with a psychotherapist. Past symptoms of depression with this patient included poor performance in school, antisocial behavior, and feelings of harming herself. Signs of depression in late adolescents may include low self-esteem, loss of interest in activities, loss of appetite, weight gain, weight loss, suicidal thoughts, attempts of harming self, disturbance in sleep, withdrawing socially, poor school performance, and irritability (Maughan, Collishaw, & Stringaris, 2013). During the visit, the patient denied any change in mood, stated that her relationships with her friends were healthy, and she did not have any desire to harm herself. She also stated that she felt the current medication regimen was effective and wished to continue treatment. My preceptor, Samantha Willard, NP, stated that she began treating TR one year ago and she was being treated with escitalopram 30mg daily at the time. The patient felt as though the medication was not effective so therapy was switched to fluoxetine 10mg daily and the patient has shown great response since. My preceptor stated that during initial appointments, the patient’s mother was always present and questioning every decision from TR and my preceptor. As time progressed, and the
JOURNAL ENTRIESJOURNAL ENTRIES (WEEKS 1, 2, AND 4) 7 new therapy took effect, the patient’s depression stabilized and improvements emotionally, physically, and academically were evident. The relationship between the patient-parent-and provider grew and my preceptor was able to gain the trust of both patient and parent. Now, the patient presents to most visits alone. An ah-ha moment for me during this visit was realizing the importance of trust in the provider-patient-parent relationship and its effects on care. The mother of the patient had decided to find another provider to manage TR’s depression because she did not trust and was not satisfied with care given by the previous provider. Through my preceptor, I was able to realize that properly identifying the patient’s needs and concerns and offering appropriate alternate treatment plans leads to effectively managing health disorders. I was also able to witness the independence, maturity, and the autonomy within the pediatric patient and how my preceptor respected her views and decisions. With effective management of the patient’s condition, my preceptor was confident and found no red flags with the patient’s condition. The mother’s initial concern for the health of her child showed that she cared not only about her physical health the child’s mental health. Parents that are involved and show concern at visits gives the providers insight into the patient-parent relationship and the concern for mental and physical health (Burns et al, 2017). References Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.
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