Nursing Assignment Acers

A Young Caucasian Girl With ADHD Essay

A Young Caucasian Girl With ADHD Essay

A Young Caucasian Girl With ADHD Essay

Examine Case Study: A Young Caucasian Girl with ADHD

You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder:

ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERS

Decision #1
  1. Which decision did you select?
  2. Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  3. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  4. Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
  1. Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  2. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  3. Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
  1. Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  2. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  3. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

***Also include how ethical considerations might impact your treatment plan and communication with clients.***

Finally:

  1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).
  2. Write paper addressing all section listed based on the decision tree.
  3. NURS 6630 
  4. Week 9 Assignment

Case Study: A Young Caucasian Girl With ADHD

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.A Young Caucasian Girl With ADHD Essay

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work. A Young Caucasian Girl With ADHD Essay

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decision were not a good choice with in-text citations noted for each.)

Choices for Decision 1: Select what the PMHNP should do:

  1. Begin Wellbutrin (bupropion) XL 150 mg orally daily
  2. Begin Intuniv extended release 1 mg orally at BEDTIME
  3. Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING A Young Caucasian Girl With ADHD Essay

A Young Caucasian Girl With ADHD Essay Sample Paper

Attention Deficit Hyperactivity Disorder (ADHD)

Diagnostic advancements for neurodevelopmental diseases have been made during the past few years. One of the often used diagnostic instruments is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The prevalence of attention deficit hyperactivity disorder (ADHD) in youngsters is a common misconception. It is a stereotype that it only has an impact on children’s attention. However, new study has revealed that ADHD affects children’s impulsivity and hyperactivity in addition to their concentration. Contrary to popular opinion, this illness may exist in adulthood, according to the National Institute of Mental Health (NIH) (2019 Case Study: A Young Girl with ADHD Sample Paper). ADHD is typically identified in the preschool and early elementary school years, but it can also persist into adulthood. It can lead to problems including impulsivity, hyperactivity, and inattention, and patients typically present with these as their main symptoms. While some ADHD individuals only exhibit one of the characteristics, others exhibit a combination of them, ADHD is known to cause specific problems such as poor academic performance, improper thinking, and behavioral concerns. According to Krull (2019), patients may also struggle to communicate their emotions and form relationships.Order Now

ADHD symptoms must appear before the age of 12 and in more than one place in order to meet the DSM-5 criteria (APA, 2013). An authorized medical professional, such as a psychiatrist or a pediatrician, should be present to diagnose ADHD. The diagnosis can also be made by a specialist in ADHD who holds a license to assess for the existence of this illness. Inattention, hyperactivity, and persistent impulsivity are the symptoms to watch out for in order to make a diagnosis. Counseling, behavioral therapy, medication, or a combination of these approaches are used to manage and treat ADHD. The goal in managing and treating ADHD is to ensure the patient regains full function and can perform better in school, or work and have better relationships. Another goal is to ensure the patient can function in a society by being able to follow the rules. Successful treatment will increase the patient’s attention span, regulate their level of activity to normal and decrease their impulsiveness.

In this paper, the focus will be on an 8-year-old Caucasian female presenting to the clinic with symptoms that indicate ADHD. The best treatment option for this patient will rely on three decisions informed by ethical and treatment guidelines for the disorder. The overall pharmacodynamics and pharmacokinetics for the drugs will be discussed

Decision 1

After reviewing the patient, a diagnosis of ADHD is made. Decisions have to be made in order to properly manage and treat this patient. My first treatment decision for this 8-year-old school-going female is to start her on Ritalin chewable tablet 10 mg orally in the morning. This choice is mainly influenced by the patient’s clinical manifestations, and the benefit-risk assessment of the available options. The objective of treatment is to improve the patient’s symptoms. According to Verbeeck et al. (2017), most pharmacological treatments for ADHD facilitate the transmission of catecholamines. ADHD patients are usually treated with stimulant drugs. Ritalin is a stimulant agent which is FDA approved for use as the first-line treatment for ADHD. Approximately 90% of patients on Ritalin show improvement of symptoms (Verbeevk et al., 2017). Ritalin achieves this by increasing the action dopamine and noradrenaline in the prefrontal cortex thus stimulating the CNS. CNS stimulation helps foster cognition and attention and restores the patient’s ability to focus. The reason for prescribing the drug in the morning is because of the need to achieve concentration during the day. The drug also has a potential of causing insomnia. A Young Caucasian Girl With ADHD Essay

The use of Bupropion is not selected because it is an antidepressant which is only used as an alternative when the patients cannot tolerate stimulants because of the side effects or if patients do not respond well to stimulants (Ng, 2017). Bupropion is registered as an antidepressant and is used off-label to treat ADHD. Despite its extensive use, it is not FDA approved for the treatment of ADHD in children. It is also associated with suicidal ideations as a side effect and evidence has shown that it is only effective in the treatment of ADHD that is comorbid with depression.

Intuniv is also not selected as it is a non-stimulant that is not recommended as the first-line treatment of ADHD. It usually takes long to start producing effects as opposed to Ritalin that takes a few minutes to start exhibiting its effects. Intuniv is however suggested as an augmenting agent if stimulants do not offer adequate improvement in symptoms (Stahl, 2017 Case Study: A Young Girl with ADHD Sample Paper).

