6660N PMH Nurse Practitioner Role I: Childand Adolescent

Walden University PRAC 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Week 9 IntroductionResourcesAssignmentPracticum ReminderMaking ConnectionsMy Progress Tracker ☰ Menu × PRAC 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Back to Course Home Course Calendar Syllabus Course Information Resource List Support, Guidelines, and Policies Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Photo Credit: Getty Images/iStockphoto Practicum Week 9 This week, you will log all of your Practicum hours in the Meditrek system. You also complete a Decision Tree concerning children with psychotic disorders. Learning Resources Required Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. “Schizophrenia Spectrum and Other Psychotic Disorders” McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf 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: Schizoaffective disorder Schizophrenia amisulpride aripiprazole asenapine carbamazepine (adjunct) chlorpromazine clozapine cyamemazine flupenthixol haloperidol iloperidone lamotrigine (adjunct) l-methylfolate (adjunct) loxapine lurasidone mesoridazine molindone olanzapine paliperidone perospirone perphenazine pipothiazine quetiapine risperidone sertindole sulpiride thioridazine thiothixene trifluoperazine valproate (divalproex) (adjunct) ziprasidone zotepine zuclopenthixol amisulpride aripiprazole asenapine carbamazepine (adjunct) chlorpromazine clozapine cyamemazine flupenthixol haloperidol iloperidone lamotrigine (adjunct) l-methylfolate (adjunct) loxapine lurasidone mesoridazine molindone olanzapine paliperidone perospirone perphenazine pipothiazine quetiapine risperidone sertindole sulpiride thioridazine thiothixene trifluoperazine valproate (divalproex) (adjunct) ziprasidone zotepine zuclopenthixol 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. 6660N PMH Nurse Practitioner Role I: Childand Adolescent. 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 strange behaviors [Multimedia file]. Baltimore, MD: Author. Assignment: Practicum: Decision Tree (Due in Week 10) Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia. 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 3: 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. 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. 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. 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. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

Introduction

According to recent research, Schizophrenia has turned out to be a serious mental disorder that interrupt individual’s lifestyle abnormally. In fact, the condition brings about combination of hallucinations, disordered thinking, delusions, impairment of daily thinking. More so, the associated disease is linked with alteration of human activities such as moods, thinking, and behavior. In the recent past, cases of such disorder have increased thus alarming the health sector as a major concern. This paper will cover a case study involving a 13-year-old Hispanic female brought to the clinic by her mother and father for checkups. The parents report the idea referred to them by their primary care provider since Carrie’s behavior has turned out difficult to manage and don’t know what they can do. Still, the paper will make a close examination of the client’s case study as well as making assessment based on probable selected choices that might be most probable in line with the provided patient case study as well as answering series of question on the decision provided. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

Probable additional diagnostic tests to be undertaken

According to the recent research, there is no proven laboratory, radiology, and psychometric test applicable for diagnosis of early onset schizophrenia condition(Clark et al., 2017). More so, patient with such a disorder is known to have issues with neurons connected to motor conditions, motor sequencing with complex movements, and sensory integration. In such a case, medics tend to conduct a full patient medical history as well as physical examination. Despite lacking an effective test for the disorder, the doctor may perform a diagnostic test such as CT scan or blood test. These tests will enable the doctor to eliminate some of the physical illnesses that the client will be having as the causes of the patient’s symptoms. At this point, if the medical personnellack any physical reasons for such a symptom then the patient will be referred see a psychologist or psychiatric. Such professionals will aid patient’s diagnosis and treatment for such condition since they are well trained to deal with such issues. Even though it is crucial to conduct a neurological examination together with a comprehensive test to asses personal cognitive functioning. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

Decision Pont One:Early Onset Schizophrenia

In regard to the presented case study, my initial remedy for Carrie’s condition will diagnose her with early onset schizophrenia. The case study present some of the reason that support my thought. Some of the supporting reasons include the following. According to Carrie’s parents reports it shows that the patient has abnormal friends “half human and half cat”, she is also characterized with “speaking spirits” in her head. Still, the minor endorses seeing and hearing strange things as opposed to other people. For instance, “things that I talk to” and delusion that come from people acting on TV programs “just for her” therefore the commercial are in apposition to tell her “what to do”. In addition, the patient tends to experience effects that are somehow constricted, seem to be pre occupied during interview session, and she avoid eye contact with the interviewer. Another supporting reason for early onset of schizophrenia is the family history of such an illness. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

