A 14-year-old female patient with a history of depression is experiencing increased social withdrawal, irritability, and significant weight loss. Considering the potential nutritional deficiencies and mental health status, which nursing intervention should take priority in her care plan?

C) Educate the patient and family about balanced nutrition and consider initiating a referral to a dietitian.

A) Increase monitoring of her blood pressure and heart rate to assess for cardiovascular changes.

B) Encourage the patient to join a peer support group to address social withdrawal.

C) Educate the patient and family about balanced nutrition and consider initiating a referral to a dietitian.

D) Suggest the healthcare provider increase the dosage of fluoxetine to manage her depression symptoms.

A 14-year-old female patient presents with increased social withdrawal, irritability, significant academic decline, and further weight loss despite stable vital signs. Given these changes, what is the most appropriate nursing intervention to prioritize in her care plan?

B) Initiate a comprehensive nutritional assessment and consider dietary supplements.

A) Increase the dosage of fluoxetine to address worsening symptoms.

B) Initiate a comprehensive nutritional assessment and consider dietary supplements.

C) Refer the patient to a psychiatrist for possible medication change.

D) Encourage family therapy sessions to improve social interactions.

A 16-year-old patient with mild anemia and low serum ferritin is being treated for nutritional deficiency. Despite initiating a targeted nutritional intervention plan, which of the following clinical signs should the nurse prioritize monitoring to assess for potential complications of her anemia?

A) Increased heart rate and palpitations

B) Increased appetite and weight gain

C) Improved mood and energy levels

D) Decreased frequency of depressive episodes

A 15-year-old patient with mild anemia and suspected protein-energy malnutrition is undergoing nutritional rehabilitation. Which nursing intervention is the most appropriate to prioritize initially to address her nutritional deficiencies?

C) Collaborate with the dietitian to implement an iron-rich and high-protein meal plan.

A) Educate the patient on the importance of increased physical activity to improve appetite.

B) Monitor the patient's hemoglobin and serum ferritin levels weekly to assess improvement.

C) Collaborate with the dietitian to implement an iron-rich and high-protein meal plan.

D) Increase the patient's fluoxetine dosage to manage depressive symptoms and improve dietary intake.

During a follow-up assessment, a pediatric patient exhibits slight weight gain and marginal improvement in hemoglobin and ferritin levels, yet continues to experience low energy levels and difficulty concentrating. The care team plans to adjust the nutrition and therapy plan. What should the nurse prioritize to enhance the patient's recovery?

B) Encourage the inclusion of more iron-rich and protein-dense foods in the diet

A) Increase the dosage of fluoxetine to address low energy levels

B) Encourage the inclusion of more iron-rich and protein-dense foods in the diet

C) Recommend additional rest periods throughout the day to manage fatigue

D) Suggest a higher frequency of therapy sessions to improve motivation

A 14-year-old female patient is undergoing treatment for anemia and depression. Despite slight improvements in weight and laboratory values, she continues to exhibit pallor, mild tachycardia, and low energy levels. Which nursing intervention is most appropriate to prioritize at this time?

A) Encourage increased dietary protein and iron intake.

B) Suggest increasing the dose of fluoxetine to address depressive symptoms.

C) Monitor vital signs closely and prepare for possible blood transfusion.

D) Implement motivational interviewing techniques to enhance therapy engagement.

A 12-year-old patient with a history of iron deficiency anemia is being followed up for her condition. Despite some improvements, she continues to experience fatigue and has a hemoglobin level of 10.8 g/dL and serum ferritin of 16 ng/mL. What is the most appropriate nursing intervention to support her current treatment plan?

A) Encourage increased intake of vitamin C-rich foods to enhance iron absorption.

B) Recommend reducing physical activity to conserve energy.

C) Suggest decreasing the dosage of fluoxetine to improve concentration.

D) Advise increasing protein intake to raise serum albumin levels.

A 16-year-old female patient with a history of anemia and depression is being monitored for her response to current interventions. Her hemoglobin level is 10.8 g/dL, and serum ferritin is 16 ng/mL. She continues to experience fatigue and fluctuating tachycardia, and she struggles with motivation despite mood stabilization. Based on this information, what should the nurse prioritize during the patient's follow-up visit to optimize her care?

A) Reassessing the patient's dietary intake and consulting with the dietitian to enhance iron-rich food options.

B) Increasing the dosage of fluoxetine to further improve the patient's motivation and engagement.

C) Initiating a cardiology referral to evaluate the cause of fluctuating tachycardia and persistent pallor.

D) Encouraging the patient to join a peer support group to address her motivational challenges.

A patient presents with increased fatigue, persistent pallor, and a decrease in hemoglobin and serum ferritin levels. The dietitian recommends improving dietary intake of iron and vitamin C. Which nursing intervention would be most effective in addressing the patient's nutritional needs?

A) Encourage the patient to consume more red meat and citrus fruits.

B) Advise the patient to take an iron supplement with a glass of milk.

C) Suggest consuming tea with meals to enhance iron absorption.

