NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Decision # 1 Differential Diagnosis

Obsessive–compulsive disorder (OCD)

Reason for the Selection

Obsessive-compulsive disorder is a prototypical impulsive, compulsive disorder. The patient experiences an unusual urge to do stereotypic, formal acts despite having full knowledge of how silly and unnecessary these behaviors are and having no genuine desire for the result of these activities. The most widely recognized kinds of compulsions are cleaning and checking (Stahl, 2014). Stress and anxiety may increase the formation of habits, regardless of whether decidedly or contrarily persuaded. In any case, as the patterns turn out to be dynamically impulsive, the experience of alleviation may never again be the driving force, and somewhat the conduct goes under external control as a conditioned reaction. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Obsessive thoughts may incorporate constant feelings of fears of damage beginning to act normally again or a friend or family member, an irrational worry with being contaminated, intrusive and unsatisfactory religious, savage, or sexual considerations, and ridiculously need to do things accurately or correctly. Tyrel case above gave the indications of the Obsessive-impulsive confusion (OCD).

Expected Result with this Decision

The predicted result indicated that he has OCD. Tyrel is alert and oriented, nervous, irritable at times, trouble staying asleep, obsess with continuous handwashing. He denies suicidal ideation. He denies visual or auditory hallucinations. There are no clear overt delusional or paranoid thought processes. Mother reported that Tyrel has been anxious, nervous, irritable at times, trouble staying asleep, obsess with continuous handwashing for about two months. He has difficulty getting to school and nervous around his classmates. Tyler missed school for eight days over the last three weeks. He was no longer playing with his best friend living across the street. He was impulsive with the monotonous behavior of cleaning and washing (Laureate Education, 2017c). NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Difference between Expected Result and the Achieved Result with Decision #1

There was not a contrast between the expected outcome and the achieved outcome as Tyrel has symptoms which indicative of OCD.

Decision #2:

Treatment Plan for Psychotherapy

Fluvoxamine immediate release 25mg orally daily

Reason for the Selection

Food and Drug Administration authorize fluvoxamine for the treatment of OCD in children eight years and older (Stahl 2014). Fluvoxamine immediate release 25mg orally daily is the medication of choice. Fluvoxamine influences synthetic compounds in the brain that might be uneven in individuals with obsessive-compulsive symptoms. Selective serotonin reuptake inhibitors affect neurotransmitters, chemicals that nerves in the brain use to communicate with each other. Neurotransmitters are released by nerves which travel across the spaces between nerves and then attach to receptors on other nerves. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Patient and family will be educated about the side effects of fluvoxamine which are drowsiness and fatigue, headache, sleeping problems, decreased libido, decreased sexual functioning, gastrointestinal problems, dizziness, nervousness, sweating and tremors. These side effects typically get better after taking the medication for a while (Ordacgi, Mendlowicz, & Fontenelle, 2017).

Cognitive Behavior Therapy (CBT) has proven to be useful in the treatment of OCD. CBT is created on the impression that distorted thoughts or cognitions cause and preserves harmful compulsions and obsessions (Foa, 2017). Exposure and response prevention (ERP) is an active form of behavioral therapy. ERP expose the patient to anxiety that is activated by the obsessions and after that preventing the utilization of rituals to lessen the uneasiness. This cycle of exposure and reaction prevention action is repeated to the point that the patient never again troubled by the fixations as well as impulses (Foa, 2017). NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

The objective of treatment is complete remission of current indications and additionally aversion of future backslides. Treatment regularly decreases or even eliminates manifestations, however not a fix since signs can repeat after the medication is stopped or therapy not completed.

Expected Result with this Decision

The expectation is that Tyrel will show some sign of improvement from taking the medication when he returns in about four weeks. Fluvoxamine allows serotonin to accumulate; serotonin depletion is thought to obsessions (Ordacgi, Mendlowicz, & Fontenelle, 2017). Tyrel’s mother verbalized that he had been some reduction in his symptoms and that he seemed little relaxes and had decreased handwashing. Tyrel had been able to go out and play with his friend which he had not done for a while. Tyrel seems to be having a little bit of problem embracing school, but his attendance has improved. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Difference between Expected Result and the Achieved Result with Decision #2

There was no difference between the expected outcome and proficient outcome because a low dosage of fluvoxamine was recommended. The patient can result in any case advantage by increasing the medication dose. Thus, it is suitable to increase fluvoxamine dosage at sleep time since the patient is reacting great to treatment administration.

