NURS 6660 Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults

NURS 6660 Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults

NURS 6660 Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults

NURS 6660 Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults
Week 6: Emergency Psychiatric Care in Childhood and Adolescence
“I can’t believe I am not dead. I want to be dead, but those pills did not work as fast as I expected. Dad found me and called 911. I cannot go on living after what they said about me on the Internet. My life is ruined and I cannot go back to school or even show my face around here. They all think I am that way, but I am not. Dad thinks this was a mistake, but he is wrong. When I get out of here, I am going to try something different, and this time it will work.”
Jessica, age 13
When psychiatric emergencies arise, they can present many challenges to the PMHNP. While there are many approaches to emergencies that are similar, there are also significant differences when dealing with children and adolescents versus adults. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency.
This week, you examine psychiatric emergencies that arise during childhood and adolescence and compare how those emergencies are assessed and treated to those of adult clients.
Photo Credit: ijubaphoto / iStock / Getty Images Plus

Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 23, “Emergency Psychiatric Medicine” (pp. 785–790)
Chapter 31, “Child Psychiatry” (pp. 1226–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

“Bipolar and Related Disorders”

Note: You will access this book from the Walden Library databases.
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:
Reversal of benzodiazepine effects

flumazenil

Aggression
Behavioral problems
Cataplexy syndrome

clozapine
propranolol
zuclopenthixol
aripiprazole
asenapine
chlorpromazine
haloperidol
iloperidone
lurasidone
olanzapine
paliperidone
quetiapine
risperidone
ziprasidone
clomipramine
imipramine
sodium oxybate

Catatonia
Extrapyramidal side effects
Mania

alprazolam
chlordiazepoxide
clonazepam
clorazepate
diazepam
estazolam
flunitrazepam
flurazepam
loflazepate
lorazepam
midazolam
oxazepam
quazepam
temazepam
triazolam
benztropine
diphenhydramine
trihexyphenidyl
alprazolam (adjunct)
aripiprazole
asenapine
carbamazepine
chlorpromazine
clonazepam (adjunct)
iloperidone
lamotrigine
levetiracetam
lithium
lorazepam (adjunct)
lurasidone
olanzapine
quetiapine
risperidone
sertindole
valproate (divalproex)
ziprasidone
zotepine

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. 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.”
Optional Resources
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.

Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)

Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations.
In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.
Learning Objectives
Students will:

Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients
Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients

To Prepare:

Review the Learning Resources concerning emergency psychiatric medicine.
Consider a case where your adult client had a psychiatric emergency. (Note: If you have not had an adult client with a psychiatric emergency, ask your preceptor to describe one of their clients with a psychiatric emergency to use as an example for this Discussion.)

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post:

Briefly describe the case you selected.
Explain how you would treat the client differently if he or she were a child or adolescent.
Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.

By Day 6
Respond to at least two of your colleagues by recommending at least one additional way you would treat a child or adolescent client differently than you would an adult and at least one additional way you would address the legal and ethical issues involved.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 6 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 6 Discussion

Assignment 1: Midterm Exam
This exam is designed to assess how you synthesize the information from all your PMHNP courses. It draws upon the material from all the textbooks from NURS 6630, NURS 6640, NURS 6650, and NURS 6660. It is very similar to what you will experience in your certification exam.
Learning Objectives
Students will:

Assess knowledge of concepts and principles related to child and adolescent psychiatry

This exam will cover the following topics:

Components of a comprehensive integrated psychiatric assessment
Assessments specific to children and adolescents
Autism spectrum disorder, ADHD, ODD, ICD
Trauma and stressor-related disorders in childhood
Anxiety disorders in childhood and adolescence
Emergency psychiatric care in childhood and adolescence

By Day 7
Complete the Midterm Exam. Prior to starting the exam, you should review all of your materials. There is a 2-hour time limit to complete this 76-question exam. You may only attempt this exam once.
This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
Submission and Grading Information
Submit Your Quiz by Day 7
To submit your Exam:
Week 6 Exam

Assignment 2: Board Vitals
This week you will be responding to twenty Board Vitals questions that cover a broad review of your Nurse Practitioner program courses up to this point.
These review questions will provide practice that is critical in your preparation for the national certification exam that’s required to certify you to practice as a nurse practitioner. These customized test questions are designed to help you prepare for your Nurse Practitioner certification exam. It is in your best interest to take your time, do your best, and answer each question to the best of your ability.
You can access Board Vitals through the link sent to you in email or by following the link below:
https://www.boardvitals.com/
By Day 7
Complete the Board Vitals questions.

Making Connections
This week, you examined psychiatric emergencies that arise during childhood and adolescence and compared how those emergencies are assessed and treated to those of adult clients.
Next week, you will develop a Parent Guide for an assigned learning or motor disorder. For your practicum, you will examine the practice of voluntary and involuntary commitment of children and adolescents with mental health disorders.

Looking Ahead
In Week 7, you will work with your group again to create a new Parent Guide, focusing on learning and motor disorders in childhood.
NURS 6660 Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults

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