Katy Diagnosis

NURSING CASE 1

Katy Diagnosis

Student Name

Course

NURSING CASE 2

Instructions

Review the interactivePediatric Case Studyand analyze the data to determine the

health status of the patient.

Follow the requirements posted in the rubric.

Use the Word document that is located within the case study to complete the case study

assignment.

Your case study should be between five to seven pages

KatyTranscript

Katyis a six-year-old girl, the second of two children of a middle-class family living

in a suburban area of a northwest city.Katyhas one sister that is two years older

than her. Her mother’s pregnancy was normal andKaty’s birth was

normal.Katyhad colic the first three months, cried extensively and was difficult to

comfort. After three months she became passive and cried very little with comfort

from her mother. Her growth and development appeared to be normal. She met all

the developmental milestones her first three years. She interacted normally with her

sister and parents, except that she would become tearful and anxious when her

parents would get a babysitter.

At age four, she was in nursery school and appeared to function normally except

during the first month whenKatyhad difficulty when her father would drop her off at

school. The nursery school was a small private school with a lot of personal

attention given to each child. Although shy, she made friends and liked going to

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nursery school after she became adjusted to the new setting. Her parents liked the

school so much that they decided to keepKatyin kindergarten at this school with

her same teachers and friends. However, tuition at the school became a problem

afterKaty’s mother became sick with lupus and was unable to work.

At age six,Katy’s parents enrolled her in first grade at the public elementary school

in their neighborhood. For the last two weeks, she has refused to go to school and

has missed six school days. She is awake almost all night worrying about going to

school. As the start of the school day approaches, she cries and screams that she

cannot go, chews holes in her shirt, pulls her hair, digs at her face, punches the

wall, throws herself on the floor, as well as experiences headaches, stomachaches,

and vomiting. Over the past two weeks, she has become gloomy, has stopped

reading for fun, and frequently worries about her mother's Lupus and that she may

die. In addition,Katyis phobic of dogs, avoids speaking and writing in public, and

wets the bed every night.

Her parents immediately made an appointment to see her PCP. Her doctor

conducted a thorough physical exam, found no physical abnormalities and then

referred her to you, a Family PMHNP.

Family history of mental health includes the following: mother has a history of panic

disorder; her father has a history of treatment with medications for ADHD as a child;

and she has a cousin diagnosed with Asperger’s syndrome.

Family mental health history

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Mother has a history of panic disorder

Father has a history of treatment with medications for ADHD as a child

Cousin diagnosed with Asperger’s syndrome

For your assignment, write a paper that addresses the following prompts using

evidence-based references to support your answers:

1. What is your provisional diagnosis, as well as the possible differentials?

2. Justify your answer with DSM-5 criteria (be short, brief and to the point).

3. IsKatytoo young to diagnose, or is there a basis for early identification and

intervention?

4. What psychiatric scales or assessment tools might you use with this patient?

With the parents? List and describe briefly.

5. How would the typical symptom patterns and phases be manifested in children

this age? In adolescents?

6. What would be your treatment plan for medications, if any? If you do choose to

offer medication as part of the treatment plan, please address the following

medications issues:

a. Target symptoms

b. Receptors affected

c. Psychiatric and system effects

d. Possible parental concerns

7. What would be your school-based treatment plan, if any?

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8. What would be the implications for the families of children and adolescents

with these diagnostic pictures?

9. How does the mother’s health play into the picture ofKaty’s diagnosis? What

type of therapy would you recommend forKaty(and her family) to work

through her issues?

10.Identify resources for patients/families with this diagnosis in the form of

community groups, web-sites, advocacy, as well as treatment resources

available in your service area.

11.What are you worried about (if anything)? Consider this question in terms of

treatment, assessment, alliance, compliance, effectiveness, safety, and other

factors.

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Separation Anxiety Disorder

Separation Anxiety Disorder (SAD) is a condition where children become nervous and

fearful when they are separated from their loved ones or they are away from home. It is normal

for children to have separation anxiety between the age of 8 and 14 months because they have

developed attachment with the people they interact with every time. Children who show

separation anxiety beyond 6 years old and the conditions lasts for more than four weeks, they are

suffering from separation anxiety disorder (Lavallee & Schneider, 2019). Some of the symptoms

of such a disorder include stomachaches, headaches and distress when separated from loved

ones. These symptoms may interfere with normal activities like playing with other children or

going to school (Lebowitz, 2019). Other symptoms associated with SAD include unrealistic and

lasting worry of something bad happening to their parents or a loved one, worry of being left by

his/her parent, refusing to go to school in order to stay with his/her parents or caregiver, fearing

to go to sleep alone or staying alone, nightmares about being separated, bed wetting, and

repeated tantrums due to high temper (Lavallee & Schneider, 2019).

Research has established that SAD is caused by both environmental and biological

factors. Essentially, SAD is caused an imbalance of two chemicals in the brain (norepinephrine

and serotonin).