Decision #3

Treatment Plan for Psychopharmacology

Increase Fluvoxamine to 50mg orally at bedtime.

Reason for the Selection

In four weeks when the patient revisited, there was a little improvement noted. He was reassessed, and the patient’s reaction to the medication was excellent with no sign of adverse side effects. It is vital to increase Fluvoxamine from 25mg to 50 mg orally at bedtime because the patient still having little problem embracing school and even handing the problem with handwashing. The dosage can be increased by 50 mg each four to seven day, until the point when the most extreme advantage is accomplished (Stahl, 2014). Fluoxetine has an elongated half-life of about 2–3 days, and its active metabolite an even elongated half-life of about two weeks. The long half-life is advantageous in that it seems to reduce the withdrawal reactions that are characteristic of sudden discontinuation of some SSRIs (Stahl 2014). NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Expected Result with this Decision

The expected outcome was that Tyrel reacts appropriately to fluvoxamine 50mg at sleep time.

Fluvoxamine works by preventing the uptake of serotonin from the spaces between nerve cells subsequent its release, so the increase of Fluvoxamine will make more serotonin available in the areas to attach to other nerves and stimulate them. Tyler symptom will improve by next visit making him interact in school better and reduce his handwashing.

Difference between what you expected to achieve with Decision # 3

There will be no difference between the expected results and the negotiated outcome. Tyler will maintain the current dose of medication because he is feeling better and no complaint of side effect. Fluvoxamine is known to have a shorter half-life of 17-22 hours after a steady dose has been established (Stahl, 2014).

Ethical Considerations that might Impact Treatment Plan

Ethical concerns about the safety, acceptability, and humaneness of exposure therapy are essential to objections against the treatment. Beneficence and Nonmaleficence to take care to do no harm and protect the welfare and rights of the patient. The safety and tolerability of exposure therapy may be determined by evaluating the outcomes associated with this treatment. The treatment program that incorporates educating the family about OCD, its treatment, and how to adequately with the patient’s therapy would be valuable, given the high occurrence of relational issues in families of OCD patients (Altis, Elwood, & Olatunji, 2015). NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Reference

Altis K.L, Elwood L.S, & Olatunji B.O. (2015) Ethical Issues and Ethical Therapy Associated with Anxiety Disorders. Curr Top Behav Neurosci; 19:265-78. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/

Foa, E. B. (2017). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 199–207.

Laureate Education (Producer). (2017c). Anxiety disorder, ODC, or something else? [Multimedia file]. Baltimore, MD: Author.

Ordacgi, L., Mendlowicz, M. V., & Fontenelle, L. F. (2017). Management of obsessive-compulsive disorder with fluvoxamine extended release. Neuropsychiatric Disease and Treatment, 5, 301–308. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th

ed.). New York, NY: Cambridge University Press.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