With the treatment option selected, I hope to see an improvement in the symptoms as soon as possible, with the patient reporting an improvement in school performance when she returns for a follow-up after 4 weeks. The patient returns four weeks later with improved symptoms but complains of some adverse effects including daydreaming and cardiac symptoms such as tachycardia. With this new information, a re-evaluation is necessary and another decision needs to made to manage this patient.

Decision 2

With new findings in the patient, my decision is to change to Ritalin LA 20 mg orally in the morning. The reason for this is that the symptoms shown could be as a result of Ritalin 10 mg chewable tablets being a short acting agent. The symptoms could also be prevented by reducing the dose to 5 mg. This would reduce the potential side effects but also the efficacy. A longer acting agent is therefore the best option to use on this patient. This way she gets a pulse dose in the morning and another dose four hours later. I would not want to switch to another drug option because Ritalin seems to be effective in improving the symptoms. Keeping her on the same dose would not change anything in terms of relieving or minimizing the side effects. She would still have symptoms of tachycardia on the same dose. Changing her medication to Adderall is not an option I would consider because she seems to be responding well to Ritalin, an aspect Cortese et al. (2018) identify as a basis for sticking to the current treatment medication. It is recommended that when patients experience side effects, waiting and making adjustments on the current medications are made before switching to a different drug. If the patient does not show any improvement, then a change in medication can be made (Stahl, 2017).

The goals of treatment remain the same as before but with a new target of reducing the patients heart rate without affecting her concentration throughout the day. The patient returns to the clinic after four weeks and reports a relief of the side effects. Her heart rate is at 92 beats a minute. This shows that the new treatment with Ritalin LA 20 mg is working with significant improvement recorded over the past four weeks.

Decision 3

Because the patient seems to be doing well on the current treatment regimen, my plan would be to maintain her on the current dose of Ritalin LA and do a re-evaluation after four weeks. Ritalin seems to be working as Katie’s heart rate is back to normal and her attention is sustained throughout the day. She also reports no additional side effects. It is recommended that the lowest dose of a stimulant needed should be used to correct a disorder and for this reason, I would not increase the dose to 30 mg. Her heart rate of 92 is within the normal range for her age and an EKG is unnecessary at this point.

Ethical Considerations

When treating patients with ADHD, many ethical considerations have to be taken into account. These include choosing the right medication for the treatment of the condition. This is important as some drug classes such as nonstimulants have harmful side effect which the patient may not be able to tolerate. This is also important because the patients are still developing and some of these drugs may impede their development. Another consideration is the patient autonomy. Because the patient is a minor, she is not able to make any decisions as regards their health and treatment. Parents therefore have to be incorporated in making decisions that pertain to the treatment of this patient and they have a right to agree to or deny treatment they don’t agree with. It is also important to try and involve the child in the treatment and breakdown everything to a language they can understand (NIH, 2019). Another ethical consideration is the cardiac effects that are associated with psychostimulants. A family history of cardiac disease should be taken into account before commencing treatment with stimulants. The last consideration is the side effects and the lowest effective dose should be prescribed and the patients monitored regularly for side effects (NIH, 2019). The patient should also be educated on these side effects.

Conclusion

In conclusion, ADHD is a disorder that starts in early childhood and can progress into adulthood if not managed well with psychotherapy and pharmacotherapy. ADHD usually present with three core symptoms i.e., inattention, hyperactivity and impulsiveness but not all patients present with all the symptoms at once. The NP has the ethical obligation to treat ADHD with the most effective options available. The first-line treatment for ADHD are stimulants such as Ritalin. Other options of treatment include non-stimulants amphetamines and antidepressants such as bupropion. When treating patients with stimulants it is important to consider the potential side effects such as cardiac effects such as tachycardia as seen in the patient. It is also important to use the lowest effective dose to treat the patients. The patient should also be involved in their treatment and patient preference is key to ensure compliance to medication.

References
  • American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., & Carucci, S. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network metanalysis. Lancet Psychiatry, 5(9), 727-738. https://doi.org/10.1016/S22150366(18)30269-4
  • Krull, K. (2019). Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis. Retrieved from https://www.uptodate.com/contents/attentiondeficit-hyperactivity-disorder-in-children-and-adolescents-clinical-features-and-diagnosis
  • National Institute of Mental Health. (2019). Attention-Deficit/Hyperactivity Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorderadhd/index.shtml
  • Ng, X. Q. (2017). A systematic review of the use of bupropion for attention-deficit hyperactivity disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 27(2), 112-116. https://doi.org/10.1089/cap.2016.0124
  • Stahl, S. M. (2017). Prescriber’s guide (6th ed.). New Delhi, India: Cambridge University Press
  • Verbeeck, W., Bekkering, G. E., Van den Noortgate, W., & Kramers, C. (2017). Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane Database Of Systematic Reviews, 10(10), CD009504. https://doi.org/10.1002/14651858.CD009504.pub2

mersin escmersin esc