Assessing a Child with Depression Comprehensive Nursing Paper Sample

Assessing a Child with Depression Comprehensive Nursing Paper Sample

Patient Initials: W.Y.

Gender: Female

Age: 14

Accompanying Adult: Mother

SUBJECTIVE:

CC: “My life is boring and stressful, and I feel I am not the person I used to be.”

HPI: W.Y. is an African American 14-year-old patient presenting at the clinic complaining about his life being stressful, feeling like she is not the same person as she used to be, and experiencing significant changes in mood and feelings. W.Y reports that she is sad most of the time, and she no longer feels optimism in life. At times, she feels she is too young to experience such significant changes and worse, most people have been telling her it is adolescence, but she thinks otherwise. W.Y. used to love art and running, but she no longer engages in these activities. The patient reports not experiencing anything fun for the last six months. She has grown quieter and often spends time alone in her room. W.Y. states that feeling more exhausted makes engaging in other activities, including school work and house chores, challenging. W.Y. also reports being easily distracted, agitated, and irritable. She also struggles to fall or stay asleep, sleeping an average of 2-4 hours daily. Her appetite has also shifted, and she has noticed a significant loss in weight. Her mother reports observing significant changes in W.Y.’s social behavior, spending less time with the family. She also engages in altercations with everyone for the slightest misunderstandings or disagreements. W.Y. reports not using any current medications or substances and alcohol.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Social History: W.Y. lives with her parents in Texas, where they moved three years ago when her father got transferred.

Education and Occupation History: W.Y. is a high school student.

Substance Current Use and History: W.Y denies substance and alcohol use or history.  

Legal History: W.Y denies legal history.

Family Psychiatric/Substance Use History: W.Y. reports that the mother suffers from an anxiety disorder, which the accompanying mother confirmed. She reports that her father uses alcohol after work and during the weekend, although minimally during weekdays.  (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Past Psychiatric History:

            Hospitalization: None.

Medication trials: None

Psychotherapy or Previous Psychiatric Diagnosis: None

Medical History: W.Y. reports suffering from stomach issues, not specified when she was young.   

• Current Medications: None.
• Allergies: W.Y. is allergic to penicillin.
• Reproductive Hx: W.Y. states she has not engaged in any sexual activities.  

ROS:  

General: W.Y. reports noting significant change in weight, a shift in appetite, and feelings of weakness and fatigue. She denies fever.  (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

HEENT: Eyes: W.Y. denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Skin: No rash or itching.

Cardiovascular: W.Y. denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: W.Y. denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: W.Y. reports changes in diet and appetite. She reports feelings of nausea and vomiting. Denies diarrhea and abdominal pain or blood. W.Y. reports having constipation.  

Genitourinary: W.Y. denies burning on urination, urgency, hesitancy, odor, and odd color.

Neurological: W.Y. states she experiences headaches. She denies dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. W.Y. reports no change in bowel or bladder control. She states difficulty concentrating and paying attention.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Musculoskeletal: W.Y. states she experiences momentary muscle pain and weakness. She denies back pain and muscle or joint stiffness.

Hematologic: W.Y. denies anemia, bleeding, or bruising.

Lymphatics: She denies enlarged nodes or splenectomy history.

Endocrinologic: W.Y. reports sweating at night. She denies cold or heat intolerance, polyuria, or polydipsia.

OBJECTIVE:

Vital signs: Stable

Temp: 98.5F

            B.P.: 120/80

            P: 85

             R.R.: 17

             O2: Room air

             Pain: 2/10

             Ht: 5’7 feet

             Wt: 128 lbs

             BMI: 20

             BMI Range: Healthy weight

LABS:

Lab findings WNL

Tox screen: Negative

Alcohol: Negative

Physical Exam:

General appearance: W.Y. appears healthy and nourished. She is well-dressed for the occasion and place. She is well-groomed, and her interaction with the interviewer was polite and normal. The patient’s mood appeared down, and she seemed disinterested at times. She appears disappointed with herself and very pessimistic about her future. W.Y.’s concentration and attention appeared impaired. (Assessing a Child with Depression Comprehensive Nursing Paper Sample ) 

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Noted regular heart rate and rhythm. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: W.Y.’s heartbeat and rhythm are normal and within normal range, and capillaries refill within two and a half seconds.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Musculoskeletal: W.Y. indicates normal range of motion and regular muscle mass for age. No signs of swelling or joint deformities. W.Y. rates her muscle and back pain at 2/10 on the pain scale.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear. W.Y. reports frequent headaches.