D) Recommend increasing the intake of high-fiber foods to improve digestion.

A patient with a history of iron deficiency anemia presents with increased fatigue, pallor, and a hemoglobin level of 10.5 g/dL. Her serum ferritin is 14 ng/mL, and she exhibits tachycardia with a resting heart rate of 105 bpm. As part of the nursing care plan, which intervention should the nurse prioritize to address the patient's current symptoms and prevent further complications?

A) Encourage the patient to increase her dietary intake of iron-rich foods and vitamin C.

B) Monitor the patient's blood pressure and heart rate every 4 hours.

C) Advise the patient to participate in daily physical exercise to improve cardiovascular function.

D) Schedule the patient for immediate cognitive-behavioral therapy sessions to enhance motivation.

Pediatric depression - Nursing Case Study

Pathophysiology

• Neurotransmitter Imbalance: Pediatric depression often involves dysregulation of key neurotransmitters like serotonin, norepinephrine, and dopamine. These chemicals are crucial for mood regulation, and their imbalance can lead to symptoms of depression.

• Genetic Predisposition: Children with a family history of depression may have genetic vulnerabilities that affect brain function and stress response, increasing their risk for developing depression.

• Stress Response Dysregulation: Chronic stress or trauma can alter the hypothalamic-pituitary-adrenal (HPA) axis, leading to abnormal cortisol levels and impacting mood stability and emotional processing.

• Key complication: Untreated pediatric depression can impair social, academic, and emotional development, potentially leading to chronic mental health issues.

Patient Profile

Demographics:

14-year-old female, student

History:

• Key past medical history: History of anxiety, family history of depression

• Current medications: Fluoxetine 10mg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Persistent sadness and withdrawal from social activities

• Key symptoms: Low energy, difficulty concentrating, changes in appetite, irritability, occasional headaches

• Vital signs: Temperature 98.6°F, Heart rate 92 bpm, Blood pressure 110/70 mmHg, Respiratory rate 18 breaths/min, Weight has decreased by 5% over the past month

Section 1

Change in Patient Status:

As the clinical team continues to monitor the 14-year-old female patient, there is a noticeable change in her status. Over the past week, her social withdrawal has intensified, and she now spends most of her time isolated in her room, avoiding interaction with family and friends. Her academic performance has declined significantly, with teachers reporting incomplete assignments and a lack of participation in class discussions. Additionally, her mother reports that the patient is experiencing more frequent episodes of irritability, often triggered by minor stressors, which seem disproportionate to the situation.

Clinically, there has been a concerning development in her appetite changes. Initially presenting with a 5% weight loss over the past month, she has now lost an additional 3% of her body weight within the last two weeks. This further weight loss is coupled with reports of skipping meals and expressing a lack of appetite, which raises alarms about potential nutritional deficiencies. Physical examination reveals that although her vital signs remain stable—temperature at 98.6°F, heart rate at 90 bpm, blood pressure at 108/68 mmHg, and respiratory rate at 18 breaths/min—there is a noticeable pallor, possibly indicating iron deficiency anemia secondary to poor dietary intake.

This change in patient status necessitates a reevaluation of her current management plan. The team considers the potential need to adjust her fluoxetine dosage or explore alternative therapies, such as cognitive-behavioral therapy, to address the exacerbation of symptoms. Additionally, conducting a comprehensive nutritional assessment and possibly initiating dietary supplements may be required to prevent further physical deterioration. These developments highlight the importance of integrating mental and physical health care to address both the psychological and physiological aspects of her condition.

Section 2

Following the decision to conduct a comprehensive nutritional assessment, the clinical team gathers data to better understand the extent of the patient's nutritional deficiencies. Laboratory results reveal a hemoglobin level of 10.5 g/dL, suggestive of mild anemia. Serum ferritin is significantly low at 10 ng/mL, corroborating iron deficiency. Additionally, her serum albumin level is slightly below normal at 3.3 g/dL, indicating potential protein-energy malnutrition. These findings support the hypothesis of nutritional deficiency, likely exacerbated by her depressive symptoms and subsequent poor dietary habits.

In response to these concerning findings, the multidisciplinary team initiates a targeted intervention plan. The patient's fluoxetine dosage is reviewed, and a gradual increase is considered, though it is decided to first prioritize nutritional rehabilitation. A referral to a pediatric dietitian is made to create a tailored meal plan aimed at increasing her caloric and nutrient intake. This plan includes iron-rich foods and the introduction of an oral iron supplement. Concurrently, weekly sessions of cognitive-behavioral therapy are scheduled to address her depressive symptoms and help her develop healthier coping mechanisms.

Despite these interventions, the patient remains at risk for further complications if her nutritional status does not improve. The team remains vigilant for potential signs of worsening anemia or further weight loss, which could complicate her current condition. Close monitoring of her progress will be essential in ensuring that her physical health does not deteriorate further, and adjustments to her treatment plan may be necessary if her symptoms do not show improvement in the coming weeks. This evolving situation underscores the necessity of ongoing assessment and the integration of physical and mental health strategies in her care.