According to Noel& Jackson, (2020) Diagnostic and Statistical Manual of Mental Health Disorder (DSM-5) schizophrenia diagnostic criteria include hallucinations, delusions, disorganized speech, negative symptoms, and grossly disorganized behavior. These criteria symptoms are present to a patient within the first month and presence of persistent symptoms persist for the next six months.Contrary to the presented Carrie case, the observed symptoms and history do not support the probable schizophrenic disorder. This is so, since for a patient to have schizophrenia disorder the symptoms must align with psychotic features. Also, the client must meet the distinguished criteria for a mood disorder that is maniac or depression. Consequently, after going through the presentation the reader is not able to concur with patient symptoms that indicates a mood disorder. However, some individuals with schizotypal personalitycondition might experience some of the psychotic episodes in connection to hallucination and delusions, but such episodic experience are not frequent or intense as the case of schizophrenia condition. In regard to the patient case, she has been experiencing often hallucinations and delusions in different intervals for a prolonged duration. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

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Decision Two: Refer for psychological testing

My second decision for Carrie will be a referral to a psychological testing. This will narrow patient’s assessment to be conducted effectively. Importantly, some of schizophrenia cases to children makes it difficult to distinguish since they might be severely or moderate impairedmaking the process turn problematic. This will be significant since there is no distinguished diagnosis for schizophrenia. A psychologist will undertake a various psychological battery testing that will aid cognitive functioning and personality. At this point, the professional will find out presence of intellectual disability if present. However, some of the test to be performed will include adult intelligent test, Minnesota Multiphasic Personality Inventory, Rorschach test. After conducting the tests, the psychologist strongly suspected presence of early onset of schizophrenia to Carrie. The aim of choosing this decision is to get more information that will easily give probable likelihood of the suspected disorder. However, this aim was successfully achieved since the psychologist after conducting several test was sure the patient was suffering from early onset of schizophrenia.

Ethical considerations impacting treatment plan and communication

Patient consent ethical consideration is applicable in this decision to ensure patient is permit the psychologist conduct various test. In this case, this rule is disregarded by the presented case study since it involves a minor. This regulation does not completely governthe process since the parent will be consulted on behalf of their daughter. This rule denies the patient to give personal consent to a particular test. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

Decision Three: Begin Clozapine 100 Mg Orally Daily

My third take for the patient is tobegin clozapine 100 mg orally daily. This type of medication is applicable in treating schizophrenia, disorder. The aim of employing this type of medication is ensure the patient has restored her balance in various natural disturbances with the brain. However, Clozapine helps n decreasing patient symptoms such as hallucinations as well as preventing suicidal acts of harming herself. Still, the 100 mg dosage will help the patient to start a new thought about herself in a positive manner thus develop less nervousness in daily activities. In this case, Carrie will use the mouth via mouth with or without food. Then, she will allow the medicine to dissolve in the mouth and swallow. Even though application of 100 mg dosage is more likely to cause side effects that can be easily noted by the patient or the parents. Some of clozapine side effects include the following fast heart rate, fever, constipation, nausea, increased hunger, headache, drowsiness, and dry mouth. Notably, when the patient is undergoing with clozapine medication is crucial to consult a professional before using or changing the medication since they are aware of interaction of clozapine with other types of drug while monitoring the patient progress.

Issuing the patient with Clozapine 100 mg orally daily dosage was primarily aiming at decreasing chance of early onset schizophrenia(Pardis et al., 2020). For instance, the patient will decrease behavior of having half friend as well as getting delusion from television of what to do. Still, there were hopes of getting compliance with such activities such as getting in touch school activities. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

Ethical considerations impacting treatment plan and communication

According to prior research, it is revealed that patient treatment is linked with various ethical consideration. However, diagnosis and treatment of early onset schizophrenia is distinguished to have a history of social and ethical problems while administering the medication. According to the American Nurses Association, PMHNP should ensure patient confidentiality is uphold to avoid any un authorized individuals from accessing private health records. This regulation is not maintained in this case since the personnel will give an in-depth explanation to the parents while issuing a certain prescription. Even though this is okay since the presented case involves a minor who is under the care of her parents.In addition, ethical law is not followed since there is no limitation of family or fried involvement in Carrie psychological therapies. Such incidences take part when a patient is given therapies such as cognitive functions and behavioral changes as a social support from close members. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