Psychiatric: W.Y.’s mood appears depressed. She reports increased irritability and insomnia. W.Y.’s concentration and attention appeared impaired.  (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Neuropsychological testing: W.Y. has impaired social-emotional functioning.

Behavior/motor activity: W.Y. demonstrated appropriate and constant behavior during the interview.

Gait/station: Stable.

Mood: W.Y. has a depressed mood.

Affect: W.Y.’s mood was depressed.

Thought process/associations: W.Y.’s thought process was comparatively linear and goal-directed.

Thought content: W.Y.’s thought content was appropriate.

Attitude: W.Y. appeared disinterested at times.

Orientation: W.Y. was oriented to self, place, situation, and time.

Attention/concentration: W.Y.’s concentration and attention were impaired.  

Insight: Good

Judgment: Good.

Remote memory: Good

Short-term memory: Good

Intellectual /cognitive function: Good

Language: W.Y.’s speech was clear, and the tone was regular.

Fund of knowledge: Good.

Suicidal ideation: W.Y. reports suicidal ideation but no active plans.

Homicide ideation: Negative.

ASSESSMENT:

Mental Status Examination:

W.Y., a 14-year-old female patient, complains of being sad most of the time, significant change in mood, losing interest in previously pleasurable activities, feeling pessimistic about the future, and reduced social interaction. W.Y. was oriented to self, situation, time, and place. W.Y.’s insight, judgment, memory, and fund of knowledge were good; her speech was clear, and her tone was regular. The patient appeared disinterested at times and indicated impaired concentration and attention. The patient had a depressed mood and was overly pessimistic about her future, including not graduating from high school. W.Y. admitted to suicidal ideation but denied current plans and denied homicidal ideation.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Diagnostic Impression

1. F32.9 Major Depressive Disorder
2. F40.10 Social Anxiety Disorder
3. F90. 0 Attention-Deficit Hyperactivity Disorder (ADHD)

Reasoning

1. F32.9 Major Depressive Disorder

The patient showed signs of depression, including feeling sad most of the time, hopeless about her future, impaired attention and concentration, sleeping difficulties, easy irritability and agitation, and a feeling of worthlessness. Also, the patient is no longer interested in previously desirable and enjoyable activities like art and morning runs. She feels weak and tied most of the time, spending most of her time in her room alone. She struggles to complete schoolwork and home chores. Per the DMS-5 criteria, for a patient to be diagnosed with depression, one should demonstrate five of these symptoms: sleeping difficulties, losing interest and pleasure, feeling inadequate and hopeless, feeling low in energy and fatigued, impaired concentration and attention, shifting appetite and weight, psychomotor problems, suicidal ideation and plan, and a depressed mood (Chand et al., 2021). W.Y. fits these criteria, confirming depression diagnosis.      (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

• F40.10 Social Anxiety Disorder

W.Y. also shows signs of social anxiety or social function impairment. Often, people experiencing depressive symptoms demonstrate social-function impairment or anxiety and worry when around other people. Depression and social anxiety disorder tend to co-occur; at some point, those with social anxiety disorder are diagnosed with MDD (Langer et al., 2019). W.Y. reports spending most of her time alone, locked in her room. She has reduced interactions with her friends and family members, which her mother worries about. Per the DMS-5 criteria, for an individual to be diagnosed with social anxiety disorder, they must demonstrate considerable fear or anxiety in a single or more social situation where they might be subjected to other people’s scrutiny or attention. These individuals must also demonstrate worry about their behavior being misjudged and experience increased anxiety or fear on social occasions, which makes other people avoid or put up with them. These experiences should occur for at least six months before these feelings impair one or more functional areas.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Additionally, fear or worry should not be linked to another mental illness (Rose & Tadi, 2021). W.Y. expresses fear and worry around other people and indicates impaired social anxiety. However, she did not fit the criteria; hence, the diagnosis was refuted.

• F90. 0 Attention-Deficit Hyperactivity Disorder (ADHD):

ADHD affects millions of children and tends to worsen as people grow. W.Y. indicates signs of ADHD, including problems sustaining concentration and attention. The patient also indicates a reduced threshold for irritation and disorganization. Per the DMS-5 criteria for diagnosing ADHD, an individual must have five or more of these symptoms, most of which must appear before the age of 12, several present in two settings, indication that these symptoms interfere with social, academic, and occupational functioning, and the symptoms are not as a result of another mental problem: impulsivity, challenges focusing, paying attention, and multitasking, increased activity and restlessness, poor planning, time management, and disorganization, and reduced irritation threshold (Magnus et al., 2019). W.Y. indicates impaired concentration and attention, increased irritability, and disorganization but does not fit the above criteria; hence, the diagnosis was refuted. (Assessing a Child with Depression Comprehensive Nursing Paper Sample )    

