lactating. Thus, this was less likely a breast abscess. NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

Hematoma- hematomas usually develop immediately following a trauma or surgery. Hematomas that are hyper acute are likely to appear as simple cysts, round with walls that are distinct (Neal et al., 2014). However, since the patient had no recent history of surgery or trauma, the diagnosis of a hematoma is less likely.

Galactocele- Galactoceles usually form when milk that is distal to an obstruction in the terminal duct accumulates. They are usually either round, oval and circumscribed. Most patients who develop Galactoceles can also develop superimposed infections thereby need drainage (Orr & Kelley, 2016). They can however resolve on their own when conservatively managed. However, it is clear that neither was this patient breastfeeding not report of a breast discharge (milk). Thus, the likelihood that this was a Galactocele is minimal.

I will start by telling the patient what is normal. This includes the color of the skin overlying the breasts, bilateral breast sizes, appearance of the areola and no breast discharge. I will then progress to explain to the patient the abnormal findings based on inspection and palpation. However, I will let the patient know that despite the abnormal findings, there is nothing to be anxious/worry about but rather consider the findings (cyst) as a common breast condition among young women of reproductive age still having their periods (Orr & Kelley, 2016). I will however insist and educate the patient on the need to perform regular self-breast exams and go for routine screening (breast cancer) basing on the fact that she has a positive family history of a maternal aunt who had breast cancer.

The patient’s plan of care would include conducting a breast ultrasound which will help to determine whether the mass is filled with either fluid or solid. If fluid filled, this will confirm the diagnosis of a cyst (Neal et al., 2014).  Otherwise, a solid mass would be confirmed to be benign as either a fibro adenoma or cancerous. If the mass can easily be felt, an ultrasound guided fine needle aspiration can be done. Fluid filled in the lump can be aspirated. When the mass happens to immediately go away, the diagnosis of a breast cyst can be confirmed (Neal et al., 2014). The patient will be informed thereafter on the need to continue performing self-breast exams to know when new cysts develop and have them drained since it is common for cysts to recur. Since the patient’s symptoms are less severe, she will be advised not to use hormone therapy based on the probable side effects they can cause. Conservatively, the patient will be advised to use ice packs for pain relief, to wear bras that are well-fitted and supportive to avoid discomfort, reconsider eliminating caffeine from her diet and use of over the counter medications such as ibuprofen or naproxen for pain relief (Neal et al., 2014). NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

 

 

References

Neal, L., Sandhu, N. P., Hieken, T. J., Glazebrook, K. N., Mac Bride, M. B., Dilaveri, C. A.,& Visscher, D. W. (2014, April). Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. In 
Mayo Clinic Proceedings
 (Vol. 89, No. 4, pp. 536-547). Elsevier.

Orr, B., & Kelley Iii, J. L. (2016). Benign breast diseases: evaluation and management. 
Clinical obstetrics and gynecology
, 
59
(4), 710-726.

Uzan, C., Seror, J. Y., & Seror, J. (2015). Management of a breast cystic syndrome: Guidelines. 
Journal de gynecologie, obstetrique et biologie de la reproduction
, 
44
(10), 970-979. NURS 615 Primary Care of Women – TSD 2 – Week 8 case study essay

NSG 6435 week 1 discussion

What are the sources of pediatric primary care in the United States? Are these sources sufficient for providing health-care services to the pediatric population? Why or why not?

The American Academy of Pediatrics created Bright Futures as a guideline for prevention and health promotion for infants, children, adolescents, and their families. This organization consists of 66,000 pediatricians, and their guidelines is considered the standard for preventive healthcare services to infants, children, and adolescents. The Medicaid is a no cost program for patients who meet the income guidelines. Medicaid in California utilizes these guidelines along with the use of early and periodic screening diagnosis and treatment program (EPSDT) (American Academy of Pediatrics, 2019). NSG 6435 week 1 discussion.

