original case presentation
You have a 17-year-old female that comes in with suspected pregnancy and limited family support. She is accompanied by her 18-year-old boyfriend who is the father of the child. While knowing she needs prenatal care, what resources and education would you try to provide and how would you encourage compliance in this vulnerable patient? What are some of the biggest risk factors that this patient faces and how can you provide quality care while being sensitive to the stigma that comes with teen pregnancy?
Sarabjit Kaur posted Aug 18,
Although teen birth rates have steadily declined over the past years, roughly 171,674 live births were reported to mothers aged 15-19 years of age in 2019 (CDC, 2021). Teen pregnancy can be challenging for many young mothers, and as patients of primary care clinicians, it is vital to accept their condition and teach the many resources that exist in order to help them in the best way. There are many resources that can help them become the best parent and knowing that the patient most definitely needs prenatal care, examples of excellent educational and financial resources are offered by the Illinois Department of Human Services that helps teen parents accomplish many goals including reducing barriers that prevents them from completing school, avoiding future unplanned pregnancies, improving parenting and life skills, and overall the health of their children (IDHS, 2020). Programs involved are examples such as homeless youth, responsible parenting, parents too soon, and Illinois subsequent pregnancy program that offers financial assistance (IDHS, 2020). The FNP has the responsibility to refer the patient to these helpful programs as an advocate of the patient. Additional education would often involve safe sex practices and protection against future unplanned pregnancies and STD’s, which can cause increased mortality. That is why some of the biggest risk factors that this patient can experience is increased STD infection, chances for ectopic pregnancy, and pelvic inflammatory disease to name a few. Providing quality care involves accepting the patient the way she is and approaching her situation by being empathetic and non-judgmental. The FNP will always be the patient’s advocate no matter when and to whom.
discussion 2 Discussion Question – Pediatrics
Original case presentation
Your patient is an eight-year-old male child who is extremely active and not doing well in school. After several visits and using the Conners CBRS, you diagnosed him with ADHD. His parents are divorced, and the father attends with the mother and is against medication but would like to talk about cognitive-behavioral approaches prior to starting medication. What is your approach with this child and his parents? What options would you present and why? If they agreed on a medication but later wanted to try the cognitive-behavioral approach to wean the child off of medication, what types of linear plan would you form, who would you involve in this plan, and how long would you expect this plan to be in place in order to show long-term improvements?
Karen Batenga posted Aug 18, 2022 3:46 PM
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Cognitive-behavioral therapy (CBT) is an effective treatment to help control behaviors from children who suffer from ADHD (Deupree, 2022). Those with ADHD may have difficulty paying attention, be fidgety and unable to sit, or have trouble controlling impulsive behaviors (Deupree, 2022). The American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment for children with ADHD younger than 6 years of age. For children 6 years of age and older, a combination of medication and behavior therapy is recommended (CDC, 2022).
In the case presented, the patient is an 8-year-old child and as a clinician, I would recommend medication in combination with behavior therapies. I would explain to the parents that medications can help children manage their ADHD symptoms and can help control behaviors that can affect their relationships with family, friends and at school (CDC, 2022). Stimulants are the mainstay of treatment for ADHD (Magnus et al., 2022). Non-stimulant medications are also available, but they do not work as quickly as stimulants (CDC, 2022). Since the father of the child is hesitant about putting his child on medications, several types of behavior therapies are effective for ADHD such as parent training in behavior management, behavioral interventions in the classroom, peer interventions that focus on behavior and organizational skills training (CDC, 2022). To determine the most appropriate route, a mental health provider will usually conduct a comprehensive evaluation of the child’s mental health to figure what type of therapy will work best for the child (CDC, 2022).
If the parents eventually agree with their child taking medications but later wanted cognitive-behavioral therapy to wean their child from medication, a referral to a dedicated psychotherapist who specializes in conducting CBT should be done. Psychotherapists can personalize and customize the therapy to the specific needs of each patient (Chand et al., 2022). Typical CBT treatments involve approximately 60-minute sessions occurring weekly for 8 to 12 weeks. Weaning off the medication will depend on how well the child is responding to the medication with behavioral therapy. Discontinuing stimulant medications maybe tolerated by a significant group of youth (Lohr et al., 2021). If after 1 month, there is an improved response from the child, the clinician may lessen the dose and taper the medication while the child is on cognitive-behavioral therapy. Upon completion of CBT, subsequent follow-up visits every 3 months is reasonable (Cash et al., 2021).
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