Reflection:

The interview went well, and the patient and mother provided pertinent information to guide disease diagnosis and treatment plan development. This experience demonstrated how depression can impact people of all ages, especially its increasing prevalence among adolescents. Some depressive symptoms are often confused with characteristics of adolescence, and people think one will grow out of it but end up escalating to adulthood. For this reason, depression often goes undiagnosed and untreated among most adolescents. The interview does not indicate the underlying cause of a shift in mood and feelings in the patient, and in another encounter with this patient, I would dig deeper to understand the probable cause of the depressive symptoms and update treatment from there. (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Treating MDD among children and adolescents is ethically challenging because of the need for informed consent from the parent in every clinical decision. Additionally, the practitioner has to observe patient autonomy, assess risks for harm, physical and mental, promote justice and equal treatment, and promote human dignity. The practitioner has to ensure privacy and confidentiality of patient data and nondisclosure. Ethical principles might conflict in some cases, especially where managing pain or emotional impairment is more important than patient autonomy. These aspects have to be weighed with the patient and the parent. The patient or parent can also refuse particular treatment modalities, and the practitioner has to abide by these preferences after providing adequate information, including risks-benefits assessment.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Promoting the health and well-being of children and adolescents with depression requires the collaboration of various stakeholders, including parents, patients, teachers, practitioners, and the larger community. Prevention and early intervention efforts are integral in reducing the chronicity of the disease (Zonca, 2021). Health promotion activities include educating about healthy diet and exercise habits, avoiding substance abuse and unsafe sex, reinforcing social-emotional skills, reducing mental stigma at school, and establishing programs and safe spaces to support children and adolescents’ mental health concerns. Healthcare stakeholders need to develop urgency in addressing mental health problems among children and adolescents.  (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Case Formulation and Treatment Plan:

W.Y. would achieve optimal health outcomes from a combination of pharmacotherapy and psychotherapy. 

Safety Risk/Plan:

W.Y. reports suicidal ideation but lacks current plans. W.Y. denies any homicidal ideation. The suicidal ideation will be addressed using psychotherapy, and hospitalization is unnecessary. (Assessing a Child with Depression Comprehensive Nursing Paper Sample )  

Pharmacological Interventions:

W.Y. should be prescribed antidepressants, which are effective in improving depression symptoms. The patient would benefit from selective serotonin inhibitors, including fluoxetine and citalopram, which will be used as first-line treatment (Chand et al., 2021). Additionally, W.Y. should be prescribed antipsychotics and mood stabilizers to help antidepressants work optimally to improve mood and elevate energy.  (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Psychotherapy:

W.Y. requires psychotherapy to help address behavioral, social-emotional functioning, cognitive processes, and thought content impairment. The patient requires cognitive behavioral therapy (CBT) to impact positive behavior like healthy dieting, exercising, and returning to previously enjoyable activities. CBT will also help address the patient’s negative emotions and feelings about her future and break the negative cycle (Chand et al., 2021). Family therapy is also required to help the patient and family members reduce conflict, create a supportive environment for W.Y., and understand how to regulate emotions. The family will understand how to identify challenging situations, increase awareness of their thoughts, emotions, and feelings and how they impact decision-making and rectify destructive behavior. (Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Education:

1. Educate the client and parent regarding medication, potential side effects and complications, and the need for medication adherence.
2. Stress the importance of following up with treatment.
3. Educate the client and parent regarding signs of withdrawal and how to reduce withdrawal risk.
4. Educate the patient regarding healthy lifestyles and coping habits.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Consultation/follow-up: Follow-up is in two weeks.  

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing). In: StatPearls [Internet]. StatPearls Publishing.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Langer, J. K., Tonge, N. A., Piccirillo, M., Rodebaugh, T. L., Thompson, R. J., & Gotlib, I. H. (2019). Symptoms of social anxiety disorder and major depressive disorder: A network perspective. Journal of Affective Disorders, 243, 531–538. https://doi.org/10.1016/j.jad.2018.09.078(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2019). Attention deficit hyperactivity disorder (ADHD).

Rose, G. M., & Tadi, P. (2021). Social anxiety disorder. In StatPearls [Internet]. StatPearls Publishing.(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

Zonca V. (2021). Preventive strategies for adolescent depression: What are we missing? A focus on biomarkers. Brain, behavior, & immunity – health, 18, 100385. https://doi.org/10.1016/j.bbih.2021.100385(Assessing a Child with Depression Comprehensive Nursing Paper Sample )

https://www.ncbi.nlm.nih.gov/