Psychiatric mental health nursing is a specialty within nursing. Psychiatric mental health registered nurses work with individuals, families, groups, and communities, assessing their mental health needs. The PMH nurse develops a nursing diagnosis and plan of care, implements the nursing process, and evaluates it for effectiveness. Psychiatric Mental Health Advanced Practice Registered Nurses (PMH-APRNs) offer primary care services to the psychiatric-mental health population. PMH-APRNs assess, diagnose, and treat individuals and families with psychiatric disorders or the potential for such disorders using their full scope of therapeutic skills, including the prescription of medication and administration of psychotherapy. PMH-APRNs often own private practices and corporations as well as consult with groups, communities, legislators, and corporations. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Advanced practice registered nurses (APRN) earn master’s or doctoral degrees in psychiatric-mental health nursing. APRNs apply the nursing process to assess, diagnose, and treat individuals or families with psychiatric disorders and identify risk factors for such disorders. They also contribute to policy development, quality improvement, practice evaluation, and healthcare reform. The practice of the psychiatric-mental health nurse (PMHN) as a Clinical Nurse Specialist or Nurse Practitioner is considered an advanced specialty in nursing. APRNs practice as Clinical Nurse Specialists (CNSs) or Nurse Practitioners (NPs). The doctoral degree for the advanced clinical practice of psychiatric nursing is the Doctor of Nursing Practice (DNP). APRNs also earn additional degrees (PhD and EdD) which prepare them to work as professors, researchers, or administrators. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Psychiatric mental health nursing is a specialty within nursing. Psychiatric mental health registered nurses work with individuals, families, groups, and communities, assessing their mental health needs. The PMH nurse develops a nursing diagnosis and plan of care, implements the nursing process, and evaluates it for effectiveness. Psychiatric Mental Health Advanced Practice Registered Nurses (PMH-APRNs) offer primary care services to the psychiatric-mental health population. PMH-APRNs assess, diagnose, and treat individuals and families with psychiatric disorders or the potential for such disorders using their full scope of therapeutic skills, including the prescription of medication and administration of psychotherapy. PMH-APRNs often own private practices and corporations as well as consult with groups, communities, legislators, and corporations. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Advanced practice registered nurses (APRN) earn master’s or doctoral degrees in psychiatric-mental health nursing. APRNs apply the nursing process to assess, diagnose, and treat individuals or families with psychiatric disorders and identify risk factors for such disorders. They also contribute to policy development, quality improvement, practice evaluation, and healthcare reform. The practice of the psychiatric-mental health nurse (PMHN) as a Clinical Nurse Specialist or Nurse Practitioner is considered an advanced specialty in nursing. APRNs practice as Clinical Nurse Specialists (CNSs) or Nurse Practitioners (NPs). The doctoral degree for the advanced clinical practice of psychiatric nursing is the Doctor of Nursing Practice (DNP). APRNs also earn additional degrees (PhD and EdD) which prepare them to work as professors, researchers, or administrators. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

Child Abuse Case Study

Morgan, a 19-year-old male comes to your office to discuss his current mood and symptoms. This is his first visit to a mental health clinic. “I’ve had 26 jobs in the last 2 years; I finally have a job that I like and I want to make it work.” As you begin to get to know him, he tells you that his mood is down and that he also has times where he has “more energy and motivation”: “That’s when I am able to get a new job.” He says that he has difficulty interacting with coworkers. “I feel like I can’t talk to them.” If it wasn’t for his supportive girlfriend, he wouldn’t be able to function. “She understands me and accepts me; she knows what I have been through.” NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

As the PMHNP listens to the client and explores what he means by some of his statements, you try to put together his story. He mentions that he has been having nightmares and is not sleeping well. He says he startles easily. He becomes withdrawn when he begins to talk about the reason for the nightmares.

“This all started a few weeks ago when a cousin of mine got out of jail.” He haltingly tells the story of his parents’ mental illness and how he had to live with various relatives.

“One cousin who I stayed with a lot took advantage of me. He molested me.” They found out he also molested other children and he went to jail. “It gives me the creeps that he is out of jail. I have to face what he did to me.”

Morgan asks about his diagnosis. The PMHNP tells him that he has some symptoms that sound like depression and anxiety, and that when a child has a traumatic experience, it can reoccur and stay with a person for many years. He acknowledges that he thought about PTSD but wasn’t sure what the symptoms look like. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay

As you think about Morgan’s story, consider the following questions: Where did he fall between the cracks? Are there agencies who advocate for children like him?

There are thousands of children like Morgan. They were in a vulnerable family situation and the “responsible” adult was not able to care for the child. Sometimes it takes years for clients to remember and disclose the abuse

Discussions regarding the certification of the psychiatric-mental health (PMH) clinical nurse specialist (CNS) resulted in its elimination by the American Nurses Credentialing Center (ANCC), effective 2014. The sole remaining advanced practice registered nurse (APRN) certification for providing psychiatric and mental health care will be the Family Psychiatric Nurse Practitioner (NP). Disagreement still lingers with the changes in certification, including fears that the role of the PMH-CNS, which include care for the child and adolescent patient population and psychotherapy, will no longer exist. Additional concerns include the loss of duties tradi-tionally performed by PMH-CNS to other behavioral health disciplines. In contrast to these fears are the hopes that a single title will reduce confusion among consumers and professionals, allow for an improvement in the allocation of resources for roles with similar core functions, and better address the current needs of individu-als seeking mental health care. This paper describes the implications of such a transition and how even with a change in title, the role of the CNS can and should survive. NURS 6660 – Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent Essay