Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:    

Decision #1      

Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2      

Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. 
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3      

Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Rubric:

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.

A clear and comprehensive purpose statement is provided which delineates all required criteria.

Demonstrates the ability to critically appraise and intellectually explore key concepts.

Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.

Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.

Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity

Uses correct grammar, spelling, and punctuation with no errors.

Uses correct APA format with no errors.

References:

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

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter 6, “Mood Disorders”
• Chapter 7, “Antidepressants”

References:

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

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

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Pediatric depression

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

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from peers in class
• Mother notes decreased appetite and occasional periods of irritation
• Client reached all developmental landmarks at appropriate ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation
• Client seen by Psychiatric Nurse Practitioner

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what the PMHNP should do:

Begin Zoloft 25 mg orally daily

Begin Paxil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID

Decision Tree Assignments

Please read these instructions VERY carefully…please ask questions if you have any difficulties
understanding the information below. My goal is to provide you with very detailed instructions
so you understand the assignment instructions.

You will have your first interactive case study assignment (decision tree) in week 2 A case study
is included in the reading assignment and you will face three different decision points. There
may not be a “right” answer and you are not expected to answer with the “right” answer at each
scenario. You will need to describe your answer and provide your rationale and evidence
supporting your decision at each decision point. Please review the information below. I feel like
it is important to share with you exactly what I am looking for in the assignments.

You will find the case studies listed in the course reading list under “required media” each week
you have a decision tree assignment.

Here is a general framework for what I am looking for on the decision tree assignments.

Provide an introduction to the disease state discussed in the case. I am looking for a high-level
summary that briefly describes the key aspects of that disease state. I do not want several pages
of information related to the diagnosis of the disease state.

Provide a high-level summary of the important pieces of information from the case-study
that is presented. I do not want the entire case study presented. The goal is that you would be
able to give your essay to someone that does not know anything about the assignment and for
that individual to be able to understand the purpose of your essay. Again….focus on the
important pieces of information that will help you make your decision.

You also want to mention the purpose of the assignment. This can be brief.

Decision Point 1, 2, and 3.
At each decision point, list the options that are presented and describe your rationale for
choosing the option you chose.

I do not want general answers….”I chose sertraline because sertraline is an SSRI and SSRIs
are approved for depression/anxiety”. I want VERY SPECIFIC reasons you chose the option you
chose. These reasons must be backed by good evidence. Feel free to include studies comparing

agents, side effects, dosing, patient considerations, therapeutic practice guidelines, comorbid
conditions, etc…. You will also need to explain your rationale for not choosing the other two
options. This is very important in your learning. Please remember that you will have
MANY more medications to choose from than three in clinical practice. When you make your
choice, you also need to describe your goals of treatment. What do you want to achieve by
initiating the therapy you picked. Again….be specific. Defend your choices like you are in a
courtroom.

After each decision, you will be presented with the outcome of that decision. You need to
discuss how that outcome was what you expected or if it was different than what you
expected and why.

You will do the above for all three decision points.

You need to use evidence to support your rationale. [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. Credible reference material only will be accepted. Sites
such as WebMD and drugs.com (among others) will not be counted.]

How to move through the case study…..

You will be presented with three options at the bottom of the case for decision point one. You
must click on one of these options to move to decision point 2.

You will then be presented with the outcome of the decision you chose for decision point 1. The
outcome is different for each of the three options (see below).

You will then choose the option for decision point 2 which will take you to the outcome of the
decision you made for decision point 2. You will then be presented with decision point 3.

Analogy:
Where would you like to go on vacation?

You would want to describe WHY you would want to go to the location of your choosing and
NOT the other two. You do not need to describe what the beach, theme park, and mountains are.

Decision 1:
Beach
Theme Park
Mountains

Let’s assume you choose beach…..

What will you do at the beach once you get there?

Again….describe why you picked the option you did and NOT the other two.

Decision 2:
Build a sandcastle
Swim in the ocean
Play frisbee

Let’s assume you chose to build a sandcastle…

What type of sandcastle will you build?

Decision 3:
A large sculpture
A small sandcastle with a moat
A detailed sand castle decorated with seashells

Note about providing evidence……..

Please note that you need to be VERY SPECIFIC when describing the reason you chose the
decision you made for each decision point. I cannot stress this enough.

Here are some examples of what I do NOT want:

• I chose sertraline (ZOLOFT) because it is an SSRI that treats depression.

• Paroxetine (PAXIL) was chosen because paroxetine increases the levels of serotonin in
the brain.