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There are 9 pediatric care measures: immunization status for children and adolescents, well-child visits for the first 15 months of the pediatric patient’s life, wellness visits for children ages 3 and 6, and adolescent wellness visits that includes preventative dental care, assessment of the patient’s BMI both children and adolescent, and chlamydia screening for female patients. California also has a partnership with managed care organizations or MCO’s, which focuses on certain pediatric preventive care such as body mass index, immunizations for 2-year-old children. Approximately 90% of children who are insured through publicly funded insurance receive services through MCO. MCO provides health education material for Vietnamese, Cambodian, Chinese, Hmong, Farsi, Korean, Lao, Spanish, Russian, and Armenian families (American Academy of Pediatrics, 2019).

These sources are adequate, since the preventative healthcare services are provided and outlined. Wellness appointments allows the parent, child, and provider to regularly assess the child’s development milestones. The provider can identify any deficiencies or developmental delay and address them accordingly with referrals based on the child’s deficiency. For example, a speech delay, it is appropriate to refer the child to a speech therapist to determine if there is a developmental delay (American Academy of Pediatrics, 2019). NSG 6435 week 1 discussion.

Are there certain pediatric populations that lack access to health-care services? Why?

There are many children that reside in the United States lack access to health-care services. This is due to the structural gaps in the healthcare programs, new programs are being established to serve low-moderate income and working status does not determine eligibility for these families (Racine, A.D.,2016). Minority children who lack access to healthcare can result in health disparities as children and adults. Approximately 15 million children in the United States or 21% live below poverty with an income level of $22,050 per year, this income for a family of 4. Poverty can hinder the child’s ability to learn and creates emotional, social, and behavioral issues. (Kuo et al., 2012).

 

What are the barrier’s to children in accessing health-care services in the United States? Why do these barriers exist? 

Poverty is the barrier that impedes access to health-care services in the United States. Other factors that contribute to barriers include: health insurance status, obesity, and children of minority receive basic health and dental care. Children are challenged with numerous social challenges within their families, schools, communities as well as environmental factors. Children and adolescents need efficient and effective healthcare and dental services. The provider must ask the child’s parents if education is needed for development milestones, obesity, breastfeeding, environmental health, mental health, and family violence (Kuo et al., 2012). NSG 6435 week 1 discussion

Reference

American Association of Pediatrics. (2019). Bright Futures. Retrieved from https://brightfutures.aap.org/states-and-communities/Pages/California.aspx

Racine, A.D. (2016), Child Poverty and the Health Care System. Academic Pediatrics, 16 (3 Suppl) S83-S89 https://doi-org.contentproxy.phoenix.edu/10.1016/j.acap.2015.12.00

Kuo, A. A., Etzel, R. A., Chilton, L. A., Watson, C., & Gorski, P. A. (2012). Primary care pediatrics and public health: meeting the needs of today’s children. 
American journal of public health
, 
102
(12), e17-23. NSG 6435 week 1 discussion

NSG 6435 week 7 discussion 1

Week 7 Project

Child neglect, mistreatment, and abuse continues to affect a significant number of children each year. According to the World Health Organization child abuse is defined as child maltreatment or neglect. In the United States approximately 3 million children are affected and at least one child maltreatment investigation is conducted each year. Child abuse is an extremely important public health matter. It is estimated that 683,000 children are victims of abuse and 1670 of these cases ended in death in 2015 (Kuang, Aratani, & Li, 2018). There are multiple risk factors for mistreatment of children, these include children younger than 4 years of age, down syndrome with special needs, global developmental delay, multiple children, parental stress, single parent, low income, tobacco use by primary caregiver, and nonbiological transient caregivers in the home (Brown et, al., 2013). NSG 6435 week 7 discussion 1

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Chronic health conditions, physical disabilities, and developmental delays are the greatest risk factors for mistreatment (Kuang, Aratani, & Li, 2018).There are different types of neglect that providers encounter on a daily basis these comprise of nonadherence with health care recommendations, delay or failure to seek healthcare, inadequate nutrition, unmanaged morbid obesity, inadequate protection from environmental hazards such as smoking, violence, and car accidents, inadequate supervision with and without injury, unmet educational needs, newborn or childhood drug ingestion and exposure, abandonment, homelessness, and inadequate clothing or hygiene (Fong & Christian, 2012).

