Posted: September 8th, 2022

Decision Tree

Decision Tree
Introduction
The case examine includes Tyrel, an Eight-year-old youngster who involves the clinic with the mom. The mom complains that the kid is exhibiting fear and nervousness for over two months. Tyrel is anxious about germs and retains washing his palms. He’s afraid of taking part in together with his buddies for concern of germs and falling sick. The remedy will begin with a analysis of the situation. The most certainly situation is obsessive-compulsive dysfunction. Based on DSM-5 standards, folks with obsessive-compulsive dysfunction current signs resembling obsession and compulsion. Therapy of the situation would require pharmacological and non-pharmacological approaches Zoloft 50mg orally every day whereas non-pharmacology will contain cognitive habits remedy. The anticipated outcomes have some variances as a result of prescription of overdose medicine. The moral points that may have an effect on the supply of care embody consent, justice, confidentiality, accountability, and constancy. The aim of the choice tree is to research the varied selections and outcomes within the remedy of an obsessive-compulsive dysfunction.
Decision #1: Differential Analysis
Decision Chosen
The chosen resolution is an obsessive-compulsive dysfunction.
Causes for Deciding on the Decision
The rationale for choosing the dysfunction is as a result of similarity of the signs. Based on DSM-5 standards, folks with obsessive-compulsive dysfunction current signs resembling obsession and compulsion. Some examples of obsession embody intrusive and undesirable ideas and pictures about doable damaging conditions (Baldermann et al., 2019). For instance, the affected person is obsessive about germs and getting sick. The undesirable ideas result in misery and nervousness which have an effect on the standard of lifetime of the affected person. Among the widespread obsessions embody the will for cleanliness and avoiding contamination. Obsessions result in compulsions which comprise behaviors that people perform to ease their nervousness. For instance, the concern of germs or falling sick compels a person to clean palms or keep away from taking part in with different youngsters to keep away from contracting a illness.
Expectations
A scientific examination of the affected person’s situation was to disclose that the affected person was affected by an obsessive-compulsive dysfunction. Among the compulsions embody the hassle to clean palms commonly and keep away from taking part in with different youngsters. The expectation was to align the signs with a particular analysis the affected person was affected by.
Expectations versus Outcomes
There isn’t any exceptional distinction between expectations and outcomes. The analysis reveals that the affected person was affected by an obsessive-compulsive dysfunction. The expectation was much like the diagnostic outcomes. Data from the signs and the standard of lifetime of the affected person was indicative of the doable circumstances the affected person was affected by. For instance, worrying about germs and washing palms commonly is an indication of obsession and compulsion. People presenting with obsessions and compulsions are recognized with obsessive-compulsive dysfunction.
Decision #2: Therapy Plan for Psychotherapy
Decision Chosen
Increase cognitive habits remedy for the subsequent 4 weeks. Refer the shopper to a therapist within the healthcare facility.
Motive for Deciding on the Decision
Cognitive habits remedy (CBT) is the remedy of alternative amongst sufferers with psychological well being points together with OCD. The main focus of the remedy is ‘right here and now’ because it doesn’t dwell on previous experiences (Hamdeh et al., 2019). CBT encourages sufferers to vary their strategy or perspective of their well being points. The remedy is efficient because it challenges shoppers to discover, perceive, and problem their pondering patterns (Hamdeh et al., 2019). For instance, you will need to problem Tyrel to rethink his notion about germs and getting sick. CBT helps people with psychological points to deal with problematic ideas, damaging feelings, and behaviors which will impair their high quality of life. For instance, Tyrel is considering the potential of getting sick till he can’t play together with his buddies. CBT is efficient because it helps a affected person to grasp the mind messages that form the habits and views of a affected person (Hamdeh et al., 2019). Research present that CBT is a remedy of alternative amongst sufferers with OCD because it modifications the views and fashions optimistic habits.
Anticipated Outcomes
After 4 weeks, the affected person studies again to the clinic within the firm of his mom. One of many observations is that the shopper dislikes the therapist. Based on him, the therapist is treating him like a child. He states that he has determined to discontinue the remedy. The mom requests for referral to a different remedy.
The expectation is that the affected person will establish the damaging thought patterns about germs and getting sick. CBT helps the affected person to establish the damaging ideas that undermine the standard of life (Hamdeh et al., 2019). For instance, Tyrel ought to be taught the distinction between a perceived and actual menace to his well being. When the affected person understands the distinction between the 2, he ought to problem the pondering patterns and alter his habits. Difficult the damaging thought patterns will result in happiness and positivity in life (Hamdeh et al., 2019). For instance, the affected person ought to cease washing palms commonly as a result of concern of contracting a illness. Tyrel ought to resume taking part in with different youngsters, attend college confidently, and keep away from ideas of all the time falling sick. Adjusting the feelings, ideas, and behaviors will result in a optimistic and glad life.
Expectations versus Outcomes
There isn’t any exceptional distinction between what was anticipated and the outcomes. When the affected person returns to the clinic after 4 weeks, he has improved the concern of germs and contracting a illness. A lower within the severity of the signs was anticipated, which was evident for the reason that affected person might now play with different youngsters. The college attendance had improved plus the conventional price of washing palms. Attaining the outcomes means the affected person is an indication of optimistic progress. The choice to discontinue remedy was sudden though it’s a widespread expertise in healthcare amenities. Referring the shopper to a different remedy is efficient to make sure the continuity of care.
Decision #three: Therapy Plan for Psychopharmacology
Decision Chosen
Start Zoloft 50mg orally every day for the subsequent 4 weeks.
Causes for Deciding on the Decision
Zoloft has a 7.9 out of 10 success price amongst all sufferers with OCD. Proof-based apply reveals that Zoloft has few negative effects and better effectiveness (Barney et al., 2017). Another excuse is that Zoloft is accepted by the U.S. Meals and Drug Administration. The well being company reveals that youngsters between 6 and 12 years ought to take 25 mg orally every day since a better dose can set off negative effects (Barney et al., 2017). The drug can’t management the signs however it’s going to enhance the outcomes. A mix of pharmacology and non-pharmacological approaches is efficient in making certain optimistic outcomes (Tobin, 2018). Sertraline is an antidepressant that improves the operation of the mind by altering the features. Zoloft will have an effect on the mind by bettering the performance of the mind. A discount within the damaging outcomes will scale back the signs and high quality of lifetime of a affected person (Barney et al., 2017). The affected person will begin with a 50mg dose since a better dose can have an effect on the security of sufferers. A practitioner can enhance or lower the dose relying on the response of the affected person.
Expectations versus Outcomes
The affected person will return to the clinic after 4 weeks. Based on the mom, the expectations are much like the outcomes aside from one end result of a lower in urge for food. When the shopper got here again to the clinic, the mom reported that the son had main enhancements. The lower within the severity of the signs consists of lowering the frequency of handwashing. Based on the mom, the son has not resumed college absolutely, however the attendance has improved. Zoloft is efficient by bettering curiosity in every day life and lowering nervousness ranges (Barney et al., 2017). The selective serotonin reuptake inhibitor helps within the reabsorption of the chemical serotonin liable for the regulation of temper and nervousness.
One of many complaints that the urge for food has lowered for the reason that son began taking the remedy. She signifies that the son eats little meals regardless of her efforts to cook dinner his favourite meals. One of many causes for the discount in urge for food is the negative effects of the drug together with nausea, dizziness, lack of urge for food, bother sleeping, and abdomen upset (Barney et al., 2017). The most effective remedies for the negative effects is to progressively scale back the dose. The negative effects are delicate and can go away inside a few weeks. For instance, the PMHNP could scale back the dose to 12.5 mg orally every day. If the negative effects persist, the practitioner may have to vary the drug.
Moral Concerns
Moral points will have an effect on the supply of care and align it to skilled apply. One of many moral issues is in search of consent from the dad or mum. The affected person is under the authorized age of consenting to remedy (Bijani et al., 2017). A dad or mum ought to accompany the affected person and consent to the remedy. For instance, the mom ought to consent to the remedy and referral to a therapist.
Healthcare companies ought to stay confidential. PMHNP ought to safe all the main points of the affected person and their situation. Sharing the main points is in opposition to Well being Insurance coverage Portability and Accountability Act (HIPPA) guidelines and may result in disciplinary points (Bijani et al., 2017). The PMHNP can solely share data if the lifetime of a affected person is in danger. One other moral subject is maleficence and beneficence, which includes the requirement to make use of data to reinforce the welfare of sufferers. Practitioners ought to enhance the standard of care by avoiding any overdose which may set off antagonistic well being outcomes (Cha, 2018). Misdiagnosis and different mistaken prescriptions should not really useful whereas treating sufferers.
Justice, accountability, and constancy are essential moral issues. Justice includes treating all sufferers equally with none type of discrimination. Accountability is the willingness to simply accept skilled duty (Bijani et al., 2017). Constancy includes remaining trustworthy to the guarantees within the scientific apply. Moral practices are important within the supply of care since they are going to make sure the supply of high quality well being outcomes.
Conclusion
The choice tree includes a case examine of Tyrel whose mom complains of nervousness and fear. The kid requires pharmacological and non-pharmacological remedy to handle well being points. The moral points that may have an effect on the supply of care embody consent, justice, confidentiality, accountability, and constancy. The remedy course of will contemplate numerous elements such because the age of the kid. A overview of the outcomes after each 4 weeks is important to find out whether or not to regulate, proceed, or discontinue the remedy approaches.