DSM-5 criteria (Separation Anxiety Disorder DSM-5 309.21 (F93.0)

Separation and anxiety disorder is a DSM-5 diagnosis that is assigned to Katy because

she exhibits an unusually strong fear and anxieties to separating from her mother. The severity

and prolonged nature of Katy symptoms authorize diagnosis for Separation and anxiety. Katy

suffers from Separation Anxiety Disorder because she has exhibited symptoms and reactions that

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resemble the disorder. She had difficulties being dropped at school by her father. At first, she

was shy and feared the school environment until she adjusted to the new setting. After enrolling

in new elementary school, she began to fear the new environment, refusing to go to school. She

spends many hours awake in the night worrying about going to the new school she was enrolled

in. She throws tantrums every morning through loud cries and screams as a reaction of refusing

to go to school. She also pulls her hair, digs her face, and throws herself on the flow, and has

been experiences headaches, stomachaches and vomiting every morning because she fears going

to school. She has stopped reading and become gloomy.

According to Diagnostic and Statistical Manual of Mental Disorders, four percent of

children and about 1.6 percent of adolescents usually experience separation anxiety disorder. The

disorder is common for children under 12 years old (Lebowitz, 2019). It is characterized by tears

at drop off at school because of being attached to their loved ones. The manual gives symptoms

of SAD such as sleep disturbance, school refusal, excessive distress when the child is about to be

separated from his/her parents and caregivers, and interference of normal daily activities.

Katy is not too young to be diagnosed with SAD because the disorder occurs to children

and adolescents too. For SAD diagnosis, the condition should last for more than four weeks and

cause distress that cannot be attributed to any other cause. A child psychiatrist or any other

professional mental health practitioner can easily diagnose SAD. The professional has to do

mental health evaluation of the child (Lebowitz, 2019). One of the notable reactions of children

with this disorder is school refusal which causes poor school attendance as well as poor school

performance. The condition also impairs social interactions and relationships as observed in

Katy. Early identification of this disorder include reactions of distress and prolonged periods of

fear of being left by those the child has developed attachment with. When the disorder is

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diagnosed, treatment interventions should be initiated to prevent any further complications and

worsening of the condition (West, Wilbanks & Suveg, 2020).

Differential Diagnoses

According to Medscape (2019) there are various disorders and behaviors that

symptomize SAD and school refusal. Examples include inappropriate academic placement,

school avoidance, illicit substance dependence, and depression among others. Unsafe school

environment has been found to be major contributor to school nonattendance. Like Katy,

children with SAD suffer more panic symptoms especially when they have an earlier experience

of a risky or dangerous school environment. Family stress and trauma, like in the case of Katy,

is another contributor.

Treatment of SAD

Treatment of Separation Anxiety Disorder in children should begin as soon as diagnosis

is done in order to have positive outcome. The treatment procedure depends in the child’s age,

symptoms and general health. It will also be informed by severity of the condition. Many

professionals use a mix of interventions and treatment procedures in children to ensure the

children overcome such disorders (Lavallee & Schneider, 2019). There are various treatment

interventions and psychotherapy that can be used which include cognitive behavior therapy

(CBT), family therapy, school input and play therapy, as well as medication in cases where the

conditions are severe.

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is highly

recommended for treatment of SAD. This treatment approach involves helping children to learn

how to understand and manage their distress and fears (Lebowitz, 2019). A specialized form of

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CBT known as exposure therapy can be tailored to meet the needs of the child. This form of

CBT involves exposing the child to separation in small and controlled levels that help them

reduce the anxiety in bits over a period of time (West, Wilbanks & Suveg, 2020). The process of

CBT also involves helping the children to develop coping skills that they can rely on when at

times when they become anxious. Children are taught how to recognize anxious feelings or

triggers of fear as well as any associated thought patterns which may contribute to fear. This is

couple with training strategies on how to manage such feelings, emotions and thoughts.

Family therapy involve incorporating parents and family members into the process of

treatment in order to improve the outcome. Parents and siblings are taught ways in which they

can interact with the child through tease out patterns to help the child learn how to cope without

them. Additionally, they are taught useful strategies which they can use to help the children at

times of anxiety (Lavallee & Schneider, 2019).

Play therapy involves helping children learn how to develop and process their feelings

and emotions, as well as learn how to manage and cope with them. This is because children may

not understand or connect the dots between feelings, thoughts and also actions. As such, they

may not be able to interpret what they are required to do when fears come their way (Lebowitz,

2019). Relaxation training can be used for children and adolescents in order to reduce the effects

of separation anxiety disorder. This may include guided relaxation, deep breathing as well as

progressive muscle relaxation which helps the children to self-soothe anxious moments.

Parents’ Help

Parents can help their children learn a number of things on how to cope and manage

anxious feelings and emotions while at home. In SAD treatment, parental involvement and

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support is very crucial in help the child manger the feelings independently. The parent should

design a plan of making the child transition to school without much difficulties (Lebowitz,

2019). This may involve taking the child early to school and helping him/her play or exercise

before they begin classes. The parent can also help the child reframe his/her thoughts through

initiating positive thoughts to avoid the child developing fear (West, Wilbanks & Suveg, 2020).

