Posted: September 8th, 2022

Decision Tree

Decision Tree
Introduction
The case study involves Tyrel, an 8-year-old child who comes to the clinic with the mother. The mother complains that the child is exhibiting worry and nervousness for over two months. Tyrel is worried about germs and keeps washing his hands. He is afraid of playing with his friends for fear of germs and falling sick. The treatment will start with a diagnosis of the condition. The most likely condition is obsessive-compulsive disorder. According to DSM-5 criteria, people with obsessive-compulsive disorder present symptoms such as obsession and compulsion. Treatment of the condition will require pharmacological and non-pharmacological approaches Zoloft 50mg orally daily while non-pharmacology will involve cognitive behavior therapy. The expected outcomes have some variances due to the prescription of overdose drugs. The ethical issues that will affect the delivery of care include consent, justice, confidentiality, accountability, and fidelity. The purpose of the decision tree is to analyze the various decisions and outcomes in the treatment of an obsessive-compulsive disorder.
Decision #1: Differential Diagnosis
Decision Selected
The selected decision is an obsessive-compulsive disorder.
Reasons for Selecting the Decision
The reason for selecting the disorder is due to the similarity of the symptoms. According to DSM-5 criteria, people with obsessive-compulsive disorder present symptoms such as obsession and compulsion. Some examples of obsession include intrusive and unwanted thoughts and images about possible negative situations (Baldermann et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). For example, the patient is obsessed with germs and getting sick. The unwanted thoughts lead to distress and anxiety which affect the quality of life of the patient. Some of the common obsessions include the desire for cleanliness and avoiding contamination. Obsessions lead to compulsions which comprise behaviors that individuals carry out to ease their anxiety. For example, the fear of germs or falling sick compels an individual to wash hands or avoid playing with other children to avoid contracting a disease.
Expectations
A clinical examination of the patient’s condition was to reveal that the patient was suffering from an obsessive-compulsive disorder. Some of the compulsions include the effort to wash hands regularly and avoid playing with other children. The expectation was to align the symptoms with a specific diagnosis the patient was suffering from.
Expectations versus Outcomes
There is no remarkable difference between expectations and outcomes. The diagnosis shows that the patient was suffering from an obsessive-compulsive disorder. The expectation was similar to the diagnostic outcomes. Information from the symptoms and the quality of life of the patient was indicative of the possible conditions the patient was suffering from. For example, worrying about germs and washing hands regularly is a sign of obsession and compulsion. Individuals presenting with obsessions and compulsions are diagnosed with obsessive-compulsive disorder.
Decision #2: Treatment Plan for Psychotherapy
Decision Selected
Augment cognitive behavior therapy for the next four weeks. Refer the client to a therapist in the healthcare facility.
Reason for Selecting the Decision
Cognitive behavior therapy (CBT) is the treatment of choice among patients with mental health issues including OCD. The focus of the treatment is ‘here and now’ since it does not dwell on past experiences (Hamdeh et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). CBT encourages patients to change their approach or perspective of their health issues. The treatment is effective since it challenges clients to explore, understand, and challenge their thinking patterns (Hamdeh et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). For example, it is important to challenge Tyrel to rethink his perception about germs and getting sick. CBT helps individuals with mental issues to cope with problematic thoughts, negative emotions, and behaviors that may impair their quality of life. For example, Tyrel is thinking about the possibility of getting sick until he cannot play with his friends. CBT is effective since it helps a patient to understand the brain messages that shape the behavior and perspectives of a patient (Hamdeh et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Studies show that CBT is a treatment of choice among patients with OCD since it changes the perspectives and models positive behavior.
Expected Outcomes
After four weeks, the patient reports back to the clinic in the company of his mother. One of the observations is that the client dislikes the therapist. According to him, the therapist is treating him like a baby. He states that he has decided to discontinue the therapy. The mother requests for referral to another therapy.
The expectation is that the patient will identify the negative thought patterns about germs and getting sick. CBT helps the patient to identify the negative thoughts that undermine the quality of life (Hamdeh et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). For example, Tyrel should learn the difference between a perceived and real threat to his health. When the patient understands the difference between the two, he should challenge the thinking patterns and alter his behavior. Challenging the negative thought patterns will lead to happiness and positivity in life (Hamdeh et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). For example, the patient should stop washing hands regularly due to the fear of contracting a disease. Tyrel should resume playing with other children, attend school confidently, and avoid thoughts of always falling sick. Adjusting the emotions, thoughts, and behaviors will lead to a positive and happy life.
Expectations versus Outcomes
There is no remarkable difference between what was expected and the outcomes. When the patient returns to the clinic after four weeks, he has improved the fear of germs and contracting a disease. A decrease in the severity of the symptoms was expected, which was evident since the patient could now play with other children. The school attendance had improved plus the normal rate of washing hands. Achieving the outcomes means the patient is a sign of positive progress. The decision to discontinue therapy was unexpected although it is a common experience in healthcare facilities. Referring the client to another therapy is effective to ensure the continuity of care.
