Therapy for Pediatric Clients with Mood Disorders AN AFRICAN AMERICAN CHIDL 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 Client complained of feeling “sad” Mother reports that teacher said child is withdrawn form peers in class Mother notes decreased appetite and occasional periods of irritation Client reached all developmental landmarks at appropriate ages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 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 process 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 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. DECISION POINT ONE Select what you should do: Begin Zoloft 25 mg orally daily Begin Paxil 10 mg orally daily Begin Wellbutrin 75 mg orally BID ASSIGNMENT INSTRUCTIONS: Assignment: Off-Label Drug Use in Pediatrics 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. Photo Credit: Getty Images 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. To Prepare • Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders. • Reflect on situations in which children should be prescribed drugs for off-label use. • Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics. By Day 5 of Week 11 Write a 1-page narrative in APA format that addresses the following: • Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples. • Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Rubric Detail Select Grid View or List View to change the rubric’s layout. Name: NURS_6521_Week11_Assignment_Rubric • Grid View • List View Show Descriptions Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.– Excellent 36 (36%) – 40 (40%) The response accurately and thoroughly explains in detail the circumstances under which children should be prescribed drugs for off-label use. The response includes accurate and specific examples that fully support the explanation provided. Good 32 (32%) – 35 (35%) The response accurately explains the circumstances under which children should be prescribed drugs for off-label use. The response includes accurate examples that support the explanation provided. Fair 28 (28%) – 31 (31%) The response inaccurately or vaguely explains the circumstances under which children should be prescribed drugs for off-label use. The response includes inaccurate or vague examples that may or may not support the explanation provided. Poor 0 (0%) – 27 (27%) The response inaccurately and vaguely explains the circumstances under which children should be prescribed drugs for off-label use, or is missing. The response includes inaccurate and vague examples that do not support the explanation provided, or is missing. Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.– Excellent 41 (41%) – 45 (45%) The response accurately and clearly describes in detail strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. The response includes accurate, complete, and detailed descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Good 36 (36%) – 40 (40%) The response accurately describes strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. The response includes accurate descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Fair 32 (32%) – 35 (35%) The response inaccurately or vaguely describes strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. The response includes inaccurate or vague descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Poor 0 (0%) – 31 (31%) The response inaccurately and vaguely describes strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence, or is missing. The response includes inaccurate and vague or incomplete descriptions and names of off-label drugs that require extra care and attention when used in pediatrics, or is missing. Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.– Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation– Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors Good 4 (4%) – 4 (4%) Contains a few (1–2) grammar, spelling, and punctuation errors Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3–4) grammar, spelling, and punctuation errors Poor 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.– Excellent 5 (5%) – 5 (5%) Uses correct APA format with no errors Good 4 (4%) – 4 (4%) Contains a few (1–2) APA format errors Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3–4) APA format errors Poor 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors Total Points: 100 Name: NURS_6521_Week11_Assignment_Rubric Learning Resources Required Readings (click to expand/reduce) Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier. • Chapter 8, “Drug Therapy in Pediatric Patients” (pp. 65—67) Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/ This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse. Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423 Note: You will access this article from the Walden Library databases. This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD. Document: Final Exam Study Guide (PDF) Required Media (click to expand/reduce) Laureate Education (Producer). (2019i). Therapy for pediatric clients with mood disorders [Interactive media file]. Baltimore, MD: Author.
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