References
Bijani, M., Ghodsbin, F., Fard, S. J., Shirazi, F., Sharif, F., & Tehranineshat, B. (2017). An analysis of adherence to moral codes amongst nurses and nursing college students. Journal of Medical Ethics and Historical past of Drugs, 10.
Baldermann, J. C., Melzer, C., Zapf, A., Kohl, S., Timmermann, L., Tittgemeyer, M., … & Kuhn, J. (2019). Connectivity profile predictive of efficient deep mind stimulation in obsessive-compulsive dysfunction. Organic Psychiatry, 85(9), 735-743.
Hamdeh, A. A., Bjureberg, J., Lenhard, F., Hedman-Lagerlöf, E., Flygare, O., Lundström, L., … & Andersson, E. (2019). Sudden positive aspects in internet-based cognitive habits remedy for obsessive-compulsive dysfunction. Journal of Obsessive-Compulsive and Associated Problems, 21, 75-81.
Barney, J. Y., Subject, C. E., Morrison, Ok. L., & Twohig, M. P. (2017). Therapy of pediatric obsessive compulsive dysfunction using dad or mum‐facilitated acceptance and dedication remedy. Psychology within the Faculties, 54(1), 88-100.
Tobin, V. (2018). Obsessive-compulsive dysfunction in youngsters and adolescents. Journal of Psychosocial Nursing and Psychological Well being Providers, 56(three), 15-18.
Cha, N. (2018). The Relationships between the Notion of Biomedical Ethics and Nursing Ethics in Nursing College students. Journal of East-West Nursing Analysis, 24(2), 154-162.

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