The ihuman avatar Tommy Acker has downs syndrome, growth and speech delay, is under the age of four, his mother is a single parent with a low- income job, who has three young children to support and cannot afford childcare. The mother has a boyfriend who sometimes is the caregiver of her children and they are both tobacco smokers. These factors increase Tommy’s risk of becoming a victim of child abuse. This ihuman case study was extremely complex and required excellent critical thinking skills. The chief complaint and physical findings especially the abdominal trauma can lead to multiple differential diagnosis. The delay in care should also raise suspicion since the caregiver’s story is inconsistent with the injuries. Since, Tommy has multiple health conditions in addition to his blunt abdominal trauma and change of condition, he was admitted to the pediatric intensive care unit for medical care and evaluation. NSG 6435 week 7 discussion 1. Child protective services is involved to protect Tommy and provide his mother the proper support she needs to care for Tommy and her other little children. Education for pediatric ethics should be provided to healthcare providers on how to deal with ethical problems in different settings (Guedert & Grosseman, 2012). Additional research is required to identify, improve, and decrease the incidences of child mistreatment, abuse, and neglect (Bright et al., 2015).

References

Bright, M. A., PhD., Thompson, L.,M.D.M.S., Esernio-Jenssen, D., Alford, S., M.P.H., & Shenkman, E., PhD. (2015). Primary care pediatricians’ perceived prevalence and surveillance of adverse childhood experiences in low-income children.
 Journal of Health Care for the Poor and Underserved, 26
(3), 686-700. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.1353/hpu.2015.0080

Brown, C. M., Girio-herrera, E., Sherman, S. N., Kahn, R. S., & Copeland, K. A. (2013). Low-income parents’ perceptions of pediatrician advice on early childhood education.
 Journal of Community Health, 38
(1), 195-204. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.1007/s10900-012-9642-0 NSG 6435 week 7 discussion 1

Fong, H., M.D., & Christian, C. W., M.D. (2012). Child neglect: A review for the primary care pediatrician.
 Pediatric Annals, 41
(12), 3000-5. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.3928/00904481-20121126-08

Kuang, X., Aratani, Y., & Li, G. (2018). Association between emergency department utilization and the risk of child maltreatment in young children.
Injury Epidemiology, 5
(1), 1-8. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.1186/s40621-018-0176-5

Guedert, J. M., & Grosseman, S. (2012). Ethical problems in pediatrics: What does the setting of care and education show us?
 BMC Medical Ethics, 13
, 2. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.1186/1472-6939-13-2 NSG 6435 week 7 discussion 1

Measuring Morbidity: Prevalence and Incidence

Read the scenario below and complete the assignment as instructed.

Scenario

In Community X (population 20,000), an epidemiologist conducted a prevalence survey in January of 2012 and reported an HIV prevalence of 2.2%. Over the next 12 months, the department of health reported an additional 50 new HIV cases between February 2012 and January 2013. The total population stayed constant at 20,000.

Part 1

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How many people had HIV in January 2012? Present or describe the formula you used to arrive at your answer.

Calculate the incidence rate assuming no HIV-related deaths over the 12-month period. Present or describe the formula you used to arrive at your answer. Be sure to clearly indicate the numerator and denominator used in your calculation and include an appropriate label for the rate. Measuring Morbidity: Prevalence and Incidence

In a summary of 200-250 words, interpret the results and discuss the relationship between incidence and prevalence. Discuss whether or not the epidemiologist should be concerned about these new HIV infections, assuming a previous incidence rate of 0.5 per 1,000 person-years prior to this updated risk assessment.

Part 2

A rapid test used for diagnosing HIV has a sensitivity of 99.1% and a specificity of 90%. Based on the population prevalence of 2.2% in 2012, create a 2×2 table showing the number of true positives, false positives, false negatives, and true negatives. Calculate the positive predicative value and negative predictive value for this test. Refer to the “Creating a 2×2 Contingency Table” resource for guidance. Measuring Morbidity: Prevalence and Incidence.

In 200-250 words, discuss whether or not the epidemiologist should recommend this test as part of a universal HIV screening program. Provide rationale for your recommendation applying the positive and negative predictive values. Present or describe the formula you used to arrive at your answer.

General Requirements

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite. Measuring Morbidity: Prevalence and Incidence