NURS 6630 Week 9 Assignment Paper

NURS 6630 Week 9 Assignment: Assessing and Treating Clients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations.

They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults.

As a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.

Learning Objectives

Students will:

Learning Resources

Note: To access this week’s required library resources, please click on the Course Readings List link in the Course Materials section of your Syllabus.

Note: Review all materials from the Discussion.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and standardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Required Media

Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as this week’s assignment’s foundation.

To Prepare For:

This case study will serve as the foundation for this week’s Assignment.

The Assignment

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. Consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, stop to complete the following:

Decision #1

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

Decision #2

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

Decision #3

  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the decision results. Why were they different?
  • Also, include how ethical considerations might impact your treatment plan and client communication.

NURS 6630 Week 9 Assignment Paper Sample

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 only impacts children’s attention.

However, a 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 preschool and early elementary school years but can persist into adulthood. It can lead to problems including impulsivity, hyperactivity, and inattention; 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 struggle to communicate emotions and form relationships.

Using the DSM-5 criteria, ADHD symptoms must be present before the age of 12 years and also in more than one setting (APA, 2013). To diagnose ADHD, an authorized medical practitioner such as a psychiatrist or a pediatrician should be present. An expert in ADHD who is licensed to determine the presence of this disorder can also make the diagnosis.

The signs to look out for to make a diagnosis are inattention, hyperactivity, and impulsivity, that has been present over a long period. ADHD management and treatment consist of counseling, behavioral therapy, medication, or a combination of these options. 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 society by being able to follow the rules. Successful treatment will increase the patient’s attention span, regulate their activity level to normal and decrease their impulsiveness.

This paper will focus 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 of the drugs will be discussed.

Decision 1

After reviewing the patient, a diagnosis of ADHD is made. Decisions have to be made to manage and treat this patient properly. 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 in symptoms (Verbeek et al., 2017). Ritalin achieves this by increasing the action of 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 the need to concentrate during the day. The drug also has the potential to cause insomnia.

Bupropion is not selected because it is an antidepressant that 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 treating 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 not recommended as the first-line treatment of ADHD. It usually takes longer to start producing effects than Ritalin, which takes a few minutes to start exhibiting its effects. Intuniv is suggested as an augmenting agent if stimulants do not adequately improve symptoms (Stahl, 2017).

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 be made to manage this patient.

Decision 2

With new findings in the patient, I decided to change to Ritalin LA 20 mg orally in the morning. This is because the symptoms shown could result from 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. Therefore, a longer-acting agent is the best option for this patient. This way, she gets a pulse dose in the morning and another four hours later.

I would not want to switch to another drug option because Ritalin effectively improves the symptoms. Keeping her on the same dose would not change anything regarding 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 because she seems to respond 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 to 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 treatment goals remain the same as before but with a new target of reducing the patient’s heart rate without affecting her concentration throughout the day. After four weeks, the patient returns to the clinic and reports relief from the side effects. Her heart rate is at 92 beats a minute.

This shows that the new treatment with Ritalin LA 20 mg works, with significant improvement recorded over the past four weeks.

Decision 3

Because the patient seems to be doing well on the current treatment regimen, I would plan 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.

Ethical Considerations

When treating patients with ADHD, many ethical considerations must be considered. These include choosing the right medication for the treatment of the condition. This is important as some drug classes, such as non-stimulants, have harmful side effects that the patient may be unable to tolerate.

This is also important because the patients are still developing, and some drugs may impede their development. Another consideration is patient autonomy. Because the patient is a minor, she cannot make any decisions regarding 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 break down everything into 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 considered before commencing treatment with stimulants. The last consideration is the side effects; the lowest effective dose should be prescribed, and the patients should be monitored regularly for side effects (NIH, 2019).

The patient should also be educated on these side effects.


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 presents with three core symptoms, i.e., inattention, hyperactivity, and impulsiveness but not all patients present with all the symptoms at once. The NP is ethically obligated to treat ADHD with the most effective options available.

The first-line treatment for ADHD is stimulants such as Ritalin. Other options for treatment include non-stimulant 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. Using the lowest effective dose to treat the patients is also important. The patient should also be involved in their treatment; preference is key to ensuring compliance with medication.