Consequently, in the Carrie’s case presented attracts big concern since there is bleaching of confidentiality code. For instance, the patient’s family and friend enquiring to be explained by the psychologist will eventually get the patient information since she relies on them for health care issues. Contrary, to the ethical consideration does not maintain patient’s confidentiality while the medic explains more about the condition of the minor and the necessary steps to be undertaken while she receives medical attention. This can be termed as professional bleach as well as a malpractice.

Nurse action to a patient should be guided by beneficence code of ethics(Ventura et al., 2020). In this case a medic action to offer a treatment plan should be give in mind to assist the patient. For instance, the patient is given Clozapine 100 mg dosage this should be followed bearing in mind the professional prescription is primarily to benefit the patient current condition. This code is a vital aspect which guide the minor to get the necessary medication that will lower the earlyonset schizophrenia symptoms. At this point, the patient will continue taking the prescribed dosage as well as noting positive outcome with the disorder. Notably, when coming up with a concrete medical decision it is important to seek extra information from consultants which will guide in removal of dilemma while dealing with a patient with early onset schizophrenia.

Another ethical consideration includes ethical voluntary participation of patients. This rule allows patient to add their take for a particular prescription. This is to ensure patient participation is uphold as well as assessment and evaluation is not coerced. Still, this rule allows the patient to undergo treatment without putting her life at risk. Besides, the ethical complication in the Carrie’s case is not guaranteed since the parents are there to supervise her medical actions. Being a minor restrict the patient to enjoy this ethical rule since parents has the monopoly over her treatment process. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

Informed ethical consent is a consideration to put in place according to the case study. More so, this rule permits the patient to receive all the details and options that are applicable in treating early onset schizophrenia condition. Also, this ethical guideline allows medics to provide the patient with the correct information for a certain drug change or prescription. By so doing, the client is put in place to make self-decision that are applicable to themselves without being forced while weighing both risk factors and potential benefits. Notably, the client is not able to make complete self-expression to the medic since she is under age and not knowledgeable enough to make critical decision at her state of mind. However, this might create an ethical dilemma when the patient object the only solution to the condition they are suffering from thus delaying the recovery process.

Conclusion

In conclusion, early onset schizophrenia should be presented to clinical personnel early enough to help treating the patient during the early stages. At this point, this will help the medic to optimize client’s assessment as well as diagnosis. More so, this gives the provider a chance to study the patient condition early enough and helping planning a keen treatment plan such as referring them to a psychologist for further assessment as well as choosing the correct medication and dosage such as Clozapine 100 mg orally daily. The treatment process should be given to a patient with early onset schizophrenia to fasten the healing process of the patient. Even though their variety of medication to treat Carrie’s disorder it is important to ensure the doctor examine the correct dosage to ensure the patient is safe from experiencing negative side effects. In this case Carrie will continue taking Clozapine 100 mg orally daily to minimize early onset schizophrenia symptoms. 6660N PMH Nurse Practitioner Role I: Childand Adolescent

References

Clark, L. A., Cuthbert, B., Lewis-Fernández, R., Narrow, W. E., & Reed, G. M. (2017). Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC). Psychological Science in the Public Interest, 18(2), 72-145.

Noel, J. M., & Jackson, C. W. (2020). ASHP Therapeutic Position Statement on the Use of Antipsychotic Medications in the Treatment of Adults with Schizophrenia and Schizoaffective Disorder. American Journal of Health-System Pharmacy, 77(24), 2114-2132.

Pardis, P., Remington, G., Panda, R., Lemez, M., &Agid, O. (2019). Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review. Journal of Psychopharmacology, 33(10), 1187-1198.

Ventura, C. A. A., Austin, W., Carrara, B. S., & de Brito, E. S. (2020). Nursing care in mental health: Human rights and ethical issues. Nursing Ethics, 0969733020952102. 6660N PMH Nurse Practitioner Role I: Childand Adolescent