Section 3

Two weeks into the intervention, the clinical team conducts a follow-up assessment to evaluate the patient's response to the nutrition and therapy plan. The patient's weight has stabilized, showing a slight increase of 1.2 kg, which is a promising sign. However, her energy levels remain low, and she continues to report difficulty concentrating at school. A repeat laboratory test reveals that her hemoglobin level has increased marginally to 10.8 g/dL, while serum ferritin has improved to 15 ng/mL. These changes indicate a positive but slow response to the iron supplementation. Despite these improvements, her serum albumin level remains at 3.2 g/dL, suggesting that her protein intake may still be insufficient.

Clinically, the patient displays pallor and mild tachycardia, with a resting heart rate of 102 bpm, raising concerns about the adequacy of her cardiovascular adaptation to ongoing anemia. Her blood pressure is within normal limits at 105/65 mmHg. Given these findings, the dietitian recommends increasing the protein content of her meals and incorporating more iron-rich legumes and lean meats. The psychiatrist suggests maintaining the current fluoxetine dose until more substantial nutritional progress is evident. The psychologist notes that while the patient is engaging in therapy, she struggles with motivation, a common challenge in pediatric depression, and recommends incorporating motivational interviewing techniques in future sessions.

The team is aware that the patient's condition, while stable, remains fragile. They emphasize the importance of continued close monitoring and interdisciplinary communication. There is a shared understanding that should the patient exhibit signs of worsening anemia or if her psychological symptoms intensify, a reassessment of her treatment plan, including potential adjustments to her medication, will be necessary. The team schedules a follow-up in two weeks, with a contingency plan to expedite care adjustments if her condition requires more immediate attention. The focus remains on supporting her holistic recovery, integrating both nutritional and psychological interventions.

Section 4

Two weeks later, the clinical team meets again to evaluate the patient's progress. The follow-up assessment reveals some mixed results. While there is a slight improvement in her energy levels, she still experiences episodes of fatigue, particularly in the afternoon. At school, her teachers report that her concentration has improved slightly, although she continues to have difficulty keeping up with the workload. Her weight has increased by an additional 0.8 kg, showing a consistent upward trend, which is encouraging. However, her hemoglobin level remains at 10.8 g/dL, and serum ferritin has plateaued at 16 ng/mL. Her serum albumin level shows a minor increase to 3.3 g/dL, suggesting some improvement in protein intake but still not to the desired level.

Clinically, the patient exhibits persistent pallor and fluctuating tachycardia, with heart rates between 98 and 105 bpm when at rest. Her blood pressure remains stable at 107/66 mmHg. The dietitian notes that while there is some improvement, the pace is not as rapid as hoped, indicating the need for further dietary adjustments. The psychiatrist, observing the stabilization in her mood, suggests a cautious wait-and-see approach before making any changes to the fluoxetine dosage. The psychologist, however, expresses concern over the patient's ongoing struggle with motivation, despite the incorporation of motivational interviewing techniques. This suggests a need for exploring additional therapeutic interventions or techniques to better engage her.

Given these findings, the team agrees that while the patient is showing signs of progress, her response to interventions is slower than anticipated. They emphasize the importance of continued close monitoring, particularly of her cardiovascular status and mental health, and decide to explore additional support strategies, such as peer group therapy, which may enhance her engagement and motivation. They schedule another follow-up in two weeks with the understanding that any signs of regression or new complications will necessitate an immediate reassessment of the treatment plan, particularly concerning her pharmacological and nutritional management.

Section 5

Two weeks later, during the follow-up assessment, the clinical team observes a notable change in the patient's status. Despite previous indications of slight improvement, the patient now presents with increased episodes of fatigue and persistent pallor. Her hemoglobin level has decreased to 10.5 g/dL, and her serum ferritin has dropped slightly to 14 ng/mL, suggesting a potential regression in her iron status. The dietitian raises concerns about her nutritional intake, particularly iron sources, and recommends re-evaluating her dietary plan to ensure adequate iron and vitamin C intake to enhance absorption. Additionally, the patient's serum albumin has returned to 3.2 g/dL, indicating a possible reduction in protein intake or absorption issues that need to be addressed.

Clinically, the patient continues to exhibit fluctuating tachycardia with resting heart rates now consistently at 105 bpm. Her blood pressure remains stable at 106/64 mmHg, but the persistent tachycardia warrants further investigation to rule out any underlying cardiac concerns. The psychologist notes that, despite the incorporation of peer group therapy, the patient still struggles with motivation and engagement, which may be contributing to her current clinical picture. The psychiatrist suggests exploring alternative therapeutic approaches, such as cognitive-behavioral therapy, to address any underlying cognitive distortions affecting her mood and motivation.

Given these developments, the team emphasizes the importance of a multidisciplinary approach to reassess and adjust the treatment plan. This includes revisiting her nutritional strategy, considering further cardiovascular evaluation, and intensifying psychological support. The team decides to schedule an immediate interim follow-up within the next week to closely monitor her clinical status and response to the revised interventions, ensuring timely adjustments to prevent further complications.