It is also important for the parent to increase playtime, healthy sleep and downtime to help the

child rest well. The parent should also be able to help the child adjust to changes by informing

him/her any routine changes before time. The parent should also help the child through

empathizing with him/her and comment on progresses made.

Typical Symptom Patterns

Children and adolescents have similar symptoms of separation anxiety disorder.

Generally, children have separation anxiety when they are separated from the people they have

developed attachment with. The fears are common between 8 and 14 months but if they become

persistent and progressive, they become separation anxiety disorder (Lavallee & Schneider,

2019). Adolescents beyond 6 years may develop SAD if the anxiety goes beyond four weeks.

Common experiences include worry about separation, death or harm of a loved person, worry

about something bad happening to the child, fear of being alone or having nightmares and lack of

sleep (Lebowitz, 2019). Other physical symptoms include nausea, fatigue, muscle aches or quick

breathing.

In the treatment intervention for Katy, medication may not be used since the condition

has not worsened beyond treatment by normal psychotherapy. If the psychotherapy processes are

followed well, Katy will manage the anxious feelings and lead a normal life. School-based

intervention for Katy may involve the parents taking the child early to school, spending some

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time with child playing in the school compound, as well as encouraging the teacher to develop a

close relationship with child in order to remove most of the fears (Lebowitz, 2019). The teacher

should be able to develop attachment with the child by spending most of the time with her as

well as training her how to manage and cope with the condition.

Implications for Family

The family and parents of Katy should play a key role in the treatment intervention in

order to ensure Katy overcomes the anxious emotions. This will entail the parents helping the

child to keep all the appointments with the psychiatrist (Lebowitz, 2019). This should be done in

a way that the child realizes the support being given by the parent. The parent should encourage

the child to become more independent in order to overcome feelings of fear (Lavallee &

Schneider, 2019). The family should be able to recognize anything that may cause fear to the

child and plan ahead in order to prepare the child to transition successfully. The parent should

work closely with the healthcare professional as well as school in order to develop effective

treatment plan. The parent should reassure the child of their support towards the healing process.

Additionally, the parents should reach out for support from local community health care

providers in order to receive relevant support (West, Wilbanks & Suveg, 2020).

The health status of Katy’s mother is one of the triggers of anxiety and fears experienced

by Katy. It is important for the mother to reassure Katy of her health and stay close to her in

order to remove the fears that Katy has (West, Wilbanks & Suveg, 2020). This kind of therapy is

known as family therapy. It is crucial that this trigger be dealt with by Katy’s mother through

offering support in her healing journey. For further support in the treatment intervention, Katy’s

family should seek help and support from local community professionals who deal with mental

health (Lebowitz, 2019). This will help the child to integrate properly with the community

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through forming helpful relationships which enable her overcome the separation anxiety. Other

treatment resources in the area include healthcare institutions that deal with mental health,

volunteers or nurses in the community who run mental health groups, as well as private hospitals

that offer mental health services.

The worries that may come about in treatment procedure touches on the fact that Katy’s

condition may be biological. Katy may have inherited this kind of condition from her mother and

therefore it may take a mix of treatment procedures to deal with Katy’s condition. If the

condition arises again, the treatment will demand a combination of psychotherapeutic and

pharmacological treatment interventions (Lebowitz, 2019). This will help in suppressing any

hormones that may cause anxiety to Katy.

School-based Treatment Plan

Good mental well-being is critical to children’s performance in school and life in general.

For this reason, Katy will be supported through several school-based treatment interventions.

Noteworthy, a multi-tiered systems of support consisting of indicated interventions, selective

interventions and universal school-wide prevention interventions. Firstly, teachers should create

a safe and conducive environment for Katy and other students who may suffer mental disorders.

This includes helping Katy build good peer and teacher relationships in order to create a sense of

belonging. The second intervention is introduction of CBT-based interventions at the school.

Assessment Tools

Katy and all other children with SAD need constant monitoring and assessment by experts who

have specialized in working with children. One of the assessment tools that should be used to

monitor and assess Katy’s mental health is Brief Psychiatric Rating Scale (BPRS). Essentially,

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BPRS assesses the severity of psychiatric symptoms. The other assessment tool that could be

used in this case is Present State Examination (PSE)-an assessment tool used to record mental

status. Also, the physician may use mental status examination to assess Katy’s progress and

response to the treatment.

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References

Lavallee, K. L., & Schneider, S. (2019). Separation Anxiety Disorder.BPediatric Anxiety

Disorders, 151–176. doi: 10.1016/b978-0-12-813004-9.00008-6

Lebowitz, E. R. (2019). Child with Separation Anxiety Disorder.BAddressing Parental

Accommodation When Treating Anxiety In Children, 117–126. doi: 10.1093/med-

psych/9780190869984.003.0011

West, K. B., Wilbanks, J., & Suveg, C. (2020). Exposure therapy for separation anxiety

disorder.BExposure Therapy for Children with Anxiety and OCD, 143–163. doi:

10.1016/b978-0-12-815915-6.00007-x

Substance, A., & Mental, H. S. A. (2016). DSM-5 Changes: Implications for Child Serious

Emotional Disturbance.

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