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Presentation/PPT
27/08/2022
PLEASE FOLLOW THE INSTRUCTIONS BELOW:
ZERO (0) PLAGIARISM
5 REFERENCES NO MORE THAN 5 YEARS, OR LESS
PLEASE SEE ATTACHED RUBRIC DETAILS AND FOLLOW APA FORMAT.
NO RUNNING HEAD, AND PLEASE ADHERE TO THE ONE (1) PAGE AS INSTRUCTED
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
Write a 1-page narrative in APA format that addresses the following:
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.
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.
You administer 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.
ALL THREE MEDICATIONS ARE PROVIDED BELOW AND DECISION POINTS TO FOLLOW.
Decision Point One
Begin Zoloft 25 mg orally daily
RESULTS OF DECISION POINT ONE
Decision Point Two
Increase dose to 37.5 mg orally daily
RESULTS OF DECISION POINT TWO
Decision Point Three
Increase to 50 mg orally daily
Guidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
Decision Point Two
Change to Prozac 10 mg orally daily
RESULTS OF DECISION POINT TWO
Decision Point Three
Guidance to Student
You have two equally compelling choices at this point. The client has only been taking the current drug at its current dose for 4 weeks. It would be appropriate to continue at current dose. Additionally, you could also increase the dose to 20 mg orally daily. A discussion of risk/benefits should be had with the childs guardian regarding this and collaborative decision making should occur. There is no indication at this point that augmentation agents are required as the child is showing a partial response to therapy.
Decision Point One
Begin Wellbutrin 75 mg orally BID
RESULTS OF DECISION POINT ONE
Decision Point Two
Change to Lexapro 10 mg orally daily
RESULTS OF DECISION POINT TWO
Decision Point Three
Guidance to Student
At this point, there is no indicating that you should change back to Wellbutrin as the child is tolerating the current medication without mention of side effects. Also, the child is experiencing a reduction in symptoms. You could also increase the dose to 15 mg orally daily, but the child has only been taking the drug for 4 weeks at this point. It may be more prudent to give the current therapy an additional 4 weeks before making any decisions to change current dose.
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