Decision #3: Treatment Plan for Psychopharmacology
Decision Selected
Begin Zoloft 50mg orally daily for the next four weeks.
Reasons for Selecting the Decision
Zoloft has a 7.9 out of 10 success rate among all patients with OCD. Evidence-based practice shows that Zoloft has few side effects and higher effectiveness (Barney et al., 2017). Another reason is that Zoloft is approved by the U.S. Food and Drug Administration. The health agency shows that children between 6 and 12 years should take 25 mg orally daily since a higher dose can trigger side effects (Barney et al., 2017). The drug cannot control the symptoms but it will improve the outcomes. A combination of pharmacology and non-pharmacological approaches is effective in ensuring positive results (Tobin, 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Sertraline is an antidepressant that improves the operation of the brain by altering the functions. Zoloft will affect the brain by improving the functionality of the brain. A reduction in the negative outcomes will reduce the symptoms and quality of life of a patient (Barney et al., 2017). The patient will start with a 50mg dose since a higher dose can affect the safety of patients. A practitioner can increase or decrease the dose depending on the response of the patient.
Expectations versus Outcomes
The patient will return to the clinic after four weeks. According to the mother, the expectations are similar to the outcomes except for one outcome of a decrease in appetite. When the client came back to the clinic, the mother reported that the son had major improvements. The decrease in the severity of the symptoms includes reducing the frequency of handwashing. According to the mother, the son has not resumed school fully, but the attendance has improved. Zoloft is effective by improving interest in daily life and reducing anxiety levels (Barney et al., 2017). The selective serotonin reuptake inhibitor helps in the reabsorption of the chemical serotonin responsible for the regulation of mood and anxiety.
One of the complaints that the appetite has reduced since the son started taking the medication. She indicates that the son eats little food despite her efforts to cook his favorite meals. One of the reasons for the reduction in appetite is the side effects of the drug including nausea, dizziness, loss of appetite, trouble sleeping, and stomach upset (Barney et al., 2017). One of the best treatments for the side effects is to gradually reduce the dose. The side effects are mild and will go away within a couple of weeks. For example, the PMHNP may reduce the dose to 12.5 mg orally daily. If the side effects persist, the practitioner may need to change the drug.
Ethical Considerations
Ethical issues will affect the delivery of care and align it to professional practice. One of the ethical considerations is seeking consent from the parent. The patient is below the legal age of consenting to treatment (Bijani et al., 2017). A parent should accompany the patient and consent to the treatment. For example, the mother should consent to the medication and referral to a therapist.
Healthcare services should remain confidential. PMHNP should secure all the details of the patient and their condition. Sharing the details is against Health Insurance Portability and Accountability Act (HIPPA) rules and can lead to disciplinary issues (Bijani et al., 2017). The PMHNP can only share information if the life of a patient is at risk. Another ethical issue is maleficence and beneficence, which comprises the requirement to use knowledge to enhance the welfare of patients. Practitioners should improve the quality of care by avoiding any overdose which can trigger adverse health outcomes (Cha, 2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Misdiagnosis and other wrong prescriptions are not recommended while treating patients.
Justice, accountability, and fidelity are important ethical considerations. Justice involves treating all patients equally without any form of discrimination. Accountability is the willingness to accept professional responsibility (Bijani et al., 2017). Fidelity involves remaining faithful to the promises in the clinical practice. Ethical practices are essential in the delivery of care since they will ensure the delivery of quality health outcomes.
Conclusion
The decision tree comprises a case study of Tyrel whose mother complains of nervousness and worry. The child requires pharmacological and non-pharmacological treatment to address health issues. The ethical issues that will affect the delivery of care include consent, justice, confidentiality, accountability, and fidelity. The treatment process will consider various factors such as the age of the child. A review of the outcomes after every four weeks is necessary to determine whether to adjust, continue, or discontinue the treatment approaches.

References
Bijani, M., Ghodsbin, F., Fard, S. J., Shirazi, F., Sharif, F., & Tehranineshat, B. (2017). An evaluation of adherence to ethical codes among nurses and nursing students. Journal of Medical Ethics and History of Medicine, 10.
Baldermann, J. C., Melzer, C., Zapf, A., Kohl, S., Timmermann, L., Tittgemeyer, M., … & Kuhn, J. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Connectivity profile predictive of effective deep brain stimulation in obsessive-compulsive disorder. Biological Psychiatry, 85(9), 735-743.
Hamdeh, A. A., Bjureberg, J., Lenhard, F., Hedman-Lagerlöf, E., Flygare, O., Lundström, L., … & Andersson, E. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Sudden gains in internet-based cognitive behavior therapy for obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 21, 75-81.
Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent‐facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.
Tobin, V. (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). Obsessive-compulsive disorder in children and adolescents. Journal of Psychosocial Nursing and Mental Health Services, 56(3), 15-18.
Cha, N. (2018: 2024 – Write My Essay For Me | Essay Writing Service For Your Papers Online). The Relationships between the Perception of Biomedical Ethics and Nursing Ethics in Nursing Students. Journal of East-West Nursing Research, 24(2), 154-162.

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