• I decided to prescribe bupropion (Wellbutrin) because data supports the use of
bupropion in……

• Think about the patient you are treating. I have had students discuss concerns with
erectile dysfunction in pediatric patients and female patients on multiple occasions. You
want to consider the patient you are treating.

Here are some examples of what I DO want:

• “As the PMHNP caring for this client, Zoloft 25 mg daily would be the first choice of
therapy for this patient. Selective Serotonin Reuptake Inhibitors (SSRIs) are known to be
the first line of treatment for children with depression (DeFilippis & Wagner, 2014).
While sertraline and paroxetine are both SSRIs, sertraline is FDA approved when treating
children whereas paroxetine has been found to be affective when treating children with
depression, it is not specifically approved by the FDA at this point in time (Stahl,
2014b).”

• “Paroxetine is not recommended in use for children due to its short half-life which can
lead to withdrawal when the medication is stopped abruptly (Nathan & Gorman, 2015).”

• Evidence supporting the effectiveness of one agent over another. How did one agent
perform when compared to another medication in clinical trials. I really like seeing these
types of comparisons.

• What do the guidelines recommend? You can typically find the reason for their
recommendation in the body of the guidelines.

• What side effects are the most concerning for the patient case study? For example: you
wouldn’t want to prescribe a medication that causes excessive sedation in a patient that
operates heavy machinery or drives transport trucks across the country.

• Consider genetics and the role genetics have in drug metabolism.

• Evaluate for the potential for drug-drug interactions.

The main point is to be very specific regarding the reason you made your choice. I have posted
the essay requirements as a checklist. I would strongly recommend using the checklist prior to
submitting your decision tree assignments to make sure you included the required information.

Don’t forget to include information related to the ethical considerations and how they might
impact yourtreatment plan and communication with your clients.

In summary: What needs to be in your essay. Use this as a checklist prior to submitting each
decision tree essay.

Introduction regarding disease state

High-level summary of patient case

Purpose of the essay statement

Decision 1

• What options were listed
• What option did you choose?
• Why did you select that option?

• Why didn’t you select the other two options?
• What was your goal of treatment
• Was the outcome what you expected? Why?

Decision 2
• What options were listed
• What option did you choose?
• Why did you select that option?
• Why didn’t you select the other two options?
• What was your goal of treatment
• Was the outcome what you expected? Why?

Decision 3

• What options were listed
• What option did you choose?
• Why did you select that option?

• Why didn’t you select the other two options?
• What was your goal of treatment
• Was the outcome what you expected? Why?

Conclusion with Ethical considerations

***Do not use the start over button and complete several different times. That is not the point. If
you do use the START OVER button, I do not want your paper to reflect this. I have had
students do it multiple times and address incorrect outcomes in their paper. I have also had
students submit a paper that defends using all three options presented at decision point number
one. You will need to click the option to move to the next screen which will provide you with the
outcome and the options for the next decision point. You will receive a ZERO on the assignment
if you do not follow the instructions correctly. I had a handful of students last semester complete
the assignment incorrectly. Please ask questions if you do not understand.

*** Plagiarism and cheating***
It will not be tolerated. As soon as I discover it, I will send you an email requesting an
explanation and will copy Academic Integrity, the PMHNP program coordinator, and the Dean
of Nursing. It places all the patients you may someday see in harm’s way and I will not allow
that to happen. As an FYI, I read the SafeAssign documents very carefully. I pull all papers that
match your paper and read each. I also run your paper through all the assistive websites (such as
Course hero, etc) and cross reference all former students in my sections along with the other
professors for this course. As you can probably gather, I take these matters very seriously. I am
here to make sure you learn the material and not copy it from some other student. Do not use
other papers for your research (I had a handful of students try that in the past). This is also
considered plagiarism.

Do not upload your papers, once written, to “assistive sites”. If I discover it, I will turn it in to
Walden.

I hope I am being crystal clear on my thoughts of plagiarism and my reactions to any that is
discovered. You should be reading your SafeAssign report and making adjustments to your
papers before turning it in to me. Remember, if you turn it in to SafeAssign after you make
adjustments, it will match at near 100% because your prior paper will match against the new
submission. That is OK.

In summary, I want to see your original, genuine work and not some other person’s work.

The information I provided above were things that arose during other semesters of teaching this
class.

I think you will enjoy the interactive case studies!

Please let me know if you have any questions!

Matthew Bledsoe, PharmD, BCPS